TFL stands for Tensor Fascia Latae. This is a small muscle found on the outside of the hip. If you place your hands on your hip bones with the thumbs in front of the hip and fingers behind you can feel your pelvis with both thumbs. Moves the thumbs backwards slightly behind the pelvis and press in there – this is your TFL!
The function of this muscle is primarily to stabilise the hip and pelvis. Although it also contributes to flex the hip (raise the leg out in front); Abduct the hip (take the leg out to the side) and medially rotate it (turn the leg with a straight knee so the foot points inwards). It attaches at the top to the pelvis (anterior iliac crest) and inserts lower down, into the IT band. The IT band basically acts as a really long, thick tendon for this muscle.
Most runners will have heard of the IT band due to the condition IT band syndrome which presents symptoms at the outer knee. Some people will refer to pain in the outer hip as IT band syndrome, but this is incorrect. TFL dysfunction can contribute towards the development of IT band syndrome, but the symptoms always occur at the knee. The close association of the TFL with IT band syndrome has led to pain conditions which stem from the TFL sometimes being referred to as TFL syndrome.
Due to it’s flexion and abduction functions and role in pelvic stability when weight bearing on one side, the TFL is used extensively when running. This can lead to it becoming overworked, especially if other abductors and stabilisors, such as Gluteus Medius, are not working effectively. Problems in this muscle are usually down to trigger points.
Symptoms of TFL Syndrome
- Pain in the outer hip (few people will actually say ‘TFL pain!)’
- Pain may refer down the outer thigh
- Pain when lying on the affected hip
- Pain is worse when weight bearing on one side
TFL myofascial trigger points may be misdiagnosed as trochanteric bursitis as the symptoms are very similar. However, the treatment of both cases in the start should be to improve the condition of the surrounding muscles and correct any existing muscle imbalances. Persistent cases should be investigated further to determine if the bursa is involved.
Treatments for TFL Pain
The initial form of treatment is to rest the condition from aggravating activities, including running. If pain at night is a problem, try laying on the other side with a pillow between the knees to prevent lengthening of the muscle which often aggravates trigger points.
Stretching the Tensor Fascia Latae (TFL)
During this rest period, stretching and trigger point therapy should be applied. To stretch the TFL the hip should be placed in the opposite position to the TFL’s functions. So, extension, adduction and lateral rotation. This can be achieved in a few positions. My stretch is achieved in standing, with the affected leg crossed behind the other leg and rotated outwards. Leaning over to the opposite side helps increase hip adduction.
Trigger pointing the TFL
Trigger point therapy can be performed best by a sports massage therapist so I would highly recommend making an appointment. It can be achieved using a massage ball or similar (like a tennis or squash ball). Simply lay on the affected side with the ball under the TFL and move it around until you find a tender spot. Usually this will refer similar pain down the leg if this is one of your symptoms. Hold this pressure for 10-15 seconds, until discomfort eases slightly. Work around the entire muscle area, applying pressure to all tender spots. Only do this a maximum of twice on each point. Initially you may only want to do this every 2-3 days as it can be a little tender for a day or so after.
Correcting muscle imbalances around the hip are important to help reduce the stress on the TFL. Developing strength in the other hip abductor muscles is a good place to start. In order to reduce the involvement of the TFL, perform exercises which start with the hip in a flexed and medially rotated position. The clam is an ideal example:
Lying on the other side, ensure the top hip is directly over the bottom one and not rotated back or forwards. The knees are bent to a right angle and feet together.
- Keeping the feet in contact, the top knee is raised up, away from the bottom knee as far as is comfortable and without cheating!
- Cheating = rolling the hips backwards to enable more movement at the hip.
- Ensure the lower back and pelvis are kept still throughout. Lower the knee back down slowly, rest and repeat.
Correcting other problems at the hip, such as an anterior pelvis tilt caused by tight hip flexors and the often resulting inhibition of Gluteus Maximus is recommended for overall improved hip function.