Recently I have begun to think of the tensor fascia lata muscle (TFL) as the “undiscovered country” of hip pain.
A week doesn’t seem to go by without my seeing a new client who says they’ve “tried everything” for hip pain.
• Physical therapy
• Deep Tissue Massage
And yet this complex muscle has rarely been mentioned as a potential root cause.
In these cases I often find that the tensor fascia lata muscle is extremely tight and tender to the touch and ischemic (low blood flow), and that direct manual release of the muscle brings relief of symptoms.
This muscle causes pain in two primary ways:
Trigger points can then refer pain to other parts of the hip, the groin, the buttocks and even down the leg.
2) When the TFL becomes chronically contracted it can exert a mechanical strain on other muscles by distorting joint movement.
For example the gluteals or the piriformis muscle often suffer from an unnatural “pull” from an excessively tight TFL.
Pain, then, might be felt in one or more of the following areas…
• Deep in the hip joint
• Into the groin
• Wrapping around the outer hip
• Deep in the gluteal muscles
• The sacroiliac joint
• Traveling down the leg
I have been considering for a long time how the TFL becomes excessively tight and locked up (aka dysfunctional) and have concluded that there are two chief reasons…
1) Weakness in the rectus femoris muscle.
The rectus femoris, the top quadriceps muscle along the front of your thigh, is your secondary hip flexor (after the psoas and iliacus which are your primary hip flexors).
And the rectus femoris muscle so often becomes weak as a result of the second reason for TFL dysfunction…
2) Excessive tightness and shortening of the psoas and iliacus.
This is a common occurrence in many of us who sit for long hours at a desk and/or commuting in our cars. The primary hip flexors, the psoas and iliacus, are put into a shortened position when we’re sitting. This can cause them to adapt to the shortened position.
Chronic shortening of the primary hip flexors, the psoas and iliacus, can causes the secondary hip flexor, the rectus femoris, to atrophy.
I believe this occurs, in part, because short hip flexors will abbreviate your stride thus reducing a full and natural leg swing.
In runners who are heel strikers this problem can be even more exaggerated. The quadriceps, and especially the rectus femoris, are severely underused.
In the reaching stride characteristic of heel strikers, the leg extends and straightens at the knee as the foot hits the ground. This leg movement disables the quadriceps muscles.
An aside for runners: underuse of the quadriceps can be rectified using the “barefoot running technique.” This technique does not require one to actually run in bare feet but rather to…
1) Adopt the upright, “running on hot coals” running method
2) To use a running shoe without the beefed up heels of conventional running shoes which don’t allow your foot to go through its full range of motion.
I recommend the Merrell’s Pace Glove for Women or Merrell’s Trail Glove for Men (the shoe I run in).
There are three strategies that alleviate excessive tightness in the tensor fascia lata:
1) Direct manual therapy treatment of the tensor fascia lata
I find that putting a client in a side-lying position with a pillow between their knees (and one to support their head and neck) is optimal.
Then direct manual pressure applied at different angles will help to locate the greatest “liveliness” in the muscle (I like to use this word instead of “pain”).
Gentle but detailed work will produce the best, most
2) Maintaining flexibility in the entire hip
Stretching of the hip flexors and the entire hip and leg.
Stretches for excellent video support.
3) Strengthening the quadriceps
I’m not a fan of seated leg extensions on a weight machine to accomplish this.
Much more effective are single leg squats. If squats are not
possible due to pain, then sitting against a wall is an excellent
Your knees should be at a 90 degree or right angle. Otherwise it’s not stable for your knees.
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