Tensor fasciae latae (TFL) is a small muscle that makes a big fuss. An overactive TFL can result in pain in various parts of the body and this pain is often misunderstood and even misdiagnosed. To address the root cause of this pain and dysfunction, it’s important to understand the associated compensatory patterns.
TFL has various functions and is associated with four movements. At the hip, TFL is involved, in flexion, abduction, and internal rotation. Its insertion at the knee via the IT band, means TFL is considered a 2-joint muscle and is, additionally, involved concentrically in tibial external rotation.
While it is involved in many actions of the lower limbs, TFL does not act alone in any of these functions and we must consider the primary movers and synergistic muscles in any given movement. The other muscles involved in hip flexion are the iliopsoas, rectus femoris, and sartorius; gluteus medius and minimus are involved in both hip abduction and internal rotation; biceps femoris in tibial external rotation.
When having to compensate for muscles with the same function not doing their jobs, TFL will eventually overpower primary movers and become shortened and hypertonic.
Common TFL Compensatory Patterns
Because it is a 2-joint muscle, an overactive TFL can cause pain at both the hip and the knee.
Compensatory patterns develop from a combination of joint dysfunction and muscle weakness. In the case of TFL, it is most often related to hip joint dysfunction and gluteal inhibition.
For example, during hip abduction, gluteus medius and minimus should fire first followed by TFL, piriformis, and quadratus lumborum. When gluteal muscles are weakened, the brain will often recruit TFL, sometimes in conjunction with piriformis. Over time, this can contribute to sciatic-like symptoms.
Over time, this chronic shortening of the TFL can eventually pull on the IT band and result in ITB syndrome or knee pain.
Minimize TFL Activation
Understanding the compensatory patterns, in order to minimize TFL activation, we must strengthen the primary movers in each of its functions.
TFL Compensatory Motion: Hip Abduction/Internal Rotation
Solution: Strengthen Gluteal Muscles
Because issues with TFL are most commonly related to gluteal weakness or inhibition, strengthening the glutes will most often be the focus. It is difficult to completely isolate gluteus medius and minimus, but studies have shown that resisted side stepping in a squat position minimizes TFL activation and increases activity of gluteal muscles.
To perform resisted side-stepping, place a resistance band at the ankles, assume a squat position, and move laterally.
TFL Compensatory Motion: Hip Flexion
Solution: Strengthen Iliopsoas
Much like the gluteal muscles, the iliopsoas works with other muscles to perform hip flexion. To minimize TFL activity while working to strengthen iliopsoas, the position of the femur is important. Because TFL is involved in internal rotation and the psoas involved in external rotation, the hip should remain in a neutral position while performing hip flexion.
A unilateral bridge can be beneficial to strengthen the gluteal muscles of the extended hip and hip flexors of the lifted leg. Unilateral work is helpful to correct imbalances, including TFL compensation.
TFL Compensatory Motion: Tibial External Rotation
Solution: Strengthen Biceps Femoris
Lying leg curls can strengthen biceps femoris, a hamstring muscle, which is involved in tibial external rotation. Using the machine to perform the leg curl, rather than performing standing hamstring strengthening exercises like deadlifts, can reduce the stabilizing function of TFL. Turning the toes inward slightly will also activate the semitendinosus and semimembranosus involved in tibial internal rotation. (*For those who have a tell-tale externally rotated tibia at rest when the knee is flexed or that manifests during an overhead squat assessment, these muscles will also have to be strengthened to restore muscle balance)
Release and stretch TFL
Finally, it is helpful to release and stretch TFL. To release, lie on a massage ball placed directly on the muscle. You can stay there and breathe or gently move to strip the muscle.
After releasing with a massage ball, you can perform a standing TFL stretch.
To stretch the right TFL, stand with the left side of your body facing a nearby wall, and place the left hand on the wall. Move the right hip into extension, bringing the leg behind you, and then into adduction, bringing the leg toward the wall. Step the foot down near the wall and hold the right leg in this position (extended and adducted). Stay for five breaths. Additionally, you could reach the right arm up and toward the wall for a lateral stretch. Repeat on the other side.
Intentional, targeted stretching and strengthening can eventually break this compensatory movement pattern and support optimal, functional movement.