TFL muscle pain sidelines athletes and active adults who need strong hips and knees to perform their best. The tensor fasciae latae is a small muscle that plays a pivotal role in stabilizing the knee, hip and pelvis.
If you’re dealing with TFL muscle pain, you’ve come to the right place! This article covers everything you need to know about the tensor fasciae latae and how to fix TFL pain.
Symptoms
An injury to the tensor fasciae latae causes pain at the TFL muscle and into the upper leg. TFL tightness often contributes to iliotibial band syndrome. IT band syndrome also causes pain on the outside of the thigh.
TFL overuse causes tight spots (called trigger points) to form in the muscle. Trigger points in the TFL cause pain down the side of the leg, as pictured here.
Overuse injuries often cause tensor fasciae latae pain. Acute injuries aren’t common at this hip muscle.
Tensor fasciae latae pain affects people who train their legs hard via sports or exercise. TFL pain plagues cyclists, runners, swimmers, and athletes who play tennis, soccer, football and volleyball.
Anatomy
The tensor fasciae latae muscle originates from the anterior superior iliac spine (ASIS) and attaches to the iliotibial (IT) band on the outside of the thigh. It’s one of two muscles that attach the IT band, along with the gluteus maximus (your biggest butt muscle).
Many physical therapists focus on the gluteus medius muscle when treating IT band syndrome. This approach isn’t wholly misguided. However, the gluteus medius doesn’t attach to the IT band, and therefore influences it indirectly.
In contrast, the TFL and gluteus maximus attach to the IT band and directly affect it.
The superior gluteal nerve (L4-S1) powers the tensor fasciae latae muscle.
The TFL works with several muscle groups to stabilize the hip joint and the knee joint. It also assists with hip flexion, hip abduction, and hip internal rotation. Hip internal rotation is pictured here:
Here’s how to palpate your TFL:
Sit in a chair and put your hand at the opening of your front pocket. Push your fingers into the meaty area. Internally rotate your hip by kicking your foot outward like you’re playing hacky sack.
Since the TFL is a hip internal rotator, you’ll feel the muscle tense up under your fingers. Try it out!
IT Band Syndrome
A quick aside on IT band syndrome (ITBS):
ITBS causes pain on the outside of the thigh, just above the knee joint. Pain is caused by fat pad compression at this location (1). Symptoms are worst at 30° of knee flexion, a common knee flexion angle during running and cycling.
IT band syndrome treatment has evolved. Old-school treatments emphasize stretching the IT band to get it “loosened up.” Antiquated approaches also advocate using a foam roller on the IT band.
Here’s why the old-school methods don’t work:
The IT band can’t be stretched.
It’s a thick piece of connective tissue with sturdy fascial attachments all along the femur. Mathematical modeling suggests it takes 2,000 lbs of force to stretch the IT band just 1%!
Bottom line:
Stop foam rolling and stretching your IT band. It’s a waste of time.
Evidence-based IT band treatment focuses on improving leg biomechanics, strengthening the hip muscles and reducing muscle tightness in the TFL and gluteus maximus (1).
Physical therapy is a great option for recurrent or persistent TFL or IT band pain. A skilled physical therapist will develop a treatment plan based on your specific impairments.
Treatment
The generic RICE prescription (Rest, Ice, Compression, Elevation) won’t help much with TFL muscle pain (2,3). Instead, try these specific exercises for TFL problems.
Stretching
I’m not a huge fan of stretching. And the TFL isn’t easy stretch. But if you’re intent on stretching your TFL, here’s how to do it.
The TFL flexes and internally rotates the hip. To stretch it, move your hip in the opposite direction (hip extension and external rotation).
Start in standing. Extend the affected hip behind you and turn the toes out. To increase the stretch, side-bend your trunk away from the affected side.
To be honest, my patients benefit from soft tissue treatment more than stretching. Stretching isn’t necessarily a waste of time. But it’s rarely the best treatment option.
Soft Tissue Treatment
This is the jackpot for TFL and IT band pain relief.
TFL Release
Tight muscles respond well to deep, sustained pressure. Apply pressure to the TFL with a lacrosse ball or myofascial release massage ball. Wedge the ball between your hip and the wall, as pictured.
Roll around until you find a sore spot, then hold pressure on the tight area until it relaxes. This technique reduces TFL muscle tone and sensitivity. A tennis ball works too if you’re especially sore.
Glute Release
The glutes work closely with the TFL to stabilize the hip. The gluteus maximus and the TFL are the only muscles that attach to the IT band. They work synergistically, so problems in one muscle can cause problems in the other.
Grab your massage ball and get to work treating tight spots in the gluteal muscles:
Dry Needling
If the techniques shown here don’t resolve TFL tight spots, trigger point dry needling is a great way to ease hip muscle soreness. To learn more about this powerful treatment tool, check out The Authoritative Guide to Dry Needling.
Ready to give it a try? Find dry needling experts in your area this search tool.
Other hands-on physical therapy techniques, like trigger point therapy and myofascial release, also reduce TFL muscle pain.
Percussion Therapy
Finally, percussion therapy (using a massage gun) can alleviate muscle tension and pain.
Research shows this treatment improves range of motion without reducing muscle strength (4). It’s also thought to reduce post-workout muscle soreness.
I use percussion therapy in the PT clinic to reduce muscle tone and alleviate patients’ pain. It’s my patients’ favorite treatment.
There are many percussion therapy tools you can use. Here are 3 great options:
Theragun PRO
This is a top-of-the-line massage gun. It comes with 6 different attachments and a rotating arm for easy ergonomics. It feels amazing on sore, tight muscles. Plus, it’s a quiet model with preloaded routines.
It’s easy on the body, less so on the wallet. Check the price here.
Hypervolt Plus
I use the Hypervolt in the PT clinic. My patients love it. It has 3 speeds and 5 attachments. The battery last up to 3 hours between charges.
At half the price of the Theragun Pro, it’s a sturdy, high-value option. See it on Amazon here.
Renpho Massage Gun
This one is a budget-friendly option for giving your muscles some TLC. Plus, it’s rated 4.6 on Amazon (over 29,000 reviews) and comes with 5 attachments.
Strengthening
Hip strengthening is essential for recovering from TFL and IT band problems. Stretching and soft tissue mobilization provide short-term pain relief.
Strengthening is vital to recovery because it builds resilience and endurance in the hip area. Since TFL muscle pain is typically due to overuse, enhancing hip strength is the best treatment for long-term pain relief.
Single Leg Stance
This balance exercise demands good motor control at the ankle, knee and hip.
If standing on one foot seems too easy, stand on an unstable surface like a folded blanket or foam balance pad. You can also close one eye (or both) to make it more difficult. Just make sure you’re in a safe spot so you don’t fall and hurt your brand new TV!
Step Downs
Step downs build single leg strength and control. They target the quadriceps and gluteal muscles. Start with a step height of 4 to 6 inches. Bent your stance leg and gently tap your other heel to the floor. Then return to an upright position.
Want to compare your leg strength side to side? See how many step downs you can do in a minute with each leg. Single leg exercises (like this) expose weakness on one side that’s easily hidden with double leg exercises like squats and deadlifts.
Prone Internal Rotation
This simple exercise engages the hip internal and external rotators to improve hip stability. It’s not supposed to be difficult.
Do the exercise for 3 to 5 minutes to build endurance. Slow, controlled motions are preferable. Jerky, choppy hip motion indicates poor hip control.
Reverse Clamshells
This exercise directly targets the tensor fasciae latae. Lie on your non painful side. Start with the knees and feet together.
Keep the knees together and lift the outside of your top foot towards the ceiling. Slowly lower back to the starting position. Repeat 10 to 20 times, or until you feel the burn in the front of your hip.
To make it more difficult, add a resistance band around your ankles or strap a light ankle weight on your foot.
Broken Clamshells
Last but not least, broken clamshells target the hip internal and external rotators. They’re more difficult than reverse clamshells, so consider yourself warned!
Lie on your non painful side. Start with the knees and feet together. Lift the top leg up, separating the knees and feet. Internally and externally rotate the hip.
Use your upper leg as the axis of motion–keep the knee in the same spot throughout the exercise. Since the goal is to build endurance, work in the 10-25 repetition range.
Single Leg Bridges
Start on your back. Straighten one leg, keeping your thighs parallel. With the opposite leg, push down into the ground and lift your hips up off the floor. Hold for 3 seconds before lowering your hips to the floor. Repeat 5 to 15 times.
Like single leg step downs, you can’t compensate for a weaker leg on this exercise. This exercise strengthens the glutes and core muscles to improve stability with single leg activities. It’s harder than it looks!
Other Pain Sources
Pain near the TFL muscle can originate from other anatomical structures. The lumbar spine frequently refers pain to the outside of the hip. The lower back is involved in lateral hip pain over 70% of the time! (5)
Many physical therapists use repeated motions for the lumbar spine to assess for a lower back component of hip pain.
Even lower back nerve pain can create symptoms at the outside of the hip. On rare occasions, the sacroiliac joint (SIJ) sends pain to the outer hip area.
Finally, hip joint problems can contribute to sharp hip pain near the tensor fasciae latae.
If you’re dealing with hip pain, it’s a good idea to have a trained healthcare professional assess your hip. Get a skilled professional on your side to figure out the source of your pain and speed up the recovery process.
For more insights on staying healthy and beating pain, join the free Facts & Physio Newsletter. Plus, get The Recovery Checklist e-book when you sign up.
