TFL Pain and Injury

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.tensor fascia latae muscle - TFL

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.

Strengthening

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.

22 thoughts on “TFL Pain and Injury

  1. Christian Montes 17th Jun 2014 — 8:03 pm

    Great article, Thanks a lot.

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  2. THE INFORMATION IS GOOD – HOWEVER FOR A NOVICE – MORE INFO IS NEEDED FOR TREATMENT, E.G., COLD PACKS/HOT PACKS???, AND FOR STRENGTHENING ALL OF THE SUPPORTIVE MUSCLES,

    THAT SAID THIS BASIC INFO PROVIDED IS VERY GOOD

    THANKS

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  3. Hi, thanks for the TFL streches; I’m 66 yrs of age, reasonably fit, lifelong Yoga practitioner/teacher; I brisk walked for many years, recently added a gentle jog, interspersing brisk stride x 2 with gentle jog x 30-50 reps for 20-25 mins daily since 3 weeks. All was going well, I loved it, then pain in left hip area, initially after jog/walk; then during; now pretty well constant. This all started up about 7 days back. I just did your standing stretch but acidentally placed affected leg in front – it really worked though! I did it the correct way but couldnt really feel much happening. Then I did the lying on my side knee lift with feet tog; seems good to create strength in surrounding area. Many thanks, I’ll be back! Jane

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    1. Will McAllister 1st Sep 2015 — 7:06 am

      Jane get yourself to a sports massage therapist who knows what they’re doing and hav some trigger point treatment coupled with stretching

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  4. ooop, mistypo…should have read “brisk walk x 20 then gentle jog x 30-50”

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  5. All this time I thought it was bursitis!
    Thanks

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  6. This is fantatic. I have been struggling with this pain for 3 months, no one knows what it is. It is 100% my TFL. Thanks!!

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  7. Thanks, I have been doing compressions and ice, but now I will start strengthening glutes and doing the clam.

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  8. You are a genius!!!!!!!!

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  9. Abigail thomas 15th Jun 2015 — 3:32 am

    Great article. I appreciate your time on this piece for people in pain such as myself.

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  10. I just discovered recently after months and months of intense research and many therapists how to get rid of a pseudo sciatica (specially when I was sitting). I am runner and cyclist and the main finding was about releasing the TFL. I was looking on every other trigger point around and it seems that the TFL TrP was the one! I definitively support the info provided in this article.

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  11. Many hours and dollars spent in therapists offices and I had never heard TFL uttered. I’m going to focus on triggerpoint therapy, strengthening and stretching and see if I can run pain-free for the first time in six years.

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  12. Pingback: Friday: Recovery Day - RunEatSnap
  13. An awesome educational tool for trainers

    Like

  14. florence leroux coleno 14th Mar 2016 — 12:21 am

    hi, i would really some advices for rehabilitation after a tear on the TFL…
    it happened 3months and half a go but never stopped training,
    I’m a professionnel ballet dancer.
    I did 45 shows over 3 months like that, had 2 prp injections..
    Now is the time , i can take more gradual rehabilitation.. what do you reckon i should start with for stamina? is bicycle better than running? swimming? what about starting activating the glut med with flippers in the swimming pool??
    when do you think i can start stretching again after this injection.. it’s been 4 days ..
    thanks so much

    Like

  15. This is the first time I’ve ever heard of TFL in the years since developing the pain. I’ve had countless physio sessions and doctor appointments, but neither could diagnose. It’s refreshing to say the least! Thanks

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  16. Fantastic article, thank you!

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  17. Could TFL syndrome cause hamstring pain?

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  18. How long could it take for this to heel? Months? Years? I’m a runner and I caught myself on a fall on a treadmill (I know, I know, bad training idea), and I’ve been messed up ever since. It’s KILLING me to not be able to run. Stretching, rolling…nothing seems to make it better. If anything, it’s worse everyday. I can feel it even walking. I want to run again so so badly.

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  19. Have had trouble w both rt and lft TFLs for several years w lots of PT treatments but no one ever talked about pressure using balls, or sports massage therapy! Thanks will certainly give both a whirl ?

    Also of extreme help to me has been a fantastic short exercise video called the Myrtle Routine for runners. Great loosening and strengthening set of 12 easy exs (including clams)! I even do them on long hikes and runs, right in the middle of the activity. I too have thought that it’s hip bursitis and get cortisone shots in one hip about every 2 months. Crazy! And I’m suffering from too much cortisol anyway so am hoping to stop that stuff and start using the pressure point relief and sports massage therapy.

    Thanks much everyone, and don’t forget to check out/google Myrtle (hip girdle) Routine!

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  20. Trevor D'Souza, PT, DPT 31st Oct 2017 — 2:04 pm

    Sorry but this exercise does not address TFL dominance in relation to movement, which is the real problem. If you don’t correct the synergy and bias TFL out with hip abduction and flexion you will have recurrent injuries. People with TFL syndrome can develop a hip flexion contracture and also Patellofemoral Pain Syndrome. Although manual mobilization of the muscle is important it is not the only approach. It definitely requires a professional to stretch the effected tissue structure along with other manual techniques.Sorry the other individual was correct in pointing out that you do not mention to correct use of modalities…

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  21. very good extract because I have this injury.

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