How to get rid of pain in the TFL (tensor fascia lata)

Do you feel an achy, dull, annoying pain in the side of your hip that’s been there for months or even years? Does it seem to get worse after any type of dynamic physical activity or any prolonged period of sitting?

It’s possible that this discomfort is due to a shortened and dysfunctional tensor fascia latae muscle, or “TFL” for short. I’ve experienced this discomfort myself so I know exactly how much of a pain in the [TFL] it can be!

In this article, we’re going to explain why your tensor fascia lata might be dysfunctional and then present a step-by-step training protocol that can help you reduce your TFL pain.

 

My TFL Story

When I was troubleshooting my chronic hip pain, there was one area in my hip that gave me a great deal of trouble. The area was on the side of my right hip and got worse after any type of dynamic activity (like basketball or running) or long periods of sitting.

Once I became a movement coach and understood hip musculature better, I discovered that the pain I was experiencing was likely due to an overactive tensor fascia lata.

Figuring out that the TFL was responsible for this nagging pain was only the first step and I soon found out that this is a tricky muscle to get to relax. After weeks of experimentation on myself, I discovered that it wasn’t only what strategies I used that mattered but the order in which I used them. Once I began using the step-by-step protocol discussed in this article, I noticed a dramatic improvement in my chronic hip pain.

I then started using this same protocol with clients who also had positive results. That said, it's important for every individual to adjust the protocol based on their needs. This is not a one-size-fits-all approach and it's important to find a routine that works for you. This is one approach that has worked fantastically for me.

 

Why does Your TFL hurt?

The TFL is a lateral hip muscle that contributes to hip flexion, hip abduction and hip internal rotation from an anatomical position. The TFL acts as a synergist (secondary mover) and not a primary mover when performing these various muscle actions. Basically it’s supposed to be a helper.

So one reason your TFL may be painful is described with the fancy term “synergistic dominance.” This is when a secondary mover does more work than it normally should to make up for the primary movers. Translation: if the primary movers are not carrying their weight (literally) then the TFL has to pick up the slack. After years of improper muscle recruitment, the TFL can become overactive, tense and painful.

For example, in hip abduction (kicking the leg out sideways), the primary movers are the gluteus maximus, gluteus medius and the gluteus minimus while the TFL acts as a synergist. If any or all of the primary movers are weak, atrophied or not able to optimally contract, the TFL might try to step in and work overtime to bring the hips into hip abduction.

Unfortunately, the TFL doesn’t like doing double duty during hip abduction and eventually it can begin to tense up, ache and become painful. It’s like when your coworker doesn’t do his job, and you end up having to cover for him over and over again.The same situation can occur in hip flexion or internal rotation as well if the primary movers of these muscle actions are dysfunctional.

It means the TFL is always doing more than it should in some motions.

Another reason your TFL may be painful is weakness. If the TFL itself is extremely weak and unable to optimally contract when it is recruited in various movement patterns, it can result in a constant sense of “tightness.” If that sounds like you, you may want to read this article.

A final other reason could be an imbalance between the TFL and muscles all around the hip (like the adductors). We’ll save that for another article or video one day.

 

How to Use This Tutorial: Improve Function to Improve Pain

Our ultimate goal here is to ease your TFL pain. To do that, we’re going to think about muscles. Always Think Muscles.

This is an important concept to grasp because there can be one movement pattern that your hip is dysfunctional in or there can be three. Until you optimize each movement pattern and achieve correct muscle balance, there is a risk that your TFL will be achy. The goal of this tutorial is to provide guidance on how to determine which of your movement patterns are dysfunctional and how to improve them.

The recommended way to use this tutorial is to identify which movement patterns you are weak in and then tailor your training to these findings.

Practically speaking, I suggest everyone perform the “TFL warm-up” from Step 1 below and then add specific exercises from Step 2 to optimize dysfunctional movement patterns.

You may only need to improve one movement pattern or you may need to improve all three of the suggested movement patterns. It really depends on you and it is highly individualized. The only way to know is to attempt each group of exercises to see if they are challenging for you. If they are challenging, then you need them. The harder an exercise is, the more you need it!

It is also important to note that the warm-up and movement patterns below are not an exhaustive list on how TFL pain can be improved. This is one routine that has worked for me and my clients, but there are a lot of other options. The important thing is to understand the principles at play.

If you find other helpful exercises or methods to improve your TFL pain, by all means include those exercises in your training protocol and use the recommendations here as a way to help you think about how you implement those exercises into your training.

 

 

Step 1 – TFL Warm-Up

The Banded Hip Circles and Softball on TFL are two great drills to warm up the hip if you’re struggling with TFL pain. You can also use this as a part of a warm-up before your normal workouts or other dynamic activities.

Banded Hip Circles

A chronically shortened TFL can cause instability and restricted movement of the femur in the hip joint. The way in which we establish stability and smooth movement in the hip joint is by introducing optimal muscle balance around the hips.

However, I've found that this can sometimes be difficult to do by simply strengthening the weak muscles because of how immobile and stubborn the hip joint can become. This is why I recommend starting with gentle banded distraction drills to mobilize the hip joint before performing any activation drills.

Instructions

• Loop a resistance band through your upper thigh and shift forward to get some resistance from the band.
• Kick the banded leg up and flex the hip so the knee is at 90 degrees.
• Get on the toes of the un-banded leg and place your hands forward resting on the floor.
• Shift your body weight slightly to the banded side.
• Slowly perform 10 gentle hip circles in a clockwise direction ensuring that the movement is isolated to the hips and the spine is not involved.
• Slowly perform 10 gentle hip circles in a counter-clockwise position.
• Internally rotate the banded hip and repeat steps 5 and 6.
• Externally rotate the banded hip and repeat steps 5 and 6.
• Switch sides and perform same sequence.

 

Softball on TFL

Once we’ve mobilized the hip joint a little bit, let’s reduce some of the excess tension in the TFL. The most helpful tool I’ve found to really get into the TFL is a softball. This may be quite painful at first and you may not be able to get much body weight on the softball in the beginning. All this means is that you need it even more so stick with it!

Make sure you’re not just doing this passively and really try to “chase the pain” so that you’re releasing some tension and allowing the muscle to relax. This can also be a good way to evaluate the progress you’re making since less tension in the muscle usually means less pain and discomfort.

Instructions

• Lay on your side and place the softball under the TFL.
• Slowly start bringing the upper body toward the floor until you feel significant tension in the TFL.
• Find an area of tension and maintain that position for 30 seconds to a minute, or until the tension dissipates.
• Look for 2 or 3 other areas of tension and switch sides. Spend 2-5 minutes on each side.

 

 

Step 2 - Movement Pattern Optimization

This step takes a look at movement pattern issues.

 

Hip Internal Rotation

A common pattern I’ve seen with individuals who have TFL pain is that they also have extremely limited hip internal rotation.

90 90 Mobility Drill with No Hands - Test for Restriction

The 90 90 mobility drill is an easy test to evaluate your internal rotation.

Instructions

• Get into a 90 90 position where the left knee is behind the right foot and your legs are both at a 90-degree angle.
• While maintaining a neutral spine, try to reverse the movement by lifting the left leg and then trail with the right leg in the same pattern.
• Notice how much restriction you have in the back hip when attempting this drill and see if you have trouble performing this movement.
• If this drill is challenging, you likely have limited hip internal rotation.
• The following are signs that the you have limited internal rotation: unable to rest back knee on ground, unable to perform movement with neutral spine, significant restriction in back hip and inability to perform movement without hands.

 

If you had trouble with that test, then here are some things you can work on.

 

Prone Hip Internal Rotation with Strap

A great way to improve internal rotation is by implementing the contract-relax technique to develop more range of motion. All you need for the below exercise is a yoga strap or a belt that can wrapped around your foot.

Instructions

• Place a strap or band (belt is ok too) under the arch of your right foot.
• Lay in a prone position with your knee at your side and flexed at 90 degrees.
• Bring the right leg toward you by pulling the strap. Maintain the 90 degree angle at all times.
• Pull the leg until you reach your end range of motion. Keep pulling at your end range for 5 seconds.
• Keep pulling the strap toward you, but now push the foot against the resistance of the strap for 5 seconds.
• Pull the strap and the foot for another 5 seconds.
• Repeat this sequence for another 2-3 cycles and then switch legs.
• 1 set; 3 contract-relax cycles on each side
  
  

After you have performed the Prone Hip IR exercise, go back to to the 90 90 mobility drill to see if there is less restriction in the movement.

90 90 transitions with hands

The 90 90 mobility drill is a great test for internal rotation but also a great mobility drill to enter and exit those deeper ranges of motion. If you are still having trouble without using your hands, try the following regression. with your hands to help you.

Instructions

• Get into a 90 90 position where the left knee is behind the right foot and your legs are both at a 90-degree angle.
• Place both hands behind you to keep the hips from spiking up too much (do your best!).
• Shift left leg to the left by picking up the knee and allow the right leg to follow in the same pattern until you assume a 90 90 position on the opposite side.
• Perform sequence for 2 minutes.
• Occasionally test the no-hands version to see if you can do it at least once or twice no hands!

 

Hip Flexion

Another movement pattern that is commonly dysfunctional in those with TFL pain is hip flexion. A great way to evaluate your hip flexion muscle function is by testing your high hip flexor muscle activity in the seated position.

This seated hip flexion sequence can function as both a test and beginner exercise to reintroduce proper hip flexion muscle engagement.   Perform the following exercise and notice if you can feel the high hip flexors begin to contract as you flex your hip and extend your knee.

 

Seated Knee Flexion and Extension

Instructions

• Sit on the edge of a chair or bench.
• Lift your left knee to activate your psoas and hold this position for 3 seconds.
• Straighten the leg out and hold this position for 3 seconds.
• 2 sets; 6 reps on each side; hold for 3 seconds in each position
• Perform all required reps on left side and then switch to right side and repeat sequence.

 

If you had trouble recruiting the hip flexors in this position or your muscles become fatigued before finishing the prescribed volume, work on this exercise for a couple weeks until it becomes easy. Remember, you’re not just passively lifting your leg. you are bringing awareness to your hip flexors and ensuring that you feel a contraction in the correct place. Once you’ve mastered the seated position, you can begin progressing to more challenging hip flexion exercises.

In the following video, you'll find some more exercises that you can experiment with as you become stronger.

Instructions

• Choose one or two of the variations and integrate into your training routine!

 

V-sit leg lifts - Intermediate/Advanced

As you get better at hip flexion, you can start to play with different angles of hip abduction and internal rotation. The V-sit leg lifts are a brutally difficult test for your hip flexors.

Instructions

• Start in a seated position with your legs extended and out to the sides to create a “V” shape.
• For the first couple sets, place your hands behind your back.
• Internally rotate the right leg, lift the leg and hold for 5 seconds. Continue lifting and internally rotating during the 5 second hold.
• Bring the leg back down and repeat the sequence for the prescribed number of repetitions.
• Switch sides and repeat same sequence.
• Once you become stronger in this position, attempt the exercise without using your hands for support.

 

Hip Abduction and the TFL

The last movement pattern is hip abduction and I intentionally placed it last because it is usually the most difficult pattern to disassociate an overactive TFL from. In my own experience, any type of hip abduction exercise would exacerbate my TFL pain.

It wasn’t until I began using the TFL Warmup that I felt confident enough to begin retraining this movement pattern.

Having said that, this is an essential hip movement to get proper control over. Move through the progressions listed below slowly and don’t try to obtain too much range of motion too quickly. Respect your current limits and ask the body for a little more range each workout. Perform the TFL Warm Up before any hip abduction exercises so your hip is nice and loose before seeking more range of motion in hip abduction.

Work on each of the below exercises until they become easy, and then move on to the next harder exercise

 

Beginner -  The Fire Hydrant / 4-point Hip Abduction

Instructions

• Get into a 4-point stance.
• Abduct your right hip out to the side until you reach your end range of motion.
• Once you feel the contraction in the lateral glute muscles, hold this contraction for 5 seconds.
• 2 sets of 5; 5 second holds
• Repeat for the prescribed number of repetitions and then switch sides.

 

Intermediate -  Side-lying leg lifts with resistance

Instructions

• Place a mini-resistance band right above your knees and lay on your left side at a 45-degree angle.
• Extend and straighten the right leg while maintaining the same angle with both legs.
• Lift the right leg 6 inches off the ground and hold it for 1-3 seconds.
• Repeat movement for prescribed number of repetitions.
• Switch side and repeat sequence.
• 2 sets of 10

 

Intermediate/Advanced - Butterfly Abduction

Instructions

• Begin in a cross-legged butterfly position.
• Under control, kick the right leg out to the side.
• Bring the leg back under control and return to the butterfly position.
• Kick the left leg out and return to the butterfly position under control.
• 2 sets of 6

Note:  If your TFL starts acting up during this exercise, regress to the easier progressions and spend more time with the TFL Warm Up.

 

Closing thoughts on TFL pain and hip pain

If you’ve been consistently using the TFL Warm Up and improving your weak movement patterns then hopefully you’re beginning to notice improvement in your TFL pain. You may start noticing that certain movements or exercises are more helpful than others. I like to tell my clients that finding out an exercise is not helpful is just as important - if not more important - than finding out an exercise is helpful.

Start filtering out the stuff that doesn’t work and continuing to improve the stuff that does. Once your TFL is feeling better and more functional, remember to keep training your hips! Pain is a sign that things are getting out of balance. So if you allow your hip muscles to get out of whack, the pain can and probably will come back.

Ultimately, you’ll want to keep progressing and challenging yourself in the movement patterns that you have the most difficulty with.

This tutorial provides some great ideas on how to get started, but eventually you’ll want to include more variety and difficulty to continue optimizing the all the movement patterns your hips are capable of. And there are A LOT of movement patterns they are capable of!