Do you have persistent knee or lower back pain, but you can’t tie it to anything in particular that you’ve done to cause it? You’re not alone. Pain in these two areas, especially among people who sit for long periods of time can change motor control strategies for people who like to walk, hike, run, cross-country ski, or cycle, which can exacerbate symptoms. Many people have a lack of hip extension, or the ability to get your leg behind you in space, which we need in order to do these types of activities. When we lack hip extension, symptoms such as acute and chronic knee pain and low back pain can rear their ugly head, but one of the biggest issues in dealing with this lack of hip extension in addition to stretching restricted muscles and strengthening weak muscles is changing habitual patterns. Read on, as we explain this more in depth.

Our bodies strive to be efficient, but often those strategies to be efficient don’t always work in our favor. Certain muscles get overworked while others get underworked, a muscle imbalance ensues, other areas of the body have to kick in that shouldn’t and, Bob’s your uncle, you have pain. This is known as a motor control issue, and the trouble now becomes how to retrain the body to use the proper movement strategies, so it doesn’t happen again. 

When we don’t have the ability to get into hip extension, whether it’s due to a poor motor strategy or because our hip flexors are tight, or both, our glutes don’t activate to propel us forward. The hip flexors, or the muscles that bring our knee up to our chest, are often in a shortened or tightened position due to prolonged sitting, which can prevent the hip from getting into extension. Today we’re going to talk about one of the most commonly restricted and overworked muscles of the hip flexor group, the tensor fascia latae. 

The tensor fascia latae, or TFL, is not a high-octane coffee drink you can get at your local Philz, but rather it’s a muscle that sits right at your front pockets on either side of your pelvis. It attaches to the anterior superior iliac spine, or your hip pointer, and it attaches with the gluteus maximus to the deep and superficial fascia of the IT band. The IT band runs along the lateral aspect of the thigh where it anchors into the lateral condyle of the tibia, or shin bone. 

The TFL works in conjunction with other muscle groups to stabilize the hip and the knee. It works with the gluteus medius and gluteus minimus to internally rotate and abduct the hip, and it also works with the gluteus maximus through its mutual attachment to the IT band to abduct the hip. It also acts with the rectus femoris, the top-most quadriceps muscle to flex the hip, or bring your knee toward your abdomen. The TFL also works with the IT band to stabilize the knee in end range extension, or straightening the knee, as it externally rotates the tibia. 

The main function of the TFL is to aid in posterior depression of the pelvis, or the act of one side of the pelvis pushing down and back, which produces push off in the gait cycle as the opposite side of the pelvis elevates anteriorly as that leg swings through. 

The TFL can become very restricted or tight from being in a shortened position, which occurs during prolonged sitting. This can lead to an anteriorly tilted pelvis, where your pelvis or one side of the pelvis tilts toward your feet, which will compress the lower back or rotate one side of the lower back causing back pain, it can internally rotate the femur (thigh bone) and externally rotate the tibia (shin bone), which can cause an incongruency of the knee joint creating knee pain and over time arthritic changes in the knee joint, it can cause the rearfoot or heel to collapse inward flattening the foot and causing ankle pain, Achilles tendon pain and plantar fasciitis, and a tight TFL can cause IT band syndrome, which can cause knee pain. 

These symptoms can cause chronic discomfort and keep you from doing the things you love. We have to note here that we are not in any way suggesting that you should immediately think your pain is due to a tight TFL. But giving you a thorough assessment to find out where your pain might be coming from is something that we can help you with at Beacon Physical Therapy. If you’re not able to come in right away and you think your TFL might be restricted and/or overused, give these exercises a try:

Soft Tissue Mobilization of the TFL:

– Exercise 1 

– Exercise 2

Re-educating the glute muscles to work instead of the TFL:

– Exercise 1

– Exercise 2

– Exercise 3

Re-educating the abdominal muscles to work instead of the TFL:

– Exercise 1

– Exercise 2

Come in for an evaluation or a checkup today, and let’s figure out the root cause of your discomfort together!