3 Steps for Eliminating Tensor Fasciae Latae PainMay 03, 2021
Are you looking for a solution to a tight, painful or achy tensor fasciae latae muscle, aka the TFL? An effective strategy is to create and execute a customized exercise program that focuses on your individual hip limitations.
A couple years ago, I created one of the most viewed articles for TFL pain online. It currently ranks 6th on Google when searching for TFL pain. You can read that article here.
Hundreds (if not thousands) of people benefited from the advice in that tutorial. This article is an update to the original and intends to further support your path toward a pain-free TFL.
What is the TFL and why does it hurt?
The TFL is a lateral hip muscle that helps with a variety of important movements of the hip - including flexion and internal rotation among others. It’s an important muscle. But it’s also next to other important muscles, as well as tendons, ligaments, joints and bones.
Hip Anatomy is Confusing but Movement doesn't have to be!
There are thousands of reasons why one can experience pain in this area of the body. When I was experiencing lateral hip pain years back, I believed it was because I had a tight TFL. I foam rolled and stretched the area daily. And it helped.
But then I became dependent on this routine. I’d do it everyday. Before any workout or playing sports. On vacation. No days off! I started questioning whether I was making a permanent change to my TFL or if I had to do this routine for the rest of my life.
If the pain kept returning, was the routine actually helpful? Did my TFL hurt because it was tight or was there something else causing discomfort in this area of my body? I had to step back and reassess whether I was on the wrong path.
After working with clients for a few years, one thing became crystal clear. Pain is complex. Complex in the sense that it is difficult to identify what is causing it. In the article, "Is Movement Therapy Rocket Science," Todd Hargrove says the following about chronic pain:
For many that self-diagnose themselves with TFL pain, you might be “looking too closely at the details.” I know I was. Whether our TFL is tight or if the pain is even coming from the TFL does not matter all that much.
The big picture is that this area of our body hurts and we want it to feel better. And a very effective way to make this area of the body feel better is to learn how to move it better.
A Better Strategy for TFL Pain - the 3-Step AER System
Instead of being laser focused on the TFL, I recommend you start looking at the hips more globally. Which foundational hip movements are you limited in? How can we help you improve this movement? What type of exercise does your body respond to best?
There is no one-size-fits-all approach. Each person working through TFL and hip pain will be weak in different movements. How someone responds to certain exercise strategies will also vary.
This is why I recommend using the AER 3-Step-System which stands for Assess, Execute and Reflect. The premise of AER is that each person’s body is different. So each person will need different strategies to get them moving and feeling better.
Step 1 - Assess Your Hip Limitations
The first step is to assess. Identify your movement limitations. It is important to test all 6 foundational hip movements before making any judgments. When I work with clients, I go through all 6 assessments even if I notice issues with the first few movements.
In this tutorial, we’ll focus on hip flexion and hip internal rotation for two reasons. First, pain in the TFL area is a sign that these two movements might be weak. And secondly, this tutorial would be 10,000 + words if we went through each of the 6 major hip movements.
Beginner Assessment for Hip Flexion
Beginner Assessment for Hip Internal Rotation
It’s important to identify what your low hanging fruit is. That way, you can spend your time on the movements that matter most.
These are only two beginner assessments. I recommend you test the other four main hip movements to get a better picture of your hip function. You may also need more advanced assessments. This should get you off to a nice start though.
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Step 2 - Execute an Effective Training Plan
The second step is to create and execute a training plan that focuses on your limitations. Most active people play sports or have some experience with popular exercise modalities. Strength training, conditioning or yoga are all great but I’m talking about something different.
I’m talking about an intelligent training plan that focuses on improving your movement. The goal with this type of training is to open up movement patterns. It's not to build muscle, get thin or become better at sport. These are awesome goals but they're different from movement improvement.
In our example, let’s say you test poorly on both the hip flexion and hip internal rotation assessments shown above. You would then include exercises that focus on improving internal rotation and hip flexion in your exercise program. Here are two common exercises I assign to beginner clients who are weak in these movements:
Beginner Internal Rotation Exercise
Beginner Hip Flexion Exercise
A training plan can last anywhere from 4 to 8 weeks. I usually start beginners off with 4 weeks so they start getting a feel for training in these types of organized phases. It’s also very tempting for people to give up too soon. If we don’t see results, it’s easy to get discouraged and jump ship.
But progress takes time. We have to learn what works and what doesn’t. Part of the process is trial and error and what works great for one person might be useless for another.
I've found that the above exercises help many clients. But they don’t help everyone. This is why the third step, reflect and reassess, is so important.
Step 3 - Reflect and Reasses
Reflecting on the training plan requires a 2-prong approach.
We first evaluate your subjective experience with the training plan. What do you think worked well in the training plan? Where do you feel like you made the most progress? Where do you feel like you got the most bang for your buck? What did you struggle with? What felt like a waste of your time?
We then evaluate your progress objectively by reassessing the movements we are trying to improve. For our example, after 4 weeks of working through the exercises, we’d retest your hip flexion and hip internal rotation.
Things likely won't change after only 1 training phase but they might after 2 or 3. The goal is to have recorded videos and notice a gradual improvement in the target ranges of motion. We use both of these metrics to determine which exercise strategies to keep or abandon.
Let's provide an example of how this would work. You perform the reverse clamshell twice a week in a 4-week training phase. In the reflection stage, you report that the exercise felt awkward and uncomfortable. This is your subjective experience.
We then reassess and we discover that your internal rotation improved. It's possible that the discomfort experienced during training was necessary to get you moving better. In fact, maybe it was nothing to fear at all. You may now interpret these sensations differently in the future with this information.
This is one hypothetical out of many possible ones. The point is that every training phase provides an opportunity to learn more about your body. We start shifting our attention to the question: “How do I move my hips better?” as opposed to “How do I heal my TFL pain?” And through this self-discovery, our TFL pain does improve because our movement and our relationship to our body improves.
My position is not that TFL pain does not exist. I just don’t believe it’s a helpful diagnosis or observation. The answer to TFL pain is the same answer to most hip pain issues - learn to move your hips better.
A well-rounded hip mobility training plan, which focuses on strength and flexibility, will target the TFL and other important hip muscles. Getting too stuck on one muscle interferes with the ability to stay honest when learning about your body.
Don't forget about all the other hip muscles!
Investigating and trying to figure out why we are in hip pain takes a lot of emotional and physical energy. I recommend you transfer that energy toward exploring how to move your hips better. How can you get your hips stronger and more flexible in a way that doesn’t aggravate your current pain levels too much?