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Integrated functional anatomy of the tensor fascia latae (TFL) and IT band. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common foam rolling, injury prevention, and stretches for the TFL.

Tensor Fascia Latae (TFL)

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This course describes the anatomy and integrated function of the tensor fascia latae (a.k.a. TFL, tensor fascia lata, tensor fasciae latae, or tensor muscle). This muscle is located on the proximal and lateral thigh, primarily anterior to the hip joint, invests in the iliotibial tract (iliotibial band), is composed primarily of type I muscle fibers, and crosses the hip joint and knee joint. The tensor fascia latae is a hip flexor, hip abductor, hip internal rotator, tibial external rotator, and may contribute to knee extension or flexion depending on knee joint angle. This course also describes the role of the tensor fascia latae in hip joint arthrokinematics, fascial integration (iliotibial band and gluteus maximus), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the TFL muscle for detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. “tight TFL”, TFL pain, hip joint pain, knee pain, runner’s knee, greater trochanteric bursitis, IT band tightness/iliotibial tract tightness, hip impingement syndrome, etc.) and tensor fascia latae exercises and techniques (e.g. TFL foam rolling, TFL release, TFL soft tissue mobilization, TFL stretch, etc. ).

Brookbush Institute's most recommended techniques for the Tensor Fascia Latae (see videos below):

TFL and Vastus Lateralis Vibration Release

The tensor fascia latae in a cadaver dissection of the leg

 Course Description: Tensor Fascia Latae

Introduction

 - muscle that stretches or tightens a part, 1704, Modern Latin agent noun from tens-, past participle stem of Latin tendere "to stretch" - 

 - 1560s, from Latin fascia "a band, bandage, swathe, ribbon," derivative of fascis "bundle" - 

 early 15c., from Middle French latéral and directly from Latin lateralis "belonging to the side," from latus (genitive lateris) "side" - 

Tensor Fascia Lata roughly translates to - "Muscle that tenses the lateral fascia"

The muscles of the hip including the TFL, glute max, glute medius, and hamstrings

Look at the layers of the hip and the relationship between gluteus minimus, gluteus medius, and the positioning of tensor fascia lata. -http://thebodykinetic.com/it-band-and-foam-roller/

Attachment and Innervation

Attachments & Innervation: Tensor Fascia Latae

Relative Location

The cross-section of the pelvis displaying the anteiror and superficial tensor fascia latae

Where is the Tensor Fascia Latae?

Palpation

Palpating the Tensor Fascia Latae

Introduction to the Tensor Fascia Latae

Actions

Hip: Abduction, flexion, and internal rotation.

Knee: Tibial external rotation. The TFL may assist in knee flexion from a position of 15° or greater; however, the TFL will also contribute to knee extension from 15° to "assistance in locking the knee" (3, 11).

Pelvis: This muscle may contribute to an Anterior Pelvic Tilt

 hip adduction, extension, external rotation, and depression of contralateral innominate. The TFL may also eccentrically decelerate knee flexion from 0 - 15° and knee extension from end range knee flexion to 15°.

The strongest synergistic relationship is likely between the TFL and gluteus minimus who share the same joint actions at the hip.

During hip abduction, the TFL works synergistically with the gluteus minimus and prime mover gluteus medius. This function also assists in maintaining a level pelvis during single-leg stance, and femoral alignment during heel strike and/or landing mechanics (eccentric control of hip adduction moment). The TFL is roughly half the mass of the gluteus minimus, and a quarter of the mass of the gluteus medius (8) - this may allude to a smaller role in hip abduction, only playing a significant role when abduction is combined with flexion (3, 21).

The TFL works synergistically with the hip flexors - psoas, iliacus, rectus femoris, gluteus minimus, and anterior 

The TFL may also produce hip internal rotation, working synergistically with the gluteus minimus, 

Although I can only speak from clinical experience, there seems to be a functional synergy between the TFL, rectus femoris, and sartorius. Over-activity and adaptive shortening of these muscles may deflect the femur into abduction during hip extension past neutral. This motor behavior is most notable in those who elicit 

, and/or Sacroiliac Joint Dysfunction (SIJD), may be related to the sign 

"Knees Bow Out" on the "Overhead Squat Assessment"

, and is often related to hip and/or knee pain. A common sign of this “dysfunctional synergy” in a gym setting is the abduction of the back leg during the eccentric phase of a sagittal plane lunge.

Arthrokinematics

Tensor Fascia Latae Muscle Actions

Fascial Integration

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

 – Although there is little research to support the notion at this point; there seems to be a fascial line that runs up from the fan-shaped TFL and continues in the same direction to course along the external obliques (In Anatomy Trains this is part of the "Lateral Line") (6). Although these muscles are definitively separated by the iliac crest they may both contribute to the body turning in on itself (hip flexion and internal rotation combined with spinal flexion and contralateral rotation – as seen in a chop pattern), and their overlying fascia (which does run continuously) may contribute to the eccentric deceleration of the kinetic chain turning outward.

 (Tensor fascia latae, vastus lateralis, iliotibial band) – The tensor fascia latae uses the iliotibial band as a tendon. The ITB is invested by fascial slips from the vastus lateralis. These fascial slips extend above the hip giving the vastus lateralis a role in resisting adduction and the distal slips give the vastus lateralis a role in increasing tension in the lateral structures of the knee. In essence, the fascial slips of the vastus lateralis allow the vastus lateralis to assist in the same joint actions that the TFL can produce. The iliotibial band continues to a complex insertion on the fibular head with fascial slips to Gerdy's tubercle (just inferior to the lateral tibial plateau), the lateral collateral ligament (LCL), lateral patellar retinaculum, anterior tibiofibular ligament, and a strong investment in the lateral intermuscular septum with a strong attachment to the lateral femoral condyle (8, 11). During tibial external rotation and/or lateral knee stabilization the TFL is activated to increase tension in the iliotibial band along with the vastus lateralis. The TFL/ITB/VL complex along with the 

 and lateral gastrocnemius comprise the functional group that laterally stabilizes & externally rotates the knee. Further, in postural dysfunction, pattern overload of this complex may lead to vastus lateralis trigger points, and the superficial fascia of the vastus lateralis becoming bound to an iliotibial band that has been pulled tight and shifted anteriorly by a TFL that is short and overactive. Because of these factors, it may be necessary to add self-administered static release techniques for the vastus lateralis, and myofascial shear techniques for the ITB to a routine aimed at returning optimal TFL neuromuscular efficiency.

 – The iliotibial band creates a complicated network that invests in several structures:   

lateral intermuscular septum with strong attachment to the lateral femoral condyle

fascial slips to Gerdy's tubercle (just inferior to the lateral tibial plateau)

The potential communicating synergies that may arise from this fascial network are staggering and could be the subject of an article unto themselves. To date, the most useful idea to arise from my personal consideration of this relationship has been the relationship between the iliotibial band and tibial external rotators. The iliotibial band may act as a communicating medium for these muscles. Mentioned later, these muscles are prone to over-activity, and a change in the motor behavior of one will often lead to a change in the others.

http://www.rvuanatomy.com/anterior-and-medial-thigh-dissector.html

Subsystems

The tensor fascia latae, gluteus maximus, and the IT band down the leg crossing the knee joint

Behavior in Postural Dysfunction

 and is often synergistically dominant for an inhibited gluteus medius (1, 2, 8, 12).

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 the TFL is short/over-active as a flexor and internal rotator of the hip.

 the TFL is short and over-active and plays a significant role due to its function as both a tibial external rotator and femoral internal rotator. Supporting the label of short/overactive is research by Padua, Bell & Clark demonstrating increased TFL activity in those who exhibit medial knee displacement, and further, that release and stretch of the TFL (along with other exercises) will reduce medial knee displacement (15, 16). Note: medial knee displacement has been shown to be predictive of ACL injury (18)

Every joint motion is relative. That is one bone moves relative to the other.

Tibial external rotation is relative femoral internal rotation.

In a closed chain, tibial external rotation combined with femoral internal rotation & approximation of the lateral knee (sometimes referred to as knee abduction) may result in medial knee displacement which is relative adduction at the hip.

It should be no surprise that the TFL is short/over-active in those who exhibit Lower Leg Dysfunction (LLD), as the TFL contributes to all of the excessive osteo- and arthrokinematics associated with this impairment. Further, the actions of the TFL oppose the glute complex implying that over-activity may result in altered reciprocal inhibition and under-activity of the glute complex, specifically the gluteus medius. Clinically, the TFL is often thought to act as an over-active synergist for an inhibited gluteus medius as was the focus of the study below:

Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. journal of orthopaedic & sports physical therapy, 43(2), 54-64.

 and may become synergistically dominant for an under-active gluteus medius. This may imply that interventions for the TFL should include release and stretching techniques and that some benefit may be gained from hip and knee mobilization (see videos below). Further, 

 may be necessary to restore optimal recruitment patterns.

Trigger points in the posterior and lateral hip region.

Abductor tendon tears correlated with TFL Hypertrophy (21)

Signs of Altered Length/Tension and Tone:

Asymmetrical Weight Shift – Short/Over-active on side of dysfunction

Anterior Pelvic Tilt (excessive lordosis) – Short/Over-active on both sides

Knees Bow In – Short/Over-active on both sides

Knees Bow Out - Short/Over-active on both sides

Feet Turn Out – Short/Over-active on both sides

Hip Internal Rotation at 90 of Hip Flexion (90/90 Hip IR)

Note: Although the TFL is an internal rotator, it is also the most likely culprit in IR restriction. It is believed that the TFL causes an anterior & superior migration of the femoral head in the acetabulum, causing impingement of the anterior capsule and/or the psoas tendon during a 90/90° IR goniometric assessment. Release and stretch the TFL and retest before addressing other internal rotators.

 Inability to adduct 10 – 15° w/ hip extended and knee bent

Palpation results in tenderness and may result in radiating symptoms to the lateral or anterior knee.

The tensor fascia lattae trigger points and referral pain patterns

TFL Trigger Point and Referral Pain Pattern - http://www.sideofsneakers.com/wp-content/uploads/2011/11/image2.png

Special Note: There is no such thing as ITB trigger points!

Often, reference is made to release and stretching (specifically foam rolling) of the iliotibial band. As connective tissue the ITB is non-contractile and slow to adapt. Although we may feel that the iliotibial band is taught, adaptive shortening of this tissue is far less likely than the iliotibial band being pulled taught by overactive musculature, or being pulled taught by the relative position of the hip and knee. Before implicating the iliotibial band as the cause of pain and dysfunction it is worth assessing the muscles that invest in the iliotibial band, specifically the TFL. From the standpoint of practice, muscle tissue adapts faster and generally has a larger capacity for change than connective tissue.

Further, CONNECTIVE TISSUE CAN NOT DEVELOP TRIGGER POINTS OR TENDER POINTS. Trigger points are muscle tissue phenomena, not connective tissue phenomena. When an individual uses a foam roll, medicine ball, or a manual therapist uses pressure to relieve tender areas in the "ITB", it actually the vastus lateralis that is being affected. As discussed above, this can have a positive effect on mechanics and the relative tension of the ITB, but it is not the ITB that is being affected directly. Long story short… there is nothing wrong with the technique, but the rationale is inaccurate.

Behavior In Postural Dysfunction

Tensor Fascia Latae (TFL) Self-administered Static Release

Vastus Lateralis Self-administered Static Release

Kneeling Hip Flexor Self-administered Static Stretch

Active Hip Flexor Stretch

Dynamic Hip Flexor Stretch (Upright Lunge Series)

Manual Hip Flexor Stretch/Thomas Test Position (Pectineus and Adductor Stretch)

Self-administered Hip Mobilization: Lateral Distraction

Self-administered Knee Mobilization: Posterior to Anterior with Extension

Techniques for the Tensor Fascia Latae

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Bell, D. R., Oates, D. C., Clark, M. A., & Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. 

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. 

Sutter R, Kalberer F, Binkert CA, et al. (2012). Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle. Skeletal Radiol. 42: 627-633.

Ray B, D’Souza AS, Saxena A, et al. (2013). Morhpology of the superior gluteal nerve: a study in adult human cadavers. 

Gottschall JS, Okita N, Sheehan RC. (2012). Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking.

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Tensor Fascia Latae (TFL)

Related Courses:

Course Description: Tensor Fascia Latae

Introduction to the Tensor Fascia Latae
3 Sub Sections

Tensor Fascia Latae Muscle Actions
1 Sub Section

Fascial Integration
1 Sub Section

Behavior In Postural Dysfunction

Techniques for the Tensor Fascia Latae
8 Sub Sections

Bibliography

Related Courses:

Comments

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Tensor Fascia Latae (TFL)

Related Courses:

Course Description: Tensor Fascia Latae

Introduction to the Tensor Fascia Latae3 Sub Sections

Tensor Fascia Latae Muscle Actions1 Sub Section

Fascial Integration1 Sub Section

Behavior In Postural Dysfunction

Techniques for the Tensor Fascia Latae8 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Tensor Fascia Latae
3 Sub Sections

Tensor Fascia Latae Muscle Actions
1 Sub Section

Fascial Integration
1 Sub Section

Techniques for the Tensor Fascia Latae
8 Sub Sections