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This fasciae is thicker on the lateral side, which is known as the iliotibial band (ITB). 

The tensor fasciae latae (TFL) originates from the top and outer portion of your pelvis from an area called the anterior superior iliac spine (ASIS). [Commit these acronyms to memory as you’ll be seeing them a lot!]

Images from the Hip Control Master Manual

At the knee when it is flexed, the TFL contributes to external tibial rotation i.e. turning the toe outwards.

These are the simple biomechanical actions of the tensor fasciae latae, however it also contributes to more complex movement and/or activation patterns.

In everyday life, one of the most important functions of the TFL is its contribution to maintaining single-leg balance, where it works in concert with the gluteals, hip adductors and the quadratus lumborum on the opposite side. [2]

One weekend I met up with my buddy Matt, who was a nationally ranked mountain biker. He was complaining that he’d been suffering from IT band pain for a few weeks.

At the clinic, I’d recently seen the chiro do some ART on the IT band of a figure skater, so I did the same thing to my friend.

Image by rougechiropractic.com

After just one treatment, his IT band pain was gone and it never came back.

I was young, inexperienced and didn’t understand the root causes of pain so for a while after that I believed ART and deep trigger point style therapy was the cure-all for chronic musculoskeletal pain.

I was quickly taught this wasn’t the case after hammering away at people who complained of pain and finding my treatments didn’t provide lasting results.

Now I understand that trigger points can occur in a muscle for a number of different reasons, one of the most common being this:

Pain in a muscle is often the result of that muscle becoming facilitated - which means it works more than it should. 

Muscles become facilitated because synergists of that muscle (muscles that perform the same function) are dysfunctional due to weakness or inhibition.

I refer to this phenomenon as pain as a result of a Compensatory Movement and/or Activation Pattern (M/AP) due to Functional Overlap. 

The TFL is compensating for muscles that serve the same function but aren’t doing their job.

When this is the root cause, static stretching, massage and trigger point therapy on the TFL will never provide lasting relief. 

To effectively address the problem requires fixing the synergistic muscles that aren’t working properly, which requires proper  understanding of anatomy and biomechanics. 

Here’s a chart of synergists to the TFL:

From Kinesiology of the Hip: A Focus on Muscular Actions [3]

Let’s say your iliopsoas isn’t functioning correctly, which is quite common because it’s often inhibited from too much sitting...

The iliiopsoas is the primary hip flexor, so if it’s not working, other muscles have to work overtime to pick up the slack because we need to flex our hips for basic everyday movements like walking and going up stairs.

So the TFL says, “I can help out!” and soon, it’s doing the job of the iliopsoas, but because it’s a relatively small muscle that averages just 2.1mm deep and 18cm long, it quickly gets overworked.

The pain due to facilitation and overuse of your TFL is exactly what happens to your muscles after a hard workout, which is known as delayed onset muscle soreness (DOMS).

DOMS is that sensation of stiff and sore muscles you feel a day or two after an intense session at the gym due to damage to the muscular fibers from the workout.

Only in the case of tensor fasciae latae pain, it’s not a good workout that’s causing the pain - it’s chronic overuse.

This isn’t cool because, unlike your workouts which are targeted and purposeful, this is just an ongoing, unintentional ache.

And unlike workouts, which you (hopefully) are spacing out to give yourself time to recover, your TFL isn’t getting this kind treatment.

This chronic overuse is why a study that looked at the size of the TFL in those with pain showed their TFL is up to two and a half times the size of a normal one! [4]

Now that you understand the many possible root causes of TFL pain, it’s clear to see that an effective approach requires restoring proper function to the dysfunctional synergists and not just poking and prodding at the poor tensor fasciae latae. 

A study showed that those with unilateral hip osteoarthritis had significantly greater TFL activity in the affected vs. unaffected hip. [5]

While we have a “which came first, the chicken or the egg” situation, excessive activity and pain in the TFL is a signal that something is wrong and that biomechanics are altered.

Whenever biomechanics are altered and compensatory M/APs are used to move about, greater stress and strain is put on all of the structures of the joint, leading to premature degeneration and inflammatory conditions like osteoarthritis.

So regardless of what came first, the osteoarthritis or the excessive TFL activity, it’s important to know that this association exists simply to provide greater motivation to fix the problem before a bigger problem manifests.

Tension and tightness in the TFL are common in those with TFL pain, as it is with any facilitated muscle.

Tension typically occurs first because the brain puts the TFL on "high alert", so it has increased muscular tone and feels like it's tight or can't fully lengthen.

When a muscle is working more than it should and doesn’t recover sufficiently, so it feels sore and tight just like your quads after a hard lower body workout at the gym. 

But because the muscle is never given the time to recover because it's always being called on to do things it's not designed for, the “use it or lose it” principle kicks in and because the muscle is never fully lengthened, it becomes tight and shortened. 

When either tension or tightness occur, the logical and conventional approach is to stretch the TFL, but as you now know, stretching only addresses the symptom since the root cause of TFL pain and tightness is a compensatory M/AP. So the tightness will quickly return.

Tightness in the TFL may also be a result of repetitive positions or movements that you do or did as a kid, for example, if you sat in the W position a lot, this shortens the TFL and it may have adaptively shortened. [6]

If you’re a runner and you’ve got a tight TFL, you may notice that on toe-off your foot rotates out and on foot strike, you’ll have a tendency to pronate. This makes your running gait less efficient and also puts you at a greater risk of shin splints.

In addition to limiting your mobility, a tight TFL left unchecked can lay the groundwork for the following postural and functional adaptations.

Because the TFL is an internal rotator of the hip, when it tightens up it can result in an internally rotated stance, which gives the appearance of knock knees.

The insertion of the ITB on the lateral condyle of the tibia can result in external tibial rotation and the appearance of duck feet when the TFL is tight. [8]

While your standing posture might not be affected, if the TFL becomes painful and weak from chronic overuse, during exercises like squats, step-ups and lunges, the knee might cave in.

Before we cover the 3 steps to eliminating TFL pain, let’s recap what you’ve learned about the true root causes of TFL pain:

Now that you have a thorough understanding of what causes tensor fasciae latae pain, I’m sure you’re thinking, “So what can I do about it?”

Enter the Precision Movement 3-Step Process to Eliminating Pain and Improving Mobility.

This process is applied not just to your TFL muscle but to the entire hip complex (and quite possibly, other joints if dysfunctions or lack of mobility are present) because TFL pain is the symptom that the muscle is being overworked - not the problem.

In the video below you’ll discover the 3 steps along with sample techniques and exercises that are unique to each step.

Moving and exercising with a structural limitation present is akin to driving with the emergency brakes on - every movement you make takes more energy and puts more wear and tear on the car.

That’s why this is the 1st step, because without it, all of your other efforts will be for nothing.

The TFL overworks because other muscles aren’t firing properly, so we’ve got to get them activated so they can start to pull their weight.

Dissociation is the breaking of habitual, dysfunctional patterns, just like someone who continues walking with a limp even after their sprained ankle has healed.

Once structural limitations are addressed and muscles are activated, it’s time to create new, efficient patterns where your body uses the muscles that should be used in movements you perform in everyday life, the gym and sports.

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This article was reviewed and updated on January 11, 2020 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include new research and information on latest surgical developments.
Read more about Dr. B here.

Following these 3 steps eliminates structural limitations, restores activation and strength to ALL of the muscles in the hip and creates efficient and functional movement patterns.

The 5 techniques in the video and 3 techniques highlighted here are samples of the types of exercises and precision with which the exercises are prescribed to fix the root cause of tensor fasciae latae pain.

Now, if this scientific and logical approach makes sense to you and you’re ready to take the next step, continue to the next page to get full details on EVERYTHING you need to do to properly apply these 3 steps to finally be rid of your tensor fasciae latae pain for good: