The link between a tight TFL and back pain
Tell me if this seems familiar. You’re driving somewhere and you can’t remember exactly how to get where you’re going, so you program your destination into your phone…
Aaaa-aand 45 minutes later with the gas tank (and your coffee cup) on empty, you’re muttering under your breath as you crawl through some weird back road traffic nightmare convinced that you’re never going to make it.
Of course you do, but you know there was a way better route and both you and your vehicle are a little worse for the wear.
It beats map quest (remember that dinosaur?), but I think we’ve all experienced the frustration of a faulty GPS. It gets us where we need to be, but not efficiently.
And interestingly enough, something similar is happening in the communication between your brain and your muscles when you experience joint discomfort and muscle tension.
In fitness, we tend to think about the large muscles that we’re firing to perform an exercise. Consider squats. If I asked you what muscles were working in squats, you’d probably say glutes or maybe quads, but it’s a lot more complicated than that.
The reality is that every time you go to move, your brain + nervous system (from here on out, I’ll just say “brain” for simplicity’s sake) sends out a series of messages to create coordinated muscular contractions throughout your body.
These contractions happen rapidly and automatically mostly beyond your conscious control. It’s this constant communication throughout your system that keeps you (unconsciously) upright when you’re sitting in a chair and allows you to walk without having to think about every step you take.
And this is why squats are more than glutes n’ quads.
When you squat, your spine/core muscles (automatically) fire in response to the load to protect your spine. Likewise, the stabilizers from your hips through your feet are firing to track your knee and hip joints and keep you from falling over.
So you can’t isolate muscles. Not really. And while specific movements will load some muscles more than others, the act of living requires a constant dance between every muscle in your body and your nervous system…and your fascial system, but given how heady this topic is, I’m not even going to touch that in this post.
Which is awesome. Except, what happens when your internal GPS fails to calibrate?
You’ll keep moving, but at a potential cost. Much like the above example of the GPS gone awry in your phone, the route your body takes to create the motions you ask of it may not be ideal and this can result in misalignment, joint compression, muscle tension and ultimately pain.
Why TFL and IT band issues aren’t just a problem of muscle weakness, but muscle timing
A great example of this is the relationship between the tensor fasciae latae (TFL for short) and the glutes (glute med in particular) when it comes to hip stabilization.
I’m vastly oversimplifying this, but here’s the cliff notes on the TFL and glute med.
The glute med and TFL are neighbors with the TFL being located to the front side of the pelvis and attaching to the IT band and the glute med being located towards the backside of the hip.
They have some overlapping actions with one notable difference being that the posterior fibers of the glute med helps track leg and knee out, where as the TFL pulls the leg and knee in.
Now before I go and make the TFL the bad guy, I want to be clear that I’m not saying not that you should never use your TFL. It’s just that you don’t want to overuse it.
The issue is that modern life + furniture (excessive sitting combined with poor standing posture) sets us up to have imbalances in the pelvis. When we hold habitual positions for too long, then our structure adapts to become efficient at holding these positions. This is how we end up with “poor” posture that ends up being reflected in everything else we do (running, lifting, ect) even though we’ve left the chair.
The end result is that we tend to be overly strong in hip flexion + internal rotation and weak in hip extension + external rotation and our brain sort of “forgets” where our pelvis is supposed to be.
Enter the faulty GPS. Ideally, when we go to move, the brain signals the muscles of the pelvis to do their thing, everything lines up and we get efficient, pain free movement.
However, with the aforementioned muscle imbalances, the pelvis is no longer positioned in a relatively neutral/functional place, which disrupts the communication between the brain and the pelvic stabilizers. This causes a faulty firing pattern, where the glute med is inhibited and the TFL has to take its place.
Remember the key difference between the TLF and the glute med?
The TFL is in the front, which primes it for hip flexion and it pulls the leg and knee in. The glute med is in the back and would help track the leg and knee out.
So if you have too much TFL and not enough glute med, then your hip and knee are going to collapse in creating a scenario for hip, knee and low back pain.
This is why if you’ve ever felt tightness /soreness on the front side of your hip or pain on the inside of your knee it might be because your TFL is going gangbusters (and the same goes for IT band problems, since the IT band attaches to the TLF and will also create external stability for the hip when the glutes are inhibited.)
So…what can you do about it?
Because the brain fires muscles in response to load and the position of our bones, one way to downgrade TLF engagement and activate glute med is to practice glute strength exercises with good alignment of the pelvis.
And if you don’t tend to live with a relatively neutral pelvis, it can be hard to hold a good position and not continue to reinforce the faulty movement pattern, which is where props are incredibly helpful.
This all sounds very esoteric, which is why I made a video of three popular hip strength exercises with an emphasis on how to use props and body position to get out of the TFL and into the glutes.
Try it out and if you have any questions, hit me up in the comments section (and if you have ongoing pain, consult a medical professional.)
Gluteus medius exercises to release tight TFL
Gluteus medius exercises to release tight TFL
https://www.youtube.com/watch?v=yV3fWQzBZes
Exercise Sequence
Side leg lift (hip abduction)
Open knee clamshell
Monster walks
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There are 11 comments on this post
You’re speaking my language! I’m adding the monster walks into my routine! Would plie squats be a good one too?
Thanks for this helpful info!
Sure thing! I certainly don’t think plie squats would hurt. They can be a nice way to strengthen the hips in gravity. Here’s a link to another post I did that highlights the plie squat: http://naablevy.com/inner-thigh-workout/ Cheers!
I suspected that my posture tends towards my legs rotating out rather than in, i.e. Opposite from what you have said will cause a tight IT band. How can I tell what is causing the issue? I tend to walk like a duck, with my toes pointed out, but am desk bound during the day, and being winter, not active enough at other times. I do also however suffer with typical office workers tight glutes from sitting too much! Could you offer me some advice? Thanks.
Hi Debbi,
Interestingly enough, when we have feet that turn out or go “duck footed” a lot of the time, we still have internally rotated legs. It’s just that because we are turned in at the hip, we end up unconsciously turning out from the knee or lower leg as a cute “cheat” to make the knee face forward instead of turning in.
With that in mind, the glute strength exercises in video in this post would probably still be beneficial to you. You can also check out this article I wrote about ankle mobility, which would pertain to walking duck footed as you mentioned: https://www.girlsgonestrong.com/blog/injury-prevention/need-better-ankle-mobility/
Additionally, you try these strength exercises: https://www.youtube.com/watch?v=CwhzzcLIsDk&t=239s or these stretches: https://www.youtube.com/watch?v=GJdV1FKrfwU
Hope this helps and feel free to shoot me an email at Nikki@naablevy.com if you have any questions.
Thank you!
Nikki
Wow! Thanks for all of that Nikki. I will certainly take a look at all of the links that you sent, and give you a yell if I have anything further to ask. I ended up getting my sports therapist to give my legs and hips a massage. Hopefully they will feel better in a couple of days for the short term anyway.
How long does it take to correct a muscle like this? I’ll be going on 2 years coming this summer with my hip pain and haven’t been able to figure it out completely. I’m only 23 and like to be very active but haven’t been able to lately. I’m going to try these moves would you recommend doing them everyday or every other and in the morning or evening?
Hi Darien,
I wish I had a straightforward answer, but really it depends.
The long short of it is that while exercises like these can be helpful, a lot of it has to do with figuring out what else is happening in your life to reinforce the movement pattern that is causing discomfort. Once you know that, it’s much easier to create a program to address those issues and challenge things, so you can resume regular activity without discomfort.
Because I don’t know your history, I’m going to say something very general here. Try both mobilizing and strengthening your hips in all directions and note which directions are hardest for you. Those might be where you want to spend more time. The advice I gave in this article might be helpful. for you too: https://naablevy.com/quad-dominance/
As far as the exercises go, my advice is usually do them whenever it makes sense in your day. Once a day is fine, but every other day might make more sense if you mix it up with other exercises as well. Feel free to reach out to me directly if you have more questions.
Nikki
I have excrutiating TFL pain in my right mid thigh (3 years s/p right hip arthroplasty). Follow up x-rays showed an osteophyte on one of my lower lumbar vertebra. I see a chiropractor weekly, have lost 50 pounds in the past year and have TRIED to be more active. But this pain almost brings me to my knees after work (desk job) and combined with my lumbar pain I have had for YEARS, I can’t walk very far unaided (I consider a treadmill “aided”) and certainly cannot stand more than 10 minutes at a time. Some of these exercises were part of my post-hip physical therapy but they don’t seem to be helping. The TRL pain started about a year and a half, two years ago and my ortho says it isn;t the hip replacement, all that looks fine. Any other suggestions?
Hi Laura,
Given that I’m not a medical professional and I’ve never seen you move or worked with you, it would be outside of my scope of practice for me to give you any specific suggestions. That being said, pain science is finding that we can have pain for all sorts of reasons beyond a weak muscle or tissue damage (and honestly I learned pain science years after I wrote this post, which is why this isn’t mentioned).
My suggestion would be that you investigate physical therapists until you find someone who is looking at your hip beyond the biomedical model. The Movement Maestro might be someone worth following, because she talks about this a lot. Hope that helps.
Nikki
Hey, I had a swollen hip bursa (left) about 2/3 weeks ago and still getting grief from my hip. It looks as if the tfl on my left side isn’t working properly. My right one seems pretty strong. I’ve got an anterior pelvic tilt and have been sat down a lot recently because I’m working from home. Think I may have damaged something by running which caused the problems. Just wondering if you could help/advise me? Thanks a lot, Jordan
Hi Jordan, without seeing you, it’s really hard for me to say. If you suspect that you’ve truly damaged or injured something, then I would suggest following up with your medical provider and/or a physical therapist who will be able to assess, diagnose, and treat you. The most I can offer is exercises within the scope of fitness for strength. flexibility, muscle balance, ect. Hope that helps. Sorry I can’t say anything more definitive.