Acupuncture for Tensor Fasciae Latae Pain
The tensor fasciae latae (TFL) is a muscle on the front of the hip that connects to the lower leg via the IT band. It is positioned above the gluteus minimus and some of the gluteus medius muscle.
The functions of the TFL muscle are to help flex, abduct, and medially rotate the hip. It helps control movement more than it produces it and works to help the gluteus medius and minimus to stabilize the pelvis.
Tensor fasciae latae trigger points and tightness can cause pain in the hip joint area and anterolateral portion of the thigh which can extend as far as the knee. This pain can feel like deep hip pain which can be further aggravated by walking or laying down on the affected side. It can be mistaken for trochanteric bursitis because the trigger point referral pattern goes over where the femur connects to the acetabulum in the hip at the greater trochanter.
Besides the TFL, trigger points in the iliopsoas, and rectus femoris are common causes of hip flexor pain.
TFL tightness can lead to shortening of the muscle which then pulls on the IT band. This can lead to issues like IT band syndrome and external snapping hip syndrome.
IT band syndrome is a common overuse injury that can occur in activities that have repetitive hip flexion like running or cycling. In some cases releasing tension in the TFL, gluteus maximus, and vastus lateralis muscles can relieve IT band pain.
External snapping hip syndrome is when there is a snapping or clicking sensation in the lateral hip that can be caused by the IT band “snapping” over the greater trochanter. Releasing tension in the TFL, gluteus maximus, and vastus lateralis can help this issue because it relieves IT band tension to stop the friction over the greater trochanter.
Origin and insertion of the Tensor Fascia Latae Muscle
The tensor fasciae latae (TFL) originates along the iliac crest, posterior to the anterior superior iliac spine (ASIS). It inserts at the iliotibial tract (IT band) which then connects to the lateral tibia at Gerdy’s tubercle. This means that the TFL connects the front of the hip to the outer part of the lower leg via the IT band.
The iliotibial tract (IT band) is a fibrous band of tissue that connects the tensor fasciae latae (anteriorly) and the gluteus maximus (posteriorly) muscles to the lower leg. Together these muscles help to stabilize the knee (via the IT band) and stabilize the hip since they cross over where the femur goes into the acetabulum (hip socket). Trigger points and muscle tightness in the TFL can cause the muscle to pull on the iliotibial tract and lead to IT band syndrome and outer knee pain.
Actions of the Tensor Fasciae Latae Muscle
Flex the hip
Medially (internally) rotate the hip
Abduct the hip
Electromyograms of the TFL show that it has two main sets of fibers that perform different functions. While jogging or running, the anteromedial fibers work more in hip flexion and are more active near toe-off to help with hip flexion. The posterolateral fibers work more in hip abduction and medial rotation and are more active during and around heel-strike.
When walking, the TFL helps during the swing phase by helping move the ilium down on the leg on the ground while tilting the contralateral hip upwards so it can swing through efficiently.
The TFL is a small yet versatile muscle which helps to stabilize both the hip and knee. It supports the gluteus medius and gluteus minimus in medially rotating and abducting the hip. It also assists the gluteus maximus via the IT band to abduct the hip and helps the rectus femoris to flex the hip. Lastly, it also acts on the tibia via the IT band to stabilize the knee in full extension and helps to laterally rotate the tibia like when kicking a soccer ball.
Synergists and antagonists of the Tensor Fasciae Latae muscle
The main synergists of the TFL are the iliopsoas, pectineus, adductor brevis, and sartorius. Secondary synergists include the adductor longus, adductor magnus (anterior fibers), gracilis, and gluteus minimus.
Antagonist muscles of the TFL include the gluteus maximus and the adductor magnus (posterior fibers).
TFL Trigger Points
Tensor fasciae latae trigger point location and referral pattern
According to Travell & Simons, tensor fasciae latae trigger points can mimic trochanteric bursitis and they refer to the referral pain caused by the TFL muscle as “pseudotrochanteric bursitis.”
TFL referral pain can also mimic trigger point pain from other muscles like the gluteus minimus, gluteus medius, and vastus lateralis.
Trigger points in the tensor fasciae latae can be associated with trigger points in other muscles. Most commonly in the gluteus minimus muscle, and sometimes in the rectus femoris, iliopsoas, sartorius, and quadratus lumborum muscles.
Tensor fasciae latae trigger points often occur with gluteus minimus trigger points, and cannot be fully eliminated if there are still active trigger points in the anterior gluteus minimus muscle, which prevent a full stretch of the TFL muscle.
Trigger points in the three gluteal muscles should always be considered when there is TFL pain since they work together in various hip movements like flexion, internal rotation, and abduction.
The TFL and IT band work together as a functional unit to stabilize the pelvis during activities like standing, walking, and running. Because of its connection to the IT band, the TFL muscle has an impact on both the hip and knee joints. TFL trigger points need to be considered in cases of lateral knee pain as well as in cases of hip pain.
In cases of lateral knee pain and IT band syndrome, it is common to find trigger points in the vastus lateralis along with the TFL.
Signs and Symptoms of TFL Tightness and Trigger Points
Hip pain which can feel deep and travel down as far as the knee
Hip pain that is worse when moving the hip
Difficulty sitting for long periods of time with the hip flexed 90 degrees or more
Difficulty walking quickly
Trouble laying down on the affected side
Can be misdiagnosed as trochanteric bursitis
IT band tightness which can be caused by TFL or gluteus maximus tightness (or both)
Pelvic and iliac dysfunction which can be caused by tightness in the TFL and quadratus lumborum (QL) muscles that overpowers gluteus medius weakness
How Do Tensor Fasciae Latae Trigger Points Form?
Trigger points in the tensor fasciae latae form from activities that keep the muscle in a static position for long periods of time or overload the muscle. Activities that place excess strain on the TFL include climbing up or downhill without proper support, walking or running on sloped surfaces, excessive pronation, and sports like running or soccer that involve a lot of hip flexion and medial rotation. Sitting for long periods of time can cause the TFL to tighten and shorten which can tilt the pelvis anteriorly or medially rotate the femur.
Another thing that can cause TFL trigger points is a Morton foot structure. This is when the second toe is longer than the big toe. This type of foot structure places less weight on the big toe and more on the second during the toe off phase of walking or running which leads to overpronation of the foot. The compensation that occurs from this foot structure can affect various areas of the body including causing TFL trigger points.
Tensor Fascia Latae Trigger Point Referral Pattern
The TFL trigger point location is generally around halfway between the ASIS and greater trochanter in the belly of the muscle. Referred pain from this trigger point is generally concentrated in the anterolateral thigh over the greater trochanter and can also extend all the way down the thigh towards the knee.
How Can Acupuncture Release TFL Trigger Points?
Trigger point acupuncture can provide a tensor fasciae latae muscle release by identifying the taut bands of muscle that create the pain referral pattern and eliciting a twitch response to relax the muscle to restore function, improve range of motion, and reduce pain.
Identifying trigger points and providing TFL muscle release with acupuncture and is one of the most effective ways to relieve pain in this muscle group.
After releasing trigger points with acupuncture, there will generally be soreness for 24-72 hours after the treatment which will feel like intense workout soreness.
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Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual. London: Lippincott Williams & Wilkins.
Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.
Janda, Vladimír. “Muscle Function Testing.” (1983).
Trammell, A. P., Nahian, A., & Pilson, H. (2023). Anatomy, Bony Pelvis and Lower Limb: Tensor Fasciae Latae Muscle. In StatPearls. StatPearls Publishing.
Paré, E. B., Stern, J. T., Jr, & Schwartz, J. M. (1981). Functional differentiation within the tensor fasciae latae. A telemetered electromyographic analysis of its locomotor roles. The Journal of bone and joint surgery. American volume, 63(9), 1457–1471.
Hyland S, Graefe SB, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Iliotibial Band (Tract) [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537097/
Iyengar, K. P., Azzopardi, C., Kiernan, G., & Botchu, R. (2022). Isolated pathologies of Tensor Fasciae Latae: Retrospective cohort analysis from a tertiary referral centre. Journal of clinical orthopaedics and trauma, 29, 101870. https://doi.org/10.1016/j.jcot.2022.101870
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