When we force our TFL muscle (Tensor Fascia Latae) to work overtime, it cops an attitude fast. We wind up with misleading chronic pain and weakness that makes us think there’s something wrong with our hip, low back, knee or even the piriformis. But the real drama queen is the TFL, the primary culprit in the dreaded “IT Band Syndrome (ITBS).” 

ITBS is an overuse injury caused by repeated trauma instead of a single incident. The muscle involved runs all the way from the top of the hip down to the outside of the knee, so it’s responsible for multiple actions at multiple joints. 

ITBS is usually caused by underlying muscle imbalances that mess with your biomechanics and form, resulting in weakness, fatigue and tightness. Other poor biomechanics like the knee and hips falling inward can contribute to the problem, too, as can weakness of the core, hips, glutes and quads. Sprinkle on some mileage increases and excessive hill training (pounding downhill takes even more of a toll than the ups), or running on an uneven/cambered road surface, and you’ve earned yourself a royally peeved TFL.  

SYMPTOMS

Symptoms of ITBS can include hip, groin or outer knee pain that feels sharp, stabbing or burning, as well as a click or pop. Usually, symptoms onset gradually then worsen with continued running or other repetitive activities. Bending at the knee usually causes noticeable pain, and you might experience swelling on the outside of the knee.

WHAT TO DO WHEN ITBS PAIN STRIKES

So what should you do when ITBS pain flares up?

  • Rest, and ice the hip and knee for 10-15 mins to help with inflammation. 

  • Take 2 days off completely before testing out the waters again. In the meantime, cross train and focus on building strength.  

  • When you head out for those first few runs, stick to the treadmill or do short (0.5 mile) out and backs from home. Why? If you feel any pain at all, it’s imperative that you stop running immediately. If you push it, you’ll set yourself back and have to start the clock all over again. 

  • Foam rolling and self-massage with a lacrosse ball are key in recovering from and preventing ITBS symptoms. Target all the muscles from varying angles. Set a timer for 3 mins and take breaks if you can’t tolerate it. If you find a spot that’s particularly painful, roll it while breathing deeply, then move on to another area and come back to it when you’re ready.

FIX THE UNDERLYING CAUSE OF THE ISSUE

When everything settles down, it’s time to tackle the contributing factors that got you here in the first place through a combination of stretching and strengthening. Not only will improving your flexibility and strength help prevent this injury from coming back, it will make you a better, more efficient runner. 

STRETCH:

  • Supine Hip and Low Back Stretch
    Lay on your back with both knees bent. Cross right leg over the left and pull toward the right side. Hold for 15 seconds and repeat 5 times. Then do the other side. 

  • Figure 4
    Lay on your back with both knees bent. Cross right leg over left making “4”. Lace hands behind the left thigh and pull up. Hold for 30 seconds and repeat 2 times. Then do the other side. 

  • Kneeling Hip Stretch
    While on your hands and knees, cross one leg in front of the other while pushing back with your hands to feel a stretch in the hips. Hold 15 seconds and repeat 5 times. Then do the other side.

  • Standing Lengthening Stretch
    Cross the injured leg behind the other one. The arm on the injured side reaches up and over to the opposite side, causing a lateral bend at the waist (not a twisting motion.) Perform 5 repetitions holding for 10- 15 seconds. Repeat on the other side.


STRENGTHEN:

Add these 4 exercises into your strengthening routine. The stronger and more flexible you are, the less likely you are to get injured again.

In these videos, we suggest a range of reps and length of time to perform each one because the right amount varies from athlete to athlete and injury to injury. If you’d like us to customize a treatment plan specific to your body and your goals, or if you have any concerns about these recommended activities, just reach out. 


RECAP

  1. STOP. Let the pain ease up. 

  2. STRETCH/SELF-MASSAGE. Ease that tension. 

  3. STRENGTHEN. Fix what’s really going on so it doesn’t happen again.

Our goal is to always keep you moving, as optimally as possible. If you’re still in pain after trying these tips, it’s time to get a movement analysis and work with an experienced practitioner (like us!) to fix the root cause of your tensor fascia latae pain.

Email us with any questions, or give us a call to chat about what’s going on with you, specifically. We’re here for you.

Happy training!

— Raymond Delacruz, PT, MSPT, CSCS, CMTPT, FAAOMPT

OTHER POSTS TO CHECK OUT

You may also be interested in this post “YOUR KNEE PAIN MIGHT NOT HAVE ANYTHING TO DO WITH YOUR KNEE” and this one, “MINIMIZING TENSOR FASCIA LATAE (TFL) ACTIVATION AND KNEE PAIN BY TARGETING THE GLUTES.”

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