Get To Know Your Muscles - TFL (Tensor Fasciae Latae)

Author: Daniel O'Grady is a Physiotherapist in Adelaide, Australia.

Most people know about their ITB (Ilio Tibial Band)  that runs on the outside of the thigh; but not as many are familiar with the strip of muscle that joins the upper part of the ITB to the pelvis. 

This small muscle is known as the TFL (Tensor Fasica Latae). 

“If you’ve ever had problems with your knee, hip, lower back, calf or achilles, chances are you have some unresolved tightness in your TFL.”

QUICK ANATOMY REVIEW:

As you can see in the picture, the ITB has upper attachments to both the gluteals and the TFL.  Any dysfucntion/weakness in the glutes means that the TFL needs to work proportionally harder.  Gluteal inhibition is common - especially if you spend a lot of time sitting.

PALPATE THE TFL ON YOURSELF:

To feel the TFL, place your finger on your front of your pelvic bone.  Slowly move down and to the outside of the thigh until you feel a ropey muscle that is the the width a finger.  It may be tender to touch.

FUNCTION:

The TFL is a hip flexor, abductor and internal rotator.  It works in conjunction with the gluteus medius and gluteus maximus to stabilise the leg during the stance phase of walking and running.  The TFL anteriorly rotates your pelvis.  Functionally, the TFL is part of the Lateral Line and the Spiral line, according to Thomas Myers in his book Anatomy Trains.

The Lateral Line

The Spiral Line

SYMPTOMS:

Overload of the TFL can lead to pain and tightness in the front of the hip.  Very common is also pain and tightness in the outer part of the knee and into the ITB.  This is most noticeable when walking or up and down stairs/hills. 

Other symptoms:

• knee and hip pain (especially outside)

• the lower back and SIJ

• upper back

• calf and achilles

As the TFL pulls the head of the femur bone forwards, chronic increased tone is one of the prime causes of hip osteoarthritis and degeneration. 

HOW THE TFL BECOMES OVERLOADED:

The TFL becomes overloaded with repeated use in the following situations:

• excessive sitting, driving, kicking

• walking and running (especially uphill and downhill)

• cycling, swimming, kayak/canoe

• meditating crossed legged in lotus position

• sleeping in the fetal position

• standing with a swayed back and wearing high heels too often

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your TFL issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building gluteal and core strength is critical to prevent a relapse. ”

TRIGGER POINT DRY NEEDLING:

Tightness and shortening of the TFL responds well to dry needling, which can de-activate the trigger points (knots in the muscle) that can form in chronic cases.  The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms.  Dry needling is certainly an unusual feeling, but definitely beats 15 minutes of deep painful massage in that area.

SELF-CARE TIPS:

• apply heat to the front of your hip 10 minutes each day

• avoid sitting cross legged

• avoid walking and jogging uphills and on sloped surfaces in the short-term

• ensure your shoes are not overly worn

• sleep on stomach or side with pillow between knees

• when running - avoid over-striding and endure proper warm up and cool down

• use cruise control on long car trips to stretch the legs

GRADED EXERCISE PROGRAM TO ADDRESS TFL OVERLOAD:

PART 1 STRETCHES:

FOAM ROLLER ITB

Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER QUADS

Go harder along the quads. Keep breathing!

HIP FLEXOR STRETCH

Feel the stretch in the front of your hip as you tuck the pelvis under gently

FOAM ROLLER TFL

Angle your body across the TFL and roll it with medium to light pressure

PRONE EXTENSION COBRA DECOMPRESSION

Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PART 2 STRENGTHENING:

The goal is to strengthen and support the muscles around the TFL

BRIDGE

Feel a stretch in the front of your hips while your glutes activate in the back of the hips

CLAM SHELL

Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

SINGLE-LEG BRIDGE

Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

PUSH-UP TO SIDE-PLANK

Activate the obliques as you twist into side plank. Try x3 on each side.

PLANK

Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

PART 3: POSTURE / NEW MOVEMENT PATTERNS

“For many people, the TFL becomes the muscle that is always switched on and over-active.

Try these movements, focusing on keeping your core and gluteals engaged. ”

STANDING PELVIC-TILTS

Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING HAMSTRING CURLS

Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

REVERSE LUNGE

Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

SIT TO STAND SQUATS

Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

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25 Things I Learnt in 2015

1.  "There is no learning without pain" - Aristotle

2014 was a challenging year for my health.  It was a major wake-up call.  With the help of many people, books and courses, I learned more about health and wellness this year than any other.      I'm very grateful to all of the teachers, mentors, colleagues, friends and family who shared their knowledge and passion.  The good thing about pain is that it is a great guide and provides an opportunity to build resilience.  "The purpose of life is to be defeated by greater and greater things." - Rainer Maria Rilke

2. The 7 minute workout app

Downloading this app for free and performing it regularly has helped build my foundation.  I admit, when I first started, I sucked. 

Thank-fully over time, I did improve and now I can now perform multiple rounds and get a great workout.  The 7 minute workout eliminates lack of time as an excuse.  You also don't need any equipment so you can keep your fitness up while on the road.  Doing one round as soon as you wake up gets the blood flowing and gets your day off to a great start.

3.  Schedule what you love to do every day

For many people, switching 'off' can be difficult.  Work and other commitments can dominate our time and energy, leaving us burnt out.  This is a powerful technique I learnt during the year.  At the start of each week, schedule in a pleasant activity each day - it might be an exercise class, going to the beach, watching a movie, cooking, going on a hike or catching up with a friend.  This gives you something to look forward to and you feel more productive and happier the rest of the day.

4.  Wellness course

We all suffer from anxiety and depression at some stage or another.  The good news is that there is free professional and effective help, just a click away.  Click here to take the Mindspot Wellbeing Course.

5.  Surround yourself with an allied health care team

I was very fortunate to find a great team in Adelaide to help me run the New York marathon.   Thanks to them, I was able to finish in one piece! Highly recommend checking them out.

Physios - Active Bodies, Adelaide Applied Physio

Dry Needling Adelaide Physio Care

Chiropractor - Amy Hereen at ChiroAdelaide

Movement coach - Mary Whaling MoovPT

Massage Rani Active Bodies, Aspects of Healing, Nicolas Mouat at Zephyr Life

Nutritionist - Steph Gaskell Nutrition Strategies

6.  Drink Bone broth

Bone broth has become very 'hipster'.  But the benefits are incredible.  I found adding bone broth to my diet was especially good for my gut health as well as keeping my knee cartilage as healthy as possible.  Read about the benefits here.

Great for drinking 1-2 cups before dinner or throw into recipes to add flavour. 

7.  Exercise in Nature

Surfing, hiking, swimming, running out in nature has benefits to our body and mind.  You are in the moment, free from technology and better able to find the 'flow'. 

Read this National Geographic article , Your Brain on Nature

Join Our Meetup

8.  Keep your microbiome healthy

The truth is our microbiomes and bacteria outnumber human cells 10:1.  Keep your bacteria healthy and they will keep you healthy!

Check out this Catalyst episode

Make this easy sauerkraut recipe

Try Kale Brock's Fermented Foods E-Course

9.  Cook with a Weber Q

Benefits

- FAST - have dinner ready in 20 minutes

- TASTES GOOD - The Weber Q holds in the flavours like nothing else

- HEALTHY - simplicity and freshness beats fancy

- PORTABLE - Cook all year round - and take it with you to the park or on camping trips

- EASY TO CLEAN - takes less than a minute, after you've done cooking and while the plate is hot - using an official Weber Wire Brush

Thanks to my Dad for recommending this one! 

10.  Learn The Art of Running

Efficient, pain-free running is at the end of a long chain of preparation and skill development.  It takes a lot of time and patience to fine tune your body to be able to adapt to the loads.  90% of runners get injured at some point.  But don't blame 'running'.  Take a look at your foundation and see what you can do to build it up, and then you will be at less risk of injury.   Key principle - build up slowly and allow your tissues plenty of time to recover between sessions.   Also, grab a decent pair of running shoes fitted at Joggers Word.  Read Chi Running

11.  Power of foam rolling - building a foundation

Introduced by Moshe Feldenkrais, the use of foam rollers have gained popularity with many athletes.  There is no better way to improve body awareness, flexibility, core strength and enhance relaxation.  Grab your free e-book here. 

12.  Public speaking

7 Steps To Fearless Public Speaking

This audiobook helped me.  2 main points I took away 1) Have something to talk about that you feel passionate about and 2) - start your talk like a conversation - ask a question and engage the audience, rather than "lecture" to them.

13.  Don't put off surgery that will help you now

Many people fear surgery and believe it is a 'last-resort'.  I did too - putting up with a meniscus tear in the knee since playing footy at Uni.  I was nervous before the surgery that I wouldn't be able to run and I'd always be a cripple.  But thanks to Dr Mario Penta, I got back to running and exercise without a problem.  The knee will never be 100% so I am careful to look after it.  Regular foam rolling, Pilates and swimming have helped my knee the most.

14.  Foundation must be built 1 step at a time

If you skip steps, you fall back into old habits and patterning that got you into trouble in the first place.  Take your time building a good foundation.  For most, this means getting onto the floor and practicing a Pilates or Yoga.  Learn to breathe, learn to relax and connect with the earth.  Get a bit more flexible with a foam roller.  Build your core.  Anything is possible once your foundation is in place. 

15.  Look after your teeth!

I learnt a lot from Adelaide's best dentist: Mark Earl at The Dental Practice.

From speaking to Mark,

- Only brush twice per day

- floss at night time

- use an electric toothbrush to avoid brushing away your enamel

- avoid excess lemon/honey drinks

16.  To Build Positive Habits, Create the right environment

- Read The Art Of Tidying Up

- surround yourself with like minded people who share your values

- if you want to exercise in the morning, set out everything you need the night before

17.  Pain is complex
Perception of threat correlates to the pain you experience better than actual tissue damage.  Threat can come from many different angles.  This cool book by Adelaide based researchers David Butler and Lorimer Mosely encourages self-reflection and learning.  Get your copy of The Protectometer

18.  Mantras calm the mind

Repeating mantras brings focus and and calm to the mind.  I was skeptical, but this is powerful stuff.  Just hearing the voices of Deva and Miten instills calmness.  Thanks to my Mum and Sister for getting me onto this. 

19.  Power of Plasticity

Norman Doidge's follow up to The Brain That Changes Itself.  Learning about neuroplasticity is empowering and gives hope.  There is a great chapter on the body-mind practice developed by Moshe Feldenkrais.  Movement with mindfulness and awareness gets to the source of many chronic pain states.  Kinesthetic sense is enhanced by using a foam roller, first used by Feldenkrais on people with neurological issues.

20.  Hydrate properly

Plain water doesn't cut it. 

Try sports hydralyte, coconut water, magnesium and nuun tablets.

21.  Get enough Sunlight

30-40% of Australians are Vitamin D deficient. Getting 20 minutes of full body sunlight per day is ideal.   Another reason to go out and exercise in nature.   Note: never use a solarium because they increase the risk of skin cancer. 

22.  HRV

Learning about the yin and yang of the autonomic nervous system was a game changer for me.  You quickly figure out how important the simple act of breathing is on your wellbeing.  I love being able to objectively rate my stress and adjust my day accordingly.  You can either buy a heart rate strap or download an app and check your HRV on your phone

23.  Primal Movement Chains

In November, I attended Perry Nickelstons first 2 day teaching course in Melbourne.  He promotes good quality movement as a basis for good health.  His exercises are fun,  challenging and 'primal'.  Things like rolling, crawling and cross body patterning - good for the body and the brain.  A solid foundation is built without reflexively, without having to over-think things.  We incorporate these exercises into our Pilates Classes.

24.  Align with your DNA

Our DNA has evolved over 2 million years and is suited to a particular lifestyle.  In this book, Daniel Lieberman contrasts our current lifestyles to those we are designed for.  His theory is that the mismatch between the two is the basis for the chronic disease epidemic going on right now.  Thanks to Luke Bongiorno for getting me onto this one.

25.  Restorative Yoga

An amazing way to get into deep, healing, para-sympathetic states of relaxation.  If you suffer chronic muscular tension, this practice can help you get to the source.

Check out this great Restorative Yoga Class at Yogita Yoga

Read Yoga For Pain Relief

Adelaide's Top 5 Day Walks

The latest neuroscience is providing some interesting research regarding the link between spending time in nature and keeping stress levels under control.  National Geographic published this article which gave a brilliant summary.  Even though the benefits of being in nature are intuitive, it's nice to see the research on how it all works.

After living in New York City for coupe of years, Fiona and I REALLY appreciated the easy access to nature when we returned to Adelaide. 

Let me know your favourite walks around Adelaide in the comments.

1.  Waterfall Gully - Mt Lofty

This 8km return loop is Adelaide's most popular hike.  About 10km from the CBD, it provides a great challenge and test of your fitness.  There's no hiding from the steep sections at the start and towards the end. 

Go early in the morning to get a car-park.  Hopefully by the time you get down the bottom, Utopia cafe will be open and you can re-charge with a devonshire tea.  And don't forget to foam roll afterwards :-)

To add an extra 4km to this hike, come back down along the Winter Track via Cleland.  It's much quieter and you'll spot tons of wildlife - kangaroos, koalas and black cockatoos to name a few.  The track comes back out at Waterfall Gully Road.

2.  Marino to Hallet Cove

This walk tests your knees with lots of steps and gully crossings.   But the views out to the Gulf of St Vincent are superb.  The rock formations are ancient and inspiring.  There are some detours where you can walk right down onto the rocks by the ocean.  Normally you can spot a few seals playing off the coasts.  Nice to make an afternoon out of it and take your time exploring.

You can walk the whole distance to Hallet Cove (14km return) or turn back anytime.  Another option is walking one way and then catching the train home.

3.  Morialta

Lot's of waking options here to suit all levels.  You can take a short stroll up to the main waterfall.  Or climb up to the second falls.  A loop winds back along the top of the valley and looks back over the waterfall.  Normally a good place to spot koalas.

Note: there are no water taps en route, so be sure to pack a drink.

4.  Moana to Southport

This is a nice coastal walk where you check out the surfers at Seaford along the way.  About 8km return.  You could finish your walk at the Deep Blue Cafe.

5.  Somerton beach to Glenelg

This 3.5km return loop is nice way to start the day and get the legs moving.  You will often see dolphins and seals splashing around along the way.  The Broadway Kiosk provides a good place for a coffee or brunch on a Sunday morning. 

Also some of the best views at sunset!

If you would like join us for a hike, sign up here

Please leave your comments and suggestions at the bottom and let us know about your favourite walks in Adelaide!

How Foam Rolling Can Help With Headaches

Many headache sufferers we see in the physio clinic have a very stiff Thoracic spines.

This is the part of the back that runs from your upper shoulder blades down to the upper waist line. 

**The thoracic spine is designed to move and be mobile**

Unfortunately for many of us - through excessive sitting, driving and generally poor posture, this part of the spine has lost its flexibility. 

In particular the upper back starts to round over time.

This stiffness then leads to compensations - commonly tightness felt in the neck, shoulders leading to chronic headaches. 

These foam roller exercises are designed to improve your posture, increase mobility through the thoracic spine and decrease the pressure on the head and neck.

If you are a headache sufferer, please give these exercises a try and let me know in the comments how you get on.

FREE PDF DOWNLOAD CLICK HERE

Follow this link for information about our Foam Roller Classes

The 5 Best Books To Read For Runners

1.  Running with the Mind of Meditation

Sakyong Mipham brings meditation and running together in this book.  He relates his experiences as a meditation teacher with the stages he went through as a beginner runner, right through to his marathons.  He also talks about balancing the sympathetic (running) nervous system with the para-sympathetic nervous system (meditation).  Once you get the balance right, great things can happen. 

2.  Chi Running

Danny Dreyer melds the world of tai chi and running and shows us the way to running efficiently and safely.  He does a great job of explaining the importance of posture, core strength and proper alignment.   The principle focus of Chi Running is to work smarter, not harder.  Understanding the body's elasticity and spring system, you can improve your efficiency by 30%.

3.  Running and being

Written in the 1970's by cardiologist George Sheehan, we get an appreciation for the internal thinking of an elite runner.  The ups and downs, depression, elation and everything in between.   This book will open your mind to the intricacies of pushing your body to reach its highest potential.

4.  The Story of The Human Body

In this book, Daniel Lieberman goes into depth to explain how our lifestyles are mismatched to what our DNA has programmed us to do.  The consequences are drastic.  This book will give you a new appreciation for movement as a powerful medicine.  He also explains that are human frames are designed to run.  Sitting and inactivity have lead to weakness in our gluteus maximus - a key muscle for efficient walking and running.

5.  Yoga for Runners

A great collection of exercises to balance the body and keep muscle imbalances from getting out of hand.  Also the author spends a good deal of time explaining the importance of rest and recovery.  Following a restorative yoga practice will be invaluable in helping your body to heal and recover from your running training.

Now it's your turn!  Please let us know your favourite running books in the comments!