Tensor Fascia Lata (TFL) Chronic Injury

Dear Dr. Bell, I have been experiencing pain in my upper left leg. I’m really not sure of the name of this area…I think the Hip Flexor? The pain occurs on the outside/top of the upper thigh, right below the waste. I have been Squatting 3 times per week for the past 8 weeks. I’m making good progress in terms of size and weight. I’m taking a week off from Squats until this is better. Any input would be great.

What you are describing is a classic Tensor Fascia Lata (TFL) Chronic Injury.

The TFL is a relatively small “Fist-Shaped” Muscle, located right under the bony outer ridge (Hip Bone) of the pelvis, close to where your pants pockets begin. The TFL attaches to the Iliotibial (IT) Band, the long tendon that runs all the way down the outside of the thigh, across the patella (knee) to insert into the lower leg.

The TFL may be small, but this muscle is critical to helping to extend the knee during the last 15% of the movement. It is also critical to keep your knee fully extended. To locate the TFL and IT Band, extend your leg and tighten your knee. Hold it in front of you, and you will feel how tight the TFL and the IT Band becomes in the fully extended position. You will feel the TFL and then your fingers down your IT Band, down the outside of your thigh, from your hip (TFL), down the IT Band (outer thigh tendon), down through the knee to your lower leg. 

When you bend the knee, the TFL will help with leg flexion as well. I suspect, that as you were increasing your strength in the Deadlift or any heavy leg extension movement, i.e. the Squat, especially Front Squats, you were forcing the TFL to execute more load than it was conditioned to safely handle. It is possible that the exact opposite could have happened, that due to your skeletal-muscular structure, the TFL may have done an inordinate amount of the work and your quads and hamstrings may need strengthening.

You will need a little experimenting to fix the problem. You can try other variations of Wide-Stance (sumo), Narrow Stance, Single Leg-Squats/Leg Presses/etc. for the quads and Leg Curls, and Stability Ball Leg Curls for the hamstrings.

For the TFL, you need stretch and strengthening exercises: Side Leg Raises, Standing Cable-Leg Abduction Exercises, and Stretch: Standing Cross-Leg Stretch.

Massage, Ice-Compression also helps: the easiest way to Ice Compress is to lay on your side with the Ice-pack directly under your TFL.

Many find relief by “Rolling”: lay on your side on a Foam Roller and roll against the Roller directly on your most affected (painful) area. You can “Roll” both the TFL and IT Band in this position.

You will initially experience some discomfort and even pain. You should be able to sense the difference between “Good Pain”: the pain experienced when you are feeling the tissues repair and regenerate Versus: Bad Pain”: the tissues are being damaged further, leading to new and harsher injuries.

Thank you for the Great Question! I suggest you take the IFPA Sports Medicine Certification Course next. This course is developed to give you the knowledge, skills, and abilities you need for the Treatment, Care, and Prevention of the many aches and pains caused by both Training and Life!

Good Luck!

Dr. Jim Bell