THE SURPRISING CAUSE OF IT BAND ISSUES, BACK, HIP AND KNEE PAIN!

The psoas has become the ‘trendy’ hip flexor muscle to talk about and work on. But all too often another hip flexor muscle, the TFL, is the main culprit of our back, hip, knee, ankle and iliotibial band (IT band) pain. The IT band is a thick bunch of fibres that runs from the outside of your hips to the outside of your thigh and knee down to the top of your shin bone. It helps to extend, abduct, and rotate your hips. If your IT band gets too tight, it can lead to swelling and pain around your knee.

Research suggests that, when working out, far more attention should be given to the TFL because it compensates for a weak glute medius, perpetuating IT Band tightness and impacting everything down to our feet and ankles. It contributes to internal hip rotation and external tibial rotation. Because of its far reaching impact it is a muscle we should not ignore.

However, the hard part about addressing TFL tightness and over activity is that many of the moves we need to do to correct the issue, can often perpetuate it!

For instance, to help prevent the TFL from continuing to compensate, we need to include glute medius strengthening.

But ever notice how you’ll do Monster Walks and feel the front side of your hip working?

Ever push through thinking “Oh yea! Feel that burn!?” Or maybe you don’t even think about what is working. You’re doing the “right moves” so you just believe you should get results, right?

Wrong!

If you’re doing the right moves but still allowing muscles to compensate, not only are you not correcting the problem, but you may be making it worse.

So when you feel that front outside of your hip working during those mini band walks? Guess what is not working as it should and what is also compensating for that under active muscle!?

Your glute medius is not getting the benefit of the exercise it should be getting and instead you’re perpetuating the overuse of your TFL! So all of that rehab isn’t going to pay off. While you need to strengthen your glute medius, you need to realize that all too often your TFL can compensate for a weak glute medius.

Because this muscle then becomes even further overworked and even shortened, it can lead to lower back hip and knee pain, and IT Band issues, foot and ankle problems!

Through our IT Band the TFL can create movement compensations down our entire leg!

And when we then see changes to our ankle mobility those changes only further perpetuate those compensations back up our kinetic chain. It’s why you can’t just ignore aches and pains. The longer you ignore them and keep pushing through, the more you then just allow compensations and imbalances to build up so there is more to have to sort through later.

If you don’t address TFL issues, you’ll end up having to address issues from your feet up!

So how can we prevent our TFL from leading to all of these aches and pains when it wants to work during the exercises we need to be doing to correct it?

 3 TIPS TO STRENGTHEN YOUR GLUTES AND PREVENT YOUR TFL FROM COMPENSATING!

1 Treat the TFL like a toddler. Keep it distracted so you can get work done.

Basically, you want to adjust movements to help make it easier to establish that mind-body connection. One way to do that is to “keep the TFL busy” by internally rotating your foot during lateral raise, or abduction, movements.

Because the TFL performs hip internal rotation, you can almost “distract” it with that movement as you use the glute medius to perform the lateral raise.

So if during lateral raises you notice you often feel the front of your hip, turn your toe down toward the ground.

You may even notice often that your toe is turned out toward the ceiling.

The TFL contributes to tibial external rotation.

So internally rotating your foot is the opposite action, which can help “shut off” the TFL. When you internally rotate your tibia, you often then internally rotate the hip by extension.

Maintaining this internal rotation, you can then perform your lateral raise movement.

If you still are struggling to feel your glute medius, you can even kick slightly back as you raise up or put your hip into extension, driving back into a slider or wall as you perform that lateral raise movement. This hip extension and slight kick back will engage your glute max, which will also hinder the TFL from taking over and allow you to potentially better activate your glute medius. This works because the TFL is a hip flexor so by putting your hip into extension, you can inhibit it from working!

2 Change the hip flexion during those abduction moves

When you’re first starting to “rehab” an issue, you need to use the moves you feel the most and build off of those.

Basically you want to take the path of least resistance to establish that mind-body connection.

If you feel a move working those glutes, use that first then dive into other moves because you’ve already established that mind-body connection.

To find that move that helps you establish that mind-body connection, you may need to adjust the exact posture you use during basic abduction moves.

By adjusting the amount of hip flexion or extension you perform the move in, you can find a way to maximize your glute medius engagement and minimize your TFL compensation.

It isn’t a clear cut and dry rule of what posture is best so you may want to play around to see what matches your personal recruitment patterns.

For some, more flexion may “distract” the TFL because it is a hip flexor.

However, for some, more hip flexion may perpetuate it being overactive during those abduction moves.

In this case, putting the hip into more extension may be key to inhibit the muscle.

While you want the glute medius to be strong in both a slightly more hip-flexed or hip-extended state, you do want to start with the move you feel working correctly to make sure you establish that mind-body connection.

The fact that hip flexion can play a role in how much you’re able to engage the TFL is why that oh so “basic” clam exercise can so often backfire too! The clam is a traditional glute activation movement. But this seemingly simple move is so often butchered.

First off, you may find you need to use that internal rotation of the tibia mentioned in the first tip to help.

Secondly, you may adjust how much you pull your knees forward or straighten your legs out. 

The key is being conscious of what you feel working to then adjust your exact amount of hip flexion. A great way to play around with different amount of hip flexion during even a bilateral abduction move is seated. You can lean back, sit up tall or lean forward to different degrees to not only strengthen your glute medius in a variety of postures but also find the exact position that works for you. Remember to focus on what you feel working so you can work around your own biomechanics.                                                                                                                                                                                                                                                                                                                             

3  Foam roll and stretch before you activate                                                                            

If you struggle to activate a muscle, you may find that foam rolling and stretching the muscle prior to doing activation moves helps.

While people debate the benefit of both techniques, with one of the main arguments against them being that the benefits are short-lived, that doesn’t mean you can’t use these “short-lived” benefits to your advantage.

By rolling your TFL and then stretching to improve your hip mobility, you can inhibit this overactive muscle, even if just temporarily.
If you interrupt that mind-body connection between your TFL and brain, and restore muscles to their proper length-tension relationships, you can then help yourself better establish the mind-body connection to the muscle you do want to work – your glute medius!

 So if you find your TFL is compensating for your glute medius no matter what posture or tweaks you do, try relaxing and inhibiting it immediately prior to doing the glute activation moves.

Interrupt that communication so you can establish a new connection to those glutes! A lacrosse ball is a great way to relax that TFL and even a simple half kneeling hip stretch with reach can improve your hip extension.

Link to Youtube video demonstrating the exercises