Ohhh My Hip…Ohhh My Leg…

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Though I don’t really mention this to people, I deal with almost constant body pain. The bizarre thing is that most of my chronic pain issues are located on the right side of my body. I wake up almost every night from intense pain in my right shoulder whenever I roll onto my right side. The pain in my shoulder is the result of a rotator cuff tear which I sustained in April of 2013 and an acromio-clavicular joint dislocation which occurred in December of 2014.

Then there is my right hip which goes into spasm almost daily, and sends a wicked pain along my tensor fascia lata, iliotibial band and peroneus longus (aka lateral thigh and leg) which at times literally takes my breath away. Fun stuff. I power through the pain, especially when a heavy leg day looms ahead, but this chronic pain has me near tears on some days. I am beginning to wonder if I have tensor fascia lata (TFL) syndrome.

My right tensor fascia lata muscle is always tight and inflamed, as is my right gluteus maximus. When my hip spasms, both of these muscles seize up as well. As a result of this ongoing issue, I often dig my knuckles right into my hip to address trigger points and to get some relief, and I also must get deep tissue massages on a regular basis to keep the spasms in check somewhat. I am actually known at the places where I get massages for being the fitness lady who needs at least 90 minute massages to address my musculoskeletal issues!

I recently stumbled upon a great post, written by by Stephen O’Dwyer, CNMT, which I am pasting here:

How the Tensor Fascia Lata (TFL) Causes Hip Pain

This muscle causes pain in two primary ways:

1) Once the TFL has been tight and ischemic for some period of time (it’s different for each individual), it can develop myofascial trigger points.

Trigger points can then refer pain to other parts of the hip, the groin, the buttocks and even down the leg.

2) When the TFL becomes chronically contracted it can exert a mechanical strain on other muscles by distorting joint movement.

For example the gluteals or the piriformis muscle often suffer from an unnatural “pull” from an excessively tight TFL.

Pain, then, might be felt in one or more of the following areas…

• Deep in the hip joint

• Into the groin

• Wrapping around the outer hip

• Deep in the gluteal muscles

• The sacroiliac joint

• Traveling down the leg

What Causes Tensor Fascia Lata (TFL) Dysfunction?

I have been considering for a long time how the TFL becomes excessively tight and locked up (aka dysfunctional) and have concluded that there are two chief reasons…

1) Weakness in the rectus femoris muscle.

The rectus femoris, the top quadriceps muscle along the front of your thigh, is your secondary hip flexor (after the psoas and iliacus which are your primary hip flexors).

And the rectus femoris muscle so often becomes weak as a result of the second reason for TFL dysfunction…

2) Excessive tightness and shortening of the psoas and iliacus.

This is a common occurrence in many of us who sit for long hours at a desk and/or commuting in our cars. The primary hip flexors, the psoas and iliacus, are put into a shortened position when we’re sitting. This can cause them to adapt to the shortened position.

Chronic shortening of the primary hip flexors, the psoas and iliacus, can causes the secondary hip flexor, the rectus femoris, to atrophy.

I believe this occurs, in part, because short hip flexors will abbreviate your stride thus reducing a full and natural leg swing.

In runners who are heel strikers this problem can be even more exaggerated. The quadriceps, and especially the rectus femoris, are severely underused.

In the reaching stride characteristic of heel strikers, the leg extends and straightens at the knee as the foot hits the ground. This leg movement disables the quadriceps muscles.

An aside for runners: underuse of the quadriceps can be rectified using the “barefoot running technique.” This technique does not require one to actually run in bare feet but rather to…

1) Adopt the upright, “running on hot coals” running method

2) To use a running shoe without the beefed up heels of conventional running shoes which don’t allow your foot to go through its full range of motion.

I recommend the Merrell’s Pace Glove for Women or Merrell’s Trail Glove for Men (the shoe I run in).

How to Treat Tensor Fascia Lata (TFL) Dysfunction

There are three strategies that alleviate excessive tightness in the tensor fascia lata:

1) Direct manual therapy treatment of the tensor fascia lata
I find that putting a client in a side-lying position with a pillow between their knees (and one to support their head and neck) is optimal.

Then direct manual pressure applied at different angles will help to locate the greatest “liveliness” in the muscle (I like to use this word instead of “pain”).

Gentle but detailed work will produce the best, most lasting results.

2) Maintaining flexibility in the entire hip

Stretching of the hip flexors and the entire hip and leg.

See Hip Stretches for excellent video support.

3) Strengthening the quadriceps
I’m not a fan of seated leg extensions on a weight machine to accomplish this.

Much more effective are single leg squats. If squats are not possible due to pain, then sitting against a wall is an excellent strategy.

Your knees should be at a 90 degree or right angle. Otherwise it’s not stable for your knees.

I love this article because it discusses a very common scenario which I see in my patients and which I am also personally experiencing. I definitely have a weak rectus femoris, partially due to the overactivity and spasm of the psoas and iliacus. Over the years I have had osteopathic manipulation to treat the psoas issue, but it keeps flaring back up. The weird thing is that I don’t necessarily sit for extended periods of time, yet my hip flexors are always tight. So if you have hip pain which never seems to resolve, you should check out the site where I found this article:

http://www.lower-back-pain-answers.com/tensor-fascia-lata.html#axzz3eaeKtVlT

I also highly recommend the stretches demonstrated on this link: http://www.lower-back-pain-answers.com/hip-stretches.html#axzz3eaeKtVlT

If you truly suffer from chronic, daily hip pain, then you can carve out a few minutes each day to perform these exercises. I have been so miserable from the pain in my hip that I am going to start doing these stretches every day. I will post a follow-up after doing these stretches consistently to provide personal feedback on the efficacy of these stretches, but the theory behind these stretches is so solid that I am sure they will make a big positive difference in my hip issues.

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