TFL - Health + Injury - Runner's World

Penny king 2

28/02/2012 at 20:08

Hi all, devastated is how I feel at the moment, been having treatment for months, for ITBS, was not getting better, I decided to go and see a different physio, I have now been told I have Tensor Fascia Lata (TFL). I am now back to square one, what has annoyed me the most, is the months of wasted on/off running and the pounds I have paid out, hopefully now the new treatment will work, good news is they have guaranteed I will be able to run the cardiff half

Penny king 2

28/02/2012 at 20:41

Can anyone suggest exercises for me to do at home, been looking on line, but I find it very confusing, too much out there, and I find it conflicting, thanks everyone

Tom Goom

29/02/2012 at 23:47

Hi Penny, it's hard to answer your question without knowing a little more about what you've tried already. What exercises have the physios given you? What treatment have you had so far?

I'm sure you know this but TFL is actually just the muscle at the top of the IT band. In theory it tightens when the glutes are weak leading to a tighter IT band. Glutes exercises are commonly given, typical are "the clam" and side lying leg lift. Only thing is if these are done wrong then they will just work TFL and not glutes.

Many people don't believe you can stretch the IT band either, it's a tough fairly inelastic band. That said people's symptoms do sometimes improve with stretches but it's not easy to stretch.

Let me know what you've tried and I'll do my best to help!

Penny king 2

01/03/2012 at 08:44

Hi Tom,
I am doing the leg lifts, also doing squats against a wall, with a ball & sitting on the ball, with my leg @ an angle, then rolling forward on my leg & pushing back on the heel. I was thinking of joining a gym (evev though I hate them) & using their hip abductor & adductor machInes & whatever else they suggest

seren nos

pirate

01/03/2012 at 08:51

did the new physio find out the cause...........eg weak glutes or other problems......they should then of suggested exercises etc

seren nos

pirate

01/03/2012 at 08:52

can't believe that a physio has guaranteed a race in october...........so many possible injuries between now and then

Green Dragon

01/03/2012 at 09:44

It's a bit worrying that you are on a forum asking for tfl exercises when you have forked out money to see a physio. You should be asking your physio for the correct exercises. If it is tfl tightness it can be stretched in a similar way to the itb.

Fido2Dogs

01/03/2012 at 10:41

And nobody has mentioned the foam roller! Good thing is to have a sports massage where they attack the tight ITB etc - then you know how it should feel when you go on the foam roller to have a go at the ITB at home. (Painful yet productive)

Seconded, go back to physio and have them check the right muscles are being used to do the exercise.
I managed to do all the usual exercises without using my glutes at all, and it was only after a fizz session where I tried several variations on the clam with the fizz's finger stuck in my glute to see whether the muscle was being used or not that we found a way of doing the exercise which did get my glute to do some of the work!

Physio in Blackheath

01/03/2012 at 11:03

Forget the foam roller for TFL - use a tennis ball and have a good dig and roll - you may actually feel your "ITB" pains as you do it beacause of the trigger points that have built up in the muscle.
I casually refer to this injury as runners hip.

Greg

Tom Goom

01/03/2012 at 11:03

Lots of potential causes for ITB/TFL issues - weak glutes, poor biomechanics (e.g. Over pronation, leg length difference) poor proprioception and control (particularly single leg balance or single knee dip) weak core, muscle tightness, or over training, running on a camber etc.

Your Physio should help you work out the cause and address it, sounds like for some reason it hasn't quite worked with the physios yet. Aside from exercise have they tried any other treatment? Fido2Dogs suggestion of a foam roller is a good one. Have they tried massage or myofascial release? Acupuncture can also be very effective. There are also a number of taping techniques that offload the ITB that can help. What stretches are you doing?

Sorry to answer your questions with yet more questions!!

Penny king 2

01/03/2012 at 17:51

I am doing the exercises they have suggested, as I said in my last statement, they gave me acupuncture the other day, not made much difference. They have not suggested anything else. They said my tfl was weak on the right side & needed strengthening, gave me the exercises to do. I went for a mile run the other day, by the evenIng both hips were so bad, I could hardly walk. In fact I feel it's worde now than before. Going for another mile run tomorrow, it will be a 2 day break in between .

Andrew DuBois

01/03/2012 at 21:01

some good advice above. I wouldn't join a gym and use those machines , in fact I would strongly advise any runner NOT to go anywhere near the hip abduction , hip Adduction machines ( or any other machine for that matter ) have a look at this blog for the reasons why

http://www.mile27.com.au/machine-weights-to-be-avoided-at-all-costs

Not sure what exercises you have been given but clams and side lying leg lifts are a very ineffective way to strengthen the glute muscles and have little benefit for a runner . Have a look at this blog for the reasons why and some alternatives.

http://www.mile27.com.au/strengthening-your-gluteus-medius-–-do-exercises-like-the-clam-or-a-side-lying-leg-lift-actually-do-anything/

Tom Goom makes some great points regarding the possible causes of ITB pain and a good physio should be addressing all of these. If they haven't I would recommend seeing a different physio.

Like most profession, all physios aren't the same , some are great and some are worse than useless. Ask for recommendations from other runners in your area to find a good one.

Tom Goom

01/03/2012 at 21:14

Must be really frustrating if it just seems to be worsening despite treatment from 2 different physios. Especially if you're struggling to manage a mile at the moment.

Without examining you it's hard to know what to suggest that'll add to what the Physios you've seen have already done.

I'd say sit down with the Physio and say, "you've said I can get back to running for the Cardiff half. At present I can't manage a mile. What's the plan to get me there? And if it doesn't work what's plan B?"

You need a clear plan from them, exercises, what hands-on treatment, when to run and for how long, gait analyses and change of footwear if appropriate etc etc. otherwise I can see this dragging on and getting more frustrating.

Next time you run you could try and self tape, see if that helps. This article has some suggestions;

http://www.physiotherapy.co.za/images/selection%20of%20taping%20tech%20article.pdf

They're mainly based around the knee but I used the one in figure 3 when I had ITB problems and was able to run pain free.

Or something around the hip, like this might help;

http://sportsmedinfo.net/kinesiology-taping/228-kinesio-taping-itb-band

Also if you're not already doing it you could try to add in "the clam" to your exercises some instructions here;

http://pilates.about.com/od/pilateswarmupandprep/ht/clam-exercise.htm

Good luck, hope you can get it sorted

Tom Goom

01/03/2012 at 21:24

Just seen Andrew's points in his blog about "the clam". Fair points to be honest. It isn't functionally related to running, there may be better ways to work your glutes. That said at present your pain sounds quite easy to aggravate so the clam may be a good place to start to try and target glutes before progressing to more weight bearing exercises.

Up to you!

Penny king 2

01/03/2012 at 21:28

Thankyou Tom & Andrew, have wrote down the addresses you gave me, will take a look tomorrow. I hope I get the Problem resolved as I enjoy running, seems my years as a couch potato, ex smoker are coming back to haunt me. I will sit down with my physio on the 12th & discuss all of the points given to me. Fingers crossed that tomorrow's run will be better, I am determined to get through this

Physio in Blackheath

01/03/2012 at 22:15

If running 1 Mile is hurting so much and leaving the area further aggravated do you think it is wise to run again so soon?
The muscle is not recovering sufficiently and therefore needs a greater period of rest and this is not just from running. You need to address all the activities that stress this areas at this current stage and allow it to settle. That includes the possibility of cutting out stretching, rollers and deep treatments. Sometimes with the best intentions those tools of our trade can make people much worse when done to an acutely irritable muscle.
I know that this has probably put me in the category of "one of those physios" but that is the reality (for now).
You also now have to consider what you are doing to the other hip - we all want to keep running but sometimes common sense says retreat before we go forward.
Good Luck

Greg

Andrew DuBois

01/03/2012 at 22:30

Good advice from Greg

Penny king 2

02/03/2012 at 10:38

Greg, u r correct, and I don't think you are one of those. I like and listen to the advice on here. I got a tennis ball last night and worked on my points, it was painful, but I stuck with it, will try 1 more run today and see how I go, if I have problems I will stop and not continue again. I am working both sides, even though physio only said the affected side, I am not neglecting the other. This will be my second run in about 2 months, I feel like I am 1 step forward 30 steps back lol.

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