Tensor Fascia Lata

Description[edit|edit source]

The tensor fasciae latae (TFL) is a muscle of the proximal anterolateral thigh that lies between the superficial and deep fibres of theiliotibial (IT) band. There is high variability inmusclebelly length, although, in most patients, the TFL muscle belly ends before the greater trochanter of thefemur^[1]. The TFL muscle is about 15cm in length^[2][3].

• The TFL works in conjunction with thegluteus maximus,gluteus medius,andgluteus minimusin a wide variety ofhipmovements, including flexion, abduction, and internal rotation.
• It acts, via the iliotibial (IT) band's attachment to the tibia, to assist withkneeflexion and lateral rotation.
• The TFL is most important clinically for assisting inpelvisstability while standing and walking.^[1]SeeLumbo-Pelvic Stability^[1]

Image 1: TFLs position, lateral aspect thigh.

Origin, Insertion and Nerve Supply[edit|edit source]

The TFL originates from theanterior superior iliac spine(ASIS) and anterior aspect of theiliaccrest. It descends between and is attached to the deepfasciaand the superficial fascia of the IT band (5 cm width). The TFL descends on the anterolateral aspect over the thigh, running superficially to the greater trochanter of the femur.

It inserts distally to the IT track/band, which is comprised of the fascialaponeurosisof the gluteus maximus and the tensor fascia latae. The IT band then runs along the lateral aspect of the thigh, where it attaches to the lateral condyle of the tibia, specifically the Gerdy tubercle.^[1][4]

Innervation: The Tensor fasciae latae is innervated by superior glutealnerve, originating from lumbar nerve 4, 5, and first sacral nerve(L4-S1) roots. It also innervatesgluteus minimusandmediusmuscles before terminating with innervation of tensor fasciae latae muscle^[5][4]

Image: Tensor fascia lata (highlighted in green) - anterior view^[6]

Function[edit|edit source]

Though small in size, the TFL works with several muscle groups to assist in the movement and stabilization of both the hip and the knee:

• Works with the gluteus medius and gluteus minimus to internally rotate and abduct the hip and with the gluteus maximus via the IT band to abduct the hip. It assists the rectus femoris in the flexion of the hip.
• Acts on the tibia via the IT band's attachment to the Gerdy tubercle of the lateral tibia. The TFL is an accessory knee flexor, though its action is only seen once the knee is flexed beyond 30 degrees. Furthermore, it works with the IT band to stabilize the knee when it is in full extension. It also acts via the IT band in the lateral rotation of the tibia. This lateral rotation may be performed while the hip is in the abduction and medial rotation, as is seen when kicking a soccer ball.

Clinically, the main function of the TFL is to assist in walking. The TFL does this by pulling the ilium inferiorly on the weight-bearing side, causing the contralateral hip to rise. The rise in the non-weight-bearing hip allows the leg to swing through without hitting the ground during the swing phase of the gait^[1]y

Physiotherapy[edit|edit source]

The TFL can become clinically significant in cases of tightening, friction between over bony prominences, or through its attachment to the IT band. The TFL can become tight, especially in situations of prolonged shortening, such as in a seated position. A shortened TFL can lead to an anterior tilt of the pelvis and/or medial rotation of the femur.

Externalsnapping hip syndrome是一个条件,病人描述明显snap on the lateral aspect of their hip that occurs with a variety of movements. Though patients will often not complain of pain from this syndrome, it can progress to become painful. Treatment is typically conservative with oral NSAIDs and physical therapy. See link.

IT band syndromeis a common overuse injury observed in runners and cyclists. Patients describe lateral-sided knee pain.

Your Older Clients may often suffer from weakened TFL actions due toVitamin B12 deficiency. Vitamin B12 deficiency typically leads toward nerve demyelination within the CNS and the PNS^[1].

Assessment[edit|edit source]

Power

The power test for the TFL is done in side-lying with hip in 45° of flexion for grade 5, 4 and 3 while for grade 2, 1 and 0, it is done in long sitting position.

The therapist is situated behind the patient with one hand is placed at the lateral surfece of the topmost thigh immediately above the knee, given downwards pressure and the other hand at the iliac crest for stability. the patient is asked to abduct against resistance.

• Grade 5如果病人能够绑架并给出主要吗tain position at end range against maximal resistance.
• Grade 4如果病人能够绑架并给出主要吗tain position at end range against moderate resistance.
• Grade 3如果病人能够绑架并给出主要吗tain position at end range against no resistance except gravity.
• The therapist stands at the side of the limb being assessed one hand is place at the ankle serving to reduced friction between the limb and the plinth while the other hand is placed at the proximal anterolateral thigh. The patient is asked to move the limb towards the therapist.
• Grade 3is given if the patient is able to abduct to 30° and maintain position at end range.
• Forgrade 1 and 0,the starting position is the same for grade 3 assessment but the hand placement of the therapist changes;one hand is placed at the the lateral side of the thigh immediately above the knee while the other hand is placed at the proximal anterolateral thigh for ease of TFL palpation.The patient is asked to move the limb towards the therapist. Grade 1 is given if therapist is able to feel contraction of the muscle and grade 0 is given if no contraction is palpable.^[2][4]

Palpation

Palpation of TFL can be done in any of the aforementioned starting position in muscle power testing. One hand is placed at the the lateral side of the thigh immediately above the knee while the other hand is placed at the proximal anterolateral thigh and the patient is instructed to abduct(move the limb being tested away from the contralateral limb) the limb being assessed. TFL can then be easily palpable at end range of the motion^[5][2].

TheOber's testevaluates a tight, contracted or inflamed Tensor Fasciae Latae (TFL) and Iliotibial band (ITB).Noble’s testand theRenne testare two other tests that are commonly used to detectiliotibial band syndrome.

Videos[edit|edit source]

The below video is on the general anatomy of TFL

The first video below is ofOber's Testthe second shows how to stretch TFL

References[edit|edit source]