Ep 493 – But First . . . the TFL: “The Rebel MT” with Allison Denney

0:00:00.4 Speaker 1: Massage therapists, are you looking to enhance your skills and improve your practice? Here's your chance. The American Massage Conference is back. This three day event will be at Disney Springs in Orlando May 16th to 18th and kicks off with Free Friday, which is open to everyone. The weekend has over 20 educators offering approved continuing education and a tribute to the late, great Eric Dalton as well as nightly cocktail receptions to network and unwind. Head over to massagetherapymedia.com/conferences to secure your pass and join us in connecting therapists globally.

0:00:31.5 Speaker 2: Anatomy Trains is thrilled to invite you to our 2025 summer program on the coast of Maine, featuring courses for both manual therapists and movement professionals. Instructors include Tom Myers, Til Luchau, Wojtek Cackowski and Sharon Wheeler. Come for the world class education and stay for a vacation on one of the most beautiful coastlines in the country. Visit anatomytrains.com for details.

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0:01:06.6 Allison: I'm just gonna go to massage school. It'll be easy. I'll learn how to help people feel better, get my own space, make my own schedule, work 20 to 30 hours a week. Piece of cake. It'll be fun. Funny thing happened on the way though. It wasn't that easy. Not because learning how to do bodywork is on par with learning brain surgery, but because life, and not life like being an adult and having kids and learning how to parent and be fiscally responsible life. Life like this unaware awareness threaded through everyday routines that occasionally and yet routinely stops me in my tracks and makes me think, what the heck? And not like what the heck, like, why is it so freaking hard to get a real human on the phone? What the heck, like, I go to make this awesome recipe I found online for dinner, but first I should start the laundry because that needs to get going. But I need to get that sweatshirt out of my car because that needs to go in the wash too. And I should also throw out some of this trash while I'm here. But then I find a gum wrapper in the shape of a heart that my daughter made before she left for college.

0:02:03.6 Allison: So now I have to take a picture of it and post about it because, you know, everyone needs to know how real this feeling is that my daughter is all grown up and where did the time go? And so I open Instagram and two hours later I am in my car doom scrolling and dinner is definitely not going to be that incredible recipe that I found on the same social media that I now hate. Dinner will be pizza and what the heck just happened. That is why being a massage therapist has not been easy. And while I admit that this endearing quality I have of getting caught up in the moment, some might call it getting distracted, is maybe my own issue and I need to get a grip, I also want to point out that the musculature that lives beneath our skin often suffers from this same adorable characteristic. Let me put it this way. Learning about muscles, where they are, what they do, why they become problematic, is often initially presented in black and white terms that fit neatly into categories. This is a good thing when it comes to learning something new. Understanding the basics is, you know, kind of an important foundation to being able to grasp the more complex stuff.

0:03:05.2 Allison: I mean, if you've never played the piano before, you would not want to start by sight reading a Rachmaninoff piece. But also, sometimes muscles can send us into tangents that can feel like back-pedaling. One pain or limitation can make us look at what's connected that is also at play, which can send us into the elaborate more on your health history mode, which can distract us from what the original issue was, which is okay, I'm just saying, but first let's look at or but first I want to know more about has often led our collective understanding of the human form to be way more comprehensive than we could have originally imagined. To give you a very specific soft tissue correlation, let's dive into the TFL.

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0:03:53.4 Allison: The tensor fascia lata, or the TFL as we lovingly call it. It sits at the top of the thigh, anchored into the anterior superior iliac spine, or that bone at the front of your hip that you can easily palpate and extends down to become the IT band. I say this purposefully. A muscle doesn't really become connective tissue, but it's a nice way to comprehend just how interconnected these tissues really are. The job of the TFL is a lot of things. In kinesiology terms, it plays a role in medial rotation, flexion and abduction of the thigh. But its bigger job is to tense the fascia lata, hence its name. The fascia lata is the deep fascial stocking of the thigh, or more specifically, it is the deep layer of fascia that surrounds the thigh muscles, separates internally to create the inner muscular septa that define the three muscular compartments of the thigh. And it extends from the iliac crest and the inguinal ligament to the superior aspect of the tibia.

0:04:50.9 Allison: The word lata comes from Latin roots relating to lateral or side. And if you look at the lateral aspect of the thigh, well, you find a big old tense band of fascia there. Only it's not just fascia. The TFL, as you may know, joins with the glute max to form the IT band. Let me clarify this. Muscles attach to bones via tendons, and for the most part we don't refer to the tendons of the body by their own names unless they are pretty significant, like the calcaneal tendon, also known as the Achilles tendon. This is a thick, strong tendon shared by the gastroc and the soleus of the posterior leg that anchors onto the heel.

0:05:29.2 Allison: The IT band is kind of like that. It's a thick, strong tendon shared by the TFL and the glute max that anchors into the lateral knee and the lateral superior tibia. Only the IT band is bigger, flatter, and a little more complicated. To understand the IT band, we must first understand that fascia has different properties in different areas of the body. In some regions, it's thin and gliding, and in some regions, it's thick and dense. Here in the lateral leg, as you might have guessed, this fascia is thick and dense because it needs to be. The muscles of the thigh are strong. It's kind of like this. The fascia lata surrounds the muscles of the thigh, dips deep to the bone in three particular areas, creating compartments of the thigh muscles, and then thickens at the lateral thigh. Kind of like those layers have merged here, and someone took a huge heat sealer to reinforce it. But wait, Allison, didn't you just say that the IT band is a tendon? Well, yes, as a matter of fact, I did. It is indeed also a tendon, which is not technically fascia. Fascia is always connective tissue, but connective tissue is not always fascia.

0:06:35.8 Allison: Sometimes it's a ligament, sometimes it's a bursa, and sometimes it's a tendon, and sometimes it's a combination of these. So here we have this thickened area of fascia along the lateral thigh that is also a tendon of the muscle called the tensor fascia lata, which, when that contracts, it not only creates movement in the hip, but it also acts on creating tension throughout the fascial stocking of the thigh, which then, because of its density along the lateral thigh and extension as a tendon anchoring onto the lateral knee and the lateral superior tibia can complicate how we approach things. Okay, here's the scenario. We have a client come in our office. They are complaining of lateral knee pain. They are a runner. They clearly have IT Band Syndrome. How do we know this? We know this because while the IT band is a tendon of the TFL, it is also at the same time, a tendon of the glute max, like I mentioned earlier. But the TFL and the glute max act as antagonists, meaning they do opposite actions. The TFL pulls the hip forward into flexion, and the glute max pulls the hip backward into extension.

0:07:40.9 Allison: And often when these are overexerted, they can create too much tension down their collective tendon, resulting in an irritation at the lateral knee known as IT Band Syndrome. Our response to this is to loosen both the glute max and the TFL to help ease the strain on the IT band in hopes that this will decrease inflammation. Because this is what we've been taught, and for good reason. It's an excellent approach. If every client that runs and presents with lateral knee pain had IT Band Syndrome, which they don't, or maybe they do, but this amazing work you're doing into these strong muscles is not working. Why? Because sometimes while the stress on the IT band is there, it's not the right kind of stress. So decreasing tension as a blanket approach will not always decrease pain. Let's just say that our client is running with a slightly externally rotated hip. This might indicate tight or overworked external rotators, but it also might be a sign that the TFL is weak. The TFL, on top of having to tense the fascia lata, is also, you might remember, responsible for internal rotation. If it was weak, the hip would default into external rotation.

0:08:51.4 Allison: It would follow, possibly, that increasing tension in the TFL would rotate the hip into a straighter gait pattern, and that correcting this imbalance may in fact decrease the irritation at the lateral knee. Or maybe our client has been a runner for years and is only now experiencing this crazy pain that has pulled them away from their favorite pastime. How in the heck could that have happened? They didn't change anything. They have a good supply of the best running shoes, but with a little digging, you find that they do no weight training, have never done any weight training, and their quads are weak relative to their TFL and glutes. Their abdominal muscles are underdeveloped, leaving their back muscles to maintain some semblance of stability, and their hamstrings are so tight, they might actually snap soon. Of course there are numerous other possibilities at play here, but this, this TFL, IT band, glute max, fascial tenderness inter-relational complexity dovetailed with this particular client's running history, age, weight, health history, eating, sleeping and hydration habits that have brought them here in this moment, into your office, this is why going to massage school is not that easy. For those of us who are gifted with the charming quality of curiosity, going to massage school is like making dinner.

0:10:05.1 Allison: It's just this easy thing. I'm just gonna do it. 25 years later, and I'm still wanting to know more before I can keep going. There is a saying. The more I know, the more I realize I don't know. I think it was originally an Albert Einstein quote. Of course it was. The smartest human to have ever lived admitted to realizing how much he didn't know. Which makes all of this okay. Going to massage school, learning about muscles, learning about anatomy and physiology, learning about how to communicate, learning about what pain is, it is all part of the grand experience, isn't it? This adorable little muscle, the tensor fascia lata, can send us down rabbit holes and tangents that introduce us to the intricate complexities and possibilities of the living tissues that lurk under our skin. And I am enjoying every minute of it.