The Tensor Fascia Lata and Unequal Leg Length©2004 Lawrence Gold
The Dr. Ida P. Rolf method of Structural Integration
Hanna Somatic Education®
"What You Can Do about Your Own Back Pain"
"The Psoas Muscles and Abdominal Exercises for Back Pain"
RELEVANT SOMATIC EXERCISES: Lessons 3 and 4 of The Cat Stretch Exercises with the Cat Stretch Daily Regimen
The tensor fascia lata (TFL) is a muscle continuous with the fascia lata (iliotibial band), a tendon of unusual shape -- a broad sheath that runs along the outer side of the thigh (like a cowboy's chaps) and inserts at the lateral epicondyle of the tibia (outer side of the knee).
It shares a movement with its neighboring muscle, the gluteus medius, which abducts and extends the thigh backward, has a different movement from the neighboring gluteus minimus, which flexes and internally rotates the thigh, and gets help from the gluteus maximus during the first part of the leg-back walking movement (when the thigh is externally rotated, right after foot-landing).
Despite kinesiological analysis based upon its location, the TFL, in most movement, neither abducts nor flexes the thigh at the hip, but lifts the opposite side of the pelvis by pulling down on its attachment near the AIIS (anterior inferior iliac spine) during foot-down walking or running. That is, when weight is on one leg and stabilized by the ground, the tensor fascia lata contracts, pulls down on its own side of the pelvis and lifts the opposite side, as the opposite leg swings forward.
The quadratus lumborum (QL) of the opposite side helps the lifting action of the TFL.
In effect, the TFL and QL together cause a reaching or elongating movement of the leg (which cannot lengthen, otherwise). The abdominal obliques of the QL side usually help, as well,
Knee-forward movement of the opposite leg in hip flexion occurs through the actions of the iliopsoas muscles and gluteus minimus.
This synergy is better understood not as "muscles helping each other," but as "the brain coordinating movements," since coordination is a brain function and coordinated leg action is inherent in organisms with legs. For movement education purposes, a higher level of brain-integration results from movement training that involves both legs at the same time, each leg doing its respective, opposite, contra-lateral movements of walking, than of training that addresses one leg at a time.
Problems of apparent unequal leg length often involve a habitually contracted TFL on the longer-leg side and contracted psoas and obliques on the shorter leg side. Hip joint compression due to contracted glutei may also be involved, a problem that often leads to hip joint replacement surgery. Heightened tension of the TFL places strain on the fascia lata, inducing "IT Band Syndrome," which can be relieved by freeing the person with a tight TFL from the reflexive muscular tension holding the TFL and its synergists tight, generally through sensory-motor training (a sub-speciality of somatic education).
Leg retraction (along its length - as would result from action of the same-side QL or obliques) inhibits or interferes with, or otherwise confuses the action of the same-side TFL and must be addressed for movement training to be optimally successful. That means the movements of both leg protraction (reaching) and retraction (pulling short) must be freed and improved. When working with the TFL of one side, a movement of knee toward chest of the other leg is useful.
Unequal leg length generally indicates an injury to one side of the body (not necessarily a lower extremity injury) at some time in life, where the change of leg length came not from the injury, but from the protective cringing at the site of injury, leading to retraction of the extremity. Activity in stressful athletic situations (such as downhill walking or running) may further trigger the retraction response.
With this understanding, it is evident why movement training via somatic education is a superior approach to unequal leg length than massage, stretching, orthotics, icing, or cortisone injections, and how somatic education can complement and accelerate progress in physical therapy.
Click here for more about the psoas muscles. Click to see a somatic training program applicable to unequal leg length conditions:
For a technical discussion of somatic education, the reader is referred to "Clinical Somatic Education - a New Discipline in the Field of Health Care," by Thomas Hanna, Ph.D. For other, less technical articles, click articles.
The Institute for Somatic Study and Development
Santa Fe, NM
Lawrence Gold, C.H.S.E.