In regards to stretching the ITB and TFL, can you suggest any stretches you have found particularly beneficial? It seems difficult to effectively stretch clients in these areas.
These are difficult areas to "stretch," as you've noted. The TFL is quite often an "over facilitated" muscle due to our society's lack of movement and sedentary lifestyle. A tight TFL and ITB often go hand in hand. This may be due again to a lack of activity (too much sitting/hip flexion!) as well as a poor choice of exercises and insufficient time spent on "warm up" and "cool down" stretching.
The process may go as follows:
- The hip flexors shorten/tighten (specifically the Psoas) due to lack of movement, too much sitting, poor exercise choices (such as chronic crunching, leg raises, biking, etc.), combined with a lack of stretching and/or poor stretching techniques.
- Due to the phenomenan of RECIPROCAL INHIBITION, the glutes become abnormally lengthened and become incapable of effectively producing hip extension, but perhaps more importantly, incapable of DECELERATING hip flexion, adduction and internal rotation during gait.
- The TFL and the glute max share a resultant of force on the ITB. When the glute max becomes long and weak due to the conditions mentioned above, the TFL becomes the dominant force in the resultant. Hence, a tight over-active TFL.
- The ITB then becomes tight and restricted as well due to its direct connection to the TFL.
Why is this important? To see this problem resolved, you must address the muscles that have "lengthened" with some sort of strengthening exercises AS WELL AS stretching the muscles you've mentioned that have "shortened" to achieve balance.
Self Myofascial Release
SMFR of the ITB and/or the TFL can be very helpful. When performing SMFR, take a "search and destroy" mentality. This means, search for any and all tender points. When found, stop rolling until the pain is 70 percent gone (relatively speaking).
- TFL: Just inferior and lateral to the ASIS
- ITB: Laterally down the length of the upper leg.
*Note: The ITB is made of tough connective tissue, which means it will NOT respond to stretching like a muscle will. Too increase its flexibility, one must perform the above exercise with as much duration and frequency as can be tolerated.
Stretching the TFL can be accomplished by performing the opposite of the muscle's function. Have the client stand in a staggered stance. Next have her/him slightly ADDUCT, EXTERNALLY ROTATE the back leg and perform a POSTERIOR PELVIC TUCK. Hold for 20 to 30 seconds and repeat three times.
If this doesn't do the trick. Have your client lay on a stretching table such as in the Thomas position to perform a basic hip flexor stretch. Perform a CONTRACT/RELAX stretching technique by pushing down and in or extension and adduction.
- Basic guidelines for contract relax stretching are:
- 25 percent contraction
- seven to 10 second hold
- Go to "new" ROM
- Hold for 20 seconds
Exercises that may be performed in conjunction with the above are:
- Lateral tubing shuffle
- Floor bridging
- Walking lunge and twist
These exercises can be found by doing a search in the PTN Exercise Library. If none of the above work for your client, you may want to refer her/him out to a massage therapist.