ITB Pain? Your Hip Flexor Could Be The Cause

When this small muscle of the hip is tight or overworked it can lead to hip, back, and IT band pain. Here’s how to avoid it.


The tensor fasciae latae — or TFL for short — is a small muscle on the outside of your hip, spanning an average of 15 cm in length. But when this area is tight, painful, or otherwise overworked, you can experience some pretty big problems in your lower half, including reduced power and efficiency while running, along with hip pain, low back pain and IT band syndrome.

Unfortunately, it’s really common for runners to experience TFL pain or tightness, Lisa Mitro, run coach and certified running gait analyst, tells Runner’s World.

The upside: There are simple things you can do at home to both prevent and treat an achy or tender-feeling TFL. Read on for all you need to know.

All About the TFL
The TFL is a muscle that starts at the top of the pelvis and inserts into the iliotibial band (a.k.a. the IT band, a long fibrous structure that runs along the side of your thigh and attaches below the outer portion of your knee), Dr Karen M. Sutton, sports medicine surgeon at Hospital for Special Surgery, tells Runner’s World.

Many people know of the TFL as a hip flexor muscle, but it also assists the glutes (especially the glute medius, your smaller side butt muscle) with hip abduction and internal rotation, Mitro says. Basically, in addition to bringing your thigh closer to your chest, it helps move your leg out to the side away from your body. The TFL also helps stabilise the hip and knee joints together by putting tension on the IT band, Sutton says. This is how it provides stabilisation for both joints at once.

In daily life, the TFL is involved in a ton of functional movements, like walking, climbing stairs, squatting, stepping out of bed, and getting out of a car, Mitro says. It also plays several roles when you run, helping to swing your leg forward as you stride and stabilising your pelvis as you land on one leg.

Fun fact: Humans are the only mammals who have a TFL and the muscle helps us walk, stand, and run using just two legs, Sutton says.

Find your TFL by placing your fingers on your pelvic bone in the front, then lowering them down about 2.5 cm and then out to the side about 2.5cm.

Common Causes of TFL Pain in Runners
There are a few reasons runners may have a tight, tender, or otherwise painful TFL. A big one: Weak glutes. When your butt muscles aren’t strong enough to do their job, the TFL can take on some of that work, Mitro explains. This places extra stress on the TFL, which can leave it feeling irritated. (An overactive TFL caused by underactive glutes can also result in lower back pain, Mitro adds, because the lumbar spine stabilisers can dominate with the hip flexors when the glutes are weak.)

Another cause of TFL pain is quickly ramping up your mileage. A sudden jump in training can overwork and ultimately tighten up this muscle, Sutton explains. This, in turn, can tug on the IT band and lead to an external snapping hip (basically, a palpable snapping or rubber band sensation on the outer part of your hip, caused by the IT band rubbing the top of the thigh bone), or IT band syndrome (a mild or severe pain on the outside of the knee that’s typically worse when running downhill).

Why You Need to Address an Irritated TFL
Treating an angry TFL won’t just reduce feelings of pain and tightness — it can also boost the power and efficiency of your running stride.

Here’s how: When you run, you ideally want to get your hip into about 15 degrees of extension (on the leg swing behind you) so that you can properly activate your glutes as you push off the ground, Mitro explains. But if your hip flexors, including your TFL, are tight, then your hip may not be able to achieve that much hip extension. As a result, your “glute is not going to contract like it should,” Mitro says, which ultimately makes your stride less powerful. “It turns into more of just mostly the hip flexors pulling the leg forward,” Mitro adds.

On the flip side, if you treat an irritated TFL and level up your glute strength, you can improve your ability to run with proper hip extension and ultimately get the most bang-for-your-buck with every stride.

How to Prevent TFL Pain
Because TFL pain and tightness is commonly caused by weak glutes, regularly strengthening your butt muscles can help reduce the chances of TFL issues. Mitro’s number-one suggestion is to incorporate running-specific exercises and movement patterns into your strength-training routine that specifically load the glutes, like deadlifts.

She also recommends doing single-leg exercises to boost your stability, as this can improve the TFL’s ability to properly stabilise your pelvis and perform hip abduction and internal rotation without getting overworked. You can do this by progressing deadlifts into single-leg deadlifts, and honing your squatting abilities with single-sided variations like skater squats, single-leg squats, and pistol squats.

Do these exercises once a week in tandem with your regular lifting routine, Mitro advises. Start with three sets of 10 to 12 reps of each. As you improve your strength, add heavier weights and decrease to three sets of eight reps per exercise.

1. Deadlift

  1. Stand with feet hip-width apart, microbend in knees, shoulders back and down. Hold a dumbbell in each hand.
  2. Slowly send hips back, hinging from the hips while keeping back flat, abs tight, and chest lifted. Engage hamstrings and glutes to resist the downward pull of gravity as the weight lowers toward the floor. Lower as far as you can until you feel a pull along the backs of legs.
  3. Drive through feet to stand back up, extending hips.
  4. Repeat for reps.

2. Single-Leg Deadlift

  1. Stand tall with both feet on the ground, arms at sides. Hold dumbbell in left hand.
  2. Shift weight to right leg, hinge forward from the hips, allow right knee to bend slightly, and lower torso to the floor, as left leg lifts behind you. Hinge forward as far as comfortably possible while maintaining a straight back, core engaged and shoulders down and back. Keep both hips square to floor.
  3. Drive through right foot to stand back up, extending hips.
  4. Repeat for reps.
  5. Then switch sides.

3. Single-Leg Squat

  1. Standing in front of a chair, facing away from it, lift left leg out in front of you.
  2. With chest lifted and shoulders back and down, extend both arms straight out.
  3. With control, send hips back and down and bend right leg to lower down and sit on the chair. Keep left foot lifted and upper body tall.
  4. Press through right foot to stand back up.
  5. Repeat for reps.
  6. Then switch sides.

Make sure you build in enough time to any training programme so you can gradually increase your running volume without sudden spikes in mileage, which can do a number on your TFL (not to mention other muscles and joints).

Sutton recommends programmes that have two to three ramp-up weeks followed by a recovery week. When planning your training, take into your account “your ability to recover relative to your sleep habits, your previous training history, your family responsibilities, your workload in your professional life and your overall stress levels,” Sutton says. “These all contribute to how quickly you can ramp up your mileage and how susceptible you are to injury.”

How to Treat TFL Pain
The first step in treating an irritated TFL is to determine what course of action might be most helpful: stretches, strength work or a combo of the two. If the muscle is feeling tight, “that doesn’t necessarily mean that you need to stretch it,” Mitro explains. It could mean that it’s weak — and thus would benefit from strength exercises — but it also could mean that it’s compensating for other weak muscles in the area, in which case you’d want to strengthen those players while loosening up the TFL.

One easy way to pinpoint the best solution for you is to test your TFL strength. You can do this with the standing hip flexion exercise: Place a mini band around your thighs, raise one leg up to hip height, then lower it back down to complete one rep. Do 10 reps, then switch sides and repeat. Perform two total sets.

Take stock of your strength side to side. If the side you’ve been experiencing TFL “tightness” feels weaker than the other side, then you’d likely benefit from strengthening that muscle. But if your strength abilities feel similar side to side — and especially if your TFL feels both tight and painful — that’s a sign you probably need to strengthen surrounding areas and also work on releasing the TFL.

Once you’ve determined which camp you fall into, pick the appropriate next step:

If you need to strengthen a weak TFL…
Do the single-leg stability exercises mentioned above: Progress deadlifts into single-leg deadlifts, and try unilateral squat variations like skater squats and single-leg squats.

If you need to loosen a tight TFL and strengthen surrounding muscles…

Step 1:
Do myofascial release. Lie face down and place a hard massage ball (or hockey ball) at the front of hip on the side that feels tight. Bend knee and move foot in and out to the side until you find the place that feels most tender. Hold for 2 to 3 minutes. Do this every day until your TFL pain is reduced.

Step 2:
Strengthen your glutes with moves like squats, glute bridges (eventually progress to single-leg glute bridges), and deadlifts (eventually progress to single-leg deadlifts; see above for step-by-step directions), Mitro says. Perform these moves three to four times a week, aiming for two sets of 10 reps each per session. If it’s on the day that you’re running, do them before lacing up. Start with just your body weight and as you increase your strength, add weights.


  1. Stand with feet shoulder-width distance apart, toes slightly turned out, shoulders back and down, and chest open and tall. Make sure to keep heels down and planted throughout the entire move.
  2. Send hips back down and back as if you’re sitting back into a chair. Bend knees to lower down as far as possible with chest lifted in a controlled movement. Aim to get thighs parallel to the floor.
  3. Drive through feet to stand back up.

Glute Bridge

  1. Lie face up, knees bent, and feet planted on the floor.
  2. Drive through heels, contracting the glutes to lift hips up toward the ceiling. Body should form a straight line from shoulders to knees.
  3. Lower hips back down slowly.
  4. Repeat for reps.

Single-Leg Glute Bridge

  1. Lie face up, knees bent, feet planted, arms down by sides on the floor.
  2. Lift right leg up toward the ceiling but keep both knees aligned.
  3. Engage glutes as you lift hips up, driving through left heel.
  4. Lower back to the floor
  5. Repeat for reps.
  6. Then switch sides.

Step 3:
Incorporate hip mobility to improve your hip extension and external rotation. Do pigeon pose for one minute each side and then do 10 hip CARs each side. Perform these moves every day until your TFL pain is reduced.

Pigeon Pose

Thomas Hengge
  1. Bend left leg and drop knee to left. Extend right leg behind you.
  2. Press right hip towards the mat.
  3. Inhale, then exhale as you walk palms as far forward as is comfortable.
  4. Hold.
  5. Release and repeat on right leg.


Yusuf Jeffers
  1. Start on all fours, knees under hips, shoulders over wrists. Keep belly button drawn in toward spine, back flat, core engaged. This is your starting position.
  2. Lift left leg out to the left side, keeping knee bent 90 degrees and stopping at hip height.
  3. Then, lift left leg back and up like you’re doing a donkey kick.
  4. Circle left hip inward to come back to starting position.
  5. Then reverse this motion, hitting the donkey kick first, then lifting knee out to the side, and returning to starting position.
  6. This is one rep. Do 10 reps.
  7. Then switch sides.

Step 4:
If a tight-feeling TFL is causing you mild pain, try dialling back your training to focus on a run/walk approach (versus just straight running), Sutton says. Also, consider heating tender areas before your run and icing them afterwards, she says.

When to See a Professional About TFL Pain
Sometimes, TFL pain warrants a little more attention than you can give it with at-home exercises and stretches. If you’ve tried some of the above moves for a week or two and your symptoms don’t seem to be getting better, consider seeing a physiotherapist, Mitro says. And if the pain gets worse? Definitely see a professional earlier, she adds.

You should also check in with a medical pro if you’ve tried regular stretches and mobility exercises, scaled back your training to a run/walk approach, and are needing regular over-the-counter pain medications to manage your discomfort, Sutton says.

Keep in mind other things can cause pain in the TFL area, like stress fractures, greater trochanteric bursitis (inflammation of a fluid-filled sac near your hip joint), osteoarthritis of the hip, and a labral tear of the hip, Sutton says, which is why it’s important to get things checked out if they don’t improve with at-home TLC.

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