Tensor Fasciae Latae (TFL) and Gluteus Minimus Static Manual Release (Soft Tissue Mobilization)

Tensor Fasciae Latae (TFL) and Gluteus Minimus Static Manual Release (Soft Tissue Mobilization)

This is Brent of the Brookbush Institute,
and in this video we’re going over static manual release of the tensor
fasciae latae and gluteus minimus. I’m assuming that if you’re watching this
video you’re watching it for educational purposes, and that you are a licensed
manual therapist or student on your way to becoming a licensed manual therapist.
Personal trainers this technique probably doesn’t fall within your scope,
although you could use the palpation portion of this video in an educational
setting to help you learn your Anatomy. I’m going to have my friend Melissa come
out, she’s going to help me demonstrate this technique. Now all of these
techniques follow a very similar protocol, over simplified that protocol
would look something like palpate and compress. We’re going to break it down a
little further than that. We want to be able to palpate and differentiate these
tissues from other muscles in the area. We do get bonus points for knowing our
trigger points, so if you know where the common trigger points in the tensor
fasciae latae are, the common trigger points in the gluteus minimus are, you
will narrow your search field a bit and you won’t have to search around quite so
much to find those local points of overactivity. We do have to keep in the
back of our head is there any tissues in this area that compression or abrasion
might insult. So are there any nerves, lymph nodes, arteries. There are some
nerves in this area but usually they’re fairly small nerves, and if you happen to
give somebody a tingling sensation or a burning sensation, it’s pretty easy to
get out of the way of those nerves by moving backward or forward. Last we have
to figure out what position can we put Melissa in that will add some tension to
this muscle. So we’ve pinned down those nodules, those trigger points, those
locally overactive muscle fibers right. We also have to make sure she’s
comfortable and possibly most importantly, that we’re comfortable that
we’re using our own body mechanics to apply pressure, so that we don’t wear
ourselves out over the course of one session or one day, one week or even one
career. We don’t want to be using so much of our hands
that we only get a couple of these techniques before we’re tired. Now let’s
start with our palpation and the anatomy involved in the tensor fasciae latae and
gluteus minimus here. The first thing you’re going to want to find is the top
of the iliac crest here right. So the top of her pelvis, because I’m going to want
to follow that to her ASIS, I’m going to go ahead and put the top of her pants
over the top of her ASIS, so I know where that’s located. I’m then going to go
ahead and find her greater trochanter. We’ve actually put a little dot here on
Melissa’s pants right, so that we can mark the greater trochanter so that you
guys can see it, if not in this view in the close-up recap. If I go from ASIS to
greater trochanter, and then back up the mid-axillary line to the to the iliac
crest here, in that triangle is my TFL, and right in the middle of that triangle
is where the TFL trigger point usually is and we have that marked off. Now the
gluteus minimus is just behind the TFL right, so the trigger point is also in
the middle of that muscle, generally speaking falls just behind the
mid-axillary line above the greater trochanter. So we’re dealing in this
little triangle right here below her pelvis and above her greater trochanter.
Now to add some tension to this muscle I’m going to kind of use a modified
Obers test right. I’m going to go ahead and bring her leg back, and if you
watched the vastus lateralis video I talked about how we should put the
vastus medialis on top of the calf, because what you don’t want to end up
with is kneecap on top of ankle because that hurts. When you start pressing, so
we’re going to take the meaty part of her of her quad here put it on the meaty
part of her lower leg, so that when I start pressing, we’re just
compressing soft tissues we don’t have any problems there. Now I’m going to
palpate across these faacicles. This is a fan-shaped muscle right, a fan-shaped
muscle whose fascicles run this way. So I’m going to palpate from anterior to
posterior to find the tightest fascicles, and then I can start. Once I find some
tight fascicles I can start moving a little bit more distal, or a little bit
more proximal to find the tightest point within those fascicles, and then of
course I’m just going to apply my pressure. I can use a thumb over thumb
technique. I can use my pisiform over thumb technique. I can use my inner
thenar groove over thumb technique here, and then you’ll notice I have the table
pretty low here with Melissa, so that I can just lean in until I get a little
increase in tissue density here. I don’t want to go further than that. I
don’t want pain. I don’t want the tissues to all of a sudden guard on me because
I’m pushing in so hard just right up until I hit some tissue resistance,
how does that feel Melissa? Yeah that’s, that’s tender. This muscle definitely
tends to get tender. A lot of people talk about IT band tightness and iliotibial
band syndrome, and runners knee, guys your IT band is connective tissue it’s not
muscular tissue. Your IT band doesn’t get tight, but your TFL will get over active
and short and pull your IT band tight. so on a lot of these individuals what
you’ll find is they have very sensitive trigger points in their TFL, and
releasing them usually does them some good. Sometimes you have to be a little
gentler, so sometimes the 30 seconds to 120 seconds static hold doesn’t work out
as well as maybe the five seconds on five seconds off, an increasing pressure
a little bit each time. Trying to desensitize that area a little
bit. Be gentle with people, you crush somebody right off the bat they might
not come back, and if they don’t come back you’re not going to have a chance
to fix their problem. Now after I get a release in the tensor fasciae latae I can
just keep moving my thumb back, keep using that same anterior to posterior
strum of her fascicles to find other tight fascicles. The gluteus minimus guys
is basically the tensor fascia latae’s nasty cousin. Both muscles do the
same joint actions, both muscles are involved in the same dysfunctions. The
only difference is the gluteus minimus, it does not have an attachment to the
iliotibial band. Once I find some tight fascicles I’m going to narrow in by
going proximal to distal, or distal to proximal to find the the tightest point
within those fascicles. And again I’m going to apply my pressure,
I could do the five-second holds on and off, increasing pressure each time if she
was really sensitive. Or I could go in so I meet tissue resistance, hold for thirty seconds to a hundred and twenty seconds. Alright guys in the next video you’ll
see or in the next section, you’re going to see us do a close up recap so you can
see exactly where I’m putting my hands. Alright guys for the close-up recap
let’s start with palpation. The top of her iliac crest is right here alright.
I’m going to put the front of her pants over the top of her ASIS, and then
we’ll kind of adjust here. Make sure our little markings there are over her
greater trochanter. So we used this little beige button to mark the greater
trochanter, ASIS, greater trochanter, up the mid-axillary line. In between this
triangle right here is her tensor fasciaE latae, that nice fan-shaped muscle. And you
can see we’ve marked off that trigger point which is basically in the middle
of that muscle. You notice just posterior to that trigger point is another trigger
point, marking this one representing the gluteus minimus which again falls behind
the tensor fasciae latae, but doesn’t have an attachment to the iliotibial
band. So as far as my palpation I’m going to use those anterior to posterior kind
of strumming, with a broad thumb here. Find the the most overactive
fascicles there, and then move. In this case since I’m starting so proximal, I’m
going to go ahead and keep moving distal until I find the tightest point, maybe
even a little nodule within those fascicles that’s where I’m going to apply
my compression. I’m going to use my dummy thumb and then either my inner thenar
groove here, or my pisiform to go ahead and apply pressure. I do find it helpful
to add a little bit of a distal to proximal angle to this to help pin down
that trigger point. I’m just going to go up to tissue resistance,
and then hold it for 30 seconds to 120 seconds. I did mention that this area
does get very tender on people. You guys have heard of iliotibial band syndrome,
runners knee, a lot of that comes from the tensor fasciae latae being overactive
in those individuals and pulling on the iliotibial band, and it’ll get it’ll just
get tender to the touch. So that five seconds on, five seconds off, five seconds
on a little harder, five seconds off to help desensitize is sometimes a better
way to start this technique. Then of course after I finished releasing this
trigger point I can just keep going with my anterior to posterior strums, and I’ll
find my next trigger point in the gluteus minimus, and again just use my
my pisiform over thumb grip here, apply pressure until I hit that first
tissue resistance, and hold for 30 to 120 seconds. So there you guys have it,
ASIS, iliac crest, greater trochanter, TFL, gluteus minimus behind it, and trigger
points right in the middle of those muscles. So there you guys go that was
static manual release of the tensor fasciae latae and gluteus minimus. As
I’ve said in all of our other manual release videos, make sure that by the
time you put your hands on somebody you are 80% sure that those are muscles that
need to be targeted with manual release techniques, and you should know that from
your movement assessments. Manual release techniques by themselves make
terrible assessments, be practising these techniques often, and if you can with
your fellow professionals. The ability to practice with somebody who also does
manual release techniques, to have these techniques done on you is learning that
you are not going to get from this video, and no matter how well I speak, or how
well we demonstrate this stuff on video, you need to have that practical
application before you try this on our patients and clients. I hope you guys
enjoyed this video. I hope you learned a lot from our video and this technique. I
look forward to hearing about your outcomes.

28 Replies to “Tensor Fasciae Latae (TFL) and Gluteus Minimus Static Manual Release (Soft Tissue Mobilization)”

  1. Thank you So much. I'm not a professional, but I just lightly rubbed (not released) those areas after finding them, and it's the first relief I have had in days. –

  2. so i understand that u would want to engage the vmo to help keep that patella in line , but what other muscles besides the glute med need strengthening?

  3. thank you so much Brent
    for such an informative video , its very very helpful,,, i am a physiotherapist .

  4. Hi I'm not a physiotherapist or anything but I have hip/back problems atm but I'm not familiar with some of these terms. What does ASIS stand for?

  5. Hi Brent, I am a Korean student studying kinesiology. This video is very very helpful and useful. I really appreciate it 🙂 Thank you so much. Today, I am going to do this release to my friends. I will let you know how they feel like! Have a great day 🙂

  6. Hi Brent! What type of work is this? What do you call what you do and what you are? I need this for my mom and I do n't k ow who to look for.

  7. Thanks but I am a teacher and public speaker. Maybe subtitles might help. And, yes you are in the public arena and therefore, if you don't like the advice, do yourself say thanks and then shut up otherwise you make yourself an ignorant person who's struggling to be the person who you want to be.

  8. This was so great! I have a client coming in that has been having tfl it band trouble and am looking forward to using some new techniques! Thank you for the information!

  9. Hoorah!!!! I’m so glad I found this video. Unfortunately I’m in the UK and so have no access to you as a therapist but I really wish I did. I’ve been having terrible pain in my knees (going up or down stairs or making sudden movements), my thighs (too painful to even put any pressure on sides) and deep pain mid thigh) and my hips and pelvis (again too painful to put any pressure on them. I’ve had an MRI last week, a nerve conduction test on lower limbs this week and been diagnosed with hyperlordosis. My glute med, min and tfl are so chronically tight as are my erector spinea and to some extent my illipsoas but my glute max and my abs are pathetically weak along with my quads. The knee pain is at the quad/patella insertion point. When I’m just walking normally the tightness in my glute med and tfl are awful. I’ve had acupuncture and physio non of which are working hence MRI and nerve conduction. I’m also diabetic (Type 1 44 years).

    I’m stretching and using massage balls but it’s way painful lol. I’m on a mission to lose weight to lessen pressure on everything.

    This video has explained so much of what I’m experiencing better than anyone I’ve dealt with so far!!! Thank you 🙏🏼. Any further advice would be so much appreciated. 😃

    I should add, if sitting or even if I try and do lying on the floor and attempt the figure 4 stretch, my legs will not relax out, they barely even open and I have to use a strap to even get my ankle onto the opposing knee. Left far worse. Extremely painful.

  10. Hi Brent, I kindly ask you a favour: When I squat (flex my hip), than I extend to stand up, why I have pain in my TFL after I stand up?
    I’ve tried to modify my squat in different ways but still have that pain… Also at night time when I lay down I feel my entire skin area of external quad and TFL burning.
    I would really appreciate your advise! Thanks!

  11. Hi Brent, currently a 3rd year medical student, (so not a PT student, but partner is working on getting in) and he found the cause of a lot of my low back and knee pain was actually my TFL and IT band. I’m EXTREMELY tender when he helps to static stretch like what you’re doing in this video(to where he can only put about 20% pressure down on my hip before my knee feels like it’s going to break off) . However I’ve found that If I lay on my back with my knees bent and relaxed and push into the more lateral part of my leg right under where the inguinal ligament would run that it illicits the same type of pain that radiates down my IT band. Was wondering if that’s just another access point to the TFL trigger point, or if I’m hitting a different muscle that is contributing to my pain as well?

    Also this video was super helpful and informative. Definitely subscribing to your channel!

  12. Brett, could you possibly do a short video focusing on hand/thumb mechanics for trigger release? I'd like to protect my joints better while working.

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