Friday, July 30, 2010

Is your TFL & ITB giving you knee pain?

Something I have come to see more often with athletes who have very poor control of their femur (a valgus collaspe as we all know), is that their TFL and ITB are extremely hypertonic. I begin to think of synergistic dominance. Thank you Shirley Sahrmann, and Leon Chaitow.

In the good old days we would have strengthen the VMO. I know that Charles Poliquin is still a big proponent of strengthen the VMO when he sees a valgus collaspe. To me I can see no sense to this line of thought. How could a muscle that attaches on the femur control the femur?

Then we came to realize that it was the proximal muscles of the hip that actually control this knee valgus. Particularly glute medius. So then glute medius became the bussword in our field. The only thing we now didnt realize was what was the optimal way to train glute medius for its main function (hip stability). In your anatomy textbooks, it will tell you that the glute medius abducts the hip. So with this in mind we thought this is how we needed to train it to get it stronger.

Thank God for Gray Cook. Gray told us that the body has a system of stabilizers and primer movers. In Janda's work and in Chaitows writtings they would call the stabilizers postural muscles and the prime movers phasic muscles. Different terms same thought process.

Gray went on to tell us that when a stabilizer is not firing right (not when it is not strong) that a prime mover will take up the slack and try to do two jobs at once. So now you have a prime mover that thinks it is also a stabilizer. This can lead to a montrol control issue that shows up as a lack of flexibility. This has also be termed stiffness by some.

So how does this all link back to the TFL & ITB giving you knee pain? Again in the good old days we would have told this person with a hypertonic of stiff TFL to try and stretch it. In essence we were banging our heads against the wall. If we just restore the reflexive ability of the glute medius to stabilize the glute medius, the stiffness in the TFL would magically start to decease.

How can we train the glute medius to do its proper (functional if you like) role. For everyone who knows Grays stuff you know the answer. Reactive Neuromuscular Technique (RNT). For those of you who do not know what RNT is, dont worry. I will put a video up next week of a few RNT techniques that I use.

Until then,

Stay Strong,


PS. Another thing to look for with valgus collaspe is excessive foot pronation. Look at the peroneus muscle group for trigger points. Just something else to consider.


  1. In my personal opinion I believe the hip external rotators are more important than the posterior fibers of the gluteus medius in creating hip external rotation. Yes, I understand that there is an imbalance in ABduction with the TFL and Gmed, however I think the Gmed (posterior) is more of a 'follower' of what the deep 6 rotators do. As I'm sure you are aware of this can set off dysfunctions in the kinetic chain all the way down to the metatarsophalangeal joints. What a complex structure we have.


    About a quarter of the way down the webpage there is a good short 3 second clip of external rotation of the hip :)