Hip pain is common in active runners. Pain on the outside of the hip is usually blamed on trochanteric bursitis or gluteus medius tendinopathy — but a tensor fasciae latae (TFL) injury is also reasonably common, and easily missed. This condition is called TFL pain, or proximal ITB syndrome. So what is tensor fasciae latae pain, and how do we treat it?
TFL pain is the hip end of the iliotibial band story. At the knee end, the same band causes IT band syndrome.
TFL anatomy
The TFL muscle starts at the front of the pelvis, at the iliac crest. It covers the outer aspect of the hip joint and forms the superior aspect of the iliotibial band. Excessive running overloads the TFL, causing swelling at its attachment to the bone — an enthesopathy. Weakness in other pelvic muscles, such as the glutes or hip flexors, is thought to increase TFL loading, worsening the problem.
Symptoms and diagnosis of tensor fasciae latae pain
People usually report pain on the outside of the hip, but TFL pain sits slightly higher than the more common trochanteric bursitis. The pain comes on with running and can last a few days before settling. Most people feel it close to the iliac crest, with some spread to the outer hip.
On examination, there’s usually pinpoint tenderness at the iliac crest, and the pain is sometimes reproduced with resisted hip abduction. It’s essential to rule out other causes of outer hip pain, including greater trochanteric pain syndrome, hip arthritis, a hip stress fracture, and nerve damage.
Imaging helps confirm the diagnosis. Ultrasound shows localised thickening and swelling where the TFL attaches to the bone, and MRI shows the changes as well, though it can miss the thickening if the right slices aren’t obtained. The attachment is considered thickened if it’s greater than 4 mm.
How do we treat tensor fasciae latae pain?
Treatment mirrors the general approach to tendinopathy.
First, reduce or avoid the activities that aggravate the hip — usually hiking and running — and cross-train with cycling and swimming to keep fit. As the pain improves, a progressive running programme keeps symptoms low on the way back.
TFL exercises
Because TFL enthesopathy is often associated with weakness in the pelvic muscles, work with a physiotherapist to strengthen any weak areas. Useful exercises include hamstring bridges, banded crab walks, and step-ups, generally done every 2–3 days.
Other treatments for tensor fasciae latae pain
When TFL pain persists despite activity modification and exercise, we add treatments that help — but don’t harm — the tendon. We try non-invasive options first, since the risks are lower.
GTN patches
GTN patches deliver nitric oxide, which is important in tendon healing, through the skin over the swollen tendon. Recent evidence suggests they improve tendinopathy pain. We generally use them for 2–3 months.
Shockwave therapy
TFL pain responds to shockwave therapy more than many other tendons. We suggest about five sessions, one a week over five weeks, alongside exercise.
Injections for tensor fasciae latae pain
Injection therapy is more invasive and less predictable, so we reserve it for TFL pain that has failed other treatments. Our first-line injection is low-dose cortisone, placed just above and below the thickening under ultrasound, which makes it more effective with fewer side effects (such as skin atrophy and depigmentation). Other options include needle tenotomy or PRP, though there’s no clear evidence that they work for TFL pain. Avoid NSAIDs for at least two weeks after needle tenotomy or PRP, and wait at least a month after a cortisone injection before having either.
Botox for a tight TFL
Where the TFL is very tight and contributing to IT band syndrome at the knee, relaxing the muscle with a Botox injection can help. That’s covered in full on our Botox for knee pain page.
Frequently asked questions about tensor fasciae latae pain
What does tensor fasciae latae pain feel like?
Pain on the outside of the hip, close to the iliac crest and slightly higher than typical trochanteric pain, brought on by running and easing with rest. It’s often pinpoint-tender at the bony attachment.
How is TFL pain different from trochanteric bursitis?
Both cause outer hip pain, but TFL pain sits higher, near the iliac crest, while trochanteric pain is lower, over the bony point of the hip. The two are easily confused — which is why TFL pain is often missed — so an accurate examination, sometimes with ultrasound, matters.
Is TFL pain the same as IT band syndrome?
They’re two ends of the same structure. TFL pain is at the hip (proximal ITB syndrome); IT band syndrome is the friction problem at the outside of the knee. A tight TFL can contribute to both.
How long does tensor fasciae latae pain take to settle?
Like most tendon problems, it can be slow, often weeks to a few months, with a consistent strengthening programme. Reducing the aggravating load early and addressing pelvic weakness speeds recovery.
Can I keep running with TFL pain?
Often, with modification — reducing volume and hills while you build pelvic strength. If the pain escalates, scale back and get it assessed. Cross-training (swimming, cycling) keeps you fit in the meantime.
Final word from Sport Doctor London about tfl tear
Tensor fasciae latae pain is a common cause of pain on the outer aspect of the hip and is often misdiagnosed as greater trochanteric pain syndrome. An accurate diagnosis allows early, effective treatment and a faster return to running and sport.
To book a one-stop hip assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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