Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Tensor Fasciae Latae and Gluteus Maximus Muscles: Do They Contribute to Hip Abduction?

Hip abductors are essential for hip function. To understand abduction weakness, it is important to know which muscles contribute to abduction force. Our aim was to investigate the effects of an experimentally induced weakness of the different muscles (tensor fasciae latae [TFL], gluteus medius and minimus (Gmed/min), gluteus maximus [Gmax]) on the abduction force. Ten participants received sequential nerve blocks of the TFL, the Gmed/min, and the Gmax. Subsequently, abduction force was measured in the lateral decubitus position in three sagittal positions of the hip (30° flexion, neutral, 30° extension). In 30° flexion, the average abduction force was 220 N without block, 187 N with block of the TFL, 83 N with block of the Gmed/min, and 97 N with block of the Gmax, respectively. In neutral position, average abduction force was 213 N without block, 200 N with block of the TFL, 82 N with block of the Gmed/min, and 115 N with block of the Gmax, respectively. In 30° extension, average abduction force was 116 N without block, 146 N with block of TFL, 61 N with block of the Gmed/min, and 94 N with block of the Gmax, respectively. An induced weakness of the TFL reduces abduction force only in 30° of hip flexion by 15%. It is not highly relevant as an abductor. An induced weakness of the Gmax reduces abduction force in flexion by 43%-56%, depending on the position. It is, therefore, highly relevant as an abductor of the hip.

The Relationship Between Tensor Fascia Latae and Gluteus Maximus Has the Potential to Indicate Early Intra-articular and Degenerative Pathologies of the Femoral-Acetabular Joint: A Narrative Review

Intra-articular and degenerative hip pathologies have become common place with the number of total hip replacements rising year on year in the United Kingdom (UK). Pathology is identified by clinicians using special tests which are researched maneuvers used by clinicians to rule in or rule out specific musculoskeletal pathologies. Special tests used for hip pathology usually have high specificity to exclude degenerative and intraarticular pathology but vary in sensitivity. These special tests are usually only conducted when a person is symptomatic and typically require radiological confirmation to diagnose. The aim of this review was to appraise research to determine whether functional changes in the TFL and UGM muscle complex could indicate degenerative and/or intra articular pathology, with a specific focus on the utility of the ratio in strength of TFL and UGM to assist clinical diagnosis. The hypothesis was that the ratio of the strength of Tensor Fascia Latae (TFL) and the upper fibres of Gluteus Maximus (UGM) could suggest early intra-articular hip pathology, and that changes to this ratio could indicate deterioration of the hip joint before symptoms present/progress.

Level of Evidence

5.

Is chronic ankle instability associated with contractile thickness of gluteus medius and gluteus maximus during functional movement and exercise? A systematic review and meta-analysis

INTRODUCTION

The gluteus medius (GMED) and gluteus maximus (GMAX) play a crucial role in postural control, and postural control is impaired in individuals with chronic ankle instability (CAI). However, the association between CAI and the recruitment of these muscles remains unclear. The purpose of this study was to explore the contractile thickness of GMED and GMAX during functional movements in individuals with CAI compared to healthy controls.

EVIDENCE ACQUISITION

A systematic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro). Included studies involved the contractile thickness of GMED and/or GMAX comparing CAI with non-CAI. The extracted data were subjected to meta-analysis for observing the differences between the two. The correlation and difference in contraction between GMED and GMAX were analyzed using the Pearson Correlation Coefficient (PCC) and t-test, respectively.

EVIDENCE SYNTHESIS

Six studies with 176 participants were found. Contractile thickness measured by ultrasound showed GMED thickness change to be lower in CAI than in controls during functional movements and exercise (WMD: -0.08; 95% CI: -0.11, -0.04; P<0.00001). There was no significant difference between the two groups with respect to contraction of GMAX (WMD: 0.02; 95% CI: -0.01, 0.05; P=0.25). The PCC and P value (t-test) between the ratio of contractile thickness of GMED and GMAX in CAI were 0.397 and 0.029 respectively, indicating activity differences.

CONCLUSIONS

CAI may be associated with weaker GMED recruitment during functional movements and exercise, but the activation of GMAX in CAI may be unaffected.

Gluteus Medius for Individuals with Chronic Ankle Instability: Assessing Muscle Activity

Emerging evidence has suggested that gluteus medius (GM) muscle activity may be critical for functional performance in individuals with chronic ankle instability (CAI). This study aimed to systematically review the literature to determine whether there are differences in GM muscle activity between individuals with and without CAI. A comprehensive search in PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro databases was undertaken from the year of inception to 10 June 2024. Studies that investigated GM muscle activity during physical activities in healthy controls or copers and individuals with CAI were included. The quality assessment was conducted using the Newcastle-Ottawa Quality scale (NOS). After review, forty studies (1840 participants) were included; NOS scoring for the included studies ranged from 5/9 to 9/9 stars. GM activity was reported for seven activities: walking (14 studies), stance-transition (four studies), jump-landing (13 studies), perturbation (six studies), balance (four studies), cutting (three studies), and other functional exercises (seven studies). The outcome measures selected to examine each task varied across studies, and electromyography (EMG) results were inconsistent. Overall, although the quality of the available studies was generally high, there were substantial methodological differences, and the activity of GM muscles in CAI participants compared to controls was equivocal. A consensus on standardization of GM muscle activity assessment reporting should be established to guide future studies.

The effects of alteration in muscle activation on the iliotibial band during an exhaustive run

PURPOSE

Long exhausted running causes pain at the lateral femoral epicondyle for some runners. The pain has been revealed to be related to the behavior of the iliotibial band (ITB) during running. The purpose of this study is to examine the effects of in-series musculature on the behavior of the ITB in healthy participants during an exhaustive run.

METHODS

Twenty-five healthy participants (15 males, 10 females) were recruited in the current study. All participants performed a 30-minute exhaustive run at a self-selected speed with laboratory-provided footwear. Muscle activities of ITB-related muscles including tensor fascia latae (TFL), gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF), and vastus lateralis (VL) were recorded using surface electromyography (EMG).

RESULTS

Maximum amplitudes at the initial stage (the first minute), the mid stage (the 15-minute), and the end stage (the 30-minute) were compared during the exhaustive running. Significant decreases (p < 0.05) were observed in the maximum amplitudes of the TFL, Gmax, Gmed, and BF at the mid (decreased by ~ 15%) and end (decreased by ~ 30%) stages compared to the initial stage. The onset and the offset remained unaltered during the running (p ≥ 0.05).

CONCLUSION

The behavior of the healthy ITB might be altered due to the activities of the in-series musculature. Excessive compression forces might be applied to the lateral femoral epicondyle from the ITB to provide stability for the knee joint during an exhaustive run. The findings could provide a basic understanding of the behavior of healthy ITB.

Are proximal and distal neuromuscular parameters able to predict hip and knee frontal plane kinematics during single-leg landing?

OBJECTIVE

To determine if proximal and distal neuromuscular parameters (EMG amplitude and median frequency - MDF) can predict frontal plane kinematics during single-leg landing.

STUDY DESIGN

Cross sectional study.

SETTING

Laboratory.

PARTICIPANTS

Fifteen participants (7 female) performed six single-leg landings with measures of frontal plane kinematics and EMG obtained 230 ms after first foot contact, totalizing 90 landings.

MAIN OUTCOME MEASURES

(i) 2D hip adduction [hip ADD] and knee frontal plane projection angle [knee FPPA]; (ii) EMG amplitude and MDF of gluteus medius [GMed], tensor fascia latae [TFL], peroneus longus [PL] and tibialis anterior [TA].

RESULTS

We observed that MDF of TA was a significant predictor of hip ADD (p = 0.037; β = -0.049 Hz; R²c = 0.30). Also, MDF of PL was significant predictor of knee FPPA (p = 0.043; β = 0.042 Hz; R²c = 0.37). Hip muscles and EMG amplitude parameters were not considered predictors of frontal plane kinematics.

CONCLUSION

The firing frequency of ankle muscles predicted the variance of hip and knee frontal plane kinematics during single-leg landing.

Tensor fascia latae and gluteal muscles myoelectric responses to increasing levels of hip medial rotation torque

Medial hip rotation is typically attributed to the tensor fascia latae (TFL) and lateral rotation, to the gluteus maximus. However, experimental studies in cadavers suggest that the TFL lacks a moment arm for medial rotation and that the gluteus maximus may act as hip medial rotator depending on the hip flexion angle. In order to address this contradictory thinking, we measured the myoelectric activity of TFL, gluteus medius and gluteus maximus (superior portion, GMaxS, and inferior portion, GMaxI) for increasing levels of medial rotation torque applied to the hip. To keep frontal and sagittal plane hip joint net torques constant during the experiments, the medial hip rotation torque was changed by displacing standard weights along an aluminum bar device, thereby producing pure medial hip rotation torques. The effect of increasing medial hip rotation torque was investigated for a fully extended hip (0°), and at 45° and 90° of flexion. We found an increase in the myoelectric activity of the TFL (∼90%↑, p = 0.002) at 90° of flexion and of the GMaxS (∼7%↑, p = 0.048) at the extended position with an increase in medial hip torque application (from 0 to 7.4 N.m.). For the GMed (regardless of hip position) and for the 45° position (regardless of muscle), no systematic changes across torque conditions were observed. In contrast to the common clinical assumption and current practice thinking, our results indicate that an increase in TFL activity is required to control for an increase in external torque towards hip medial rotation.

The immediate effects of Kinesio Taping on running biomechanics, muscle activity, and perceived changes in comfort, stability and running performance in healthy runners, and the implications to the management of Iliotibial band syndrome

BACKGROUND

Kinesio Taping is frequently used in the management of lower limb injuries, and has been shown to improve pain, function, and running performance. However, little is known about the effects of Kinesio Taping on running biomechanics, muscle activity, and perceived benefits.

RESEARCH QUESTION

This study aimed to explore the immediate effects of Kinesio Taping on lower limb kinematics, joint moments, and muscle activity, as well as perceived comfort, knee joint stability, and running performance in healthy runners.

METHODS

Twenty healthy participants ran at a self-selected pace along a 20-metre runway under three conditions; no tape (NT), Kinesio Tape with tension (KTT), and Kinesio tape without tension (KTNT). Comparisons of peak hip, knee angles and moments, and EMG were analysed during the stance phase of running.

RESULTS

KTT exhibited significant increases in peak hip flexion, peak hip abduction and hip external rotation compared to NT. Moreover, the KTT condition showed a trend towards a decrease in peak hip internal rotation and adduction angle compared to the NT condition. EMG results showed that Tensor Fascia Latae activity decreased with KTT compared with NT, and Gluteus Maximus activity reduced with KTNT when compared with NT. Ten of the 20 participants indicated important improvements in the comfort score, six participants in the knee stability score, and seven participants in the running performance score when using KTT.

SIGNIFICANCE

These results suggest that changes in running biomechanics previously associated with ITBS can be improved with the application of kinesio tape, with the greatest effect seen with the application of kinesio tape with tension. Perceived improvements were seen in comfort, stability and running performance, however these benefits were only seen in half the participants. Further work is required to explore the biomechanical effects and perceived benefits in different patient groups.

Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?

OBJECTIVE

Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB.

METHODS

The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived.

RESULTS

According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention.

CONCLUSIONS

High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.

Association of tensor fascia lata hypertrophy and fatty infiltration in the presence of abductor tendon tears: a radiographic study

Hip abductor tendon tears of the gluteus medius and minimus are becoming a well-recognized source of pain and dysfunction, primarily in middle-age females. Like the rotator cuff, fatty infiltration (FI) can occur after tearing of these tendons. While the association of TFL hypertrophy after abductor tendon tears has been established, its association with FI has not been well studied. Our hypothesis is that hypertrophy of the TFL will be associated with FI of the abductors. All patients &gt;18 years old undergoing primary surgical repair for a confirmed tears on MRI, without a history of prior hip surgery or osteoarthritis, were included. The following measurements were obtained from MRI: TFL cross-sectional area, TFL:sartorius volume ratio, and modified Goutallier grade of gluteus medius and minimus. Seventy patients met inclusion criteria and were divided in two groups, those with (n = 28) and those without FI (n = 42) of the abductors. The FI group was on average older (65 versus 58 years, P &lt; 0.00016). TFL hypertrophy and TFL:sartorius volume ratio were significantly associated with FI (P= 0.00069). Following abductor tendon tear and subsequent FI, there exists significant TFL hypertrophy in patients without a prior history of hip surgery in our patient cohort.