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Proximal attachment. The superior anterior iliac spine and adjacent portion of the iliac crest.
Distal attachment. The iliotibial tract of the fascia lata attaches to the lateral condyle of the tibia.
Function. Strains the iliotibial tract, helping to strengthen the knee joint in an extended position; helps flexion, abduction and internal rotation of the hip; Helps the gluteus medius and minimus muscles stabilize the pelvis when walking.
Palpation. To localize the tensor fascia lata, the following structures must be identified:
. The superior anterior iliac spine is a bony protrusion located below the iliac crest and serves as the attachment site for the inguinal ligament. Easily palpated.
The greater trochanter of the femur is a bony protrusion on the lateral surface of the thigh, located approximately a hand's length below the iliac crest; lies on the same horizontal line with the pubic ridge.
The iliotibial tract of the fascia lata is a long fascial plate lying on the outer surface of the thigh. Is the thickened part of the fascia surrounding the thigh; the distal part is attached to the lateral condyle of the tibia. The condyle insertion is palpated anterior to the biceps femoris tendon insertion. The iliotibial tract is palpated in a sitting position with the knee bent and the heel raised off the floor.
To identify the tensor fascia lata muscle, have the patient lie on their back and rotate the thigh inward against gentle resistance—the tensor fascia lata muscle will be easily palpated in this position. Using flat digital palpation, trace the course of the fibers from the superior anterior iliac spine to the connection with the iliotibial tract of the fascia lata on the lateral surface of the thigh. The tensor fascia lata muscle lies anterior to the greater trochanter of the femur.
Pain pattern. Deep pain in the hip joint, extending from the outer thigh to the knee, may resemble the pain of greater trochanteric bursitis. The pain makes it difficult to walk quickly or lie on the affected side, and may make it difficult to sit with the hip joint fully flexed.
Causal or supporting factors.
Walking or running on uneven surfaces; long-term immobilization of the limb; unexpected excess load.
Satellite trigger points. The anterior bundles of the gluteus minimus, rectus femoris, iliopsoas and sartorius muscles.
Affected organ system. Genitourinary system.
Associated zones, meridians and points.
Lateral zone. Shao-yang gallbladder foot meridian. GB 29.31.
Stretching exercises.
1. Performed standing or sitting on the edge of a chair. Bend your right leg at the knee and rotate your hip outward. Grasp your ankle with the same hand, pull your heel towards your buttock, stretching the thigh and hip joint as much as possible. Hold the pose until you count 10-15.
2. Maintain your balance by leaning on a wall or table. Cross your legs so that the affected leg is behind you. Grab the knee of your uninjured leg and squat down on it so that the injured leg slides along the floor in the opposite direction, trying to press your shin to the floor. Fix the pose until the count is 10-15.
Strengthening exercise. Take a knee-elbow position. Shift your body weight to the knee on the uninjured side so that the thigh and lower leg of the other side can move freely. Keeping the knee of the affected side bent, move that leg to the side until the inner thigh is in a horizontal position. Return to the starting position. Repeat 5-10 times.
D. Finando, C. Finando
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Proximal attachment. The superior anterior iliac spine and adjacent portion of the iliac crest.
Distal attachment. The iliotibial tract of the fascia lata attaches to the lateral condyle of the tibia.
Function. Strains the iliotibial tract, helping to strengthen the knee joint in an extended position; helps flexion, abduction and internal rotation of the hip; Helps the gluteus medius and minimus muscles stabilize the pelvis when walking.
Palpation. To localize the tensor fascia lata, the following structures must be identified:
. The superior anterior iliac spine is a bony protrusion located below the iliac crest and serves as the attachment site for the inguinal ligament. Easily palpated.
The greater trochanter of the femur is a bony protrusion on the lateral surface of the thigh, located approximately a hand's length below the iliac crest; lies on the same horizontal line with the pubic ridge.
The iliotibial tract of the fascia lata is a long fascial plate lying on the outer surface of the thigh. Is the thickened part of the fascia surrounding the thigh; the distal part is attached to the lateral condyle of the tibia. The condyle insertion is palpated anterior to the biceps femoris tendon insertion. The iliotibial tract is palpated in a sitting position with the knee bent and the heel raised off the floor.
To identify the tensor fascia lata muscle, have the patient lie on their back and rotate the thigh inward against gentle resistance—the tensor fascia lata muscle will be easily palpated in this position. Using flat digital palpation, trace the course of the fibers from the superior anterior iliac spine to the connection with the iliotibial tract of the fascia lata on the lateral surface of the thigh. The tensor fascia lata muscle lies anterior to the greater trochanter of the femur.
Pain pattern. Deep pain in the hip joint, extending from the outer thigh to the knee, may resemble the pain of greater trochanteric bursitis. The pain makes it difficult to walk quickly or lie on the affected side, and may make it difficult to sit with the hip joint fully flexed.
Causal or supporting factors.
Walking or running on uneven surfaces; long-term immobilization of the limb; unexpected excess load.
Satellite trigger points. The anterior bundles of the gluteus minimus, rectus femoris, iliopsoas and sartorius muscles.
Affected organ system. Genitourinary system.
Associated zones, meridians and points.
Lateral zone. Shao-yang gallbladder foot meridian. GB 29.31.
Stretching exercises.
1. Performed standing or sitting on the edge of a chair. Bend your right leg at the knee and rotate your hip outward. Grasp your ankle with the same hand, pull your heel towards your buttock, stretching the thigh and hip joint as much as possible. Hold the pose until you count 10-15.
2. Maintain your balance by leaning on a wall or table. Cross your legs so that the affected leg is behind you. Grab the knee of your uninjured leg and squat down on it so that the injured leg slides along the floor in the opposite direction, trying to press your shin to the floor. Fix the pose until the count is 10-15.
Strengthening exercise. Take a knee-elbow position. Shift your body weight to the knee on the uninjured side so that the thigh and lower leg of the other side can move freely. Keeping the knee of the affected side bent, move that leg to the side until the inner thigh is in a horizontal position. Return to the starting position. Repeat 5-10 times.
D. Finando, C. Finando
lies on the anterolateral surface of the pelvis
Start: external lip of the iliac crest, closer to the superior anterior iliac spine
Attachment: Passes into the fascia lata of the thigh (iliotibial tract)
Function: Stretches the fascia lata and the iliotibial band. Through it it acts on the knee joint and flexes the hip. Due to their connection to the tensor fascia lata, the gluteus maximus and gluteus medius muscles contribute to movement of the knee joint
Comb
The shape is close to a quadrangle.
Start: Superior ramus and crest of the pubis
Attachment: pectineal line of the femur
Function: Adducts and flexes the hip, slightly externally rotating it
Gluteus maximus muscle
wide and thick fleshy mass of diamond shape; It determines how much the buttocks will protrude. Holds a person's torso in an upright position.
Start:. Dorsal surfaces of the sacrum and coccyx
Attachment: Gluteal tuberosity of the femur, iliotibial tract
Function: Extends the thigh in the hip joint, with strengthened lower extremities, extends the torso, maintains the balance of the pelvis and torso. Abducts the hip.
Biceps femoris
Located along the lateral edge of the posterior thigh. There are two heads in the muscle - long and short.
Start:
Long head– Ischial tuberosity
Short head– Lateral lip of the linea aspera, lateral epicondyle of the femur, lateral intermuscular septum of the femur
Attachment: Head of the fibula, lateral condyle of the tibia, fascia of the leg
Function: The long head extends the thigh, bends the lower leg, and when the lower leg is bent, turns it outward
Semitendinosus muscle
In the middle, the muscle is often interrupted by an oblique tendon bridge.
Start: Ischial tuberosity
Attachment: Medial surface of the tibial tuberosity, fascia of the leg
Function: Extends the thigh, flexes the lower leg. When the shin is bent, the shin turns inwards
Semimembranosus muscle
The outer edge of the muscle is covered by the semitendinosus muscle.
Start: Ischial tuberosity
Attachment: Medial condyle of the tibia
Function: Extends the thigh, bends the shin, rotates it medially (with the shin bent)
Since the muscles of the posterior group of thigh muscles spread over two joints, with a fixed pelvis they, acting together, bend the lower leg at the knee joint, extend the thigh, and with a strengthened lower leg, they extend the torso together with the gluteus maximus muscle. When the knee is bent, the same muscles rotate the lower leg, contracting separately on one side or the other. The semimembranosus muscle internally rotates the tibia
Gluteus medius
The muscle is thick, there are two layers of bundles - superficial and deep. 
Start: Gluteal surface of the ilium
Attachment: Apex and outer surface of the greater trochanter
Function:
Gluteus minimus
The shape resembles the gluteus medius muscle, but is much thinner in diameter. Covered throughout.
Start: Gluteal surface of the ilium
Attachment: Anterolateral surface of the greater trochanter
Function: the anterior bundles rotate the thigh inward, the posterior bundles rotate the thigh outward
Pear-shaped
Passing through the greater sciatic foramen, the muscle does not completely fill it, leaving small gaps along the upper and lower edges through which blood vessels and nerves pass.
Start: Pelvic surface of the sacrum lateral to the sacral foramina
Attachment: tip of the greater trochanter
Function: Rotates the hip outward
Thin muscle
Long, slightly flattened, lies subcutaneously, located most medially.
Start: from the anterior surface of the pubic bone downwards, it passes into a long tendon, which bends around the medial epicondyle of the femur behind.
Attachment: attaches to the tibial tuberosity.
Even before its insertion, the gracilis tendon fuses with the tendons of the sartorius and semitendinosus muscles, as well as with the fascia of the leg, forming the superficial pes anserine.
Function: Adducts the thigh and also takes part in flexing the tibia, turning the leg outward
Long adductor
located on the anteromedial surface of the thigh.
Start: The superior ramus of the pubis is below the pubic tubercle, lateral to the gracilis muscle.
Attachment: Medial lip of the linea aspera of the femur
Function: Adducts the hip, flexes, and rotates it outward
The fascia lata of the thigh (fascia lata) is thick, tendinous, with thigh muscles on all sides. Proximally, the fascia attaches to the iliac crest, inguinal ligament, pubic symphysis and ischium, connects posteriorly with the gluteal fascia, and continues downward into the fascia of the leg. In the upper third of the anterior thigh, within the femoral triangle, the fascia lata consists of two plates. Its deep plate (lamina profunda), covering the pectineus muscle and the distal iliopsoas muscle in front, is called the iliopectineal fascia (fascia iliopectinea).
The superficial plate of the fascia lata (lamina superficialis) in front covers the superficially lying anterior muscles of the thigh (sartorius muscle, rectus muscle, adductor muscles of the thigh), as well as the femoral artery and vein lying on the deep plate of the fascia lata (along the iliopectineal groove). In the superficial plate distal to the inguinal ligament there is an oval saphenous ring through which passes the great saphenous vein of the leg, which drains into the femoral vein. The subcutaneous ring (oval fossa, fossa ovalis) is closed by the ethmoidal fascia, in which there are numerous openings for the passage of small vessels and nerves. Laterally, the subcutaneous ring is limited by a crescent-shaped edge. The superior horn (cornu superius) of the falciform margin is wedged medially between the inguinal ligament above and the ethmoidal fascia below. The lower horn (cornu inferius) of the falciform edge, being part of the superficial layer of the fascia lata of the thigh, limits the subcutaneous ring from below. The saphenous ring is the external (subcutaneous) opening of the femoral canal (see above) in the event of a femoral hernia exiting the pelvic cavity through the femoral canal under the skin of the thigh.
Two intermuscular septa extend from the fascia lata, which envelops the thigh muscles, forming osteofascial and fascial sheaths for the muscles. The lateral intermuscular septum (septum intermusculare femoris laterale), attached to the lateral lip of the linea aspera of the femur, separates the posterior group of muscles (biceps femoris) from the anterior group (quadriceps femoris). The medial intermuscular septum (septum intermusculare femoris mediale), attached to the medial lip of the linea aspera of the femur, separates the quadriceps femoris muscle, located in its anterior region, from the adductor muscles (pectineus, adductor longus and others). Sometimes in the posteromedial region of the thigh there is a weakly defined posterior intermuscular septum, separating the adductor muscle group (adductor magnus and gracilis) from the semimembranosus, semitendinosus muscles belonging to the posterior muscle group of the thigh.
The fascia lata, splitting, forms fascial sheaths for the tensor fascia lata, the sartorius and gracilis muscles. On the lateral side of the thigh, the fascia lata, thickening, forms the so-called iliotibial tract, which is the tendon of the tensor fascia lata. The fascia lata below continues to the knee joint, which covers the front and sides, and even lower passes into the fascia of the leg. At the back, the fascia lata extends over the popliteal fossa and is called the popliteal fascia.
In the anterior region of the knee, under the skin and under the fascia, there are a number of synovial bursae. Lies between the layers of superficial fascia subcutaneous prepatellar bursa(bursa subcutanea prepatellaris). Under its own fascia is prepatellar subfascial bursa(bursa subfascial prepatellaris). Slightly below the patella there is subcutaneous bursa of the tibial tuberosity(bursa subcutanea tuberositas tibia), as well as subcutaneous infrapatellar bursa(bursa subcutanea infrapatellaris).
To perform its function, the tensor fascia lata pulls on a wide layer of fibrous tissue that covers the outer side of the thigh. The fascia lata and its central tendon transmit the force of this and the gluteus maximus muscles to the hip and knee. The tensor fascia lata helps flex the knee and hip. The same muscle is involved in lifting the hip forward and to the side and in turning the leg inward. It takes part in stabilizing the pelvis and knees during walking and running. In runners and track and field athletes, these muscles are very developed. Changing the sitting position also requires the participation of these muscles.
Symptoms
Trigger points in the tensor fascia lata cause pain in the hip joint just anterior to the greater trochanter (Figure 9.1). There are two places where trigger points may be present - one in front, directly under the pelvic bone, the second two to three centimeters behind the first. In some cases, the pain may extend along the outer thigh to the knee (not shown). There is also a deep, dull pain behind the hip area, between the ischium on that side and the greater trochanter (not shown). A muscle that has shortened under the influence of trigger points makes it difficult to straighten the hip and makes a person walk more slowly. You have to stand with your hips and knees slightly bent. When the trigger points in the tensor fascia lata are at their most active, it is almost impossible to lean back.
The tightened muscle puts pressure on the pelvic bone, the pelvis moves forward, and an unnatural curve appears in the lower back. This same impact can create the impression of a shortened leg. The thigh becomes very sensitive and it is difficult to lie on it. Pain from trigger points in the tensor fasciae lata is mistaken for hip bursitis or a sign of thinning hip cartilage.
Reasons
Excessive walking, running, or climbing puts excess stress on the tensor fasciae lata. Overload leads to the fact that subsequent sitting ends in the formation of trigger points due to the fact that the muscles remain in a shortened state. The same thing happens if you sleep with your knees raised. These muscles become even more tense when walking or running on uneven ground. They have to work harder to compensate for gait in worn-out shoes or foot instability caused by Morton's foot, which is discussed in Chapter 10. The tensor fascia lata muscles are engaged whenever you stand on your feet. They experience unnecessary stress if you carry a heavy load while walking and if you are overweight. Try to avoid prolonged sitting if these muscles bother you. If you have signs of limited mobility in your hips, take care not to sit in a hunched position or sleep in a fetal position. Keep in mind that walking, running and other physical exercises will be too harmful for muscles that lack elasticity and flexibility. Monitor the condition of your hip joints. Restricted mobility is a clear sign of the presence of trigger points. Overloading any muscle that has trigger points quickly activates them, and pain cannot be avoided.
Treatment 
To locate the belly of the tensor fascia lata by contracting the muscle separately, first locate the greater trochanter, a bony protrusion on your hip. Figure 8.22 will help you. Place your finger in front of the greater trochanter and shift the weight of your body from foot to foot (Fig. 9.2). The muscle will swell and fall in turn. If you simply rotate your knee or foot inward or lift your leg to the side, the muscle will also contract. The tensor fascia lata is a muscle that works very intensely. It will not be possible to perform a deep massage of this muscle with your fingers; they will not create the necessary leverage, but the Tera Keynes device will cope with this (Fig. 9.3), just like a tennis or lacrosse ball pressed against the wall (Fig. 9.4). Trigger points can be located deep within this muscle. If there is a thick layer of fat on the thighs, you can use an even smaller and harder ball. Place the ball in front of the large skewer and press firmly against it. Roll the ball across or along the muscle fibers, whichever is more comfortable for you. Typically, along with the tensor fasciae lata, several other muscles are also affected by trigger points. If you have pain or stiffness in your hips, explore all of the muscles listed in the Trigger Point Index called Outer Thigh and Hip Pain. Make sure that the tension in the iliotibial band on the outside of the thigh is caused by the tensor fascia lata and gluteus maximus muscles due to trigger points in them. Tenderness in this area is more likely due to trigger points in the underlying vastus lateralis muscle, which is part of the quadriceps femoris muscle.
