Weak tensor fascia latae muscle leads to…


TFL - 1.4 - BP3DBased on our findings in the Diagnosis Foundations screening program, weakness of the Tensor Fascia Latae (TFL) is very common.  What kinds of performance and health issues can you get from this?  Let’s look at TFL anatomy, actions, measurement methods along with the implications weak TFL strength can have on your athletic performance and health.

Anatomy – The TFL is located on the lateral side (outer side) of the pelvis and is superficial (towards the skin).  The top of the muscle attaches to the front 1/3 of the iliac crest (this is the top most part of the pelvis just below the waist).  The muscle is relatively short (shown in black) and runs 3-10″ down the lateral side of the thigh.  There it connects to the long fascia latae or iliotibial band (shown in blue) which runs down the side of the thigh and attaches to the lateral tibia, just below the knee.

TFL - Glut Max - Iliotibial band - YThe TFL along with part of the gluteus maximus form the two arms of the letter “Y”.  The long vertical portion of this complex is the iliotibial band.

Action – The actions of this muscle are dependant on if it is working alone or in conjunction with the gluteus maximus.  If it is working alone, the TFL performs a complex combination of the following motions.  It will abduct the thigh (lift to the side), flex the thigh (lift forward) and internally rotate the lower limb.  This results in the lower limb being lifted forward on the diagonal, half way between straight forward and straight to the side.  If the TFL works in concert with the gluteus maximus, it will abduct the lower limb or laterally flex the pelvis.

Diagnosis – Weakness in the TFL can be determined with manual muscle strength testing, careful observation of pelvis alignment during walking, standing, running and other tests. Supporting information can be gained through a detailed history as well as physical examination for neurological, vascular and orthopedic signs.  Measurement of TFL ranges of motion and exact muscle strength determinations are available with specialized equipment when required for more detailed examinations, insurance purposes or research.

Functional Implications – Let’s consider the functions of the TFL when working by itself, or when working in conjunction with a portion of the gluteus maximus. When working alone – TFL weakness, will result in compromised movement in the following situations:

  1. Flexion of the limb to the forward diagonal

When working with other muscles – TFL weakness will result in compromised movement in the following situations:

2. Lateral knee flexion/stability
3. Abduction of the lower limb
4. Lateral flexion of the pelvis
5. Forward rotation of the pelvis

Let’s look at each of these in a bit more detail.

1)  Flexion of the limb to the forward diagonal – When working by itself, the TFL is directly responsible for forward diagonal motion of the limb.  Forward kicks tn the outside diagonal as well as accelerating the body backward to the opposite diagonal will both use this muscle.  The TFL will also be involved in braking forward diagonal movement of the body as well as braking the relatively rarely used backward cross over kick or back roundhouse kick.

2) Lateral Knee Flexion/Stability – This stabilization function is accomplished in conjunction with a portion of the gluteus maximus muscle.  Although the knee joint does not have appreciable lateral flexion, the TFL / gluteus maximus combo provides critical stability of the knee in this direction.

3) Abduction of the lower limb – Straight sideward leg lifts or accelerating the body laterally to the opposite side will be the motions achieved by the coordinated action of the TFL and the tibial head of the gluteus maximus muscles.  These same actions are also achieved by the direction of the gluteus medius working by itself.

4) Lateral flexion of the pelvis to the same side – When used in conjunction with the tibial head of the gluteus maximus, the TFL will help flex the pelvis and body laterally to the same side.  This action also provides critical stability of the pelvis during one legged phase of walking or running.

5) Forward rotation of the pelvis – This motion is brought about by any of the following muscles: TFL; psoas; iliacus and rectus femoris of the quadriceps. This action is used in sit-ups or thigh flexion.

Injury Susceptibility – In addition to performance degradation, athletes with weak TFL muscles, will be susceptible to increased rates of injury in each of the 5 categories of functions listed above.

1 Flexion of the limb to the forward diagonal – Hip joint imbalances are a consequence of chronic weakness of the TFL.  The imbalances will place increased stress on the cartilage of the hip socket and femoral head and increase the rate of wear and tear on the joint.  When the imbalance is severe enough for a long enough period of time, the risk of developing cartilage degeneration, hip osteoarthritis and eventual need for hip replacement increases.

2) Lateral Knee Flexion/Stability – The TFL and the tibial head of the gluteus maximus provide the only muscular support of the lateral knee via the iliotibial band.  This provides critically important support for the lateral collateral ligament of the knee.  Chronic weakness of the TFL will result in excessive knee lateral movement, gradually stretching the lateral collateral ligament.  Over time, this ligament will become lax resulting in further excess mobility of the knee.  As the abnormal hypermobility persists, chronic sprains, cartilage erosion and osteoarthritis will develop eventually increasing the prospects of knee replacement surgery.

3) Abduction of the lower limb – In addition to the hip imbalance injury issue noted in #1 above, weakness of the TFL will contribute to decreased stability when walking.  This will increase the risk of falls as the severity of weakness progresses throughout a lifetime.  Falls are a major health issue with seniors frequently resulting in broken bones

4) Lateral flexion of the pelvis to the same side –  Weakness of the TFL (or gluteus medius or gluteus maximus tibial head) can result in the pelvis rocking side to side excessively when in the one legged stance phase of walking or running.  This excessive rocking will put increased pressure on the bursa’s in the hip region and increased friction on the iliotibial band.  This is one of the major causes of iliotibial band syndrome.

5) Forward rotation of the pelvis – Weakness of the TFL can contribute to the pelvis rotating more posteriorly than it should.  This will typically also result in a flattened low back.  These abnormal postures will put excessive strain on the low back muscles as they work in a mechanically disadvantaged position.  The lumbar discs will also receive increased pressure on them as the result of the posterior pelvis rotation and flattened low back.  If present to a sufficient degree for a long enough period of time the risk of developing disc degeneration, neuralgias and spinal osteoarthritis increases substantially.

Identification – Learn how to test for muscle strength imbalances with education certification courses offered by the Diagnosis Foundation.  Identifying muscle weakness early, enables you to correct these conditions before they reach a clinical state, when correction takes a minimal effort.

Fall Prevention Screening



Senior hispanic man working on a white background
Senior hispanic man working on a white background

The Diagnosis Foundation (DxF) will be doing a Fall Prevention screening at the Sayville Public Library.  There are many factors contributing to falls, including:

  • Vision impairment
  • Obstructed environment
  • Equilibrium or inner ear impairment
  • Decreased proprioception (sensory awareness of body and joint position)
  • Decreased overall muscle strength & control
  • Decreased individual muscle strength or symmetry

There are diagnostic tests to look at each of these factors separately or in groups.  This screening will involve a brief assessment of overall risk of falling assessment along with a more in depth look at individual muscle strength and control.  Each person will be screened on muscle strength symmetry and control of 12 individual muscles in each leg.

Each screen takes 15 minutes to complete and participants with abnormal findings will be referred to their own health care providers for follow up.  Participants without providers or those needing recommendations for physicians who do individual muscle strength testing, differential diagnosis or treatment will be referred to the DxF DxProvider data base.

This screening is free but scheduling an appointment is highly recommended.

Importance: “Unintentional falls are a common occurrence among older adults, affecting approximately 30% of persons aged >65 years each year.” (1)  In the US, “in 2003, a total of 13,700 persons aged >65 years died from falls, and 1.8 million were treated in emergency departments (EDs) for nonfatal injuries from falls.” (2)

When: The event runs 3:00-5:00 pm on Thursday, December 12, 2013.

Where: At Sayville Library 88 Greene Ave. Sayville, NY 11782

Clothing: Wear comfortable clothing to sit, stand and lay down.  Shorts or pants recommended.

For additional info:

1 – Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001;82:1050–6.

2 – Retrieved from http://www.cdc.gov/ncipc/wisqars

Target stores sets itself apart with GMO free products. How do you set yourself apart?


target-msTarget sets itself apart by announcing its store brand is non GMO. Whole Foods started the trend when it noticed a 15-30% increase in a products sales when it is labeled GMO free. Chipolte restaurants have signed on with development of a new GMO free menu and Ben & Jerry’s ice cream has announced a new non GMO product. 1

They respond to a public need and they will be successful. At the Diagnosis Foundation (DxF), we have been responding to the public’s need for answers about important health questions. We developed a course in Balanced Muscle Strength to target workouts for individuals. When individual muscles are tested for strengths and weaknesses, a purposeful workout is designed to improve safety, health, and performance.

Read more facts about setting yourself apart.

Certification courses

Education courses


You go to the gym, exercise or do yoga, and now your joint clicks….what next?



Soccer Player Holding Injured Knee --- Image by © Royalty-Free/Corbis

Diagnose the cause! While some clicks and noises in the joints are relatively ok, others mean that something is wrong.  How can you tell? Should you just wait and see what happens?

No!  Waiting could be just the wrong choice. Some noises are the early warning signs that the joint is not working right.  These kinds of issues can frequently be fixed rather quickly if caught early enough.  Let it continue for too long, and you may find that at some some day, ‘out of the blue’ major damage occurs.  A spinal disc ruptures, a cartilage gets cut, bony spurs are discovered on x-rays. Now you can’t do the activities like you once could and recovery is likely to be a lot longer and the residuals will be much higher.

Let’s go into a little more details on the mechanisms for clicking and noisy joints as well as some of the potential underlying causes.

Clicking joints can come from:

  • The bones of the joint are not centered properly – and moving out of their socket/groove
  • The bone is riding out of the proper position, rolling over cartilage of some other tissue improperly
  • A tendon near the joint is dislocating out of its’ groove or proper position
  • Ligaments are loose allowing the bones to move excessively
  • The joint is malpositioned such that movement causes excessive suction and a sudden fluid shift causing a ‘pop’ like when you pull a finger knuckle.  Even a well positioned joint can be made to ‘pop’ if enough force is put on it.  (The mechanism is similar to pulling a wet suction cup off of a flat surface)
  • Cartilage or other soft tissue has been damaged and a piece has broken off, with the bone rolling over it.
  • Calcium deposits have built up around the joint that rub against some other tissue with movement

What are some causes? – Most of these possibilities are caused directly or indirectly by, or a long term complication of, some kind of imbalance in a joint.  Imbalances can come about for many reasons including:

  • Trauma – stretching or damaging muscles, tendons or ligaments, etc.
  • Surgery – intentionally damaging, muscles etc.
  • Muscle imbalances – from activities that exercise certain muscles more than others
  • Connective tissue imbalances – from over stretching joints in some direction
  • Nerve issues – causing muscle contractions to be too strong or too weak in certain directions
  • Circulation issues – causing a buildup or deficiency of chemicals that are needed to allow the muscles to work properly
  • Bone issues – malformed bones from trauma, birth defect or other cause
  • Other – scar tissue, pressure from swollen tissues,

Does that mean it’s time to stop exercising? That you are too old?  No.  but it does mean that something needs to change.  Pushing through joint clicking is very likely to exacerbate the problem.

Find the cause! – The first thing to do is find out why the joint is clicking.  If you have addressed the issue sooner rather than later, the odds are improved that you can fix the cause relatively quickly.  If instead, you have ignored the clicking, covered it over with pain medication or tried to work through it, the odds are increased that it will take a longer period of time to fix.

Where can you start to address a clicking joint?   If you have noticed the clicking fairly quickly after it has started, a thorough history of what you were doing near the time when it began can many time reveal the cause.  You may be able to do this yourself to some degree.  Answer these questions:

  • Where does it click?
  • When does it click?  With what motions?  Is it repetitive or just once every hour or so?
  • Is it painful?  Does it have any other sensations with it? (dull, tingling, burning, itchy, etc.)
  • Do any symptoms linger after the clicking?
  • When did it first start?  What were you doing right then? For the days before?  The week before?
  • Has it been getting better or worse?
  • Have you had this before?  If so, what treatments did you use?  Did it help?
  • Any change in workout routine?  If you lift a lot, spend some good time looking carefully at the possibility that you have altered your routine, or been working out some muscles more than others.
  • Change in DIet?  Supplements? Medications?

If you are not able to figure out and fix the clicking relatively rapidly through your own investigations, get somebody with more experience to look at all of the possibilities.  Find somebody to work with who understands possible causes of a clicking joint and knows how to determine which ones are involved. The greater the number of possible causes of clicking your health partner can determine, the more likely that you will be able to do all your health work with one health or fitness provider.

Some of the skills you want your provider to be trained and experienced with include:

  • Able to evaluate individual muscle strength & balance
  • Able to measure joint ranges of motion & connective tissue integrity
  • Able to determine nerve & vascular competence
  • Able to determine functional motions, timing and control of joint movement
  • Access to ordering x-ray, MRI or other imaging tests.
  • Most importantly – you want your health & fitness partners to be able to talk with you and work with you.  In most situations, you will get far better results when you know what is going on and are an active participant in the recovery process.

The main thing, is don’t ignore it and don’t cover it up and hope it will go away.  Typically, the quicker you start work on a clicking joint, the easier it will be to fix, and the less residual scar tissue or other damage you will have.

How many amino acids are there?


GlycineProteins are a group of chemicals in the body that make up your muscles, ligaments, tendons, enzymes and the basic structural framing of your body. Proteins are made up of very long strings of 20 different amino acids, each arranged in a very specific sequence. Of these 20 different amino acids, 10 must be supplied from the diet. Your body can then convert these 10 essential amino acids into the others needed to produce every protein in the body. These 10 amino acids are thus called the “Essential Amino Acids”.

Experimental Evidence
The amino acids that are essential in the human diet were established in a series of experiments led by William Cumming Rose. The experiments involved elemental diets to healthy male graduate students. These diets consisted of cornstarch, sucrose, butterfat without protein, corn oil, inorganic salts, the known vitamins, a large brown “candy” made of liver extract flavored with peppermint oil (to supply any unknown vitamins), and mixtures of highly purified individual amino acids. The main outcome measure was nitrogen balance. Rose noted that the symptoms of nervousness, exhaustion, and dizziness were encountered to a greater or lesser extent whenever human subjects were deprived of an essential amino acid.(1)

Being assessed and then treating deficiencies for essential amino acid can prevent: chronic fatigue, assessing the risk of heart disease, depression, autism, attention deficit hyperactivity disorder, inflammation, and neurological disorders. (2)

Diagnosis before treatment is essential in the process of health. It doesn’t help to build muscles by taking Goji berries if your body is deficient in even 1 essential amino acid. Similarly, it doesn’t help to build strength if your exercise program doesn’t diagnosis which muscles are weak compared to their opposing muscles. It only takes a small variation in muscle balances to create a joint that is not working to its maximum.  It’s a kinetic connection! Want to learn more about joint health?

For more info about diagnosing muscle imbalances: Free Balance Muscle Strength screening to promote power, speed and strength!

For more info see:
Genova Labs

2- http://altmedicine.about.com/od/healthconditionsatod/a/amino_acids.htm

It’s a boy! Now what? Postpartum recovery exercises.


Pregnant womanWhat happens during nine months of pregnancy with a baby growing inside of a mother’s abdomen?  One of the results (besides a new member of the Royal Family) is that stomach muscles get stretched and the low back arch forward becomes increased.  These alterations to the mother’s body can remain long after pregnancy unless measures are taken to correct the imbalanced muscles.  In fact, the lower back arch for healthy adult women is on average, almost twice as large as men.  (1)  Pregnancy is one of the factors contributing to this major difference in the shape of women compared to men. 

What does it all mean?  When the lumbar arch forward becomes too great, it has less strength and stability.  An excessive curve in the low back (lumbar region), requires less bio-mechanical stress to cause damage and pain.  New mothers will be subjected to plenty of bio-mechanical stress as they carry their growing baby around every day.

A lumbar injury could happen during pregnancy, show up right after delivery or perhaps even years later.  As long as the muscle imbalance remains, the lumbar region will remain susceptible to injury.  These kinds of joint aches are quite common.  Joint problems, particularly in the low back represent the number 2 reason for doctor visits.

Of course there are a lot of factors that contribute to increasing the lumbar curve forward.  High heels can contribute to increasing the lumbar forward arch, so can straight leg sit ups.  The sum of all the activities, exercises, stretches, injuries and surgeries that you have ever experienced, all contribute to your shape, contours and muscle balance.  The key to preventing joint imbalance injuries, is to check your bio-mechanics on a regular basis.  Is your lumbar arch forward too big?  Too small?

Get your muscle strength tested.  Find out if the muscles that pull your lumbar region backward are weaker than those which pull it forward.  Get your posture analyzed, measure your flexibility.  Listen to your body and learn how it works.  For example, you can learn the basics of muscle strength testing in as little as 4-6 weeks.  Don’t wait until you can’t get out of bed with joint pain. Take these easy and inexpensive steps now to truly prevent illness.  Continue the joy of pregnancy with a long, active, healthy life, sharing your children’s accomplishments as they continue to grow.

1 – http://www.ncbi.nlm.nih.gov/pubmed/21576723

What is the #2 reason for doctor visits?


The #2 reason people visit the doctor is for joint pain related to osteoarthritis disease. When you visit a doctor who is not trained in muscle imbalances, the only treatment is to prescribe pain relieving meds. This does not treat the underlying cause and only masks the problem until more complications occur. Most of muscle imbalances can be corrected with exercises. Do you want to prevent osteoarthritis disease? Start now by educating yourself!

The Diagnosis Foundation promotes health with free Balanced Muscle Strength screenings to educate the public. In addition, we have certification courses open to the public!

Read about screenings
Read about our online course

Careers in Muscle Strength & Balance Testing

You get certified in muscle strength & balance testing (MS&BT) through the DxF. Now what?
There are lots of possibilities depending on what you are already involved in. Let’s take a look at some of the possibilities.

For those of you who are already in the health field: personal trainer, yoga instructor, physician, allied health professional or coach.

Whether you have your own office, studio, team or work out of somebody’s gym, you can add muscle strength testing to your business right away. This will give you the tools you need to get superior results and set you apart from the competition.

For those of you new to the health field: Here are some options:

· Work with the DxF – whether you volunteer for our public screening program, or work your way up to become one of our paid tutors, examiners or instructors, we are always looking for people to help bring muscle strength testing to the world.

· Affiliate with health professionals – With each muscle strength & balance testing course and certification you complete, you will learn more muscle tests and related anatomy. The more muscle strength tests you learn, your options for obtaining work with sports doctors, chiropractors, physical therapist and personal trainers on a part time or full time basis increases.

· Set up your own testing service – Depending on your state laws, you may be able to establish your own muscle strength & balance testing service. Once you complete all 8 units of the MS&BT series, you will have learned 100 different muscle tests, related anatomy, physiology and research to use in your own business.

Manual Muscle Strength Testing: Validity & Reliability


Young Doctors SmilingGet certified as a Balanced Muscle Strength Screener – Legs in 4-6 weeks! Time varies based on background in anatomy and biology.

Manual muscle strength testing has been around at least since 1915 with over 6 textbooks on the topic currently in publication. Let’s first define exactly what we are talking about when we describe manual muscle strength testing for this article.

Muscle testing falls broadly into 2 major categories. One category uses testing to measure strength based upon the functional capacity of the muscle and the directly affiliated nerves. The other category utilizes muscle testing as a method of gaining insights into remote areas of the body or even other people. This article is addressing the first category of measuring direct muscle strength.

Muscle testing may be done using equipment, manual methods or a hybrid of the two. State of the art testing where documentation is required for insurance or legal cases typically involves sophisticated equipment (i.e. Cybex, Biodex). While muscle strength testing with this type of equipment can be extremely accurate, it tends to be limited in the number of different muscles that can be measured and takes extensive amounts of time and money to perform.

Manual muscle testing for strength utilizes the examiner’s senses to evaluate how much strength the subject is capable of producing with each test. Accuracy suffers to some degree because of this and results are recorded in a semi-quantative manner (i.e. 0-100%) rather than in pounds of force. On the plus side, manual testing offers a much broader range of muscles that can be measured and can be done in a much quicker time frame and lower cost.

Hybrid systems utilize devices that the examiner holds in their hand to measure the peak force that subjects can exert with their muscles. These hybrid systems are somewhere in between the sophisticated systems and purely manual methods regarding the number of different muscles that can be tested and the accuracy of the results, time and cost.

Cuthbert & Goodheart did a peer reviewed, nationally indexed study of over 100 research articles done on purely manual muscle testing methods. There findings concluded that there was “good reliability and validity in the use of MMT [manual muscle testing] for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias.” (1)

More recently (2010), Fan and others, did a study on inter-rater reliability of manual muscle strength testing for intensive care patients.  They found “MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.” (2)

In 2000, Gregson found that using the Medical Research Council scale for manual muscle strength testing provided reliable results for all muscle groups tested. (3)

1 – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847521/

2 – http://www.ncbi.nlm.nih.gov/pubmed/20213068

3 – Gregson JM. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing. 2000;29:223–228

What’s the #1 reason women don’t workout?


woman-curlingWomen who didn’t workout reported more often they didn’t have enough time! That means they don’t place enough value on staying fit. How can women see the value in a workout routine? A couple big factors are: 1) they need to know that exercising is going to help and 2) that the exercises won’t cause problems.

The largest preventable risk factor for the development of arthritis is muscle imbalances.  The best way to correct these11 imbalances is through exercises.  When you consider that the #2 reason for all doctor visits is arthritis and how many people get joint replacements for chronic arthritis, starting an exercise program begins to sound like it could be well worth the time.

It is not enough to just do exercises.  They need to be the correct exercises.  This is why it is important get tested for individual muscle strength first before beginning an exercise program.  Muscle imbalances can be acquired by many different reasons including: traumas; accumulation of imbalanced every day activities; imbalanced exercise programs; crooked seats; saggy beds and more. Over time, if not addressed and corrected, pain, injury, drug therapies, surgery, and osteoarthritis diseases can develop.

Good health is good motivation!

Battle of the Boxes II, CrossFit Competition – August 17


amrap-fitness-logoThe Diagnosis Foundation will be exhibiting and performing balanced muscle strength screenings at a CrossFit fundraising competition, Battle of the Boxes II.

The DxF Screening is free and open to the public.  The competition is a team event from other CrossFit Boxes.

When: The events will take place on Saturday, August 17, 2013 beginning 8:15 am.

Where: AMRAP Fitness / CrossFit South Rockland, 80 Red School House Rd, Unit 110, Chestnut Ridge, NY

Activities include:

  • DxF Free Health & Fitness Screening: Balanced Muscle Strength testing of 12 muscles in the legs.  Designed to improve athletic performance, decrease injuries and prevent certain forms of osteoarthritis
  • This is a team event – 2 men, 2 women
  • Divisions: Open (ages 16 to 39), Masters (40+)
  • Awards

Proceeds will go to The Crohn’s & Colitis Foundation of America. The Crohn’s & Colitis Foundation of America (CCFA) was founded in 1967 to find cures for Crohn’s disease and ulcerative colitis and improve the quality of life of adults and children affected by these diseases.

For additional info: