Chronic IT BAND and quad TIGHTNESS and patella Knee Pain (Chondromalacia Patella?)

Training Injuries
1

Chronic anterior knee pain // chondromalacia patella // patella femoral pain syndrome (PFPS) // Excessive Lateral Pressure Syndrome (ELPS) // Lateral Compression Syndrome // Lateral Facet Syndrome of Patella

Let me begin with some backround. I am 23 years old male currently living in Canada. I have had anterior knee pain in my right knee for over 6 years. It started when I played soccer, and it just got worse. My IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them. I have tried physiotherapy from multiple physiotherapists, ART, electrically stimulated trigger point dry needling (PENS/electroacupuncture), acupuncture, massage therapy, foam rolling (lacross ball, PVC pipe, rumble roller), suction cupping, strengthing glute medius and maximus, VMO strengthening, core strengthening, orthotics, intra articular prolozone injections, joint supplements, heel wedge for leg length discrepency (my right leg is 1.1 cm shorter confirmed on x-ray).

I dont do any physical activity besides physiotherapy. My pain is at a constant 5/10 (it fluctuates, sometimes its lower, but sometimes like in rainy days or cold days its even higher, as I am writing this its at a 7/10). Basically all the physiotherapists are perplexed at my issue and they say that I should not be feeling so much pain. They think my overall mobility and flexibility isn’t that bad (one of them said, hes never seen someone with so much pain with such good mobility). But when they massage they notice that my soft tissue is really tight with lots of “junk” or adhesive knots.

Sometimes the tightness is really painful and feels almost like a cramp. If I massage, and self-myofascial release religiously for awhile and dont do any activities it will loosen up a little. But even a little bit of daily physical activity will cause it to tighten up (i.e., cleaning the house, sex, moving large furniture, dancing at the bar/club, working out without foam rolling and stretching right at the end).

Joint supplements:

  1. NEM - natural egg shell membrane (500mg)
  2. pycnogenol (100mg)
  3. fish oil (2000mg)
  4. krill oil (500mg)
  5. curcumin (500mg)
  6. Serrapeptase (270 000 IU)
    Note: They dont seem to have helped much. I am thinking of replacing my curcumin with Thorne Meriva (a high potency curcumin, with 20x more absorption) based on all the good reviews. Someone even said its worked better than cortisone shots. I have also tried MSM and type 2 collagen from fortigel.
    General Health Supplements:
  7. Magnesium Biglycinate (200mg)
  8. Vit D (2000mg)

Diagnostic imaging done:

  1. X-ray on knee - showed nothing abnormal besides patella tilt (although when I examine it myself their seems to be a little less joint space when compared to the left knee, I asked the sports physician, he said that’s because of the tilt)
  2. ultrasound - showed mild inflammation in my right knee, nothing serious
  3. MRI - getting it done in January (update: Had MRI, it showed no cartilage, ligament, meniscus or tendon damage)
  4. X-ray for leg length - right leg 1.1 cm shorter (been adviced to wear 0.5 cm heel wedge under my right foot shoes)

Previous treatments:

  1. Physiotherapists/Massage therapist/FMS certified strength and condition specialist- looked at mobility, muscular imbalances, glute medius, glute maxmus, VMO strengthening, core strengthening, stretching, self myofascial release, foam rolling, suction cupping, ART, massage therapy, orthotics, gait analyses, heel wedge for leg length discrepency, electrically stimulated trigger point dry needling, acupuncture, went to Fowler and Kennedy sports medicine clinic in London Ontario and many other places.

  2. Dr Robert Banner (London ON) - 6 treatments of Prolozone injections, once every month so far. Only noticed temporary relief of pain, maybe for 2 weeks after each injection (relief was dramatic, it decreased pain by 70%). Has recommended EMF (electromagnetic field) protective devices such as diodes. He says it may help since my symptoms are worse on rainy days. Seems very pseudoscience tho.

  3. Osteopath - Currently seeing an osteopath, only started. I had 2 treatments done thus far. She has noticed that I am kypthotic, and lordisis. Also noticed that my right pelvis is shifted anteriorally (hip misalignment). She has made my back feel good thus far but has not relieved my knee pain and IT band muscle tension. She is not that experienced either but has a very cheap rate (shes only in school).

Possible Future treatments:

  1. Botox (Dr. Gordon Ko in Markham) - into the vastus lateralis (any maybe hip flexor). This has shown to be effective in some recent studies for patients with refractory anterior knee pain. The idea is you shut down the vastus lateralis for 3 months, and you continue to do physiotherapy, this gives you a window of time for selectively strengthening and isolating the VMO. This will help with tracking and tilt issues, and can give symptomatic relief of muscle tightness during the 3 months. Its good for addressing muscular balance issues. Dr. Gordon Ko also does PRP, prolotherapy, hyaluronic acid, and botox into the joint.

  2. HGH/testosterone/IGF-1/PSGAGS/hyaluronic acid/dextrose(self injection) - have read this has helped some people. I am looking into injecting into my own knee to save thousands of dollars. This can help regenerate possible cartilage damage I might have.

  3. Dr. Anthony Galea (Etobicoke/Toronto) - he is a prominent sports medicine physician infamous for treating athletes and giving them HGH. Don’t know what kind of treatment he would give me. I know he does PRP, but I dont know if he can give HGH anymore since its illegal here in Canada and hes gotten in trouble for that.

Help me:
I am looking for some advice and how to proceed. My chronically tight IT Band, quadriceps, and Hip flexors just dont seem to loosen up! My new physiotherapist has me doing postural work/exercises now. I have been going at it for about 1 month now, it doesnt seem to help. He thinks that bad posture might be contributing. 1 month ago he said give it 3 months, and I should see improvements. (He even said that I can expect to see an 80%, but he doesnt know for sure because I am an unique case, he said I shouldn’t be feeling that much pain since I am not even doing physical activity).

2

[quote]xianchixan wrote:
Chronic anterior knee pain // chondromalacia patella // patella femoral pain

Let me begin with some backround. I am 23 years old male currently living in Canada. I have had anterior knee pain in my right knee for over 6 years. It started when I played soccer, and it just got worse. My IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them. I have tried physiotherapy from multiple physiotherapists, ART, electrically stimulated trigger point dry needling (PENS/electroacupuncture), acupuncture, massage therapy, foam rolling (lacross ball, PVC pipe, rumble roller), suction cupping, strengthing glute medius and maximus, VMO strengthening, core strengthening, orthotics, intra articular prolozone injections, joint supplements, heel wedge for leg length discrepency (my right leg is 1.1 cm shorter confirmed on x-ray). I dont do any physical activity besides physiotherapy. My pain is at a constant 5/10 (it fluctuates, sometimes its lower, but sometimes like in rainy days or cold days its even higher, as I am writing this its at a 7/10). Basically all the physiotherapists are perplexed at my issue and they say that I should not be feeling so much pain. They think my overall mobility and flexibility isn’t that bad (one of them said, hes never seen someone with so much pain with such good mobility). But when they massage they notice that my soft tissue is really tight with lots of “junk” or adhesive knots. Sometimes the tightness is really painful and feels almost like a cramp. If I massage, and self-myofascial release religiously for awhile and donÃ??Ã?¢Ã???Ã???t do any activities it will loosen up a little. But even a little bit of daily physical activity will cause it to tighten up (i.e., cleaning the house, sex, moving large furniture, dancing at the bar/club, working out without foam rolling and stretching right at the end).

Joint supplements:

  1. NEM - natural egg shell membrane (500mg)
  2. pycnogenol (100mg)
  3. fish oil (2000mg)
  4. krill oil (500mg)
  5. curcumin (500mg)
  6. Serrapeptase (270 000 IU)
    Note: They dont seem to have helped much. I am thinking of replacing my curcumin with Thorne Meriva (a high potency curcumin, with 20x more absorption) based on all the good reviews. Someone even said its worked better than cortisone shots. I have also tried MSM and type 2 collagen from fortigel.
    General Health Supplements:
  7. Magnesium Biglycinate (200mg)
  8. Vit D (2000mg)

Diagnostic imaging done:

  1. X-ray on knee - showed nothing abnormal besides patella tilt (although when I examine it myself their seems to be a little less joint space when compared to the left knee, I asked the sports physician, he said that’s because of the tilt)
  2. ultrasound - showed mild inflammation in my right knee, nothing serious
  3. MRI - getting it done in January
  4. X-ray for leg length - right leg 1.1 cm shorter (been adviced to wear 0.5 cm heel wedge under my right foot shoes)

Previous treatments:

  1. Physiotherapists/Massage therapist/FMS certified strength and condition specialist- looked at mobility, muscular imbalances, glute medius, glute maxmus, VMO strengthening, core strengthening, stretching, self myofascial release, foam rolling, suction cupping, ART, massage therapy, orthotics, gait analyses, heel wedge for leg length discrepency, electrically stimulated trigger point dry needling, acupuncture, went to Fowler and Kennedy sports medicine clinic in London Ontario and many other places.

  2. Dr Robert Banner (London ON) - 6 treatments of Prolozone injections, once every month so far. Only noticed temporary relief of pain, maybe for 2 weeks after each injection (relief was dramatic, it decreased pain by 70%). Has recommended EMF (electromagnetic field) protective devices such as diodes. He says it may help since my symptoms are worse on rainy days. Seems very pseudoscience tho.

  3. Osteopath - Currently seeing an osteopath, only started. I had 2 treatments done thus far. She has noticed that I am kypthotic, and lordisis. Also noticed that my right pelvis is shifted anteriorally (hip misalignment). She has made my back feel good thus far but has not relieved my knee pain and IT band muscle tension. She is not that experienced either but has a very cheap rate (shes only in school).

Possible Future treatments:

  1. Botox (Dr. Gordon Ko in Markham) - into the vastus lateralis (any maybe hip flexor). This has shown to be effective in some recent studies for patients with refractory anterior knee pain. The idea is you shut down the vastus lateralis for 3 months, and you continue to do physiotherapy, this gives you a window of time for selectively strengthening and isolating the VMO. This will help with tracking and tilt issues, and can give symptomatic relief of muscle tightness during the 3 months. Its good for addressing muscular balance issues. Dr. Gordon Ko also does PRP, prolotherapy, hyaluronic acid, and botox into the joint.

  2. HGH/testosterone/IGF-1/PSGAGS/hyaluronic acid/dextrose(self injection) - have read this has helped some people. I am looking into injecting into my own knee to save thousands of dollars. This can help regenerate possible cartilage damage I might have.

  3. Dr. Anthony Galea (Etobicoke/Toronto) - he is a prominent sports medicine physician infamous for treating athletes and giving them HGH. Don’t know what kind of treatment he would give me. I know he does PRP, but I dont know if he can give HGH anymore since its illegal here in Canada and hes gotten in trouble for that.

Help me:
I am looking for some advice and how to proceed. My chronically tight IT Band, quadriceps, and Hip flexors just dont seem to loosen up! My new physiotherapist has me doing postural work/exercises now. I have been going at it for about 1 month now, it doesnt seem to help. He thinks that bad posture might be contributing. 1 month ago he said give it 3 months, and I should see improvements. (He even said that I can expect to see an 80%, but he doesnt know for sure because I am an unique case, he said I shouldn’t be feeling that much pain since I am not even doing physical activity).[/quote]

This is way, way , way , way , way too complicated.

Let’s start from scratch,

have you done eccentric based exercise as well as done PNF technique stretching multiple times per day of the quad?

Is your pain quad ligament or tendon?

Have you done patellar taping/tried bracing?

What is your daily activity regime/exercise?

Quite banging your head against the wall with these guys, lets get to the basics and go from there.

I would do ACP/PRP 10/10 before doing any of that quack stuff some of these clowns mention.

If your 23 and having “chronic pain” there is something someone is missing, get the MRI and get someone of quality to read it.

3

[quote]BHOLL wrote:

This is way, way , way , way , way too complicated.

Let’s start from scratch,

have you done eccentric based exercise as well as done PNF technique stretching multiple times per day of the quad?

Is your pain quad ligament or tendon?

Have you done patellar taping/tried bracing?

What is your daily activity regime/exercise?

Quite banging your head against the wall with these guys, lets get to the basics and go from there.

I would do ACP/PRP 10/10 before doing any of that quack stuff some of these clowns mention.

If your 23 and having “chronic pain” there is something someone is missing, get the MRI and get someone of quality to read it. [/quote]

Hey BHOLL,

Glancing over some of your other posts, you seem really passionate in helping people heal. I have the same passion, but I feel like I have hit a roadblock with myself that I can’t pass. I know that I am missing something in the puzzle on healing myself. I will try to answer your questions.

1)I do not think I have the eccentric based exercises (maybe I have without realizing it tho). Most of the exercises I have done involved first doing basic exercises such as clam shells, bird dogs, X-band walks, hip thrusts, planks, lying side leg lifts against wall etc…, then I added 90/90 split squat, single leg squats, single leg deadlifts, wobble board balance. This was in order to activate the glute medius, glute max, and then start getting VMO involvement as well as doing more functional exercises. More recently (this past month) I am also doing postural exercises, focusing on keeping an aligned spine while maintaining different positions, and also doing body weight squats with an aligned posture.

I am not familiar with PNF stretching so I do not know if I have done it (maybe I have without realizing it). I will research it and see if it can benefit my situation. I will also ask my physiotherapist if it might have any role with my recovery. I can predict he will say it wont, because hes pretty convinced that any stretching, and myofascial release will only be a temporary solution on me (i.e., not addressing the underlying cause). Hes hard fixed on addressing my posture (even tho he thinks it isn’t to bad, and hes seen people with worse posture that aren’t in pain at all). I do however stretch everyday and foam roll every day, mostly addressing the quads, hip flexors, and IT band (I also address other muscle groups just not as much).

I typically do physiotherapy exercises every 2-3 days now (once upon a time I was really strict and was doing it every 2 days but noticed I wasn’t really getting anything out of them, so I slowed down a little), The exercises last over 1 hour, and I follow it with foam rolling, and stretching, and suction cupping which also lasts over 1 hour. The whole session ends up being between 2-3 hours. I also do postural exercises every day followed by foam rolling (if I dont foam roll after the exercises my muscles will be very tight and be in pain). The postural exercises are about 20 minutes followed by 20 minutes of foam rolling. The physiotherapist told me to do it 4 times a day. But I dont see that as realistic (where am I going to do them in school, and where am I going to find the time since I am already doing so much rehab work. I have done them atleast once a day, and sometimes twice.

The pain is between the femor and patella (right in the patellofemoral joint), more so on the lateral side, and it seems to be more near the proximal aspect of the patella. Its a dull achy pain that is often times difficult to describe and hard to pin point. Almost feels like their is a lot of pressure on that side, and its compressed and cant breath. I don’t think theirs anything wrong with the quad lig/tendon because I have had ultrasound done showing nothing, also many physiotherapist, and OS checked via manual testing. They all seem to think its chondromalacia patella, femoral pain syndrome.

I have tried patella taping, it helps with the pain a little, nothing to dramatic.

I am looking into self injecting a regenerative solution as a possible route (first going to wait to get MRI done). But I feel that still isn’t addressing the underlying issue. Because my IT band is really tight and gets easily aggrevated. So even if I inject PRP their is still something else going on.

I appreciate your help,

4

[quote]xianchixan wrote:

[quote]BHOLL wrote:

This is way, way , way , way , way too complicated.

Let’s start from scratch,

have you done eccentric based exercise as well as done PNF technique stretching multiple times per day of the quad?

Is your pain quad ligament or tendon?

Have you done patellar taping/tried bracing?

What is your daily activity regime/exercise?

Quite banging your head against the wall with these guys, lets get to the basics and go from there.

I would do ACP/PRP 10/10 before doing any of that quack stuff some of these clowns mention.

If your 23 and having “chronic pain” there is something someone is missing, get the MRI and get someone of quality to read it. [/quote]

Hey BHOLL,

Glancing over some of your other posts, you seem really passionate in helping people heal. I have the same passion, but I feel like I have hit a roadblock with myself that I can’t pass. I know that I am missing something in the puzzle on healing myself. I will try to answer your questions.

1)I do not think I have the eccentric based exercises (maybe I have without realizing it tho). Most of the exercises I have done involved first doing basic exercises such as clam shells, bird dogs, X-band walks, hip thrusts, planks, lying side leg lifts against wall etc…, then I added 90/90 split squat, single leg squats, single leg deadlifts, wobble board balance. This was in order to activate the glute medius, glute max, and then start getting VMO involvement as well as doing more functional exercises. More recently (this past month) I am also doing postural exercises, focusing on keeping an aligned spine while maintaining different positions, and also doing body weight squats with an aligned posture.

I am not familiar with PNF stretching so I do not know if I have done it (maybe I have without realizing it). I will research it and see if it can benefit my situation. I will also ask my physiotherapist if it might have any role with my recovery. I can predict he will say it wont, because hes pretty convinced that any stretching, and myofascial release will only be a temporary solution on me (i.e., not addressing the underlying cause). Hes hard fixed on addressing my posture (even tho he thinks it isn’t to bad, and hes seen people with worse posture that aren’t in pain at all). I do however stretch everyday and foam roll every day, mostly addressing the quads, hip flexors, and IT band (I also address other muscle groups just not as much).

I typically do physiotherapy exercises every 2-3 days now (once upon a time I was really strict and was doing it every 2 days but noticed I wasn’t really getting anything out of them, so I slowed down a little), The exercises last over 1 hour, and I follow it with foam rolling, and stretching, and suction cupping which also lasts over 1 hour. The whole session ends up being between 2-3 hours. I also do postural exercises every day followed by foam rolling (if I dont foam roll after the exercises my muscles will be very tight and be in pain). The postural exercises are about 20 minutes followed by 20 minutes of foam rolling. The physiotherapist told me to do it 4 times a day. But I dont see that as realistic (where am I going to do them in school, and where am I going to find the time since I am already doing so much rehab work. I have done them atleast once a day, and sometimes twice.

The pain is between the femor and patella (right in the patellofemoral joint), more so on the lateral side, and it seems to be more near the proximal aspect of the patella. Its a dull achy pain that is often times difficult to describe and hard to pin point. Almost feels like their is a lot of pressure on that side, and its compressed and cant breath. I don’t think theirs anything wrong with the quad lig/tendon because I have had ultrasound done showing nothing, also many physiotherapist, and OS checked via manual testing. They all seem to think its chondromalacia patella, femoral pain syndrome.

I have tried patella taping, it helps with the pain a little, nothing to dramatic.

I am looking into self injecting a regenerative solution as a possible route (first going to wait to get MRI done). But I feel that still isn’t addressing the underlying issue. Because my IT band is really tight and gets easily aggrevated. So even if I inject PRP their is still something else going on.

I appreciate your help,
[/quote]

If it truly is chondromalacia patella, then there isn’t anything you can do to heal that tissue (it is cartilage) that is outside of injection or surgery. ACP/PRP injections I have seen be pretty effective for soft tissue healing, however most of the cases I have seen involved a different diagnosis than yours. Strengthening the quads has been shown to decrease pain but guessing by your length of pain/symptoms it may not be a simple fix. The postural stuff is good but most likely will only prevent further progression and you may get some mild relief from it.

5

In terms of chronic muscle tension/tightness/adhesions. What can be done. It seems I have tried so much things, none of it has worked.

6

ART

Active Release Technic

7

JFG I am guessing you didnt read my initial post. I have tried ART in combination with a bunch of other things with no success.

8

Yes, I did.

The lack of success is not ART (or anything else for that matter), it is the lack of education (this is not a shot at you).

Just like a work out, you need consistency. Going “once or twice” will not work, well, for anybody.

First thing you need is to find someone. Just like any relationship, you need to be able to communicate. Also, your therapist needs to look at the whole of you. I have lost count on how many physiotherapist “tried” to fix my knees by concentrating on my knees. When I found someone that checked me from head to toe (didn’t try to sell me “must needed supplements” or had me on a program before I sat down), things changed. That guy started on my gluteus… But, he also explained, in as much detail as I could take in, what he was doing and why. it also took him 6 months to “fix” my right knee and 9 months for my left knee (I’m old, lots of scar tissue).

This is after probably 3 xrays (over 10 years), exercise programs, and more disciplines (rolfing, physio, osteo, some weird chiro, magnets, acupressure, acupuncture, etc, etc, etc).

You mentioned that massage therapist "feel’ the soft tissue knots. ART will take care of that, if you want to see it thru and you find someone you can work with. If you are in Calgary, I know exactly who you need to see. He actually specializes in cases like yours.

9

Why haven’t you had an exploratory scope done? Has anyone checked the infrapatellar fat pad? With your leg relaxed, press the proximal end of your patella lifting the distal end, then put pressure on the patellar ligament. Pain reproduction would point towards fat pad involvment, and would increase my suspicion of something going on with your patellar cartilage.

I’m thinking the IT band tightness is resulting from the knee pain, not the other way around. Strengthening in your hamstrings and glutes will help the “stabilization” system of your knee, especially considering you played soccer.

I keep things simple with my therapy (at least I try to), joints either need stability or mobility. To me, without assessing mind you, I would lean towards this being an issue of dynamic stability of the knee (like slowing it down during the kicking motion) and the resultant irritation of anterior knee structures, and the compensations that follow. Definitely inquire about an exploratory scope to rule out chondromalacia patellae.

10

I will get an MRI done before I consider a scope. Scope seems to invasive for me at this point. MRI should suffice for showing cartilage damage.

I have also been following mobility wod and kelly stars advice/philosophy in the last weeks. It has helped with muscle tightness and knee pain but only mildy. It is frustrating that the progress is so slow, but it also gave me some hope that If i stick to it for a longer period of time I might be able progress even more. Haven’t tried voodoo band squats yet, but heard good things about this.

Im pretty sure the infrapatella fat pad has been checked by orthopod and other therapists. The pain doesnt seem to be coming from that area. its more in the proximal part of the patella. Symptoms point towards chondromalacia patella.

11

JFG I have been getting ART done for some time now. Its over rated and not as effective as some people say it is. Maybe it works for simple cases, and easier problems. But for complex issues i would put it on the lower end of the modalities I have tried. Glad it helped you in your complex problem (you might be the exception). I am surprised that it seemed to be more effective than all those other modalities that you have tried. I keep hearing rolfing is better than ART.

Heres the order of things I found most effective more soft tissue work and muscle tightness/tension/knots:

Electrically stimulated trigger point dry needling (electroaccupuncture) >> suction cupping self myofascial work > ART > Rumble roller/lacross ball/EZ bar self-myofascial work > massage therapy > stretching (2 mins, PNF, contract and relax) > PVC pipe >accupuncture > foam roller > stretching

I have yet to try rolfing

I am looking at buying my own electro accupuncture machine because this modality seemed to be the must effective to me. The physiotherapy however charges 40$ for 1 session and they only target 2 muscles (1 on each leg, or 2 on the same leg). They also arent aggresive enough, i.e., they dont put the needles deep enough or the intensity high enough for maximal effect. Everytime I ask to turn up the intensity they turn it up by just a little. I can also do it twice a week and target multiple muscle groups.

I have heard very good promise with voodoo band work as well. I am looking into buying some voodoo bands.

I will update on the effectiveness of these modalities.

12

OP,

I have a few questions, which may or may not be relevant.

  1. You stated the issue started six years ago when playing soccer. Was there a specific trauma you recall or did it gradually creep up?

  2. Beside the obvious goal of reducing the pain, what (if any) goals do you have strength and conditioning related? For example, do you want to play soccer again? Or take up another sport (and, if so, what would that be)?

  3. What is your education background and what is your current profession?

The third question may seem neither here nor there; however, if you choose to answer the first two, I’d appreciate your answering this as well.

13

Hi,

Do this breathing, learn to run tension through your body. Stop. Just do it. Try the VooDoo bands. You may be holding onto trauma. Try this.

Also, lower IT band, roll out with steel rod. Self explanatory, try a screw driver rolled into the side of the leg. Get a yoga strap, pull leg across body. Pull let to outside of body, tendons could be tight.

Please note that I read your post and did not memorize. I am not here for debate only help.

Thanks,

B

14

Finally got a pair of voodoo bands. Today I tried voodoo flossing my quadriceps while performing squats and calves whiles performing calve raises. So far no difference in my muscle tension/adhesions and tight quadcriceps and IT band. It didn’t even help temporarily. It was only 1 try so far, so I didn’t really expect a miracle. I will continue doing it at least 2 times a day and update my progress. Maybe I have to wrap it tighter? It felt like the bands were at 75% full tension.

15

[quote]xianchixan wrote:
Finally got a pair of voodoo bands. Today I tried voodoo flossing my quadriceps while performing squats and calves whiles performing calve raises. So far no difference in my muscle tension/adhesions and tight quadcriceps and IT band. It didn’t even help temporarily. It was only 1 try so far, so I didn’t really expect a miracle. I will continue doing it at least 2 times a day and update my progress. Maybe I have to wrap it tighter? It felt like the bands were at 75% full tension.[/quote]

Do yourself a favor and keep the receipt. Or at least keep them in good condition for a re-sell.

I’m not stating these bands don’t serve a purpose. I am stating that I doubt very much they will help you.

16

[quote]56x11 wrote:
OP,

I have a few questions, which may or may not be relevant.

  1. You stated the issue started six years ago when playing soccer. Was there a specific trauma you recall or did it gradually creep up?

  2. Beside the obvious goal of reducing the pain, what (if any) goals do you have strength and conditioning related? For example, do you want to play soccer again? Or take up another sport (and, if so, what would that be)?

  3. What is your education background and what is your current profession?

The third question may seem neither here nor there; however, if you choose to answer the first two, I’d appreciate your answering this as well. [/quote]

  1. The injury gradually creeped up, their was period of time were my knee was very swollen about 7 years ago. Dont know if this might be related. But once the swelling subsided, I continued to overwork myself in soccer and wrestling. Then the classicaly symptoms of patella femoral pain syndrome starting appearing. Tight IT bands and quadriceps, and anterior knee pain. I went to physio but continued to play sports heavily. The physio initially helped but then I started getting worse as I changed physio places when I moved to a new city. I stopped going to physio all together and the symptoms got worse over the years. It was at its worse 2 years ago. Since than their has been minor improvements through massive amounts of physio, and self-myofascial release.

  2. I would like to not constantly think about my knee and tight muscles. It restricts me from doing many recreational activities including sports. I would also like to go to the gym once I recover. The rehab process has been taking away all my time during my day, I have no time for other activities. I would like to travel but I am hesitant because It won’t even be a good time with my muscles all tight and the knee pain, and it takes away time from my rehab process. 2 weeks gone, and my progress goes to shits and back tracks. I don’t want to feel like a disabled 60+ year old man at such a young age. Even after having just having sex during certain positions really hurts and tightens my quads and IT bands. Its hard for me to clean the house without pain. Daily activities have become a chore.

3)I am a student at a university studying medical science as an undergrad, now I am doing a masters in biomedical engineering. This requires a lot of sitting which obviously isn’t helping my situation. I find it frustrating that my peers can sit for hours at end without having the same issues as me. Since I have started my Masters I will be doing somewhat less sitting as I am in a lab. But their is still material I must study for hours on end.

17

[quote]xianchixan wrote:

[quote]56x11 wrote:
OP,

I have a few questions, which may or may not be relevant.

  1. You stated the issue started six years ago when playing soccer. Was there a specific trauma you recall or did it gradually creep up?

  2. Beside the obvious goal of reducing the pain, what (if any) goals do you have strength and conditioning related? For example, do you want to play soccer again? Or take up another sport (and, if so, what would that be)?

  3. What is your education background and what is your current profession?

The third question may seem neither here nor there; however, if you choose to answer the first two, I’d appreciate your answering this as well. [/quote]

  1. The injury gradually creeped up, their was period of time were my knee was very swollen about 7 years ago. Dont know if this might be related. But once the swelling subsided, I continued to overwork myself in soccer and wrestling. Then the classicaly symptoms of patella femoral pain syndrome starting appearing. Tight IT bands and quadriceps, and anterior knee pain. I went to physio but continued to play sports heavily. The physio initially helped but then I started getting worse as I changed physio places when I moved to a new city. I stopped going to physio all together and the symptoms got worse over the years. It was at its worse 2 years ago. Since than their has been minor improvements through massive amounts of physio, and self-myofascial release.

  2. I would like to not constantly think about my knee and tight muscles. It restricts me from doing many recreational activities including sports. I would also like to go to the gym once I recover. The rehab process has been taking away all my time during my day, I have no time for other activities. I would like to travel but I am hesitant because It won’t even be a good time with my muscles all tight and the knee pain, and it takes away time from my rehab process. 2 weeks gone, and my progress goes to shits and back tracks. I don’t want to feel like a disabled 60+ year old man at such a young age. Even after having just having sex during certain positions really hurts and tightens my quads and IT bands. Its hard for me to clean the house without pain. Daily activities have become a chore.

3)I am a student at a university studying medical science as an undergrad, now I am doing a masters in biomedical engineering. This requires a lot of sitting which obviously isn’t helping my situation. I find it frustrating that my peers can sit for hours at end without having the same issues as me. Since I have started my Masters I will be doing somewhat less sitting as I am in a lab. But their is still material I must study for hours on end.
[/quote]

As I suspected, you’re a science/research guy. The reason why I asked you to provide your
education and profession is that, in my experience, this can influence how one attempts
to resolve problems.

Your background is a strength in that you have solid analytical and research skills.
However, it’s also a weakness in that good old fashion common sense becomes less and less
common.

This weakness, I feel, is reflected by some of the more exotic protocols you suggested.

For example, you said you’re considering botox. Regardless of the studies you may have
read, this is questionable at best. Any S/C Coach worth a damn knows there are simpler
methods of teaching people to activate the VMO. It borders on the absurd to suggest that
someone injects botox into a nearby muscle, the VL in your case, to shut it down for
three months. Three months?! This opens up a Pandora’s box of many other potential issues
down the road.

A far less exotic - yet something that may warrant reconsideration - is the heel wedge
for your shorter leg. You mentioned the 1.1 cm leg length discrepancy and the .5 cm wedge
you were advised to wear. Did you ask why the lift is less than half the length of the
discrepancy itself? Regardless of the reason given, did you consider trying a different
size? Perhaps this could alleviate some of the alignment issues. This may be a case of
Occam’s razor or it may make neglible difference. It is definitely a less invasive method
than the botox.

You also need to ask yourself if there isn’t some part of you that actually enjoys the
current predicament you’re in. You mentioned how the medical professionals see you
as a “unique case.” Could it be that you, in some manner, relish this? Only you know the
answer. And I wouldn’t be surprised if you’re insulted. Keep in mind that I’m not here to
win a popularity contest. If there is any validity to this theory, nothing you try will
give long-lasting results for the simple and undeniable reason that you consciously or
subconsciously don’t want it to.

If, however, you genuinely want to improve your situation, here’s my suggestion.
Keep working with and communicating with your medical professionals. At the same time,
continue to evaluate the level of their performance. Do they pass the gut test? In other
words, do you have that queasy feeling in your gut that there are better options out
there? If so, trust it.

Be tactful yet vigilant when you’re with them. It’s a fine line. If they’re less than
first rate in their approach, you owe it to yourself to move on. However, you do NOT want
to develop the reputation as an argumentative patient because this can taint how future
caregivers perceive you.

While you’re doing this, go to the gym and start training around the issue (remember to
keep the medical staff in the loop).

The key word is: TRAINING. With the exception of the knee, you need to start viewing
yourself as an athlete that still has untapped potential.

Right now, you’re so hyper-fixated on correcting this that you’re missing out on
potentially rewarding things that an intelligent and consistent exercise program can
provide.

With enough research (this is where your academic background will help) and the right coaching you should not have any problems implementing an intelligent program that allows you to make progress in how you look, perform, and feel - without aggravating the knee in question.

And I’m aware of some of the things you’re doing such as clamshells - which is a fine
exercise that I often program depending on the individual. However, I suspect you’re approaching
your current routine in terms a patient trying to fix his knee and not an athlete trying
to improve overall. This is an important distinction you must understand.

I’ll say it again: you’re approaching your current routine in terms a patient trying to
fix his knee and not an athlete trying to improve.

You’ve noticed I used the word “intelligent” twice. Be smart about how you do things in
the gym. For now, I strongly recommend: a rep range NO LOWER than eight (always leave 2
or more good solid reps left in the tank each set); controlled eccentrics (anywhere from 2-5
seconds); perfect form (do not grind out ugly reps); a mix of unilateral and bilateral
movements; dumb bells, cables, body weight, and bands should be given priority.

At this point, your primary focus should be strengthening the weak links along the
kinetic chain. Remember: ever since the injury, your body has compensated in the way it
moves. For example, your proprioception needs work; you also have overactive and underactive muscles. If you incorporate my earlier advice, you will make subtle and gradual discoveries
which will address these deficiencies. Again, this is where your analytical skills will help in the research, the execution, and monitor/adjustments of the program you adopt.

At a MUCH later time, you can introduce incorporating protocols such as the stretch
reflex and compensatory acceleration. But NOT NOW.

And if you choose to wholeheartedly take this path, an interesting phenomenon just might
take place: your perception will change for the better. The filters through which you
view yourself, others, the information you give and receive will be greatly enhanced. And
little by little, the clues you’ve been seeking just may become more apparent.
For example, you just might recall a piece of advice that someone gave in the past and
you’ll see this in a new (and possibly beneficial) light. You may also achieve more
clarity on what to add and what to remove. And with each discovery, you’ll be just that
much closer to what you’re looking for.

18

[quote]56x11 wrote:

As I suspected, you’re a science/research guy. The reason why I asked you to provide your
education and profession is that, in my experience, this can influence how one attempts
to resolve problems.

Your background is a strength in that you have solid analytical and research skills.
However, it’s also a weakness in that good old fashion common sense becomes less and less
common.

This weakness, I feel, is reflected by some of the more exotic protocols you suggested.

For example, you said you’re considering botox. Regardless of the studies you may have
read, this is questionable at best. Any S/C Coach worth a damn knows there are simpler
methods of teaching people to activate the VMO. It borders on the absurd to suggest that
someone injects botox into a nearby muscle, the VL in your case, to shut it down for
three months. Three months?! This opens up a Pandora’s box of many other potential issues
down the road.

[/quote]

This may seem exotic but I feel I tried almost every other treatment option under the sun except for surgery. This is a less invasive and a higher efficacy treatment. Their are about 3 or so publish research studies on the internet showing good results in using botox treatment in the vastus lateralis for refractory anterior knee pain. I would not think about this if other treatments have worked. It is only natural to think outside the box when you have tried everything inside the box. I agree this “might” lead to potential issues, however studies showed no side effects after 3 year follow ups… It doesn’t fully shut down the muscle, their is still some activity during the 3 month period the botox is in effect.

I will still try some other approaches before going down the botox road. Right now I am trying to avoid sitting for long periods of time, I am starting to stand for a good proportion of my day. I have also added voodoo band squats to my regime at least twice a day. I feel the voodoo band flossing helps loosen the leg muscles pretty effectively just from over 1 week of use. It seemed to be almost magical, but then I the tightens recently has came back due to a period of mandatory long sitting session (2 days of all day sitting), missing some of my self-myofascial and mobility work routine during the 2 days, and dancing at an event. Its very frustrating.

19

[quote]56x11 wrote:

Do yourself a favor and keep the receipt. Or at least keep them in good condition for a re-sell.

I’m not stating these bands don’t serve a purpose. I am stating that I doubt very much they will help you.

[/quote]

56X11 why dont you think the voodoo bands will help? They seem to due a better job than the rumble roller at relaxing my tense muscles.

20

[quote]56x11 wrote:

You also need to ask yourself if there isn’t some part of you that actually enjoys the
current predicament you’re in. You mentioned how the medical professionals see you
as a “unique case.” Could it be that you, in some manner, relish this? Only you know the
answer. And I wouldn’t be surprised if you’re insulted. Keep in mind that I’m not here to
win a popularity contest. If there is any validity to this theory, nothing you try will
give long-lasting results for the simple and undeniable reason that you consciously or
subconsciously don’t want it to.

[/quote]

I dont know what kind of crazy people you have helped, but I aint one. I do not enjoy the situation I am in at all. It is ruining my life in many ways. I wrote that previous therapist/doctors etc… say im a “unique case” in order to let people know that the typical conventional therapies have failed, and no one knows what to do next. So offering advice like foam roll, strengthen VMO, glute medius etc… is of no use to me. TRUST ME WHEN I SAY THIS IS NOT A SITUATION I WANT TO BE IN.