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

Bigger Stronger Leaner Injuries and Rehab
21

OP,

I suggest you re-read my post on 1-13. Don’t do it now but in a few weeks or even several months down the road.

If you scoff at the thought that you might consider revisiting this thread in April or May (or even later), know this: Your current approach and mindset has convinced me that you’ll still be at square one. Perhaps then, you may be more receptive to any suggestions that you find challenging or even confrontational.

That’s it from me. I’ve unsubscribed to this thread. I wish you the best of luck. And don’t forget that, to some extent, we each create our own luck, good and bad.

22

[quote]xianchixan wrote:

[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.
[/quote]

Next step MRI results, try grastoning the area

23

[quote]BHOLL wrote:

[quote]xianchixan wrote:

[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.
[/quote]

Next step MRI results, try grastoning the area[/quote]

For this particular OP, grastoning will most likely yield the same lackluster results. If you want to chase windmills, be my guest.

Now, as stated in my earlier post, I really am exiting this thread.

24

[quote]BHOLL wrote:

Next step MRI results, try grastoning the area[/quote]

I will be getting my MRI results back this Wednesday. I will report on it once I get them.

Grastoning is an option that I have thought of trying, but also thought to myself how would it be different than ART, and all the other self-myofascial work I have been getting. It is still something I might consider, right now I am using to much different modalities and paying to much therapists to go that route. I don’t expect to much from it however just from my previous history of having things like that fail. It is not to much different from ART.

I have also ordered an electroaccupuncture machine and I am planning on giving myself electrically stimulated trigger point dry needling once it comes in. I hope that the combination of:

  1. electrically stimulated trigger point dry needling
  2. Voodoo band squats 2-3x a day
  3. Mobility work 2x a day (Rumble roller, stretching, lacross ball)
  4. Continuing Working out glute medius, VMO, and core (atleast 2x a week)
  5. Avoid/minimize sitting
  6. No aggravating activities
  7. Continue seeing osteopath for manipulations: helps with pelvic alignment and posture

will solve my case.

25

Got my MRI results, and went over them with the primary care sports medicine physician.

Findings:

"1) No cartilage damage
2) meniscus, ligaments, tendons all normal
3) Fluid: Soft tissue lesion at the proximal tibiofibular joint: might be a ganglion cyst or a soft tissue hemangioma.

Fluid: A loculated lubulated serpiginous high T2 signal focus is present in close proximity to the proximal medial tibial fibular joint, the inferior aspect incompletely included in the scanning range. The visualized portion of the soft tissue abnormality measures 2.9 x 1.2 x 0.5 cm sagitatal, AP and transverse respectively. On the 3-S series, questionable subtle fluid-fluid levels are present within a few of the locules.

Impression:
No major internal derangment

Soft tissue lesion possibly arising from the proximal tibiofibular joint, incompletely included in the scanning range, of uncertain clinical significance. The finding may represent a proximal tibiofibular ganglion cyst. A soft tissue hemangioma is included in the differential diagnosis. An ultrasound is suggested to delineate the full extent of the pathology."

I am not feeling pain in the proximal tibio fibular joint, so I dont think this is related to my anterior knee pain (pain that appears to be between the patella and femor slightly laterally and proximally). She mentioned the cyst might be due to the prolozone injections I got. Maybe its compressing the peroneal nerve? The doctor says I have patella femoral Pain syndrome, and to keep strengthening my core, VMO, glute medius.

Whats everyones thoughts on this?

26

Started electroaccupuncture on myself yesterday on my quadriceps for 15 minutes each leg. I Feel some benefits in terms of muscle tension already. Agonizing dull anterior knee pain behind the knee cap still persists along with crepitus. Knee pain worse during knee flexion (sitting etc…). Patella feels compressed along the femur close to the distal quadricep ligament but on the lateral aspect.

Symptoms similar to chondromalacia patella, but MRI and X-ray ruled out any cartilage damage. Sports medicine physician pretty much conclude I have patella femoral pain syndrome. Which is weird because it feels like their is more going below my knee cap. I remember when I first got patella femoral pain syndrome a few years ago, the pain was much different.

The pain is much worse now than a few years ago, and it feels different… The right Knee cap (knee that hurts) even looks more compressed (especially laterally) than than the left knee cap visually, doctors and therapists dont ever notice this when examining the knee. X-ray did not show any significant tracking or alignment issues, just a slight patella tilt.

27

There’s really no way of answering this without personally doing an exam, but I would like to remind you that your knee pain is a symptom. Working the knee and surrounding muscles hasn’t been working so I don’t personally think that using different modalities is going to help since most soft tissue work operates under similar mechanisms. Before throwing more money at home rehab equipment I would go somewhere to get gait and respiration assessed. Respiration is vital to spinal stability and a prerequisite to postural reeducation. Your “tight” muscles may not be relaxing because your brain needs them to be tight to assist in stabilizing the spine. Respiratory dysfunction can also cause increased perception of pain by changing the pH of your blood. Just some food for thought.

I would also strongly suggest that you stop needling yourself, especially if you’re doing it often. I see little therapeutic benefit to reintroducing the inflammatory process to a muscle group.

If you haven’t already, fix up the diet by identifying and removing any pro-inflammatory foods.

28

[quote]CroatianRage wrote:
There’s really no way of answering this without personally doing an exam, but I would like to remind you that your knee pain is a symptom. Working the knee and surrounding muscles hasn’t been working so I don’t personally think that using different modalities is going to help since most soft tissue work operates under similar mechanisms. Before throwing more money at home rehab equipment I would go somewhere to get gait and respiration assessed. Respiration is vital to spinal stability and a prerequisite to postural reeducation. Your “tight” muscles may not be relaxing because your brain needs them to be tight to assist in stabilizing the spine. Respiratory dysfunction can also cause increased perception of pain by changing the pH of your blood. Just some food for thought.

I would also strongly suggest that you stop needling yourself, especially if you’re doing it often. I see little therapeutic benefit to reintroducing the inflammatory process to a muscle group.

If you haven’t already, fix up the diet by identifying and removing any pro-inflammatory foods.[/quote]

Just a question, what is background knowledge?

Gait was already assessed, everything was relatively normal, chiropodist only mentioned that I have tight calves, and lordosis and kyphosis (anterior pelvic tilt) which I already knew.

I will keep the respiration in the back of my head and will do some more research on that as a contributing factor, for some reason I doubt its playing a role. Respiratory problems wouldnt explain why I only have tight muscles in my lower extremity, mostly my quads and IT band are the problematic areas in terms of being so tight that their painful and when you try to poke it their hard as rock with lots of adhesions felt.

The electrical stimulate trigger point dry needling has been the most effective modality I have tried in terms of relieving muscle tension and adhesions. If anything it reduces the inflammation associated with fibrotic tissue. Their are numerous studies showing it reduces scar tissue formation, fibrosis etc… I have only administered it to myself once, and I plan on continuing perhaps twice a week. In the past I received it from a physiotherapist but it was only every 2 weeks because of the price, travel, and time, plus they were not aggresive enough with the intensity and depth of the needles. The few times they would put it in deeper by accident or a stronger intensity I would get much better results. Thats why I have started doing it myself.

I am already eating a highly anti-inflammatory diet. I do not eat much if any gluten, or omega-6. Supplementing with high dose fish-oil for 3 months did not seem to help any symptoms

29

I am a chiro. How can you tell me on one hand that you only have tight muscles in the lower extremity and then go on and say you have an exaggerated kyphosis? Your motor patterns are screwed up and your brain is using prime movers as stabilizers. Reestablishing motor patterns starts with core stability which can’t be established with dysfunctional respiration. Like I said before, your knee pain is a symptom. Your tight muscles are a symptom. You’re placing too much emphasis on your symptoms and not enough on your problems. Find an FMS/SFMA doc or someone who will look at you without putting tunnel vision on your knee. I anticipate you have several months of rehab in front of you and my guess is very little of it will involve the knee.

Your other option would be to rely on needling and electricity for temporary relief until the problem inevitably gets worse.

30

[quote]xianchixan wrote:

[quote]BHOLL wrote:

Next step MRI results, try grastoning the area[/quote]

I will be getting my MRI results back this Wednesday. I will report on it once I get them.

Grastoning is an option that I have thought of trying, but also thought to myself how would it be different than ART, and all the other self-myofascial work I have been getting. It is still something I might consider, right now I am using to much different modalities and paying to much therapists to go that route. I don’t expect to much from it however just from my previous history of having things like that fail. It is not to much different from ART.

I have also ordered an electroaccupuncture machine and I am planning on giving myself electrically stimulated trigger point dry needling once it comes in. I hope that the combination of:

  1. electrically stimulated trigger point dry needling
  2. Voodoo band squats 2-3x a day
  3. Mobility work 2x a day (Rumble roller, stretching, lacross ball)
  4. Continuing Working out glute medius, VMO, and core (atleast 2x a week)
  5. Avoid/minimize sitting
  6. No aggravating activities
  7. Continue seeing osteopath for manipulations: helps with pelvic alignment and posture

will solve my case.[/quote]

Its different in that its free

31

[quote]BHOLL wrote:

[quote]xianchixan wrote:

[quote]BHOLL wrote:

Next step MRI results, try grastoning the area[/quote]

I will be getting my MRI results back this Wednesday. I will report on it once I get them.

Grastoning is an option that I have thought of trying, but also thought to myself how would it be different than ART, and all the other self-myofascial work I have been getting. It is still something I might consider, right now I am using to much different modalities and paying to much therapists to go that route. I don’t expect to much from it however just from my previous history of having things like that fail. It is not to much different from ART.

I have also ordered an electroaccupuncture machine and I am planning on giving myself electrically stimulated trigger point dry needling once it comes in. I hope that the combination of:

  1. electrically stimulated trigger point dry needling
  2. Voodoo band squats 2-3x a day
  3. Mobility work 2x a day (Rumble roller, stretching, lacross ball)
  4. Continuing Working out glute medius, VMO, and core (atleast 2x a week)
  5. Avoid/minimize sitting
  6. No aggravating activities
  7. Continue seeing osteopath for manipulations: helps with pelvic alignment and posture

will solve my case.[/quote]

Its different in that its free
[/quote]

So your suggesting to buy the equipment used for grastoning and do it on myself?

32

[quote]CroatianRage wrote:
I am a chiro. How can you tell me on one hand that you only have tight muscles in the lower extremity and then go on and say you have an exaggerated kyphosis? Your motor patterns are screwed up and your brain is using prime movers as stabilizers. Reestablishing motor patterns starts with core stability which can’t be established with dysfunctional respiration. Like I said before, your knee pain is a symptom. Your tight muscles are a symptom. You’re placing too much emphasis on your symptoms and not enough on your problems. Find an FMS/SFMA doc or someone who will look at you without putting tunnel vision on your knee. I anticipate you have several months of rehab in front of you and my guess is very little of it will involve the knee.

Your other option would be to rely on needling and electricity for temporary relief until the problem inevitably gets worse.[/quote]

Its good to know you are qualified to give some legitimate information. I will take your advice seriously.

When I say I have tight muscles in IT band and quads. I mean they arent just slightly tight. They are extremely tight, and painful, so much so that therapist have said thats the tightest IT band they have ever seen (it has improved dramatically since doing a vigorous therapy routine for a few months now). The other areas specifically upper extremity isn’t that bad. Its not any different from other people with kyphosis or lordosis who dont have any knee pain. Some people even have much worse kyphosis and have no symptoms. Besides a large kyphosis and lordosis translates to lower back pain which I do not present.

I have already seen someone SFMA/FMS certified therapist. I dont think they are any doctors who have the certification so I dont know what you mean when you wrote “find a SMFA/FMA doc”. I am assuming that was a typo. Anyways the therapist said that the tests were pretty much inconclusive and they couldnt find anything wrong with me to suggest my symptoms. He did find what he says is a lot of “junk” in my right hip (my right knee is the one that hurts). He also noticed my right pelvis is shifted anterioraly (pelvis misalignment). I went to an osteopath and she also noticed that my right pelvis is shifted anteriorally. I have been going to see her a numerous times already for lumbopelvis adjustments to help with re-alignment. I don’t know if this is even related to my knee pain symptoms but it might be playing a role. I am aware that if the right pelvis is shifted anteriorally then the right knee will tend to go into valgus. However when expecting my valgus visually, both knees seem pretty good in that their isn’t any noticeable valgus even during movements.

I still doubt I have dysfunctional respiration. Why is it only my right knee that hurts than? How come I dont have any symtoms of dysfunctional respiration? Plus I dont breath rapidly or anything, I am fairly calm, and even meditate. Supposed I do have dysfunctional respiration, what can even be done to fix that?

33

SFMA is reserved for those with special training (DPTs and DCs) so that’s why I used “doc.”

There’s no telling why some people can have bad posture and be fine while others it can compound into chronic pain. I have a friend who I have no idea how he doesn’t buckle his spine every time he squats, but he somehow doesn’t (most likely will eventually, though). My suggestion is that someone your age in your conditioning shouldn’t have chronic tightness unless there is an underlying compensation.

Respiration is the first thing I would assess at this point since you’ve seemingly had everything else looked at and worked on. Abdomen filling, lateral rib expansion, and no vertical upper thorax movement is a good place to start.

The hips could very well be your culprit. An anterior-superior pelvis can result in a functional short leg on the opposite side, which leg was short? Buuuuuut, then we run back into the issue of what is causing the hip stuff?

34

I know my case is different, but I will share with you my situation. I had hip pain that started 3.5yrs ago. After a year, my IT band was extremely tight. There pain up and down the IT band with a pain in my right knee and down the front of the calf. I have not slept on my right side for over 3 years and was awoken every night when I rolled over on it.

I spent 2 years doing PT, ART,chiro., etc… I did cortisone injeciton that did nothing. I also, did 2 different PRP injections in the hip to no avail. I just had arthoscopic hip surgery 2 weeks ago, where they scraped my femor and cam, repaired a slightly torn cartilage, cleaned out some inflation in and around the joint. It is really early on, but I can say, my IT band tightness, pain in my quad and knee are now gone. I will update you on my progress…

35

[quote]ATLRGC wrote:
I know my case is different, but I will share with you my situation. I had hip pain that started 3.5yrs ago. After a year, my IT band was extremely tight. There pain up and down the IT band with a pain in my right knee and down the front of the calf. I have not slept on my right side for over 3 years and was awoken every night when I rolled over on it.

I spent 2 years doing PT, ART,chiro., etc… I did cortisone injeciton that did nothing. I also, did 2 different PRP injections in the hip to no avail. I just had arthoscopic hip surgery 2 weeks ago, where they scraped my femor and cam, repaired a slightly torn cartilage, cleaned out some inflation in and around the joint. It is really early on, but I can say, my IT band tightness, pain in my quad and knee are now gone. I will update you on my progress… [/quote]

Good to know, I’ve been struggling with ITBs pain for 10+ years. I hope the surgery works out for you. Keep us posted.

36

[quote]CroatianRage wrote:
SFMA is reserved for those with special training (DPTs and DCs) so that’s why I used “doc.”

There’s no telling why some people can have bad posture and be fine while others it can compound into chronic pain. I have a friend who I have no idea how he doesn’t buckle his spine every time he squats, but he somehow doesn’t (most likely will eventually, though). My suggestion is that someone your age in your conditioning shouldn’t have chronic tightness unless there is an underlying compensation.

Respiration is the first thing I would assess at this point since you’ve seemingly had everything else looked at and worked on. Abdomen filling, lateral rib expansion, and no vertical upper thorax movement is a good place to start.

The hips could very well be your culprit. An anterior-superior pelvis can result in a functional short leg on the opposite side, which leg was short? Buuuuuut, then we run back into the issue of what is causing the hip stuff?[/quote]

The right leg (leg with knee pain) is short (confirmed on x-ray). Which is weird because most literature I search shows that the longer leg will have a more tense IT band, and also more knee pain. My right leg is shorter by 1.1 cm. I dont know if I should wear a heel wedge or not.

Some people who dont recommend a heel wedge: A clinical biomechanic who does research at my university and is highly involved in gait and foot mechanics says 1.1 cm difference doesnt need a heel wedge. Also, soc-doc doesnt recommend it (hes highly regarded in this field), and some other online sources and therapists dont recommend it.
Some people who recommend a heel wedge: However, a PM&R physician with a chiropractor who work together both recommended one. Also, a visit to a new osteopath today who is experienced and did her thesis on leg length discrepency recommends a heel wedge.

I had an argument with the osteopath today saying that I have been told not to were a heel wedge and that 1.1 cm isn’t significant enough, and that about 50% of the population has atleast a 0.5cm leg length discrepency. She thinks its playing a role in my injury and that her osteopathic treatments will not help if I dont use a heel wedge.

37

My plan:

Keep up with my routine right now while I get the following things below done:

  1. 3-D gait analysis and pedorthist - Get another opinion on whether or not my leg length discrepancy requires a heel wedge - going to make an appointment with Solescience (Colin Dombroski one of the field leaders on leg length discrepancy and only Canadian certified pedorthist with a Phd in rehab science, and owner of solescience) and get a 3-d video gait analysis.

  2. EMG and PM&R sports med physician - Get an appointment with a PM&R (physiatrist) physician specializing in sports medicine - ask him whether or not my leg length discrepancy requires heel wedge. Ask for EMG to be done to firing ratio of the VMO with the VL and to check the timing of muscle firing to see if the VL is firing before the VMO. Also, if possible check the firing of other muscles such as gluteus max, glute medius, hamstrings. Also, I will ask his opinion on botox injection for PFPS. This information will help me decide whether or not I should get botox and heel wedge. Will also ask for help in my case in general and his opinion on my proximal tibiofibular ganglion cyst, doing ectroaccupuncture and if he knows anyone else that might be able to help.

  3. MRI - Get another MRI for my proximal tibiofibular joint to fully elucidate whether or not their is a ganlgion cyst their or if their is any differential diagnosis and if this is related to my knee pain.

  4. Osteopath - Keep seeing my current experienced osteopath once every 2 weeks

  5. Physiotherapist - I found a highly regarded physiotherapy in my area named Rob Werstine whose past president of the Canadian Physiotherapy Association (CPA) which meant he was part of a board of 8 members representing all physiotherapist across Canada, and he past chair of National Orthopedic Division. He also an adjunct professor teaching physiotherapy. → I am thinking of making an appointment with him as well to get his input on my case. Would like to get the 3-D gait analysis and EMG done first and go to him with that information.

38

Update:

  1. 3-D gait analysis and pedorthist: I went to solescience for an assessment with Colin Dombroski (a field leader in leg length discrepancies in Canada). He said he recommends a full foot lift of 0.5cm for my 1.1cm discrepancy. He says even small discrepancies might cause problems. In the research hes doing hes seeing that small discrepancies can throw off gait, and kinematics. He was also saying that in the orthopedic literature they say 2cm is the cut of for treatment because they are biased. Must hip surgeries cause a leg length discrepancy below 2 cm, so the clinicians want to keep the performing surgeries so they say 2cm is the cut off. He said having a discrepencie is like I am constantly stepping in a divot loading the joint more. Overall tho he analysed my gait visually and said it looks pretty good even with someone with a discrepancy or injury. I showed him my previous heel wedge and he says it wasn’t helping help me because it was to small. He says although the back is cut to 0.5cm your supposed to measure from the middle of the wedge and it looks to be about 0.3mm only. Plus the wedge lifts only the back of my heel causing my pelvis to shift forward. Full leg lifts is definitely what he recommends. The 3-D gait analysis is scheduled for 1 month. He will test my gait prior to the leg lift, then he will also make me a few full length foot lifts that I can take. He will then do another 3-D gait analysis a few months after (I think he said 1-2 moths) to see the changes. Hes mostly focusing on the pelvis and knee kinematics.

FMS (Functional Muscle Screening) Results: So although someone did the FMS testing back in October. I asked for the results via email a few days ago and I got them back:

Here are Tommy’s assessment results - it’s nothing groundbreaking but it’s good to have all the info you can:

Dave, here is the assessment Report

Moves extremely well in patterned motions. Far better than expected, almost flawless

Standard Squat- Pass
Heels Up Squat- Pass, but still with knee soreness
Overhead Squat- Pass

All done with full range and excellent posture

Ankle Flexion- Excellent. Even and large range.

Single Leg Strength- Full easy pistol on both sides with good posture

Glute activation- a little unstable, but activation in extension/abduction is obvious

Hamstring Mobility- Very good, although lots of quad cramping with quad activation

Anterior Hip- The only place I found obvious issue. Both anterior hips (deep) were tight, and in knee flexion there was obvious internal rotation to compensate. Right side is worse than left.

Did a Klatt’s test but it didn’t show anything obvious.

My conclusion

Very strong, very mobile- not your obvious issues you associate with knee pain

However, I am assuming that in deep squatting and knee flexion the tight anterior hip is forcing internal rotation. Not with an obvious collapse at the knee but deep inside right in the hip capsule. If this is indeed the case his knee caps will be shifting and not gliding correctly- leading to knee pain. It also fits with his symptoms

Right knee pain constantly, left knee pain when squatting

Right is worse than left, but both increase in soreness with flexion

Go over this with him and let me know what your thoughts are after session 1.

I would say with some good smashing and band capsule stretching this should clear up over time.

–
Tommy Caldwell

39

What I feel is causing/contributing to my issues. (although I am likely missing things as I have not been able to heal from this injury)

  1. Overactive/dominant/tight quads - slightly pulling the patella up and laterally, also contributing to anterior pelvic tilt.
  2. Overactive/dominant/tight hip flexors - inhibiting the glutes, contributing to tightness in IT band and lateral pull on patella. They were being overactive by prolonged sitting among other things. Also contributing to internal rotation of my femur during knee flexion without an obvious valgus.
  3. Weak/inhibited Glutes - at least relative to my other muscle groups, they were being inhibited by prolonged sitting. Also, hard to activate/strengthen them if hip flexors were overactive. Can’t get full hip extension for full glute activation unless hip flexors loosen up. Also contributing to anterior pelvic tilt and internal rotation of femur during knee flexion. Also hamstrings would preferentially activate during glute activation exercises as I noticed my hamstrings would fatigue during hip thrusts/glute bridges.
  4. Tight IT band - I have no idea why it gets triggered to become tight so easily. My overactive hip flexors and weaker glutes are most definitely contributing to this problem. Perhaps my leg length discrepancy is also playing some role causing my right pelvis to shift forward and somehow leading to excess IT band tightness and knee pain… this is purely speculative,
  5. Anatomical Leg length discrepancy - might be playing some role in my slow recovery from this injury. My right leg is shorter by 1.1 cm which is causing my right pelvis to shift forward. How is this causing or contributing to my tight IT band and patella femoral pain I have no idea.
  6. Loading the knee/patella during squat movements - overactive quads and hip flexors, with weaker glutes and hamstrings, and anterior pelvic tilt is contributing to preferential activation of quads during squats or closed chained knee flexion.
  7. Anterior Pelvic Tilt - Quad,hip flexors dominance, and weaker glutes and core contributing to anterior pelvic tilt. Which might be promoting internal rotation of femur and stressing the patellofemoral joint during squatting patterns.

Things that seem to be helping:

  1. Physio exercises to strengthen glutes (maximus, and medius) also some hamstring activation. Trying to minimize quad activation but at the same time trying to do functional exercises such as squats, single leg squats, split squats/lunges. While also doing exercises such as hip thrusts/glute bridges, side lying leg lifts against wall, x-band walks, front and side lying planks
  2. Doing the mobs 2x a day targetting hip flexor, quads, IT band, (and sometimes calves, adductors, piriformis). Mostly rolling with the lacrosse ball and rumble roller. With stretches at the end.
  3. Voodoo band squats with band around the bottom of knees (2x a day usually)
  4. Rolling out the hip flexors prior to glute activation exercises. This has given me more sore glutes than previously. Also noticing less activation with hamstrings probably because I can get into a further range of motion and full hip extension.
  5. Avoiding sitting. This has probably contributed to me being able to get full hip extension during glute activation workouts.
  6. Doing capsule stretching/band distraction roughly once a day after my mobs. Targeting the hip capsule.
  7. Suction cupping and electro-accupuncture has been able to reduce muscle tension a lot. Don’t do these as often as the mobs however but seem to be really effective when I do them. No permanent changes however.

Note:

  1. Ankle range of motions is good with good dorsiflexion
  2. VMO doesnt seem weak as their is easy contraction/activation when I contract my quads. Also its of decent size. Perhaps their is slight earlier firing of the vastus lateralis and delayed firing of the VMO tho. Will try to get EMG to know for sure
  3. Foot Arch is of decent size.
  4. No obvious valgus during knee flexion
  5. Mobility seems good
  6. toes point out 5-10 degrees usually which is good
  7. gait analysis seems good. 3-D gait analysis will show it in more detail once I get it.

It seems like I have it all figured out and I know my issues. But the problem is I have been doing everything to correct the problem for awhile now with only mild improvements. The biggest improvements have come since January were I made some changes to my routine since following mobilitywod which has been of great help. My IT band has seemed pretty loose for awhile until recently I triggered it to become really tense and painful again doing some physical activity during daily life involving an open chain knee flexion (just as tense as it used to be). This might be indicating that nothing really has changed except for me masking my symptoms with all the mobility wod work and self-myofascial release. I hope this is not the case.

Next step:

  1. See a legit well recognized physiotherapist who will confirm what I speculate are my issues during his assessment. Hopefully he will make alterations to my regime to improve my routine. Also, get advice from him in regards to the leg length discrepancy and pelvic tilt contribution to my injury.
  2. Also, looking to go see someone to get electro-accupuncture done on my hip flexors so I can get into more hip extension and better activate my glutes. This will give me the window of opportunity to strengthen my glutes in ranges I wouldn’t normally be able to go in.
  3. Get my full length foot lift and 3-d gait analysis in 1 months time
  4. Keep seeing Osteopath
  5. See a physiatrist/PM&R doctor specializing in sports medicine for his assessment, input and hopefully EMG analysis on: VMO to VL activation patterns, quads to hamstrings activation patterns, and glute to hamstring activation patt erns. This will give me a better idea of what is exactly going on. Perhaps also help me decide if I would benefit from botox into either the hip flexors or vastus lateralis.
  6. If I dont see large improvements within 2-3 months. I will consider flying from my location (Toronto/London Ontario to Los angeles) to see world renowned leader in Patellofemoral Pain and Glute/hip activation Chris Powers and his staff at the movement performance institute. The facility is highly sophisticated. Heres a link: About MPI | Movement Performance Institute
  7. If all else fails will consider botox for hip flexors or vastus lateralis.
40

I’ve read through this whole thread and I don’t see one mention of strengthening hamstrings. Now, I’m not going to step on Croatian’s toes here as he and other therapy professionals have given a lot of solid advice, most particularly about checking things upstream and downstream of the knee and not being so fixed on it.

Still, you have very tight calves, anterior pelvic tilt, and kyphosis. Well, both tight calves and APT point to weakness in hamstrings and abs among other things, and I will tell you that in my coaching and my brother’s coaching experience we have never seen a soccer player with strong enough hamstrings. In fact, 99% of them that both of us have seen have the hamstring stabilizing force of a wet noodle. They also, almost as a whole, have incredibly tight calves and often have knee pain. Fixing hamstring strength almost always improves their pain and posture.

Everything else I can leave to the therapy professionals, but you sir need to seriously strengthen your hamstrings and abs. The emphasis here is on strengthening, so it will take time, at least 2 months worth. You also need to voodoo band your claves, right up to the knee joint, and work on loosening them up. They are contributing to stiffness.

You mentioned Kelly Starrett earlier–one thing he harps on all the time is thzt the body is a “system of systems” and oftentimes focusing onthe area that hurts is not the focus that brings results to the root cause of the pain or tightness. He does a lot of capsular work on hips with band distraction and other things–it would be good for you to look into some of that rather than simply the soft tissue work and things that you already have. Those are valuable things as well, but I am another person that senses tunnel vision starting to creep up on you. If Dr. Caldwell is correct in his notes, then some capsule work may help as he notes.