One other note here–you mention that hamstrings take over on glute exercises like bridges. This doesn’t necessarily mean they are strong, just that your motor patterns are messed up. I would of course suggest doing all your glute work first, and then hamstrings last. I would also amend my last post and say that you need to get your glutes stronger as well–which you have touched on several times in the thread already. My question would be though, HOW are you strengthening your glutes? Body weight exercises only? You may wan to consider working on adding weight to certain exercises after you do your activation drills. Activation is great (clamshells etc), but it is still only half the battle. You still need to actually make them stronger.
Hey Aragorn
I was previously working out my posterior chain a lot (hamstrings, glutes)with and without weights. It only help mildly. Even when I used weights. I did this for 2 years. I think it might be because it was causing a larger imbalance between my glutes and hamstrings as my hamstrings would probably be activating more and becoming more loaded.
Also, for more reason why I dont think I should focus on training the hamstrings is theirs evidence showing that hamstring loading contributes to patellofemoral pain. Heres a published articles that goes against what your saying as weak hamstrings being the culprit for my patellofemoral pain.
Clin Biomech (Bristol, Avon). 2011 Oct;26(8):841-6. doi: 10.1016/j.clinbiomech.2011.03.016. Epub 2011 May 4.
Hamstrings loading contributes to lateral patellofemoral malalignment and elevated cartilage pressures: an in vitro study.
Elias JJ1, Kirkpatrick MS, Saranathan A, Mani S, Smith LG, Tanaka MJ.
Author information
Abstract
BACKGROUND:
Hamstrings loading has previously been shown to increase tibiofemoral posterior translation and external rotation, which could contribute to patellofemoral malalignment and elevated patellofemoral pressures. The current study characterizes the influence of forces applied by the hamstrings on patellofemoral kinematics and the pressure applied to patellofemoral cartilage.
METHODS:
Ten knees were positioned at 40�??�??�??�?�°, 60�??�??�??�?�° and 80�??�??�??�?�° of flexion in vitro, and loaded with 586 N applied through the quadriceps, with and without an additional 200 N applied through the hamstrings. Patellofemoral kinematics were characterized with magnetic sensors fixed to the patella and the femur, while the pressure applied to lateral and medial patellofemoral cartilage was measured with pressure sensors. A repeated measures ANOVA with three levels, combined with paired t-tests at each flexion angle, determined if loading the hamstrings significantly (P<0.05) influenced the output.
FINDINGS:
Loading the hamstrings increased the average patellar flexion, lateral tilt and lateral shift by approximately 1�??�??�??�?�°, 0.5�??�??�??�?�° and 0.2mm, respectively. Each increase was significant for at least two flexion angles. Loading the hamstrings increased the percentage of the total contact force applied to lateral cartilage by approximately 5%, which was significant at each flexion angle, and the maximum lateral pressure by approximately 0.3 MPa, which was significant at 40�??�??�??�?�° and 60�??�??�??�?�°.
INTERPRETATION:
The increased lateral shift and tilt of the patella caused by loading the hamstrings can contribute to lateral malalignment and shifts pressure toward the lateral facet of the patella, which could contribute to overloading of lateral cartilage.
For another explanation: http://www.sportsmedres.org/2011/06/hamstrings-loading-elevate.html
From my research it seems weak glutes are a much larger culprit in terms of anterior pelvic and patellofemoral pain. Also, weak glutes will lead to overactivation of hamstrings leading to muscular imbalance as they are the synergistic muscle. Plus sitting for extended periods (which is what I was doing in the past, but I have now decided to try to stand as much as I can) of time cause the hamstrings to remain in a shorted/flexed position while the glutes are in a stretched/inhibited position.
All tho I do feel my hamstrings are weaker than their antagonists the quadriceps. To address this any strengthening I do for the glutes will cause their synergistic hamstrings to also be strengthened/activated. I worry any more hamstring work will be contributing to the imbalance. Plenty of exercises I do already incorporate the hamstrings such as: glute bridges/hip thrusts, single leg squats, split squats, and double leg squats. I only do body weight right now.
I do however agree that its a possibility that my motor patterns might be messed up rather than a strength imbalance but I am leaning towards it being a combination of both motor patterns being dysfunctional/delayed firing and strength imbalance
And trust me their is no tunnel vision in me. I have extensively tried to analyze a lot of possible contributing factors and have tried addressing them. If I had tunnel vision why would I be doing such a systematic approach to address this problem and seeing multiple specialists? If anything the physiotherapists and advice I have been given are tunnel vision in that they just go by the book and say, “oh you have patellofemoral pain syndrom, for this condition you have to strengthen the glute medius, VMO and core, and also do some foam rolling.” Thats something I already knew and easily figured out by just a simple google search or a pubmed search for a research article. They dont seem to think outside the box or try looking at other areas. It wasn’t until pretty recently that my leg length discrepancy was noticed. A bunch of physiotherapist have missed that. Thats just one example of them overlooking possible risk/contributing factors.
I will still bring up weak hamstrings with the next physiotherapist and the PM&R physician I see. Hopefully the EMG will be able to show any dysfunctional motor patterning and muscle firing and weakness.
Thanks for your input,
looking forward to your response
p.s what is your background/level of experience or knowledge
Thanks for your input Aragon.
You might have a point with the weak hamstrings. I always knew I was quad dominant over my hamstrings, however I did not know if it would effect my knee pain dramatically as things on the internet doesn’t show any evidence of weak hamstrings leading to patellofemoral pain or a patella tilt. I have been trying to understand what is happening and rationalize a mechanism so I can spend my time effectively addressing what needs to be addressed.
I went to see a very good physiotherapist in my area. And he mentioned a lot of the things you said. He noticed my hamstrings are really weak, and even said their weaker than my glutes (which he said they should be). But he said that both the glutes and hamstrings are weak. He also said that my right glute medius (the side of the knee pain) isnt firing at all during the clamshell.
He said my pelvis is compensating by shifting during the workout and I am working out other muscles such as low back and hip flexors during the clamshell, so I cant even isolate the glute medius. He mentions that my right side kinetic chain is dysfunctional with no glute medius activation and also the anterior pelvic tilt is contributing to IT band tightness.
He said all the exercises I am doing arent working effectively because the glute medius aren’t firing during them at all. He recommends isolating the glute medius and then integrating them to more functional workouts. He said the reason I am still having the tight IT band and knee pain is that I haven’t effectively isolated the glute medius when I would do glute medius activation exercises.
Based on his assessment, evaluation and watching me and feeling my muscle activation he said I must have been compensating with other muscles during the workouts.
He suggests strengthening my hamstrings (Supine bridge leg curl, stiff leg deadlift, narrow stance squat), and isolating my glute medius (clamshell - with a very conscious effort on my form and motor pattern to ensure I am activating the glute medius and not other muscles)
One possible explanation of the cycle that is happening with me is this:
- Weak hamstrings* + sitting to much+ tight hip flexors + tight quads + quad dominant + weak glutes and core–> leading to anterior pelvic tilt
- Anterior pelvic tilt → glutes are inactivated because I am always in slight hip flexion due to the anterior pelvic tilt
- Glute inactivation → leads to a compensatory increase in hip flexor activation and tightness and also IT band tightness**
- IT band tightness → leading to a lateral pull on the knee (especially during knee flexion), also hip flexor tightness may be leading to internal rotation of femur relative to the patella during knee flexion (all tho not in an obvious knee collapse)
Glute medius weakness:
- Glute medius is not firing → leading to compensatory increase in hip flexor and IT band tightness
- IT band tightness → leading to patella tilt
I will do what my physiotherapist suggests along with what I have already been doing and update my progress.
Updated Daily Mobility/Rehab Routine:
Morning Routine: aprx 45 mins
- Warm up (aprx 2 mins): skipping, leg swings etc…
Inhibit and Lengthen Tight/Overactive Areas:
2) SMR hip flexors, quads (10 mins)
3) Capsule stretch/banded distraction: Hip external rotators, Ant hip capsule (5 mins)
3) Couch Stretch PNF: Rectus femoris (3 mins)
Activate/strengthen weak areas:
- Clamshell (3 sets)
- Supine single leg bridge (3 sets)
- Front plank (2 sets)
- Voodoo band squats (20 reps)
Night Routine: aprx 50 mins
- Warm up (aprx 2 mins): skipping, leg swings etc…
Inhibit and Lengthen Tight/Overactive Areas:
2) SMR hip flexors, quads (10 mins)
3) Capsule stretch/banded distraction: Hip external rotators, Ant hip capsule (5 mins)
3) Couch Stretch PNF: Rectus femoris (3 mins)
Activate/strengthen weak areas:
- Clamshell (3 sets)
- Supine single leg bridge (3 sets)
- Front plank (2 sets)
- Voodoo band squats (20 reps)
SMR
- IT band, calves, hamstrings, adductors
Strengthening/corrective exercises routine to address muscular imbalances (2-3x a week):
total time: 1 hr 30 mins- 2 hours
Warm Up: (5 minutes)
- Skip (aprx 2 mins), leg swings
Inhibit and Lengthen Tight/Overactive Areas: (15-20 mins)
2) SMR hip flexors, quads (10 mins)
3) Capsule stretch/banded distraction: Hip external rotators, Ant hip capsule (5 mins)
3) Couch Stretch PNF: Rectus femoris (3 mins)
My strengthening Routine: aprx 45 minutes
-
Clamshells: Glute medius/max
-
Supine single leg glute bridge: Glute medius/max
-
Single leg squats: functional, glutes, hams, quads
-
Stiff Leg Deadlift (SLD) /Romanian Deadlift (RDL): hamstrings, glutes
-
Side plank: core, glute
-
Supine bridge curl: hamstrings
Post strengthening Self-Myofascial Release: (10 mins)
- IT band, gastroc, ant tibialis, hamstring, adductors
Suction Cupping - 15 minutes
-hip flexors, quads, IT band, hamstrings
-sometimes adductors, gastroc, ant tibialis
Routine is based on advice from multiple physiotherapist and a recently visited good experienced physiotherapist. Also, readings from published research studies, online readings, exceptional recommendations online by Chris Powers, and online articles written by guys like Bret Contreras, Mike reinold, mike robertson, mike boyle, Eric Cressey, and Chad Waterbury.
Some changes made
- Took out 90/90 split squat → to much activation of TFL might be counterproductive, also single leg squat work glutes more
- Side lying leg abduction–>to much activation of TFL might be counterproductive, clamshells or X-band walks are much better at preferentially targeting glutes
- Stretch/SMR tight antagonist muscle areas prior to strengthening weak areas–>to get more ROM and activation of weak areas
- Focus on capsule stretching/banded distraction especially for external hip rotation
5)Do activation exercises twice a day (morning and night do clam shells and supine single leg bridge)–>before I was not doing this.
Update:
I have been seeing my new physiotherapist for 3 weeks now (2 visits), and have been doing my updated routine for 3 weeks now. Also, been seeing 2nd osteopath twice in 3 weeks. Knee pain has pretty much stayed the same. Quad and IT band tightness is manageable with rigorous mobs, physiotherapy, and standing more often. But with a day or 2 off the routine tightness reaches painful levels and knee pain increases. However knee pain persists even when doing mobs, and physiotherapy. Loosing hope that my situation will get better and been feeling slightly depressed last few days.
My glutes have been firing during my clamshells, x-band walks, and hip/glute bridges. Been feeling my glute medius best with clamshells, and have upgraded to doing them with a resistance band last week. Overall tho I feel my entire glutes (mostly glute max) being worked a lot doing the x-band walks. I am still having difficulty mobilizing my right hip external rotation. I have been doing banded distractions to get a capsule stretch twice a day for my right hip capsule.
On the brighter side I have an appointment for a 3-D gait analyst and for a full length foot lift tomorrow. I am hoping that a full length foot lift of 0.5cm to address my anatomical leg length discrepancy of 1.1 cm is the missing piece to my patellofemoral pain situation. However, when thinking rationally I cant see how it can have a significant impact on my situation (and neither does my physiotherapist) so I dont expect it to be a miracle. I was really hoping that activating my glute medius and increasing my external range of motion on my right hip would decrease my symptoms . The fact that it hasn’t so far in 3 weeks is a major blow. I will keep at my routine for now, I will also have to make a 3rd appointment with the physiotherapist soon to re-analyze me and to get new progressions for the exercises.that are becoming to easy.
[quote]xianchixan wrote:
Update:
I have been seeing my new physiotherapist for 3 weeks now (2 visits), and have been doing my updated routine for 3 weeks now. Also, been seeing 2nd osteopath twice in 3 weeks. Knee pain has pretty much stayed the same. Quad and IT band tightness is manageable with rigorous mobs, physiotherapy, and standing more often. But with a day or 2 off the routine tightness reaches painful levels and knee pain increases. However knee pain persists even when doing mobs, and physiotherapy. Loosing hope that my situation will get better and been feeling slightly depressed last few days.
My glutes have been firing during my clamshells, x-band walks, and hip/glute bridges. Been feeling my glute medius best with clamshells, and have upgraded to doing them with a resistance band last week. Overall tho I feel my entire glutes (mostly glute max) being worked a lot doing the x-band walks. I am still having difficulty mobilizing my right hip external rotation. I have been doing banded distractions to get a capsule stretch twice a day for my right hip capsule.
On the brighter side I have an appointment for a 3-D gait analyst and for a full length foot lift tomorrow. I am hoping that a full length foot lift of 0.5cm to address my anatomical leg length discrepancy of 1.1 cm is the missing piece to my patellofemoral pain situation. However, when thinking rationally I cant see how it can have a significant impact on my situation (and neither does my physiotherapist) so I dont expect it to be a miracle. I was really hoping that activating my glute medius and increasing my external range of motion on my right hip would decrease my symptoms . The fact that it hasn’t so far in 3 weeks is a major blow. I will keep at my routine for now, I will also have to make a 3rd appointment with the physiotherapist soon to re-analyze me and to get new progressions for the exercises.that are becoming to easy. [/quote]
3 weeks? jeezus, give it 3-4 months
[quote]BHOLL wrote:
[quote]xianchixan wrote:
Update:
I have been seeing my new physiotherapist for 3 weeks now (2 visits), and have been doing my updated routine for 3 weeks now. Also, been seeing 2nd osteopath twice in 3 weeks. Knee pain has pretty much stayed the same. Quad and IT band tightness is manageable with rigorous mobs, physiotherapy, and standing more often. But with a day or 2 off the routine tightness reaches painful levels and knee pain increases. However knee pain persists even when doing mobs, and physiotherapy. Loosing hope that my situation will get better and been feeling slightly depressed last few days.
My glutes have been firing during my clamshells, x-band walks, and hip/glute bridges. Been feeling my glute medius best with clamshells, and have upgraded to doing them with a resistance band last week. Overall tho I feel my entire glutes (mostly glute max) being worked a lot doing the x-band walks. I am still having difficulty mobilizing my right hip external rotation. I have been doing banded distractions to get a capsule stretch twice a day for my right hip capsule.
On the brighter side I have an appointment for a 3-D gait analyst and for a full length foot lift tomorrow. I am hoping that a full length foot lift of 0.5cm to address my anatomical leg length discrepancy of 1.1 cm is the missing piece to my patellofemoral pain situation. However, when thinking rationally I cant see how it can have a significant impact on my situation (and neither does my physiotherapist) so I dont expect it to be a miracle. I was really hoping that activating my glute medius and increasing my external range of motion on my right hip would decrease my symptoms . The fact that it hasn’t so far in 3 weeks is a major blow. I will keep at my routine for now, I will also have to make a 3rd appointment with the physiotherapist soon to re-analyze me and to get new progressions for the exercises.that are becoming to easy. [/quote]
3 weeks? jeezus, give it 3-4 months
[/quote]
Yeh I realize it will take longer, but one would think their would be some signs of benefit, not complete recovery or anything just a little sign that things are moving in the right direction. Doesn’t seem to be the case right now. 3 weeks of busting my ass trying to do all the things correct and nothing. I will be more patient, but its hard when I was busting my ass before this 3 weeks with this new routine for 1 year doing a similar but different routine of corrective exercises for my situation. I do have some good news however in regards to a 3-D gait analyses I just had today.
3-D gait analyses:
The biggest issue was found in my hip:
- My left leg has an excessive pelvic drop (trendelenburgs sign):
-which means my right glute medius (the side with my knee pain) isnt being activated to prevent the pelvic drop on the left leg (meaning that during my right legs stance phase of gait my left pelvis is dropping because glutes arent firing properly)
-funny enough its only my left leg with the excessive pelvic drop, my right leg actually has a reduced pelvic drop, meaning that the glutes are firing enough on my left leg during its stance phase of gait which prevents my right leg from dropping.
-But the experienced and highly regarded pedorthist said this is also adding to the asymmetry because the right side has reduced pelvic drop while the left side has excessive pelvic drop
Possible conclusion that can be made: The right glute medius isn’t being activated or firing properly thus explains why I have knee pain symptoms on my right knee only.
Solution:
- Learn to activate my right glute medius
- strengthen the right glute medius,
- and then integrate the new found strength into functional activities.
I am focusing on 2 major exercises to address this issue (I am still doing my routine but with a focus on the 2 exercises below):
- Clam shells (focus on right side)
- X-band walks
- Increase hip external range of motion on right side (Capsule stretching doing banded distractions, hip openers)
Since I have been doing the clamshells I have feel my right glute medius being worked so I know I can activate it. I guess its just a matter of keep working those exercises until I can strengthen it a sufficient amount and then finally integrate the new found strength and learn to activate it during functional exercises (squats, single leg squats, lunges, walking, running etc…)
I will keep with the routine and additionally focus on the above exercises for 1-2 months. After 1-2 months I will get the 3-D gait analyses re-tested to see if their has been improvements made. If their hasn’t been major improvements in both the gait pattern and/or my symptoms I will look into getting a full length foot lift on my shorter leg.
[quote]xianchixan wrote:
3-D gait analyses:
The biggest issue was found in my hip:
- My left leg has an excessive pelvic drop (trendelenburgs sign):
-which means my right glute medius (the side with my knee pain) isnt being activated to prevent the pelvic drop on the left leg (meaning that during my right legs stance phase of gait my left pelvis is dropping because glutes arent firing properly)
-funny enough its only my left leg with the excessive pelvic drop, my right leg actually has a reduced pelvic drop, meaning that the glutes are firing enough on my left leg during its stance phase of gait which prevents my right leg from dropping.
-But the experienced and highly regarded pedorthist said this is also adding to the asymmetry because the right side has reduced pelvic drop while the left side has excessive pelvic drop
Possible conclusion that can be made: The right glute medius isn’t being activated or firing properly thus explains why I have knee pain symptoms on my right knee only.
Solution:
- Learn to activate my right glute medius
- strengthen the right glute medius,
- and then integrate the new found strength into functional activities.
I am focusing on 2 major exercises to address this issue (I am still doing my routine but with a focus on the 2 exercises below):
- Clam shells (focus on right side)
- X-band walks
- Increase hip external range of motion on right side (Capsule stretching doing banded distractions, hip openers)
Since I have been doing the clamshells I have feel my right glute medius being worked so I know I can activate it. I guess its just a matter of keep working those exercises until I can strengthen it a sufficient amount and then finally integrate the new found strength and learn to activate it during functional exercises (squats, single leg squats, lunges, walking, running etc…)
I will keep with the routine and additionally focus on the above exercises for 1-2 months. After 1-2 months I will get the 3-D gait analyses re-tested to see if their has been improvements made. If their hasn’t been major improvements in both the gait pattern and/or my symptoms I will look into getting a full length foot lift on my shorter leg.[/quote]
You need to get hooked up with an infrared sleeve to wear on your knee, problem is the preliminary research is still being conducted, you would def benefit from it.
You need to push the prowler! Full foot strikes and go slow focusing on gluteal contraction. The prowler push is the only exercise that strengthens the glute max, glute med and hamstring at the same time. Your most like quad dominant. Get stronger and stronger pushing the prowler.
It is the only thing that fixed my IT band pain that lasted for 6 years. I went to PTs, chiros and massage therapists. I bought books from Mike Robertson to Kelly Starrett. Prowler pushing fixed it.
nick
Thanks for your insight,. Sounds very interesting with prowler push (emphasizing gluteal contraction and full foot strikes). Ill bring it up with my physiotherapist see what he thinks about it. Doing some research I didn’t find any evidence to supports it use for patellofemoral pain syndrome. It could be one of the exercises overlooked however. It seems to also activate the quads tho from what I have read (and from a biomechanical stand point your extending your knee so their must be quad activation), so I dont know how much if of a posterior chain exercises it would be. Definitively something to consider tho.
You mention its the only exercise that activates the glute max, glute med, and hamstrings. Wouldnt a single leg deadlift , single leg squats, box squats, and squats with resistance band around knees pulling knee in (while you push the knees out) also activate the glute max, glute med, and hamstring?
Update:
Symptoms/Pain
I dont want to speak to soon, but I am feeling some progress. Symptoms are a lot better, tightness has decreased, and knee pain is better. However, it still doesnt feel right, patella still feels compressed and tilted still gives me pain going down stairs. Not much pain at all when walking, or standing mostly just discomfort. Also, it feels like the tightness and knee pain can return to high levels anytime if triggered so I must be cautious all the time and avoid doing a lot of things.
Exercises/Glute medius
Glute medius feels like its firing when doing clamshells. I have also been doing a lot of x-band walks and voodoo band squats with resistance band around knees pulling knees in (while I try to push knees out). Also been doing a lot of single leg glute bridges/hip thrusts.
Banded distractions/External ROM
Banded distractions for my right hip capsule doesnt feel like its working to increase my external range of motion for my right hip/femur. It still very limited in external range of motion.
I am going to see physiotherapist on Monday.
[quote]xianchixan wrote:
nick
Thanks for your insight,. Sounds very interesting with prowler push (emphasizing gluteal contraction and full foot strikes). Ill bring it up with my physiotherapist see what he thinks about it. Doing some research I didn’t find any evidence to supports it use for patellofemoral pain syndrome. It could be one of the exercises overlooked however. It seems to also activate the quads tho from what I have read (and from a biomechanical stand point your extending your knee so their must be quad activation), so I dont know how much if of a posterior chain exercises it would be. Definitively something to consider tho.
You mention its the only exercise that activates the glute max, glute med, and hamstrings. Wouldnt a single leg deadlift , single leg squats, box squats, and squats with resistance band around knees pulling knee in (while you push the knees out) also activate the glute max, glute med, and hamstring?[/quote]
Of course it has quads in it but much less when you do full strikes. The benefit of doing this over other work is your working the hip ball in the socket while moving forward thus working the hip girdle. I have attached another good exercise for you.
My symptoms are improving slightly, however it seems to be taking way to long. The physio had me do a lunge variation to try to emphasize glute medius activation, however my IT band flared up and knee pain came back really harshly for a few days. It took some smashing/rolling, stretching, E-stimed dry needling, and glute medius activation at home for a couple days to get back to normal. However, after the lunges my glutes were really sore indicating perhaps I was activating the glutes in a way I wasn’t before.
But then why the IT band flare and knee pain? Maybe my knees tracking near my toes during the lunge had a role in the flare of symptoms. I have my next physio appointment on Thursday, I will discuss with him in regards to what the lunges did. He is trying to integrate my new glute medius strength that I have gained (from doing isolated and non-functional exercises) into a functional exercises thats why he had me do the modified lunges. I started to do 1 leg stance hip hikes tho as an alternate to the lunges (seems to work the glute medius in a similar way and is somewhat functional). Perhaps the lunges can be the progression after the 1 leg stance hip hikes get easy.
Nick,
Thanks for the exercises. They seem to be to far of a progression for me to do right now (their to quick and I wouldnt be able to effectively work my glute medius since they are not being activated when I walk even). Something to consider tho once I progress.
[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]
Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[quote]darsemnos 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]
Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]
I told the OP that I’m unsubscribing from this thread. However, since he’s been posting updates, I have looked into his situation.
Until now, I’ve decided to keep my comments to myself.
You conveniently took out a small segment that only serves your agenda. Anyone who reads that snippet and nothing else won’t get the whole background.
If people look at the COMPLETE post that I wrote, there is a message of optimism - especially the closing paragraph.
[quote]56x11 wrote:
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.
[/quote]
For anyone who wants to read my complete post, you can find it 1-13-2014
Furthermore, I specifically told the OP that his self-pity is just a theory. Like it or not, there are a certain segment of people out there who, in some perverse manner, find delight in playing the role of the eternal victim.
It is unfortunate and a little sad that the OP and you inferred only the negative and did little or nothing to give credence to the positive.
Indeed, since I made this post, I’ve noticed the OP has done more or less what I suggested, which is to continue working with practitioners in his area and maintain some semblance of training so that he can, little by little, find improvement.
darsemnos, I don’t know exactly what your particular case is. I will say that, of the handful of posters who frequent this subforum that actually have the formal training and experience to comment on various injuries, NONE of us are being compensated for our time here. We do so because it’s in our nature to see others get better. So it shouldn’t surprise any objective individual to see why posters who are argumentative, non-compliant, passive-aggressive, and display any other negative behaviors are also the ones who get the least amount feedback.
And this comment that you made:
[quote]darsemnos wrote:
Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]
does little more than expose someone lashing out. For every incompetent S/C Coach, Ortho, Chiro, PT, there are others who take a great deal of pride in their work and are quite good at what they do.
All this anger and cynicism on your part only begets more of the same. You can scoff at this all you want but anyone can look up your posting history and the evidence is there.
[quote]56x11 wrote:
[quote]darsemnos 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]
Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]
I told the OP that I’m unsubscribing from this thread. However, since he’s been posting updates, I have looked into his situation.
Until now, I’ve decided to keep my comments to myself.
You conveniently took out a small segment that only serves your agenda. Anyone who reads that snippet and nothing else won’t get the whole background.
If people look at the COMPLETE post that I wrote, there is a message of optimism - especially the closing paragraph.
[quote]56x11 wrote:
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.
[/quote]
For anyone who wants to read my complete post, you can find it 1-13-2014
Furthermore, I specifically told the OP that his self-pity is just a theory. Like it or not, there are a certain segment of people out there who, in some perverse manner, find delight in playing the role of the eternal victim.
It is unfortunate and a little sad that the OP and you inferred only the negative and did little or nothing to give credence to the positive.
Indeed, since I made this post, I’ve noticed the OP has done more or less what I suggested, which is to continue working with practitioners in his area and maintain some semblance of training so that he can, little by little, find improvement.
darsemnos, I don’t know exactly what your particular case is. I will say that, of the handful of posters who frequent this subforum that actually have the formal training and experience to comment on various injuries, NONE of us are being compensated for our time here. We do so because it’s in our nature to see others get better. So it shouldn’t surprise any objective individual to see why posters who are argumentative, non-compliant, passive-aggressive, and display any other negative behaviors are also the ones who get the least amount feedback.
And this comment that you made:
[quote]darsemnos wrote:
Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]
does little more than expose someone lashing out. For every incompetent S/C Coach, Ortho, Chiro, PT, there are others who take a great deal of pride in their work and are quite good at what they do.
All this anger and cynicism on your part only begets more of the same. You can scoff at this all you want but anyone can look up your posting history and the evidence is there.
[/quote]
I find no delight in this whatsoever. I actually daydream about running. Often when driving and listening to music, I imagine myself running and jumping around like I used to be able to, because it’s SO MUCH FUN.
I’m lashing out because I’ve been treated terribly by the industry. Not on purpose, but by extremely pervasive low quality of care. Not that they don’t try, but that they only try within a very narrow paradigm. I’ve seen some doctors I regard as quite good, based only on how they interact with me. They actually listen to what I say, and I can see the wheels turning so to speak. But I’ve seen more of the other kind. Ones that basically don’t have time for me. But even the good ones, when they can’t help me, don’t give me any options. More times than I remember a doctor has said, here, go see this guy (named specifically) and I go to the PT facility only to be placed with someone else. Of course it’s my fault for not being more assertive there, but it also indicates a lack of communication between the doctor and PT.
People see asking questions as argumentative.
I’m a unique case. I’ve been told I move better than every other patient by one PT. I basically pass the FMS screens. I doubt these things are true now, but that’s because things have gotten significantly worse in the past 6 months.
There is something wrong with me that has not been diagnosed that is not easy to diagnose and that is unusual.
When I pursue this line of thought, by trying to get people to help me figure it out, if I question what they say at all, they get all bent out of shape. They seem to think any questioning is a challenge to their credentials or something. And then THEY lash out at me just because I dare ask clarifying questions.
I can’t prove this, but I wasn’t the first to throw an insult. I got attacked for asking too many questions and not immediately accepting people’s conclusions due to my real world experience of my own problem.
I’ve had one practitioner basically tell me I’m delusional because I didn’t agree that I had made progress, or at least not the kind of progress I wanted. Whatever was fixed may have been an issue that would have led to other problems, but it was not the problem I sought treatment for. That is blaming me. Most PT’s just tell me they can’t help me after 6 weeks or so and don’t give me any further options, and I’m sad to say, I percieve an inclination by them to put down in their records progress when little to none exists. It’s just a vibe, but one I’ve gotten strongly and repeatedly. I’ve had many people on forums like this one tell I have body dismorphism and I’m a hypochondriac, just because it’s hard to describe the nature of my problem. This is essentially blaming me.
And I’ve tried ignoring the problem. Playing sports, skiing, hiking, lifting. Basically, living as if I had no problem. But inevitably this results in pain.
I don’t pity myself.
But I actually do recognize that this problem has altered my psychology. It makes me so frustrated that I can’t figure it out on my own. THAT’S why I’m seeking help here. I understand people don’t get paid here, but I’d pay people if someone offered one on one consultations. People have recommended resources to learn about sources of these kinds of problems, but I am so frustrated that it’s almost completely paralyzing mentally and thus my trying to figure this out on my own is too stressful. I don’t have any shame in admitting I need someone to walk me through rehab. Both the diagnosis and treatment. I need intensive support both in the diagnosis portion, so I can understand the nature of the problem, and in the rehab portion, as in consistent support making sure I’m doing exercises right, feedback on my questions about exercises, etc.
“continue working with practitioners in his area and maintain some semblance of training so that he can, little by little, find improvement.”
I AM doing this. I’ve only been in the Albany, NY area since July and I’ve already seen half a dozen doctors, two PT’s, and a chiropractor about this. And one of these doctors was in NYC, a three hour drive each way, and a former team doctor for the NY Jets. I was actually extremely happy with the level of care he provided. He demonstrated exceptional bedside manner, gave me tons of time, but he just didn’t have any answers and I could tell it bothered him that he couldn’t help more. I’ve driven 2.5 hours each way to see another doctor in CT.
I’ve tried to stay active, hiking, skiing half a dozen times here and flew out to Utah to ski with my best friend there, lifting(trying to work around the discomfort, avoiding squats and deadlifting instead, trap bar deadlifting instead, avoiding leg exercises altogether at times), jumping rope, playing flag football in the fall, flag football and rugby this spring, but I had to give up on the rugby due to this issue, and I think it may be wise to give up on the flag football. I told the PT I’m seeing now I don’t think I should be playing sports, and she agreed. My rectus femoris just ends up going crazy and I’m crippled the next day, and sore for days after. This is a new problem.
When I come to places like here asking for help in finding a practitioner who will stick with me I just get told to keep doing what I’m doing. Cycling through doc’s and PT’s. I basically exhausted the supply practitioners where I used to live up till 9 months ago.
You have no idea how ecstatic I’d be to be able to tell a practitioner, “you gave me my life back.”