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

Bigger Stronger Leaner Injuries and Rehab
61

^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January to the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.

62

[quote]56x11 wrote:
^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January advised the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January also advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. Quite the contrary. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.
[/quote]

Well you’re generally right in the first three paragraphs of the above. Except I didn’t call YOU out specifically. Just warned the OP that this will happen if you have a difficult problem. And it will. The fact remains that this is not an atypical response on forums like these. Especially if you brainstorm openly on the forum as to the nature of the problem. If you’ve not been in the position of being told there’s a good chance it’s only a psychological problem preventing you, for years and years and years, from doing the things you love, you really can’t comprehend how frustrating it is.

63

[quote]darsemnos wrote:

[quote]56x11 wrote:
^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January advised the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January also advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. Quite the contrary. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.
[/quote]

Well you’re generally right in the first three paragraphs of the above. Except I didn’t call YOU out specifically. Just warned the OP that this will happen if you have a difficult problem. And it will. The fact remains that this is not an atypical response on forums like these. Especially if you brainstorm openly on the forum as to the nature of the problem. If you’ve not been in the position of being told there’s a good chance it’s only a psychological problem preventing you from doing the things you love, you really can’t comprehend how frustrating it is.

[/quote]

By including a small portion of what I stated, the OP’s cynical response (I say cynical because he did little to acknowledge the optimistic things I stated in the January post), you, in fact, did single me out.

And if you’re so jaded of the reception you get on this or similar subforums, returning and making inflammatory statements as you did in the 4-28 post won’t win you any friends. Just as I stated in the earlier post: that is little more than lashing out.

And you know nothing of my past. Hasn’t it occurred to you that there is a reason I have a history of posting in this subforum? (which can be easily checked by anyone with a T-Nation account)

And hasn’t it occurred to you to as to why I post here less and less…? Why some of the more helpful posters of 2010-2012/13 rarely, if ever, post here anymore…? These are, of course, rhetorical questions in that I already know the answer. And the sooner you accept what that answer is, the better off you’ll be in the possible resolution of your injury.

64

[quote]56x11 wrote:

[quote]darsemnos wrote:

[quote]56x11 wrote:
^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January advised the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January also advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. Quite the contrary. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.
[/quote]

Well you’re generally right in the first three paragraphs of the above. Except I didn’t call YOU out specifically. Just warned the OP that this will happen if you have a difficult problem. And it will. The fact remains that this is not an atypical response on forums like these. Especially if you brainstorm openly on the forum as to the nature of the problem. If you’ve not been in the position of being told there’s a good chance it’s only a psychological problem preventing you from doing the things you love, you really can’t comprehend how frustrating it is.

[/quote]

By including a small portion of what I stated, the OP’s cynical response (I say cynical because he did little to acknowledge the optimistic things I stated in the January post), you, in fact, did single me out.

And if you’re so jaded of the reception you get on this or similar subforums, returning and making inflammatory statements as you did in the 4-28 post won’t win you any friends. Just as I stated in the earlier post: that is little more than lashing out.

And you know nothing of my past. Hasn’t it occurred to you that there is a reason I have a history of posting in this subforum? (which can be easily checked by anyone with a T-Nation account)

And hasn’t it occurred to you to as to why I post here less and less…? Why some of the more helpful posters of 2010-2012/13 rarely, if ever, post here anymore…? These are, of course, rhetorical questions in that I already know the answer. And the sooner you accept what that answer is, the better off you’ll be in the possible resolution of your injury. [/quote]

There is significant truth to my statement. Productive or not, it’s true. Are you willing to admit that? I admitted the truth to important aspects of your statements, because I admit when I’m wrong and there was simply no denying your statement. Why is it so hard to admit it?

The injury forum doesn’t attract bad people. It attracts injured people. And it attracts injured people who couldn’t get helped elsewhere. It is by very design, an attractor of people with problems not easily addressed by conventional methods and the kinds of fixes that are recommended at your first visit to a doctor and PT. If this were not the case, there should just be a sticky that says, go to the doctor, and no injury forum at all.

So where you see bad people with bad attitudes who have from the get go had an axe to grind with the industry, it’s the opposite. It’s people who have dealt extremely patiently with the industry and have failed to make progress. And then when they question the industry, in any way, they get attacked. And this is people who spend time in the gym, and are familiar with hard work. I’ve done 20 rep breathing squats. With low weight because I’m weak, but I’ve felt the dread before it and pushed through it. I stuck out the 5 minute wall sit in high school gym class the very first time I tried it as an unathletic person who never played sports but one season of track and field in middle school. My legs were shaking so hard the gym teacher pointed me out and called me a retard. You don’t do that with a weak mind looking to fail that wants to me dysfunctional because it’s fun in some psychologically pathological way. That’s not to say I’m badass or any such nonsense. I’m not. Just that we’re not mental weaklings looking for problems.

You know, the last time I got sent a survey for PT treatment I responded. I don’t recall ever getting a survey in the mail any other time, but this time I did. I said as follows:

I was seen for evaluation by one PT. Didn’t see that PT but one other time in my weeks of treatment. I was never sure which PT was the one overseeing my care. I never got an explicit home exercise program. I was just told, literally, do some of the stuff you do here. It was literally that vague. My last day of treatment I wasn’t even going to be seen by an actual PT for a final assessment and review of progress, except that I said something to that end as I was leaving. They were going to let me JUST LEAVE without another word uttered.

I sent these comments back to the PT facility in the mail and included my name, though that was not requested. They called me up and thanked me for my honest assessment and said it was accurate and appropriate. I told them on phone that it wasn’t just them. I wasn’t JUST upset at them, but frustrated with the entire system. They weren’t entirely unique in all of these flaws in treatment, but I don’t recall having the heart to say they were the only instance in which all of these flaws came together at one facility and that it was by far my worst PT experience among numerous examples. I was extremely tactful, because I HATE making people feel bad. That’s the last thing I wanted to do, and too often, I’m much too tactful with PT’s and doctors. It’s very hard for me to say anything that I think might come across as insulting their qualifications.

Maybe I’ve just been unlucky so far. Random events do cluster in apparently in ways that seem meaningful but often aren’t, to pattern seeking mammals.

As pointless as my initial comment was, I think you’re far too quick to judge us. You don’t know what we’ve been through, how many hours we’ve devoted to getting better, following home exercise programs while under the treatment of a PT, how hard and persistently we’ve tried to get doctors and PT’s to work with us, how often, maybe due merely to the nature of their practice and schedule, they simply don’t have the time for the more difficult/unusual problems facing some of their patients. But you know, they should have back up plans, alternative recommendations, doctors and PT’s they know can spend more time with patients, instead of blank stares.

Maybe, just maybe, we’re not the only ones who are too quick to judge and condemn. Maybe, just maybe, there’s plenty of that to go around. Maybe, just maybe, there is significant validity to complaints like mine.

65

[quote]darsemnos wrote:

[quote]56x11 wrote:

[quote]darsemnos wrote:

[quote]56x11 wrote:
^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January advised the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January also advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. Quite the contrary. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.
[/quote]

Well you’re generally right in the first three paragraphs of the above. Except I didn’t call YOU out specifically. Just warned the OP that this will happen if you have a difficult problem. And it will. The fact remains that this is not an atypical response on forums like these. Especially if you brainstorm openly on the forum as to the nature of the problem. If you’ve not been in the position of being told there’s a good chance it’s only a psychological problem preventing you from doing the things you love, you really can’t comprehend how frustrating it is.

[/quote]

By including a small portion of what I stated, the OP’s cynical response (I say cynical because he did little to acknowledge the optimistic things I stated in the January post), you, in fact, did single me out.

And if you’re so jaded of the reception you get on this or similar subforums, returning and making inflammatory statements as you did in the 4-28 post won’t win you any friends. Just as I stated in the earlier post: that is little more than lashing out.

And you know nothing of my past. Hasn’t it occurred to you that there is a reason I have a history of posting in this subforum? (which can be easily checked by anyone with a T-Nation account)

And hasn’t it occurred to you to as to why I post here less and less…? Why some of the more helpful posters of 2010-2012/13 rarely, if ever, post here anymore…? These are, of course, rhetorical questions in that I already know the answer. And the sooner you accept what that answer is, the better off you’ll be in the possible resolution of your injury. [/quote]

There is significant truth to my statement. Productive or not, it’s true. Are you willing to admit that? I admitted the truth to important aspects of your statements, because I admit when I’m wrong and there was simply no denying your statement. Why is it so hard to admit it?

The injury forum doesn’t attract bad people. It attracts injured people. And it attracts injured people who couldn’t get helped elsewhere. It is by very design, an attractor of people with problems not easily addressed by conventional methods and the kinds of fixes that are recommended at your first visit to a doctor and PT. If this were not the case, there should just be a sticky that says, go to the doctor, and no injury forum at all.

So where you see bad people with bad attitudes who have from the get go had an axe to grind with the industry, it’s the opposite. It’s people who have dealt extremely patiently with the industry and have failed to make progress. And then when they question the industry, in any way, they get attacked. And this is people who spend time in the gym, and are familiar with hard work. I’ve done 20 rep breathing squats. With low weight because I’m weak, but I’ve felt the dread before it and pushed through it. I stuck out the 5 minute wall sit in high school gym class the very first time I tried it as an unathletic person who never played sports but one season of track and field in middle school. My legs were shaking so hard the gym teacher pointed me out and called me a retard. You don’t do that with a weak mind looking to fail that wants to me dysfunctional because it’s fun in some psychologically pathological way. That’s not to say I’m badass or any such nonsense. I’m not. Just that we’re not mental weaklings looking for problems.

You know, the last time I got sent a survey for PT treatment I responded. I don’t recall ever getting a survey in the mail any other time, but this time I did. I said as follows:

I was seen for evaluation by one PT. Didn’t see that PT but one other time in my weeks of treatment. I was never sure which PT was the one overseeing my care. I never got an explicit home exercise program. I was just told, literally, do some of the stuff you do here. It was literally that vague. My last day of treatment I wasn’t even going to be seen by an actual PT for a final assessment and review of progress, except that I said something to that end as I was leaving. They were going to let me JUST LEAVE without another word uttered.

I sent these comments back to the PT facility in the mail and included my name, though that was not requested. They called me up and thanked me for my honest assessment and said it was accurate and appropriate. I told them on phone that it wasn’t just them. I wasn’t JUST upset at them, but frustrated with the entire system. They weren’t entirely unique in all of these flaws in treatment, but I don’t recall having the heart to say they were the only instance in which all of these flaws came together at one facility and that it was by far my worst PT experience among numerous examples. I was extremely tactful, because I HATE making people feel bad. That’s the last thing I wanted to do, and too often, I’m much too tactful with PT’s and doctors. It’s very hard for me to say anything that I think might come across as insulting their qualifications.

Maybe I’ve just been unlucky so far. Random events do cluster in apparently in ways that seem meaningful but often aren’t, to pattern seeking mammals.

As pointless as my initial comment was, I think you’re far too quick to judge us. You don’t know what we’ve been through, how many hours we’ve devoted to getting better, following home exercise programs while under the treatment of a PT, how hard and persistently we’ve tried to get doctors and PT’s to work with us, how often, maybe due merely to the nature of their practice and schedule, they simply don’t have the time for the more difficult/unusual problems facing some of their patients. But you know, they should have back up plans, alternative recommendations, doctors and PT’s they know can spend more time with patients, instead of blank stares.

Maybe, just maybe, we’re not the only ones who are too quick to judge and condemn. Maybe, just maybe, there’s plenty of that to go around. [/quote]

Oh believe you me, I’ve dealt with more than my fair share of people who’ve gone through ortho after ortho, pt after pt, and so on. There are differences, of course; I never stated or implied otherwise.

It was you who INFERRED wrongly.

Speaking of which, it’s becoming more and more evident that you’re perception of reality is questionable.

You flat out text what I wrote on 1-13-2014 OUT of context to make a blanket statement. Here it is again:

[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]

Yet you FAIL to acknowledge the overall tone of optimism I end that particular post on. Here it is:

[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]

You offer no apology, no sense of wrong doing on your part.

And let’s not forget the blanket statements:

[quote]darsemnos wrote:
Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]

Yet you keep returning to the very same subforum you appear to despise.

So instead of offering any type of mea culpa, here you are again, nailing yourself to the cross. Whether you’re right or wrong in doing so, how do you think you’re going to attract anyone qualified to help you on here or any other forum with that type of attitude?

66

[quote]darsemnos wrote:

Maybe, just maybe, we’re not the only ones who are too quick to judge and condemn. Maybe, just maybe, there’s plenty of that to go around. Maybe, just maybe, there is significant validity to complaints like mine. [/quote]

And if you’re so convinced of this, start your own thread. Give your entire history and see if you get any bites.

Taking what I stated to another person, and taking that statement out of context to paint me in a light that only suits you, and not owning up to it speaks volumes.

As I stated earlier, all your anger and cynicism only begets more of the same. You fail to understand this. And this one of the reasons why you’ll fail to change your lot.

67

[quote]darsemnos wrote:

There is significant truth to my statement. Productive or not, it’s true. Are you willing to admit that? I admitted the truth to important aspects of your statements, because I admit when I’m wrong and there was simply no denying your statement. Why is it so hard to admit it?

[/quote]

I specifically stated the following in an earlier post:

[quote]56x11 wrote:

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.

[/quote]

Your perception of what I stated and what you claim don’t line up.

[quote]darsemnos wrote:

The injury forum doesn’t attract bad people. It attracts injured people. And it attracts injured people who couldn’t get helped elsewhere. It is by very design, an attractor of people with problems not easily addressed by conventional methods and the kinds of fixes that are recommended at your first visit to a doctor and PT. If this were not the case, there should just be a sticky that says, go to the doctor, and no injury forum at all.

[/quote]

The injury forum also attracts people who only want to hear what their preconceived notion of the right answer is. The person who most likely herniated a disc dead lifting yet wants to return to the gym asap to hit that precious PR is a classic example.

Again, your perception of the injury forum and what actually takes place here don’t line up.

There are those who genuinely cannot afford medical help, but you certainly do not belong to this group. And I have no control over the quality or lack thereof of the professionals you’ve seen.

There are those who received questionable care and post here; however, and this is where you fail miserably, they approach the matter with an open mind.

Nearly every one of your posts reeks of self-entitlement.

You’ve repeatedly displayed an argumentative attitude.

Your perception of past dialogues is questionable at best.

And you think this will bring on the best and the brightest who’ll gladly help you here or anywhere else?

[quote]darsemnos wrote:

So where you see bad people with bad attitudes who have from the get go had an axe to grind with the industry, it’s the opposite.

[/quote]

Here you are again, taking what I stated to the OP OUT OF CONTEXT and projecting yourself as him.

Again, your perception of what took place is questionable.

[quote]darsemnos wrote:

I was extremely tactful, because I HATE making people feel bad. That’s the last thing I wanted to do

[/quote]

Yet you come here, showing next to no signs of conciliatory behavior. You’re more interested in turning this whole mess into a verbal checkers game and you’re angry because I won’t ‘king’ you.

I bet I can go to any other random subforum you’ve posted in and see similar behaviors.

[quote]darsemnos wrote:

Maybe I’ve just been unlucky so far. Random events do cluster in apparently in ways that seem meaningful but often aren’t, to pattern seeking mammals.

[/quote]

To a certain extent, we all make our own luck. Your overwhelmingly negative disposition will do nothing to change your current lot. Laugh this off if it makes you feel better; I haven’t met one happy individual who are as self-centered and as bitter as you come across.

[quote]darsemnos wrote:

As pointless as my initial comment was, I think you’re far too quick to judge us. You don’t know what we’ve been through

[/quote]

Try going through close to a dozen surgeries over a period of three months. And try going through complications a year later and going through another surgery and six months of rehab. Try going to bed wondering if you’re going to keep your leg. You think you know what agony is? And do you honestly think I went on the internet to tell my tale of woe? When there are people who are even worse off?

[quote]darsemnos wrote:

Maybe, just maybe, we’re not the only ones who are too quick to judge and condemn. Maybe, just maybe, there’s plenty of that to go around. Maybe, just maybe, there is significant validity to complaints like mine. [/quote]

Maybe, just maybe, you need to accept the fact that your problem isn’t so tragic in the grand scheme of things. Nevertheless, it is your problem. So maybe, just maybe, if you adjust how you interact with others, you will, even in the smallest of increments, get closer to your goal. And if your demeanor stays the same, then I am sorry for you.

68

[quote]56x11 wrote:

[quote]darsemnos wrote:

[quote]56x11 wrote:

[quote]darsemnos wrote:

[quote]56x11 wrote:
^^^

The first mistake you made, whether or not you want to accept it, is that you took my post back in January to the OP - another individual entirely - personally.

My post back in January advised the OP was NEVER addressed to you - yet you somehow act as if it is.

My post back in January also advised the OP on various things he can proactively do to improve his situation - with a distinct tone of optimism - yet you forgot to mention this when calling me out in your 4-28 post.

Let me assure you: difficult cases is what gets me excited; the ability to solve the problem that others could not. At the same time, there is only so much that can be done via an online forum. And even if I had the inclination to see what possible solutions I can offer, I’m certainly not inclined to do so to someone who pulled the stunt you did.

The second mistake you made is that you lumped me into this group of people who label all difficult cases as nutjobs when that is clearly NOT what I did to the OP. Quite the contrary. If you had the decency to post my entire 1-31-2014 thread rather than plucking out a snippet and trying to spin it to your whim, I wouldn’t take offense.

Perhaps someone else will come along who has the formal training and real-world experience to take on your case here. Yet the fact that you don’t own up to what you did in the 4-28-2014 post and the fact that you’re more interested in now turning this into a rhetorical checkers game does little more than confirm my earlier statements. And, for you, that’s a shame.
[/quote]

Well you’re generally right in the first three paragraphs of the above. Except I didn’t call YOU out specifically. Just warned the OP that this will happen if you have a difficult problem. And it will. The fact remains that this is not an atypical response on forums like these. Especially if you brainstorm openly on the forum as to the nature of the problem. If you’ve not been in the position of being told there’s a good chance it’s only a psychological problem preventing you from doing the things you love, you really can’t comprehend how frustrating it is.

[/quote]

By including a small portion of what I stated, the OP’s cynical response (I say cynical because he did little to acknowledge the optimistic things I stated in the January post), you, in fact, did single me out.

And if you’re so jaded of the reception you get on this or similar subforums, returning and making inflammatory statements as you did in the 4-28 post won’t win you any friends. Just as I stated in the earlier post: that is little more than lashing out.

And you know nothing of my past. Hasn’t it occurred to you that there is a reason I have a history of posting in this subforum? (which can be easily checked by anyone with a T-Nation account)

And hasn’t it occurred to you to as to why I post here less and less…? Why some of the more helpful posters of 2010-2012/13 rarely, if ever, post here anymore…? These are, of course, rhetorical questions in that I already know the answer. And the sooner you accept what that answer is, the better off you’ll be in the possible resolution of your injury. [/quote]

There is significant truth to my statement. Productive or not, it’s true. Are you willing to admit that? I admitted the truth to important aspects of your statements, because I admit when I’m wrong and there was simply no denying your statement. Why is it so hard to admit it?

The injury forum doesn’t attract bad people. It attracts injured people. And it attracts injured people who couldn’t get helped elsewhere. It is by very design, an attractor of people with problems not easily addressed by conventional methods and the kinds of fixes that are recommended at your first visit to a doctor and PT. If this were not the case, there should just be a sticky that says, go to the doctor, and no injury forum at all.

So where you see bad people with bad attitudes who have from the get go had an axe to grind with the industry, it’s the opposite. It’s people who have dealt extremely patiently with the industry and have failed to make progress. And then when they question the industry, in any way, they get attacked. And this is people who spend time in the gym, and are familiar with hard work. I’ve done 20 rep breathing squats. With low weight because I’m weak, but I’ve felt the dread before it and pushed through it. I stuck out the 5 minute wall sit in high school gym class the very first time I tried it as an unathletic person who never played sports but one season of track and field in middle school. My legs were shaking so hard the gym teacher pointed me out and called me a retard. You don’t do that with a weak mind looking to fail that wants to me dysfunctional because it’s fun in some psychologically pathological way. That’s not to say I’m badass or any such nonsense. I’m not. Just that we’re not mental weaklings looking for problems.

You know, the last time I got sent a survey for PT treatment I responded. I don’t recall ever getting a survey in the mail any other time, but this time I did. I said as follows:

I was seen for evaluation by one PT. Didn’t see that PT but one other time in my weeks of treatment. I was never sure which PT was the one overseeing my care. I never got an explicit home exercise program. I was just told, literally, do some of the stuff you do here. It was literally that vague. My last day of treatment I wasn’t even going to be seen by an actual PT for a final assessment and review of progress, except that I said something to that end as I was leaving. They were going to let me JUST LEAVE without another word uttered.

I sent these comments back to the PT facility in the mail and included my name, though that was not requested. They called me up and thanked me for my honest assessment and said it was accurate and appropriate. I told them on phone that it wasn’t just them. I wasn’t JUST upset at them, but frustrated with the entire system. They weren’t entirely unique in all of these flaws in treatment, but I don’t recall having the heart to say they were the only instance in which all of these flaws came together at one facility and that it was by far my worst PT experience among numerous examples. I was extremely tactful, because I HATE making people feel bad. That’s the last thing I wanted to do, and too often, I’m much too tactful with PT’s and doctors. It’s very hard for me to say anything that I think might come across as insulting their qualifications.

Maybe I’ve just been unlucky so far. Random events do cluster in apparently in ways that seem meaningful but often aren’t, to pattern seeking mammals.

As pointless as my initial comment was, I think you’re far too quick to judge us. You don’t know what we’ve been through, how many hours we’ve devoted to getting better, following home exercise programs while under the treatment of a PT, how hard and persistently we’ve tried to get doctors and PT’s to work with us, how often, maybe due merely to the nature of their practice and schedule, they simply don’t have the time for the more difficult/unusual problems facing some of their patients. But you know, they should have back up plans, alternative recommendations, doctors and PT’s they know can spend more time with patients, instead of blank stares.

Maybe, just maybe, we’re not the only ones who are too quick to judge and condemn. Maybe, just maybe, there’s plenty of that to go around. [/quote]

Oh believe you me, I’ve dealt with more than my fair share of people who’ve gone through ortho after ortho, pt after pt, and so on. There are differences, of course; I never stated or implied otherwise.

It was you who INFERRED wrongly.

Speaking of which, it’s becoming more and more evident that you’re perception of reality is questionable.

You flat out text what I wrote on 1-13-2014 OUT of context to make a blanket statement. Here it is again:

[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]

Yet you FAIL to acknowledge the overall tone of optimism I end that particular post on. Here it is:

[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]

You offer no apology, no sense of wrong doing on your part.

And let’s not forget the blanket statements:

[quote]darsemnos wrote:
Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]

Yet you keep returning to the very same subforum you appear to despise.

So instead of offering any type of mea culpa, here you are again, nailing yourself to the cross. Whether you’re right or wrong in doing so, how do you think you’re going to attract anyone qualified to help you on here or any other forum with that type of attitude?

[/quote]

Did I not acknowledge the validity of some of your statements?

I don’t despise this forum. My statement wasn’t blanket. Practitioners and people. Did I say all practitioners and people? No. Then it’s not a blanket statement.

69

[quote]darsemnos wrote:

Did I not acknowledge the validity of some of your statements?

I don’t despise this forum. My statement wasn’t blanket. Practitioners and people. Did I say all practitioners and people? No. Then it’s not a blanket statement.[/quote]

On 4-28-2014 you wrote:

[quote]darsemnos wrote:

Get used to this. Practioners and people at these forums will start blaming you for the failures of an industry.
[/quote]

I am increasingly convinced that everything you get, you will have earned in spades.

70

56x11

Sorry if I came across is cynical (as I did not comment on all the advice you gave me). I did read it, however I just did not know how to respond to all of it. I appreciate your concern and effort to help regardless if your thorough advice will help or not. Its only so much one can do through online forums. All tho I can empathize with darsemnos because I have also gotten bad treatment, and physiotherapy advice. I also know through education as part of my Masters program in biomedical engineering in musuculoskeletal health research this is a problem in the health industry. Their often times is a barrier between clinician and patient in terms of communication. Often times the clinician, physiotherapist etc… initially either offers prescription drugs (if its a clinician), and/or basic physiotherapy exercises (if its a physiotherapist) without much thought just from what the book or guidelines tell them to do. They might also give some lifestyle modification advice (although very minimal and not comprehensive, and very general). If these first recommendations do not help, they often DONT do whats in their power and expertise to further help. Even if they have other colleagues, or if they know other health care practitioners, tests etc… they dont use these other resources to help the patient (mind you, their are exceptions to this).

For example,
The primary care sports medicine physician kept telling me I have patellofemoral syndrome and kept repeating I need to keep doing physiotherapy even tho its been a long period that I have been doing physiotherapy with a physiotherapist that works in the same building. “It has only helped mildly” and I told her “we dont know whats wrong with me however”. She goes, “yes we do, we know you have patellofemoral pain syndrome”. But patellofemoral pain syndrom is such a general diagnoses, this really doesnt say much in terms of how I need to be treated. It doesn’t tell me if the cause of the pain is from a quad/hamstring imbalance, or if its from a leg length discrepancy or if its from glute max or medius weaknes, or if its from pelvic assymetry, or if its from etc… etc… etc… The sports medicine physician said she cant do anything else for me. (Alll tho I am sure she knew tests and other physiotherapists or medical practitioners that may have helped). I had to get my own 3-D gait analyses done, no one recommended me it, not even the primary sports medicine physician, even tho it was in the same building as her. The 3-D gait analyses helped pinpoint what was going on in me and clearly showed a substantial assymetrical glute weakness on one side (trendelenburg sign), and it showed everything else to be pretty much fine. The very good physiotherapist that I am currently seeing after trying 6 crappy physiotherapists was not recommended to me by the sports medicine physician even tho they work for the same building. It was a friend whos also had multipled injuries that told me about the physiotherapist after he also tried multiple physiotherapist. So their were obviosly things she could have recommended or done that she didnt. Their is even and PM&R specialist that is her colleague in the same building that can perhaps do some functional tests, EMG tests, etc… but she did not even mention him. It was me who had to mention him after doing research online. Its the health care practioners job to come up with ideas to help the patient not the patients job.

The physiotherapist I was with before seeing my knew physiotherapist had me doing all of these different exercises some of which might have been helping others might have been making the situation worse or maybe weren’t doing anything. Also, for the exercises that might have been helping I might have been doing them wrong as the physiotherapist was not adequately checking form, muscle activation, motor pattern etc… This was not the first physiotherapist that did a lackluster job with me. One of the previous ones had me doing quad exercises to strengthen the VMO, when clearly the quads (and VMO) was not the reason I was having patellofemoral pain. My quads were strong, and they were much stronger than my hamstrings. This was just adding to my pain, and making my symptoms and condition worse. If adequately figured out what is causing my issue rather than by following what the text book says to do for patellofemoral pain syndrome, then I would have been fixed awhile ago.

71

Update:

Went to physiotherapy. I told him that the lunges resulted in a flare in symptoms. I also told him that I have been doing hip hikes instead. He said thats an excellent exercise to transition into the lunge eventually. He also showed me the correct way to do the lunges and this time around I did not get any knee pain after. He had me do a number of new exercises as well. My glutes were definitely being worked in the exercises he had me do, I was feeling the burn. I have listed 3 of the main exercises he had me doing with descriptions of each.

New exercises:

  1. Modified lunge

  2. Modified single leg deadlift (with hip external rotation)

  3. Modified hip hip hike/step up

  4. Modified lunge:
    -done facing the wall with hands on wall for more control
    -almost all the load should be on the front leg through the heel, back leg should be on floor but with no weight/load on it (so if you wanted to lift it off the ground you can easily do so)
    -chest leaned forward but with a straight posture so center of mass is balanced (if your not leaning forward you will fall backwards, and you would also be putting more weight on your back leg which you dont want)
    -hips squared
    -your not moving your front knee forward rather your bending your front knee down (very similar to single leg squat)
    -your using your glute medius on your front (loaded) leg to perform the lunge and to hip hike the opposite hip to keep the hips leveled in height
    -focus on small movements first
    -make sure front leg does not collapse in at the knee

  5. Modified single leg deadlift
    -perform the single leg deadlift
    -hold something for more control (i.e., 2 poles, 2 chairs, etc…)
    -keep hips squared/parallel to the floor with back straight and one leg straight back parallel to the floor at the bottom position
    -once at the bottom position, rotate your hips and shoulders while keeping your back and shoulders aligned with your hips, thus externally rotating the hips and the leg that is straight back parallel to the floor.
    -when externally rotating the glutes should be working.
    -I was unable to perform this without the holding unto 2 poles (similar to ski poles). Motor control and balance was difficult.

  6. Modified hip hike/step up (this one is hard to describe)
    -standing with one leg on an elevated platform facing wall
    -put the opposite leg behind you, crossing the elevated leg
    -all load should be on the elevated leg on the heel
    -straighten the leg thats on the platfoorm, lifting the leg behind you, swing it towards the elevated platform away from your front leg (similar to the modified lunge, single leg squat, and hip hike)
    -glute medius should be used when lifting the front leg (similar to single leg squat or modified lunge, and hip hike) and maintaining balance while swinging the back leg towards the platform.

The physiotherapist told me that since the lunges were to hard I should focus on the following progressions in the order listed. Once the first exercise listed gets easy I will move unto the next etc…

  1. Hip hikes - increase reps as it gets easy, and then start doing modified hip hike/step ups
  2. Modified hip hike/step ups - increase reps as it gets easy, and then start doing modified single leg deadlifts
  3. Modified single leg deadlift (holding both arms on something for control) - increase reps as it gets easy
  4. Modified single leg deadlift (holding 1 arm on something for control) - increase reps as it gets easy
  5. Modified single leg deadlift (holding on nothing) - increase reps as it gets easy
  6. Modified lunge (using the wall to help with control) - increase reps as it gets easy

While implementing the progressions above, I will still continue to keep doing:

  1. clamshells using higher reps and holding for longer,
  2. x-band walks doing more reps
  3. Modified single leg glute bridge with external rotation
  4. Stiff leg deadlifts with 40 lb dumbells (80 lbs total)
  5. Voodoo band squats with resistance band around knee

I will also add supine leg curls on yoga ball (without hip extension, and with toes pointed forward) to workout the hamstrings. I was reluctant to do this before despite my physiotherapists recommendations as it was also activating my hip flexors. However, I tried them again and it seemed to work my hamstrings a lot with minimal hip flexor activation. So it might be a good exercises in addition to the stiff leg deadlift to help address the quad/hamstring imbalance. I will also continue smashing/rolling the leg, and hip flexor/quad stretches and hip external rotation banded distractions (capsule stretching) twice a day.

I have my next physiotherapy appointment in 2 weeks. Hopefully, I make some progress by than. Wish me luck

72

Heres a routine I came up with for glute strengthening, pelvic stability and patellofemoral pain syndrome from the vast amount of research I have done and from my own physiotherapy experience.

8 levels:
1 - Posterolateral hip (glute) muscle isolation (non-weightbearing, activation)
2 - double limb support (static, activation)
3 - single limb support (static, activation)
4 - double limb support (dynamic, strength)
5 - single limb support (dynamic, strength)
6 - double limb support (ballistic, movement re-education)
7 - single limb support (ballistic, movement re-education)
8 - sports specific

1 - Posterolateral hip (glute) muscle isolation (non-weightbearing, activation)

Exercises

  1. Clamshells
  • neutral pelvis
  • bi-planar motion
  • use resistance band, progress to stronger band and 60 second hold
  1. Firehydrant
  • lift leg to side and slightly back
  • maintain neutral pelvis
  • tri-planar motion
  • use resistance band, progress to stronger band and 60 second hold
  1. Sidelying plank/clam shell hybrid
  • perform clamshell while in side plank position
  • dont roll hips back
  • engages core

Progression criteria: hold each exercises for 60 seconds bi-laterally

Level 2 - double limb support (static, activation)

Exercises

  1. Static squat with hip bias
  • hold squat position at aprx 80-90 degrees
  • knees slightly greater than shoulder width apart
  • use resistance band around knees
  • externally rotate knees
  • lean forward with torso
  • keep torso neutral
  1. Static sumo squat
  • hold sumo squat position at aprx 90-90 degrees
  • lean slightly forward
  • toes pointing out
  •   use resistance band around knees

Level 3 - single limb support (static, activation)

Exercises

  1. Hip hike
  • single leg stance
  • raise pelvis on one side
  • hold position
  1. Bent over hip hike
  • same as above except bend over by hip hinging and leaning forward
  1. Standing firehydrant
  • similar to above
  1. Wall stance
  • one leg stance with side against wall
  • leg against wall is lifted at aprx 90 degrees
  • push against wall with the stance leg while lifting pelvis (hip hiking)
  • hold position

4 - double limb support (dynamic, strength)

Exercises

  1. Squat with hip bias
  • lean forward with torso
  • weight on heels
  • push butt back
  • resistance band around knees
  • externally rotate knees
  • knees slightly greater than shoulder width apart
  • dont track knees over toes
  • progress towards weights
  1. Sumo squat
  2. Lunge with hip bias
  • similar to a skater squat or king deadlift
  • perform lunge motion
  • lean forward
  • weight on front leg and heels
  • dont track knee over toes
  • keep pelvis neutral (by hip hiking the pelvis on the opposite side as the front leg)
  • use something to hold unto for better control, progress towards holding unto nothing and weights

5 - single limb support (dynamic, strength)

Exercises

  1. Bulgarian split squat with hip bias
  2. standing birdogs
  3. Single leg deadlifts
  4. Standing firehydrants
  5. Hip Hike
  6. Bent over hip hike
  7. Step ups
  8. Step downs
  9. Single leg squats
73

I agree very much with the posts that 56X11 made near the top of this page. There is ALOT of wisdom in his posts. I know that because I have spent the last 10 years being the guy that he is talking about. I cant help but think of myself when I read your posts, OP.

Ive spent around 10 years trying to get rid of my injuries: flying all over the country to be examined, reading years worth of articles/forums, and doing diligent prehab things to help. I’m more or less in the same position as I started. I am actually grateful for the knowledge and experiences I’ve had even though I want to be able to train harder and make progress. The road has led me to currently pursuing the career of a physio.

WIth all that said, the biggest thing I’ve learned, more than how the hip affects the knee etc, is that the mental aspect to rehab is greater than I ever thought. This is a fairly novel revelation to me. I had an “ah-ha” moment a year or so back that changed the way I look at rehab an pain in general.

I have some questions I want you to answer. What are the first things you think about before you go to bed and/or wake up? How much of your day is spent thinking about your posture, pain, and rehab techniques? Has the search for an answer isolated you from your friends/family?

i have found that I used my injuries as a distraction from other aspects of my life. It was an attempt to gain control of something that could not fundamentally be controlled. It gives me a sense of hope: tomorrow I’ll be better and tomorrow will be better than today. It started really small and before I knew it I had trapped myself in this little box where my injuries was my whole life. My experience was now a slave to treating injuries.

I know you said that you do not want to feel this way and that you do not like it. I believe you and have compassion towards your situation. However look at your life and ask how much energy goes towards your injury treatment. Observe yourself as if you were looking at another persons life and objectively assess your situation.

My comments here are not judging you but my intent was to help you look at your situation from another way.

74

Update:

Good news. I have been seeing progress. IT band hasn’t flared up but I have been cautious not to aggravate it. Knee feels a lot better but still not nearly 100% With the exercises I have progressed to single leg support static but I continue to do double leg support static and isolation exercises with higher reps. Smashing and rolling out my muscles was just hiding the symptoms. My issue seems to be a muscular imbalance and motor control problem. Even my pelvis is out of alignment (especially for dynamic exercises) because of asymmetrical glute medius weakness. When doing a dynamic exercises the pelvis shifts asymmetrically. I have to learn how to control my pelvis and keep it neutral.

75

[quote]hogan06 wrote:
I agree very much with the posts that 56X11 made near the top of this page. There is ALOT of wisdom in his posts. I know that because I have spent the last 10 years being the guy that he is talking about. I cant help but think of myself when I read your posts, OP.

Ive spent around 10 years trying to get rid of my injuries: flying all over the country to be examined, reading years worth of articles/forums, and doing diligent prehab things to help. I’m more or less in the same position as I started. I am actually grateful for the knowledge and experiences I’ve had even though I want to be able to train harder and make progress. The road has led me to currently pursuing the career of a physio.

WIth all that said, the biggest thing I’ve learned, more than how the hip affects the knee etc, is that the mental aspect to rehab is greater than I ever thought. This is a fairly novel revelation to me. I had an “ah-ha” moment a year or so back that changed the way I look at rehab an pain in general.

I have some questions I want you to answer. What are the first things you think about before you go to bed and/or wake up? How much of your day is spent thinking about your posture, pain, and rehab techniques? Has the search for an answer isolated you from your friends/family?

i have found that I used my injuries as a distraction from other aspects of my life. It was an attempt to gain control of something that could not fundamentally be controlled. It gives me a sense of hope: tomorrow I’ll be better and tomorrow will be better than today. It started really small and before I knew it I had trapped myself in this little box where my injuries was my whole life. My experience was now a slave to treating injuries.

I know you said that you do not want to feel this way and that you do not like it. I believe you and have compassion towards your situation. However look at your life and ask how much energy goes towards your injury treatment. Observe yourself as if you were looking at another persons life and objectively assess your situation.

My comments here are not judging you but my intent was to help you look at your situation from another way.[/quote]

I feel that I have used my injuries as a distraction from other areas of my life because I want to get this part of my life handled because it is limiting me in my progress in other areas of life. Looking at my life objectively a tremendous amount of time and energy has gone into trying to correct/fix my injury. This is because having the injury is quite physically painful and also limits what I can do. Just the physical pain itself zaps away lots of time and energy. I felt the same as you when you say your injury becomes your whole life. However, I have been seeing a lot of progress (slowly) and it is not my life anymore in recent weeks/months. The search for an answer has isolated me from friends and family but I feel I have found the answer, and I making progress now. I have been spending more time with friends and family now.

Thanks your insightful posts. I am glad I am finding progress, and this brings me hope that my injury can be cleared up. Even at this point I feel a lot better than I did 4 months ago, and even 2 months ago. A lot of my progress has been during the last 2 months. My IT band isn’t as tight and hasnt flared (although I am being careful not to trigger it, and I am avoiding dynamic movements such as running, sports, dancing etc…)

My knee hasn’t felt this good in a long time (however its still tilted laterally and compressed and not nearly 100% fixed). My pelvis stills shifts to one side during dynamic movements. Its even slightly shifted while I am standing.

76

Update:
I feel like my progress is stagnating. I have been able to decrease my knee pain and IT band tightness dramatically but this was only for a few days after which I caused them to flare during a physiotherapy session without rolling them out extensively and perhaps doing to much exercises I was not ready for.The IT band and knee pain returned to similar levels experienced months earlier and since then I have not been able to bring it down to the levels before the flare. I feel like my symptoms are easily triggered because underlying issue is still not fixed.

Glute strengthening:
I have progressed in my glute strengthening regime. I am using stronger bands, using higher reps, and feeling my glute fire. This is still not translating to improvements in symptoms however. I am doing a lot of single leg work. A variation and progression of the hip hike the single leg stance bentover firehydrants seems to burn the glutes the most at this point.

Self-myofascial release:
I am still smashing/rolling my hips and legs with rumble roller, battlerstar, and lacross ball. Doing the couch stretch and banded distractions. My external rotation has improved (as noted by myself and my physiotherapist). I can sit cross legged now without getting pinching feeling in hips.

Motor control:
I have improved in motor control, but the pelvis still seems to move asymmetrically during functional exercises (such as squat) unless I have a mirror and I consciously try to shift pelivs. Also, just standing on both legs my pelvis is shifted with the right side (side of effected knee and glute medius weakness) rotated forward,

Next physiotherapy appointment:
Physiotherapist has given me over 2 weeks from today to keep doing the exercises. If I dont seem to get an improvement in symptoms, I will have to discuss with him other possible options such as EMG to look at muscle firing/activation. Maybe that information will help pinpoint more accurately what is going on. I would be interested in seeing the EMG activity of my right and left glute medius during different exercises and compare them, as well as EMG activity of hamstring and glute max during various exercises such as glute bridge to see how they are co-contracting. Also, interested in comparing quad contraction of both legs and quad to hamstring/glute ratio. Also, check to see if hip flexors are overactive and check adductor firing relative to other muscle groups and compare them on both sides. Their is a PM&R sports medicine physician that might be able to do these EMG recordings.

E-stimed trigger point dry needling:
Doing this in different areas of my quad and IT band for 4 days in a row seemed to make huge improvements in my symptoms of both my IT band tightness and my knee pain (knee felt like it was less compressed and tracking a lot better). However, when I went to physiotherapy and he made me do some new functional excercise, my symptoms flared and returned to previous levels. I am assuming that the trigger point dry needling was just addresing the symptoms rather than the cause. It released my IT band tightness, however the weak glute medius is still their so the IT band would tense up eventually especially if triggered through physical activity.

77

Update:
I feel I have not made any progress. If anything my knee pain and symptoms have slightly gone worse (perhaps due to triggering the symptoms through inappropriate activity one time). The next time I see my physiotherapist is 3 weeks from now. Thats more than enough time to see any progress. If there is no progress, I will ask for an appointment with a PM&R sports medicine physician to get a another opinion/assesment and do EMG analysis.

I would hope to get EMG analysis done on:

  1. VMO to VL activation ratio and timing
  2. quad to hamstring activation ratio and timing
  3. hamstring to glute activation ratio and timing
  4. TFL to glute medius activation and timing
    Furthermore, I am considering seeing another physiotherapy clinic with a physiotherapist that is an olympic athlete, with 12 years of experience and certified pilates instructor. She does a lot of postural work. Also, the clinic offers IMS (intramuscular stimulation).

Glute strengthening
Glute seems to be firing as I feel the burn during exercises. The standing firehydrant still seems to be activating it the most, also X-band walks seems to give a nice burn.

Self-myofascial release
The IT band seems to be tight now (it got triggered easily through light activity that involved bending the knees and hip) even tho I have been doing e-stimed dry needling and smashing/rolling on rumble roller and lacross ball.

Motor control
There still seems to be pelvic misalignment with the hips leaning towards my right side (perhaps due to glute medius weakness on the right side leading to pelvic drop on left side). During a squat its hard to perform it symmetrically and maintain neutral pelvis, the pelvis seems to shift out of alignment and lean towards the right side pretty easily even with conscious effort in front of mirror.

78

As somebody else has already recommended, I would look into corrective breathing techniques, as they can help through the kinetic chain, both cranial and caudal, not to mention also getting into a more parasympathetic mode which may help with muscular tonicity. With some of the complaints you have given (tight IT Band, kyphosis/lordosis postures, chronic pain), I honestly feel it would be of benefit to explore.

I personally utilize the PRI approach in many of my treatments and have had very good success with several hip and knee issues from those who have bought into the system and followed through with the given plans. If you’d like a more detailed description as to why the PRI approach may be of help, you can see their website at: http://www.posturalrestoration.com. Or if you have specific questions, I can try to answer them the best I can.

I will self admit to being relatively new to utilizing their approaches - only for the past 2.5 years - and have only taken two of their courses. But even with my little experience with using the approaches, when I included them into my other strategies, I noticed some very good results.

Also, being that this has been an ongoing 6-7 year issue, this is NOT going to resolve quickly and you can’t expect a miracle cure. It is going to be a roller coaster recovery - moments of success and improvements, mixed in with moments of regression and frustration. Also, you self admitted to being told you were using improper lunge technique and when corrected the exercise felt better.

Be aware of how you are performing all other exercises as well (Make sure toes do not flare out/hips don’t externally rotate during XBand walks) and be humble enough to have technique checked and rechecked by those qualified to do so.

79

Update:
So there has been very little progress in the last 1-2 months. I feel like my progress has stagnated and my symptoms arent improving noticeably. I still get a return of symptoms (tight IT band, and painfully achy knees right around the patellafemoral joint) when I load the knee, and avoid doing mobility/foam rolling/stretching/myofascial release. I still cant do any physical activity without intense flare of symptoms.

I just recently seen my physiotherapist, and he says we are going to need to take a new approach. He looked at my hamstring tightness while keeping a lumbar curvature (not letting my lower back round). Apparently he found that my hamstrings are completely restricted. In order to get full range of motion for my hamstrings I move my lumber spine to much. He then tried getting me to stretch my hamstrings while preventing my lumbar spine from rounding. This was very difficult to do and co-ordinate.

He then had me lay supine with my feet flat on the table and knees up with a blood pressure cuff on my lumbar spine. He had me raise one of my legs while telling me to not move my lumbar spine as indicated by the pressure changes in the pressure gauge. I found it nearly impossible to not move my lumbar spine while lifting my leg.

He said that my lumbar spine and deep core muscles are unstable and move around to much leading to lots of pelvic and hip motion, which leads to excessive motion of my femur during dynamic tasks, leading to my patellofemoral symptoms. He then tried to teach my to activate my transversus abdominis, diaphraghm, and pelvic floor by just doing breathing exercises. He noticed I was breathing through my chest and not through my diaphragm. He said my deep core muscles arent being activated thus leading to lumbo-pelvic instability. He said I have poor motor control and I have to learn how to activate my deep core muscles to prevent excessive motion of my lumbo-pelvic complex.

Glute strengthening
He said continue doing the glute strengthening exercises. I do feel the glutes working when doing the single leg squat/lunge against wall, x-band/lateral side walks, one leg standing fire-hydrants, and clamshells.

Self-myofascial release
Still seem to have tightness in IT band, hamstrings, quads, etc… Smashing/rolling on lacross ball and rumble roller seem to be temporary solutions and only help a little. Also, been doing E-stimed trigger point dry needling everyday for 15 minutes.

Deep core, transverse abdominis, diaphragm, pelvic floor and lumbo-pelvic stability
He gave me a few exercises to work on for this that I am still confused about. The most important he said is just getting the diaphragm to work for breathing. He said breath with your stomach/diaphragm area rather then chest. Also something about decreasing the belt line (space between belt line on pants and stomach). He said as I get better start contracting my pelvic floor muscles slightly during the breathing exercise. The 2nd exercise is lying supine with knees bent and raising one leg without moving the lumbar spine/lower back.

Hamstring tightness
The 3rd exercises is doing a straight leg deadlift to help lengthen the hamstrings.

Future:
I made an appointment in a few days with an experienced physiotherapist whose also a pilates instructor and an olympic athlete. She should be able to help with my lumbo-pelvic instability issue and deep core muscle strengthening.

80

Levelheaded thanks for your response it was very helpful.

I will look into PRI, and deep breathing. THIS was also brought up by my physiotherapist, whoo said I was breathing through my chest not through my diaphragm. I will take the advice here and the advice brought up by my current physiotherapist and take action in regards to working on my deep core muscles, diaphragm, deep breathing, pelvic floor, and lumbo-pelvic complex. I made an appointment to see another experienced physiotherapist who specializes in core-musculature and posture. Shes a STOTT PILATES Certified Rehab Instructor, and olympic athlete who uses clinical Pilates stabilization principles. Although, I dont think she is postural restoration certified. Hopefully, she will be able to help.

Technique:
For x-band walks I thought a slight external rotation is good. Isn’t avoiding internal rotation more important. I will remember to having my technique checked and re-checked.