Forums General Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years! Re: Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years!

AvatarRyan Cloutier


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
1) Modified lunge (Skater squat/King deadlift):
-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
2) 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. 
3) 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 to smash/roll out my leg, and do hip flexor/quad stretch, and hip external rotation banded distractions twice a day.
Next physiotherapy appointment is in 2 weeks. Wish me luck on my progress.