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

jtrue funny enough my physiotherapist brought up the point that I have slightly weaker adductors on the effected side (side with knee pain and glute medius weakness). He says we want to strengthen the adductors but not so much that they are compensating for the glute medius. He says functional exercises will strengthen the adductors effectively while also strengthening the glute medius. 

Kaitlin thanks for all the help thus far

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.