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
    Maybe look into seeing a  physiotherapist whose a pilates instructor or postural restorative certified. Perhaps your lumbo-pelvic complex is unstable and you have poor motor control leading to excessive motion of pelvis and femur, thus leading to knee pain.

    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.

    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.