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!

Joshua A bradleyJoshua A bradley

Wow guys, this is one heck of a series of posts.  I’m floored by how much effort you’ve put into this.  I’m not nearly on your level but perhaps my experience can shed some light.  My quick background is that I’ve had patellofemoral knee pain for 7 yrs now, and over the last 3 years it’s significantly affected my quality of life.  No sports, no jogging/running, no sitting with my knees at 90 degrees for more than a few mins at a time, not able to walk down stairs at all.  I haven’t gone the extreme lengths you guys have to fix it, but I’ve gone to 4 different physical therapists for months at a time.  They all recommended a variety of the same thing… strengthening quads, hips, vmo, and rolling out IT band.  Everything seemed to marginally help, but nothing fixed it.  Over time it grew worse.  I began to fear taking flights (due to the long sit times), and I could no longer sit in an office chair at work, had to stand.  Inactivity made my knees worse, very quickly.  Walking for up to 30mins at a time always helped.  I’m writing because as of recently I’ve gotten a lot better.  I’m hoping it sticks and that i’m not posting this prematurely, but I feel ya’lls pain and wanted to share some of the things I’ve learned which have helped:  

  • Despite all my strengthening with PTs, none of them focused on my hamstrings.  Hamstrings don’t tie directly into the patella, so they’ve been mostly ignored.  I went to the gym a few weeks ago and thought I’d give the hamstring curl machine a try for the first time in years. Turns out I had trouble curling 20 pounds!  And when I did, I noticed my calf muscles would quickly kick in to help.  Having trouble with 20 pounds was a huge red flag obviously, and I’ve spent the last 2 weeks just focusing on that.  Within a couple weeks my pain started to reduce.  This whole F’ing time that was my main problem!  I see red just thinking about it.  So basically I was told by my PTs that I would need to continue doing the straight leg 4 ways and all the exercises they gave me for 30 minutes a day for the next year and then I’d finally be cured.  Which is what ya’ll have been doing.  But my experience shows that continuing what’s not working isn’t the answer.   The 3 months I did those exercises every day were some of the most depressing of my life.  To put in all that work and make little to no progress is extremely frustrating, as you know.  Instead, I found a muscle that had no strength whatsoever and within a couple weeks of training the problem was sorted.  I realize that something as obvious as a weak hamstring likely isn’t ya’lls problem, I just write all this to caution you away from strengthening the same 4 muscles over and over again, because that is likely not the answer.   Instead, work out your core, your back, calves, adductors, etc, and try to find something that might be weak and that you were missing.  
Other observations over the last few years:
  • Foam rolling is great.  But it’s like taking a drug.   It’s a temporary fix and then you need the next fix to be even stronger.  So I upgraded from a foam roller to pvc to a black rumble roller.  What’s next, metal spikes?  I think rolling is good to continue, but I don’t think it’s the answer
  • After 4 PTs and 2 sports medicine docs and 2 orthopaedists, I finally figured out my problem without them.  The internet is great too for anecdotal evidence.  But the takeaway is that doctors and PTs only know so much.  They rely on studies that apply to problems large groups of people face, not unique problems like Kefu has with one leg shorter than the other.  Also we know our bodies best, so we can’t rely completely on someone else to fix us.
  • Where’s your pain? If it’s to the right or left of the patella it could indicate the problem is from a muscle connected at the sides, like the IT band.  If the pain is above or below, it could indicate a hamstring or quad issue  
I think that’s all I’ve got.  Best of luck to you guys