Hi Kefu,

I apologise, I haven’t read your entire post or any of the comments on this thread. That being said, in response to:

“My IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them, especially my IT band. I have tried physiotherapy from multiple physiotherapists, ART, electrically stimulated trigger point dry needling (PENS/electroacupuncture), acupuncture, massage therapy, foam rolling (lacross ball, PVC pipe, rumble roller), suction cupping, strengthing glute medius and maximus, VMO strengthening, core strengthening, balance work on wobble board, orthotics, intra-articular prolozone injections, joint supplements, heel wedge for leg length discrepency (my right leg is 1.1 cm shorter which was confirmed on an x-ray).”

If you’re stretching a muscle and it’s not helping than that muscle isn’t the problem. Rolling, needling, massaging etc of your IT band is a waste of time. Trigger point your gluteals and you’re ITB will loosen up. That’s your short term fix, your long-term fix is to strengthen your gluteals.

A muscle will get tight because it’s being overworked. This can be for a number of reasons, the ones likely applicable to you are that the muscle is weak and it’s being overworked or it’s compensating for a movement dysfunction/other weak area/weak synergist.

The tricky part, without examining you, is what your movement dysfunction is. This will be a bit of a guessing game.

Let’s start with VMO retraining. The research shows a correlation between decreased VMO bulk and knee valgus. Unfortunately, almost everyone in the health care field has taken this to mean weak VMO=knee pain/knee valgus/chondromalacia patella. Weak VMO is not a cause of knee valgus it’s a symptom. What is knee valgus? What movement is occuring at the knee joint when your knees move medially (valgus). There is no movement at the knee, the movement is occuring at the hip. When your knees medially deviate your hips are internally rotating; therefore, if you cant hold your knees neutral your hip external rotators are dysfunctional (weak).

As for your hip flexor and quadriceps tightness this can be for several reasons. I’d sort out your weak external rotators first and see if this resolves your quads and hip F. I know you said you did clam shells but have you been doing them correctly? If your hips roll back your not doing anything. Are these the only gluteal exercises you’ve done? Are you only focusing on strength or have you done gluteal activation exercises?

Tight quads can be a result of your hip extensors not working properly OR they can cause your hip extensors not to work properly. If you’re stretching your hip F and the problem is getting better than it’s probably the latter. Otherwise you knee to get your hip extensors working/activating again. This will most likely be your gluteals and in particular glut max. Weak hip extensors force you to rely on other muscles – quads and calves to compensate.

Your anterior knee pain could also be patellar tendinopathy. I won’t go to much into this because it gets lengthy but if this is the case you need to start seriously rehabing it immediately.

Hope that gives you somewhere to start.