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Daily Mobility Exercises by Dr. Kelly Starrett › 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!
I think my situation is closest to jtrue, granted I didn’t read every post, but I am a Physical Therapist (a GOOD one) that works with professional athletes among other things, and I have anterior lateral/superior knee pain. I have had it since highschool, and it gradually got worse. Finally I started training as an athlete for my sport and decide I am going to fix this. I have never had a patient like me and I have never had a physician or clinician identify why. Knee flexion to 90 degrees in a squat is sometimes 8/10 pain, sometimes in both knees.
The only medical findings: left knee Baker’s cyst, few calcium pyrophosphate crystals, no problem on right. Slight kyphosis. glute/hip weakness on affected side (left) because of pain with tone. Slightly reduced mobility on affected side for sacrum, ribs, thoracic spine, and shoulder, reduced spinal rotation away from affected side, no apparent calf tightness but reduced symptoms with stretch to reduce tone especially if it’s a self stretch by dorsiflexing foot. Hip adductor tightness Right>Left, quad tightness L>R, hip flexor tightness R>L.
Pain is worse after a day of rest. If I wanted to set myself up for some seriously debilitating pain where I couldn’t walk down the stairs I would train hard one day, not stretch quads/hip flexors or hips afterwards, eat sugar/carbs/gluten (anything inflammatory) then rest a whole day, that night I would wake up in so much pain the sheets hurt me.
The best I can figure out so far for this illusive pain and what helps me:
1. Got MRI, finding something small/mechanical is chronically irritated at onset maybe, for me it’s the cyst, sight fluid increase puts pressure on site superior and lateral to patella.
2. Rolling out my trigger points, I have one above the area of irritation, one on posterior boarder of middle ITB, one TP on distal 1/3 of vastus.
3. Avoid all sugars, inflammatory foods and sometimes gluten/carbs as they increase my pain especially on bad days.
4. Ice during flare-ups, take antiinflammatories if I have to perform.
5. Stretch quads/hip flexors, hip external rotators, proximal hamstrings, gastrocs, deep pelvic muscles ONLY WHEN I AM MAXIMALLY WARMED UP, otherwise I only stretch structures involved with tone and other small micro injuries occur = more irritation. Best stretch for me to reduce pain is one that turns off the opposite muscle, example dorsiflexing foot to stretch gastroc, or better yet keeping the whole body engaged while stretching, example down dog or hanging on a deep lunge.
6. Get mad, let it out. All the years of pain build up and take a toll, let my heart heal and feel the resolve to push through pain.
7. Good posture. String pulls chest up, don’t let your hips posteriorly rotate especially while sitting.
8. Do front squats for a while if I have to squat and keep chest up, stick butt out, knees out. If I can’t do it because it’s too painful I do a sumo squat and each rep I slowly inch my feet where they need to be for a regular squat until the tone changes.
9. Warm up with dead lift, back extensions, posterior chain. Warm up gently and progress. Sometimes ankle alphabet. Engage affected side. Focus on warming up hips. Knees completely depend on mobile, strong skilled hips and ankles.
10. On good knee days I push it as hard as I can. Hard strength training, sprinting, pushing my limits and the pain virtually disappears and lasts several days if I stretch right afterwards and watch my diet. Everything maximally engaged.
These things have not completely taken away my symptoms because of the cyst, but as I get stronger and more mobile it’s getting better.
I hope my experience helps, interested to see what else comes up.