Wow, found this searching for an issue I’m having with a chronically tight IT band,hip flexors, and quads. It’s scary how much we have in common. I’ve only had this specific issue for a couple years, I had other knee issues prior to the IT Band hell.

I’m mostly into cycling and ski mountaineering, with a little climbing thrown in now and then. In the past I played hockey and lacrosse, but haven’t played those for some time. Currently 32, issues started occurring 3 years ago. Original issue that popped up for me was some medial knee irritation caused from cycling. I fixed that issue with a bike fit, it comes back to haunt me if I ride a bike with too narrow of a q-factor.

Fast forward to after fixing that issue and going back to training hard, riding 6 and 12 hour solo races.  I started to feel some tightness in both IT bands after one especially hard effort racing.  I foam rolled, stretched, and followed all the conventional wisdom out there that I could find at the time and went back to overtraining.  Well, the next time the issues popped up they were here to stay.  At first it was mostly chronic tightness felt throughout my lower extremities, mostly IT band, quads, hip flexors, and calves, but lately I’ve also been having some lateral knee pain, which I believe is caused by lateral patellar tilt and tracking.  The tight IT band feels like it is pulling that lateral renticulum and causing the edge of the kneecap to graze the cartilage underneath my patella.  I also feel pressure sometimes, like something is pulling my kneecap towards the back of my knee.  Pain has never been too bad, but the long term issues this could cause scare me.  I should mention that I’m a desk jockey, work in an office, and sat for long periods previously.  I now have a standing desk, which has seemed to help, but definitely isn’t the magic bullet some people would have you believe.

I’ve gone through a number of PT’s and finally found one that got me started on the right track.  Working on hip mobility, strengthening my core, glutes, and hamstrings.  Like you I have only been doing my exercises 3 times a week, with myofascial release on a more regular basis.  Following a similar routine as you, rumble roller, lacrosse ball, etc.  I’ve also been doing some self administered astym or gua sha to the lateral side of my quad and IT band.  This seems to help reduce local adhesions.  Unfortunately PT’s in UT aren’t allowed to practice dry needling yet, I would be first on the list if they were able to.  Anyways, I can get temporary relief from the tightness and associated pain by firing up my glutes doing isometric holds of either clamshells or side lying single leg windshield wipers with an exercise ball.  This seems to reduce the tones of the muscles pulling on the IT band. Also incorporating single leg hamstring curls, single leg romanian deadlifts, and various planks.  I’ve been laying off the sqauts for a bit since the lateral knee pain popped up.  The deadlifts and isometric glute exercises give me the most benefit.  Also, noticed lately that when I really dig into my rectus femoris I can feel the lateral knee pain pop up, so I’ve been focusing on stretching and massaging that as well.  I too feel like there is something I’m missing to get back to 100%.

I think Alpha919 is onto something above when he mentioned that once he started focusing on all these areas and “smashing” those structures his glute started firing normally on the affected side and the pain subsided.  Right now when I contract my glutes the affected side contracts less than my normal side.  I really have to work to get it to fire with the same intensity.  I feel like all the tight structures are causing this.  I’m going to commit going forward and start on a daily routine, please post back with how the flossing is going.  I think I need to start that as well.

Don’t mean to take over the thread, but would love to share what’s working for both of us in an effort to try to beat this thing.  Appreciate all the other posts with all the info, videos, and encouragement.  It’s a frustrating injury as it doesn’t heal like a broken bone and there can be so many causes.