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!

02/20/2014 at 4:59 pm #74185
AvatarRyan Cloutier
Member
Update:

1) 3-D gait analysis and pedorthist: I went to solescience for an assessment with Colin Dombroski (a field leader in leg length discrepancies in Canada). He said he recommends a full foot lift of 0.5cm for my 1.1cm discrepancy. He says even small discrepancies might cause problems. In the research hes doing hes seeing that small discrepancies can throw off gait, and kinematics. He was also saying that in the orthopedic literature they say 2cm is the cut of for treatment because they are biased. Must hip surgeries cause a leg length discrepancy below 2 cm, so the clinicians want to keep the performing surgeries so they say 2cm is the cut off. He said having a discrepencie is like I am constantly stepping in a divot loading the joint more. Overall tho he analysed my gait visually and said it looks pretty good even with someone with a discrepancy or injury. I showed him my previous heel wedge and he says it wasn’t helping help me because it was to small. He says although the back is cut to 0.5cm your supposed to measure from the middle of the wedge and it looks to be about 0.3mm only. Plus the wedge lifts only the back of my heel causing my pelvis to shift forward. Full leg lifts is definitely what he recommends. The 3-D gait analysis is scheduled for 1 month. He will test my gait prior to the leg lift, then he will also make me a few full length foot lifts that I can take. He will then do another 3-D gait analysis a few months after (I think he said 1-2 moths) to see the changes. Hes mostly focusing on the pelvis and knee kinematics. 

FMS (Functional Movement Screen) Results: So although someone did the FMS testing back in October. I asked for the results via email a few days ago and I got them back:

Here are Tommy’s assessment results – it’s nothing groundbreaking but it’s good to have all the info you can:

Dave, here is the assessment Report

Moves extremely well in patterned motions. Far better than expected, almost flawless

Standard Squat- Pass
Heels Up Squat- Pass, but still with knee soreness
Overhead Squat- Pass

All done with full range and excellent posture

Ankle Flexion- Excellent. Even and large range.

Single Leg Strength- Full easy pistol on both sides with good posture

Glute activation- a little unstable, but activation in extension/abduction is obvious

Hamstring Mobility- Very good, although lots of quad cramping with quad activation

Anterior Hip- The only place I found obvious issue. Both anterior hips (deep) were tight, and in knee flexion there was obvious internal rotation to compensate. Right side is worse than left.

Did a Klatt’s test but it didn’t show anything obvious.

My conclusion

Very strong, very mobile- not your obvious issues you associate with knee pain

However, I am assuming that in deep squatting and knee flexion the tight anterior hip is forcing internal rotation. Not with an obvious collapse at the knee but deep inside right in the hip capsule. If this is indeed the case his knee caps will be shifting and not gliding correctly- leading to knee pain. It also fits with his symptoms

Right knee pain constantly, left knee pain when squatting

Right is worse than left, but both increase in soreness with flexion

Go over this with him and let me know what your thoughts are after session 1.

I would say with some good smashing and band capsule stretching this should clear up over time.

— 
Tommy Caldwell

Performance Coach and Consultant
Founder and Head Coach- Hybrid Training System
Founder and CEO- Hybrid Fitness Centres
Founder- HTS Hockey