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!

AvatarRyan Cloutier

My issues seem very similar to yours:

1) Overactive/dominant/tight quads – slightly pulling the patella up and laterally, also contributing to anterior pelvic tilt. 
2) Overactive/dominant/tight hip flexors – inhibiting the glutes, contributing to tightness in IT band and lateral pull on patella. They were being overactive by prolonged sitting among other things. Also contributing to internal rotation of my femur during knee flexion without an obvious valgus. 
3) Weak/inhibited Glutes – at least relative to my other muscle groups, they were being inhibited by prolonged sitting. Also, hard to activate/strengthen them if hip flexors were overactive. Can’t get full hip extension for full glute activation unless hip flexors loosen up. Also contributing to anterior pelvic tilt and internal rotation of femur during knee flexion. Also hamstrings would preferentially activate during glute activation exercises as I noticed my hamstrings would fatigue during hip thrusts/glute bridges. 
4) Tight IT band – I have no idea why it gets triggered to become tight so easily. My overactive hip flexors and weaker glutes are most definitely contributing to this problem. Perhaps my leg length discrepancy is also playing some role causing my right pelvis to shift forward and somehow leading to excess IT band tightness and knee pain… this is purely speculative,,
5) Anatomical Leg length discrepancy – might be playing some role in my slow recovery from this injury. My right leg is shorter by 1.1 cm which is causing my right pelvis to shift forward. How is this causing or contributing to my tight IT band and patella femoral pain I have no idea.
6) Loading the knee/patella during squat movements – overactive quads and hip flexors, with weaker glutes and hamstrings, and anterior pelvic tilt is contributing to preferential activation of quads during squats or closed chained knee flexion.
7) Anterior Pelvic Tilt – Quad,hip flexors dominance, and weaker glutes and core contributing to anterior pelvic tilt. Which might be promoting internal rotation of femur and stressing the patellofemoral joint during squatting patterns.
Things that seem to be helping:
1) Physio exercises to strengthen glutes (maximus, and medius) also some hamstring activation. Trying to minimize quad activation but at the same time trying to do functional exercises such as squats, single leg squats, split squats/lunges. While also doing exercises such as hip thrusts/glute bridges, side lying leg lifts against wall, x-band walks, front and side lying planks
2) Doing the mobs 2x a day targetting hip flexor, quads, IT band, (and sometimes calves, adductors, piriformis). Mostly rolling with the lacrosse ball and rumble roller. With stretches at the end.
3) Voodoo band squats with band around the bottom of knees (2x a day usually)
4) Rolling out the hip flexors prior to glute activation exercises. This has given me more sore glutes than previously. Also noticing less activation with hamstrings probably because I can get into a further range of motion and full hip extension. 
5) Avoiding sitting. This has probably contributed to me being able to get full hip extension during glute activation workouts. 
6) Doing capsule stretching/band distraction roughly once a day after my mobs. Targeting the hip capsule.
7) Suction cupping and electro-accupuncture has been able to reduce muscle tension a lot. Don’t do these as often as the mobs however but seem to be really effective when I do them. No permanent changes however. 
1) Ankle range of motions is good with good dorsiflexion
2) VMO doesnt seem weak as their is easy contraction/activation when I contract my quads. Also its of decent size. Perhaps their is slight earlier firing of the vastus lateralis and delayed firing of the VMO tho. Will try to get EMG to know for sure
3) Foot Arch is of decent size. 
4) No obvious valgus during knee flexion
5) Mobility seems good
6) toes point out 5-10 degrees usually which is good
7) gait analysis seems good. 3-D gait analysis will show it in more detail once I get it.
It seems like I have it all figured out and I know my issues. But the problem is I have been doing everything to correct the problem for awhile now with only mild improvements. The biggest improvements have come since January were I made some changes to my routine since following mobilitywod which has been of great help. Especially thanks to Kaitlin and others who have contributed their advice. My IT band has seemed pretty loose for awhile until recently I triggered it to become really tense and painfull again doing some physical activity during daily life involving an open chain knee flexion (just as tense as it used to be). This might be indicating that nothing really has changed except for me masking my symptoms with all the mobs and self-myofascial release. I hope this is not the case.
Next step: See a legit well recognized physiotherapist who will confirm what I speculate are my issues during his assessment. Hopefully he will make alterations to my regime to improve my routine. Also, get advice from him in regards to the leg length discrepancy and pelvic tilt contribution to my injury. Also, looking to go see someone to get electro-accupuncture done on my hip flexors so I can get into more hip extension and better activate my glutes. This will give me the window of opportunity to strengthen my glutes in ranges I wouldn’t normally be able to go in.