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!

03/13/2014 at 7:57 pm #74299
AvatarRyan Cloutier
Member

Update:

1) Got MRI done on my proximal tibia-fibular joint. Will review results with sports-medicine physician in a week or two
2) Osteopath appointment set up for next week. I will talk to her about what she thinks is going on. 
3) 3-D Gait analysis, and full length foot lift (on my right foot). I have an appointment scheduled in two weeks.
4) Physiotherapy: Had an appointment today. He mentioned the biggest difference he notices between my two sides is the difference in external rotation (he thinks this might be the biggest contributor in terms of my right patellofemoral pain). My right leg (side of painful knee) has limited external rotation ROM and also experiences discomfort deep in the hip capsule during external rotation. He says it doesn’t have the same “give” when he compares the 2 legs, and he says its not a muscle tension issue, rather its tight hip capsule on the right side (meaning the connective tissue and ligamants deep inside the joint). He wants me to focus on external rotation ROM stretches (along with my physiotherapy routine) for 2 weeks before I see him again. He wants to know if I can gain ROM in external rotation and if that will correlate with symptom relief. He is able to increase my external ROM during the physiotherapy session when he performs manipulations/stretches after a glute activation warm up. My symptoms do feel better today. But it could also be due to: him taping my knee, or because I have been generally having better symptoms each day since I had a flare up of IT band tightness and knee pain last week due to prolonged sitting, or maybe its just placebo.
Dont stretch over pain threshold: I asked him about doing capsule stretching using a band (banded distractions). He says its perfectly fine, and it should also help and that he is familiar with mobilitywod and kelly starret. One thing he mentioned is to not perform the stretch to the point that one is having pain during the stretch. I was always stretching pretty hard before and experienced discomfort during the stretches almost like a little pin in the capsule (like a pain due to a stretch). He said that I have to avoid that and stretch the ROM right before you experience that. Because the pain can be counterproductive as it can cause more tightness due to a guarding reflex. After my banded distraction capsule stretch for hip external rotations it would be hard for me to walk and I would have a temporary limp that I have to walk off for a few minutes, just because of the long, intense capsule stretch. Is that to much?

I dont feel a stretch however If i dont stretch to the point of a discomfort level. It feels like I am not stretching at all using his advice. What is mobilitywods view on this topic? I might start a new thread asking this question. 

He mentions that stretching the ligaments can be done due to a phenomenon called creep. So I will begin doing some research on stretching ligaments and creep. Heres a a link I found on the topic just for starters: