Has anyone determined a cause for the tightness you are experiencing?
It sounds like the people you have seen are going after symptoms, but not what is causing the symptoms.
The symptoms will continue or continue to display new symptoms until the cause is addressed.
Have you looked upstream/downstream of the issue?
IT Band/ Hip flexor episodes
Episode 361: Pathomechanics and IT Band Hell Part 1

Can you specify where exactly the pain is? ie. Below the knee, above the knee, medial, lateral, in the middle, etc. And what movements cause the most pain?

I was in a similar situation recently. Long story short, at the beginning of June I began getting this anterior knee pain, right above the knee. I would wake up in the morning with my knee feeling stiff, like it was under constant pressure. The pain worsened after prolonged periods of sitting, and seemed to hurt most when my knee was in more flexion. The pain would die down to around a 1-2/10 after a really good warmup / session of foam rolling and stretching. Despite being a trainer myself, I let this go on for almost 5 months. Training for the AF > focusing solid mobility (bad).  Out of frustration I visited a Physio who told me to do quarter squats off of a phone book, and ice it. $30 wastedddd.

I’m going to say I don’t believe in VMO imbalances causing this kind of knee pain, and that’s an outdated theory, and anyone prescribing quarter squats and TKE’s is probably wasting your money. 

I finally decided to sack up and research the hell out of the situation and commit to rehab 100%.

The problem with your approach is that you said you do physio exercises only 3 days a week, but 2-3 hours long. You need to do them maybe max 1 hour, but EVERYDAY, twice a day. If your situation is like mine, your tight quads, hip flexors, and calves are all pulling on your knee either directly, or indirectly through fascia. After loosening those up, my “weak glute” started firing just as strong as the unharmed side.

This is how I kicked what would have been a never ending cycle of misdiagnoses from doctors for years:

1) Smash your quads, ITB, and hip flexors. Specifically, your rectus femoris. Show no mercy; you need to drop the foam roller and start smashing that with a barbell and a softball. Spend 8:00 per leg, twice a day.

2) Couch/wall stretch like it’s your job. I’m talking like at least 3 times per day, at 2:00 per leg (6:00 per leg / per day). This is the most important in conjunction with #1.***

3) Voodoo band your high hip, mid quad, suprapellar pouch, and high calf / right below your patella. Perform squats (good form) and calf raises / stretches while in the bands for ~ 20 reps.

4) Smash and stretch your calves.

5) Smash your anterior tibialis; use a tennis ball, or lax ball and start to “peel” it off your tibia.

Assuming your situation is similar, commit to this for a couple of weeks and you’ll just notice one day that you’re pain free. Unfortunately, I don’t have any time tonight to hunt down links for those 5 things, but Kaitlin is usually a wizard when it comes to links, so she may beat me to it sometime this weekend. Good luck!

You need to start looking at quality over quantity.
Spending 2-3 hours at a time is too much.
You want to be spending time every day. Shorter sessions with higher quality work.
15-20 minutes 3 or 4 times a day is one place to start.

Pro Episode # 35 – MWod Pro-User Request Friday: The IT Band Primer
Episode 361: Pathomechanics and IT Band Hell Part 1
Episode 361: Pathomechanics and IT Band Hell Part 2
Episode 361: Pathomechanics and IT Band Hell Part 3
Daily Rx December13th

Episode 142: Tight IT Band and Hip Flexor Fix: Runners?
Episdoe 23: Runner’s Legs
Episode 04: Silent P in Filet, Very Paleo

Episode 206: The Couch Series
Pro Episode # 52 – Pro user Request Friday: Couch Stretch Feel Weird? It’s a Diagnostic Tool too.
Episode 353: Floss Bomb! Worse is Better
Episode 271: Full Over Head Test and Super Couch
Episode 235: Recover Your Anterior With the Super Couch
Episode 29: Use Your TV to Time Your Pain: Hips and lower leg

Pro Episode # 36 – Voodoo Floss Series # 3: The High Hamstring
Introducing the Bone Saw: Calf Smash Redux
Episode 303: It’s Not Rocket Science, It is the NASA Calf Game
Episode 194: Why Do You Hate Your Calfs?
Episode 25: Heel Cords of a Cheetah, Achilles Well Being

Daily Rx Saturday, August 17th, 2013
Use a supernova

1) Isn’t it hard to fit in all the various exercises required within a 1 hour period? Would I focus on different parts during each session, or would I do the same part for both sessions (i.e., would I roll out the rectus femoris with a barbell in both sessions? and if so wouldnt it get bruised or damaged for so much work?). Why was doing the exercises for 3 times a week but for longer periods of time wrong?

A) Every time you smash, follow up with a 2 min stretch. But if you’re just waiting around somewhere, feel free to stretch too.

B) Use the barbell smash only a few times a week, if you’re banged up, slow it down.

C) I don’t know the exact physiology on why, but you need to make a neuromuscular change that will require higher frequency.

2) Your 5 points all mention mobility/stretching/self myofascial release work, but you havent mentioned any strengthening for muscular imbalances (i.e., glute, core strengthening, and functional exercises-besides the squats). Did you not do any strengthening to correct for muscular imbalances? Why were you tight in the first place? I have been told that self-myofascial work will only correct the symptoms, after which I will get tight again. I have tried doing self-myofascial work twice a day before for an extended period of time to no avail.

A) In my particular instance, I don’t think I have any major muscular imbalances. My personal theory is that the notion of strengthening the posterior chain for knee pain doesn’t solely help because of muscle imbalance, but rather that people who have strong posterior chains usually have better biomechanic (ie. don’t leg press a squat) and don’t let their anterior chains get overworkedand tight (through indirect anterior stretching; you can’t finish full hip extension if your anterior chain is out of wack).

B) I was tight in the first place because I was running 4-5 times a week, swimming 3 days a week, and fin swimming 2 days a week (Air Force). I neglected stretching. I wasn’t as strict on my biomechanics either. That’s the first change to make. No knee valgus, no excessive knees over toes, etc.

C) You need to stretch/mobilize to not get tight. But you need to break up all that stiffness with the myofascial work to aid the mobilization. It’s like peanut butter and jelly.

3) The barbell, and soft ball sounds very interesting. Are they better than a PVC pipe, rumble roller, and lacrosse ball that I have been using? I have an E-Z bar at home will that suffice? I rolled out my rectus femoris with that last night by putting the bar with protrusions on top of my leg and dragging it slowly, seemed to be effective for that muscle, and some of the adductors and vastus lateralis. Cant seem to get any other muscle groups with the EZ bar tho.

I don’t know necessarily what is better, but I prefer the PVC pipe, softball, and occasionally the barbell. I think the lax ball is too small and causes bruising for my legs.

4) You mention couch wall/stress each leg. My problematic knee is the right one, although I have tight IT band/quad/hip flexor complex on both sides. Should I still do both legs, or focus more on my right leg?

Ideally as a coach, I would tell you to do both equally. When I was in full mob-mode, I probably paid 70% attention to the bad one and 30% to the okay one. As things eased up, I even them out. Don’t neglect the other one, it could end up like the other one if you don’t! But I’m not gonna lie, couch stretching like 3-5 times a day sucks, it’s not fun. That’s probably why I didn’t want to double it.

5) I am not fimiliar with voodoo banding the high hip, mid quad, and high calf. I have seen one of kellies videos were he vodoo bands somones suprapatellor pouch with a half lacross ball under the band, and makes him do squats. What will voodoo banding those areas you mention do? And If I voodoo band do you suggest to have half a lacrosse ball under the band? Is their a video that shoes voodoo beanding the hi hip, mid quad, and high calf while performing squats. I checked all the videos you posted Kaitlin. Maybe I missed it.

Voodoo flossing helps restore sliding tissues, and also helps flush out joints as well as get some new blood to them. Above the knee often gets matted down with all the common muscle insertions. I’ll post some videos here in a little.

6) All the exercises/stretches kelly performs with some type of band, around the high hip and gluteal fold area while stretching the hip flexor/high quad complex. Is that with a voodoo band? You did not mention performing those exercises, did you not perform them,? Are those capsule stretches?

That is just a jump stretch band. It’s not a bad idea to throw those in when you can. It can be awkward to set up though. I only used banded distractions about 10% of the time.

After I get all the links to videos, I’ll resubmit my 1-5 to help make things clearer.

1) You are covering too much at one time.
As Kelly has noted keep it to 3 mobs a day.
Trying to mob everything all the time doesn’t work well and there isn’t time for that everyday.
Determine where the biggest performance limiters are and start there.
You don’t need to be as concerned with the individual muscles addressed vs you are impact anything that is tight in the targeted area.
Episode 321: Programming for Mobility
Post 400: Movement Hierarcy- Movement Complexity, Injury Rehab, and Making the Invisible Visible
An MWod Model for Post Surgery/Post Injury Rehab
Spending so much time at once isn’t wrong per se, but there are more effective ways to go about it.
Only doing it 3 times a week is not frequent enough. You are breaking habit and forming new ones.
Your body needs the stimulus for the new position/rom/movement pattern more often because they are a new position/rom/movement pattern. The more the stimulus is there the better.  As you work with these changes they will become habits/default patterning and you won’t need to think about it so much to have the correct movement pattern/positioning.
This can take some time because you are retraining things. You are creating new neuropathways for the changes in position/movement pattern.
Yes, you can work on the same areas more than once a day. If you are bruising I would recommend taking another look at things. I have not bruised from mobility work.

You may not be seeing improvement because you aren’t addressing the cause of the issue. If you are only addressing symptoms symptoms or new symptoms will continue to occur because the cause of the issue is still there.
You need to take a systems approach.
Pro Episode # 21 – Pro-User Request Friday: Not Seeing The Change? You Need a Systems Approach.
Do you know there are strength imbalances?
Pro Episode # 25 – Matt Hasselbeck Edition: Advice for the Uni-Lateral/One Sided Athlete
Sometimes when movement patterns are improved and mobility is addressed imbalances go away because the system is no longer compensating for something else. SMR corrects symptom when it is addressing symptoms. Same thing applies if the cause is not addressed the improvements will not remain. You can chase symptoms forever. 2 times a week is not frequent enough to see change/improvements. There are no days off with this stuff.

3) The tools you use can change based on what the goal is and what you are addressing.
Yes, a barbell is better than PVC for areas that need something more than PVC. A rumble roller is great for some areas other areas I would not use a rumble roller. I would recommend getting a Gemini to replace the 2 lax balls taped together, and a supernova. These up the anti another few levels.
The ez bar could work if there is enough weight to the bar. A regular bar is 33 or 43 pounds.
Use it and see. This is a question you will need to answer.
Don’t be as concerned with the individual muscles targeted vs you are impacting anything tight in the targeted area.
4) YES, you need to address both sides. You may spend more time on the side that is tighter, but where both sides are tight you need to improve both sides.
5) Voodoo flossing hits compression which is another way to address an area to see change.
Try it and see what it does for you. What do you have to lose by trying it?
I did not list every video that addresses the areas mentioned. Do a search and look through the episodes and daily rx. This will help with your understanding as well.6
6) No, those are jump stretch bands.
Voodoo Band http://www.roguefitness.com/voodoo-floss-bands.php?SID=vu5m001h0g9qo75e46ilpo2pf5
There are episodes where Kelly uses a voodoo floss band.
Different tool, bands etc. are used to address different properties.
It goes back to the goal of the mob and what aspect(s) you are looking to improve.
You should always use a band when able to use one.

Just curious – is your leg length discrepancy a permanent structural issue or do you find it is correctable via, say, a chiro who manipulates you and he can get your legs the same length for at least the short while?

Videos as mentioned. Do these several times a day, but don’t go overboard for more than an hour. Let us know how things go, good luck.

1) Smash your quads, ITB, and hip flexors. Specifically, your rectus femoris. Show no mercy; you need to drop the foam roller and start smashing that with a barbell and a softball. Spend 8:00 per leg, twice a day.

Correct Quad Smash Technique:
http://www.youtube.com/watch?v=5nlarY4AdQw

Barbell Smash:
http://www.youtube.com/watch?v=c57xVyqTEjw

2) Couch/wall stretch like it’s your job. I’m talking like at least 3 times per day, at 2:00 per leg (6:00 per leg / per day). This is the most important in conjunction with #1.***

http://www.youtube.com/watch?v=-ZX1QMTdAC4

3) Voodoo band your high hip, mid quad, suprapellar pouch, and high calf / right below your patella. Perform squats (good form) and calf raises / stretches while in the bands for ~ 20 reps.

http://www.youtube.com/watch?v=-RYMV0salw8

http://www.youtube.com/watch?v=JVRTnKUgARA

How To Make Your Own Voodoo Bands:
http://glennpendlay.wordpress.com/2012/02/17/got-tendonitis/

4) Smash and stretch your calves and anterior tibialis:

http://www.youtube.com/watch?v=fCFlfgCqpK8

5) Pay Attention to exercise form, and other mobility aspects above and below the knee.

http://www.mobilitywod.com/2013/07/pro-episode-31-user-request-friday-live-from-the-games-patellar-tendonitis/

I have not used suction cupping, but if you are seeing improvements with it continue doing it.
Have a plan 30 minutes of mobility work 2 or 3 times a day. Morning, night, and if you have the opportunity to spend time during your lunch at work that may be another option to work on it.
Doing strength 3 times a week works.
If adding weight to the bar work continue doing it.
If aren’t able to add weight to the bar for something you may consider getting a heavier bar. Sometimes you can find used bars on Craig’s list. You may not be ready for a heavier bar.
You can get everything from Rogue Fitness:
Voodoo Bands 
Jump Stretch Band  1 option OR 2nd option
Supernova
Gemini 
Therabands don’t have enough resistance. You will not have a problem with jump stretch bands or their durability. You want a green and a blue.
Yes you can use them for x band walks. This video shows someone using one How to do xwalks
Yes doing a dynamic warm up before mobility work could help. Message me if you want ideas on it.
Warm up and mobility work are 2 different things so yes a warm up is helpful.
When I workout I wear shoes. You want a flat shoe DC, Vans are a good option, Nanos, All-Stars. For Oly sessions wear Oly shoes.
For every day life something flat DCs, Vans, All Stars if you need a dress shoe there are flat options there.
Orthotics may be worn for some time, but you want to strengthen your foot so your foot is making the change not the orthotic making the change for your foot.
Have you watched the Rebuilding your feet 3 videos or the Flat Foot Solution?
Start here for moving away from wearing orthotics.
Yes you should go barefoot at home whenever possible.
If you wear a wedge in your shoe you should always wear it.
Going back and fourth can throw things off and cause you to make compensations when you don’t have the wedge in your shoe.
I asked before, but is this something that can be corrected having a chiropractor adjust your hips/pelvis?
I ask because I know someone who had a situation like this rectified. At first it can take 3 adjustments per week moving to 2 then one then when needed as the muscles learn the new positioning and can hold the position.

to echo Kaitlin’s comment – in my early days of PT, a PT guy found that one of my legs was slightly shorter than the other.  So he gave me orthotics with a slight lift.  These worked for a while. but then i started working with another PT and he worked soft tissue and adjusted spine/pelvis and found that he could get my legs the same length. Whoa. later i learned that many with leg length issues could be fixed without orthotics, but required other types of therapy.  i tossed my orthotics and fixed my movement patterns.  Everything worked naturally better.  So yeah it was in vogue to use orthotics many years ago, and for some who have permanent structural problems like true bone length issues, they will require orthotics.  but for people like me, it’s better to fix the muscular and skeletal problems, as well as fix movement patterns.  then i don’t need orthotics as a crutch, which was probably causing other problems like cramping out during a marathon, etc.

There’s probably a diminishing returns point where duration isn’t going to help as much as more frequent times throughout the day. And the routine looks good. If your posture and shoulder aren’t hurting you, you can probably take those out to cut down mornings and nights down to 30min. Then maybe throw the back/shoulder stuff in a couple days a week, but probably no need to do it as much as the leg/hip stuff. 

For now, just focus on the mob work and see where it gets you, with your 3 days of strength training a week.

When having long sessions the quality of the session can be less than the quality of a shorter more focused session.
The anatomical leg length discrepancy can come from the “right hip seems to be more “junky” and tight than the left, which is also causing the right hip to be tilted forward/anterior.” If you clean that up and have a better position the difference may be corrected.
Episode 352: Dealing With Old Junky Tissue
Going barefoot is a good strengthening activity for the feet.

If the difference is 1.1cm and it is recommended to wear of wedge for 2+cm difference then it doesn’t sound like it is recommended to wear a wedge.

If you are working on something for an extended amount of time and not seeing an improvement you need to change your approach.
Pro Episode # 21 – Pro-User Request Friday: Not Seeing The Change? You Need a Systems Approach.
Are the corrective exercises you are doing focus on the symptom of the pain or focus on the cause of the ant pelvic tilt or tight IT band? Are you doing any of the MWODs that address these?
If the exercises only address symptoms the situation is not going to improve because the cause is still present.
Some situations can take some time to improve because you are retraining muscle/tissue to a new position.
You are unlearning one habit and creating a new neuropathway for the changed positioning.
This can take some time us with breaking any habit and creating a new habit.

Have you approached this with a smash session, a hot bath, and then a banded distraction session?  The heat of a hot bath helps the muscles relax. The heat acts like a sweat warmup in which you can get into the mobs without a much of a wait for that warm feeling.

Daily Rx August 21 hits on hip flexion and the seated position

Good to hear you are seeing improvements in your situation.
When there is a long standing issue it will take time and alot of time to correct. The amount of time things remain in place following a session will increase as more returns to its proper place/positioning.
You are working to improve the situation which will not happen over night. As more items are corrected more will come into better placing/position.

If you are completing something for another look you may need to do it with another doctor if you weren’t satisfied with the evaluation from the prior time.
Is there a coach with a strong knowledge and mechanics& technique background that can look at your movement patterns with different skills?
 

Sounds like the cause of the discrepancy is not from something out of alignment.
Then it sounds like the heel wedge will start to address the situation.
It sounds like she knows alot about the subject.

When you had a heel wedge before was it the correct size? Is the one suggested the same?
Have you addressed the type of shoes you are wearing and working out in?
Did you make any adjustments is anything when wearing the heel wedge in the past?
This changes things if you continued wearing the same pair of shoes they may have been off from your movement patterns when not wearing the wedge.

Did anyone who told you not to do use a wedge offer any other advice?
Did anyone who told you not to see you in person?

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.

 My pelvis on one side was further back than the other
side, which was causing a functional leg length discrepancy. When my PT
corrected that via manual manipulation I felt a release of tightness down the lateral side of . 
The trick was keeping myself in alignment, I’m finally to the point that
I stay in alignment.  I think overall I have some anterior pelvic tilt
though.  The exercises I mention above seem to correct for that, but I
constantly have to remind myself to keep my pelvis underneath my core.

I totally hear you about how this can change your mood.  I too feel like an old man when I should actually be in my prime athletically.  I can actually stay quite active as long as I keep up with my routine, but it’s no way to live.  I literally spend most of my down time at home rolling around on a foam roller, doing self massage, researching, etc.  I feel the best on the weekends if I do my strengthening routine on Friday and stay active throughout the entire weekend.  If I just lay around at home or work at my desk in one position it seems to bring the tightness back.  I think part of what I’m experiencing is a postural issue or the lack of control I have over my pelvis.  My quads are ridiculously strong, but I have weak hamstrings, and core, which seems to contribute to the patellofemoral pain.  Seems like this occurs a lot in communities where skiing and cycling are the main activities.  Everything I do is quad dominant…

One thing that seemed to help when I was feeling horrible bi-lateral tightness in both quads and IT bands was to sleep with a pillow underneath my pelvis/lower back.  Not sure why this helped as it seems like it would put more stress on the hip flexors and quads, but it felt like the tone reduced in the tight muscles.

Looking at picking up some more mobility tools, Kaitlin has a great list above.  Which jump stretch band do I want for getting into the hip capsule?  Looks like I would only be able to use that band at the gym with something solid to attach it to?  Is the black 41″ band sufficient for muscle distraction?  X-Walks look good, assuming the 12″ band will work for those?

Kefu, have you noticed a good outcome with the electro acupuncture machine?  I have a cheap e-stim, but if there is an equivalent to dry needling I’m all ears.

The two bands i would recommend getting are the green one and black one from Rogue.  these will allow most people to do any kind of band distraction for upper and lower body.

As it turns out someone at my workplace gym has a green rouge band that is just living on the pull up bar.  I’ll probably hold off and just borrow that one for now.  Did a couple of the recommended mobility exercises, including the barbell quad smash and the wall stretch.  Quad smash was good, didn’t feel much worse than my black rumble roller, but had better control over the pressure I was applying, vastus lateralis felt the tightest.  The wall stretch was an eye opener, couldn’t get my foot anywhere close to vertical against the wall like Kelly(http://www.mobilitywod.com/2010/08/episode-02-dont-go-in-the-pain-cave/) tons of tightness felt in the rectus femoris mostly.  Going to target the quads for a week along with some ankle drills while I’m standing at my desk.

For myself I can feel a difference as soon as I start my routine. Firing up the glutes and hamstrings seems to reduce the tone in the other muscles that are tight, reducing the pull on my IT band and allowing my kneecap to track straighter.

My issue has been that after a rest day the tightness returns. I would think if you continue to fire up those muscles that help keep you in better alignment it would generally help. So maybe lifting heavy a couple days a week to increase strength and doing very lightweight or bodyweight exercises as a form of active recovery on the other days would be helpful. Going to test my theory this week and see how I feel. Not sure about doing the same exercise multiple times during the day, but can’t see how it would hurt.

Yeah, I usually do the myofascial and mobility drills afterwards.  I don’t think I warm up as well as I should, probably need to work on that.  I feel like for me strengthening gives the most benefits so far, just like you the muscles that were tight are less so after my routine.

My left hip flexor on my affected side was extremely tight for a bit, started doing hamstring curls along with the other exercises and that seemed to make a huge difference.  What is your hamstring to quad strength like?  I get cramps in my adductors for some reason if I really push it aerobically ski touring or cycling.  Haven’t focused on them all that much, other than some foam rolling every now and then.

Flossed for the first time last night, did my calves and above my patella.  Need to try to get into the high hip area tonight.  Not sure how much of a difference it made, felt pretty good today, but I usually do the day after my routine.  Went to the gym did some clams, light one legged deadlifts, quad smash with barbell, and wall stretch.  That wall stretch is tough, upper quads are very tight, along with insertion into the hip flexor.  Since I have a standing desk I’ve also been concentrating on my posture, especially keeping my feet pointing straight.  I have  a tendency to toe out.

What is your leg anatomy like?  I’m a bit bow-legged.

Know of Contreras and Reinold out of that list.

Community MWod Video: Gray Cook On Injury Prevention Screening and Setting Movement Pattern Baselines

Jeff Alexander has some great SMR stuff
http://smr.networkfitness.com/

Ok, so I haven’t been doing squats for a bit since they seem to irritate my knee.  Worked with the Voodoo bands on the 18th, doing bodyweight squats with good form.  Next morning it seemed like the tightness was coming back, pulling on my kneecap.  On the 19th I went through my strength routine, no squats, or anything that really works the quad for that matter, also did some self administered astym, mostly on the spot the IT Band attaches to the kneecap.  Feel good so far this morning.  I’m wondering if my quads are just overactive/tight so anytime I work them they start pulling on things they shouldn’t?  I’ll read throgh those articles Kefu and Kaitlin

On my affected side my hamstring is so much weaker than the other side, glute also seems more inhibited.  Just going to work on hip and quad mobility as you have suggested before I do my strength routine, as well as after, along with glute, hamstring, and core strengthening.  Staying away from any quad strengthening.

Thanks for posting that Kefu. Gives some othets some additional things to look at if they aren’t getting results.

Followed my plan to continue with my strength plan and add in more mobility work this week, mostly focused on the quads for now. Felt pretty good during the week, no real knee pain, maybe some twinges. Went backcountry skiing today and felt my hip flecked, IT band, and lateral quad start to tense up, didn’t cause pain, more of an irritated feeling.

Got home and decided to really focus on smashing my quadriceps on the affected leg. Using a 30lb kettlebell I moved it up and down my quads until I found the tender spots. Worst spot is on the vastus lateralis right near where it attaches to the patella. Since I started working that spot it’s become very tender and formed a more noticeable knot, is that normal? I feel like the wall stretch isn’t really hitting my vastus lateralis. I feel it a lot in the rectus femoris and hip flexors. Is there a specifc way to target the vastus lateralis with a stretch after a smashing session?

I feel like I’m zeroing in on what is causing my issues. I feel like the following are my main issues. Tight overactive quads, tight and shortened hip flexors which are both pulling me into anterior tilt, which I feel like are inhibiting my glutes, this creates even more work for the hip flexors and tightens up my IT Band, also contributing to the lateral pull on my kneecap. My weak hamstrings and core aren’t strong enough to keep me in a neutral position. Muscles in the front are currently winning.

google doug kelsey PhD, PT about ‘runners knee’. its quite unique and physiologically sound.
the issue is the PF joint surface itself may be weak and needs to be toughened. you need to heal the joint itself first, not muscle/tendon, etc. They all have different load capacities. And even though the MRI is ‘normal’ does not mean the cartilage hasn’t softened.

Hope you’re seeing some results Kefu.  I am slightly better since trying to do mobility work daily, my strength regimen 3 days a week, and doing some bodyweight exercises that fire up the glutes, core, and hamstrings more often.  I went ski touring in Jackson this weekend, did about 20 miles and
12,000 vert with some deep trailbreaking over 2 days which is a big effort compared to normal day
tours.  Felt slight twinges in my lateral knee, but better than before.  Need to commit to more wall and couch stretching, only doing about 2 minutes per day for each leg.

 Also paying more attention to posture while standing, contracting core and glutes every so often.  Sleeping on my stomach with a pillow under my hips also seems to hips.  I think I mentioned that already.  Also using an exercise ball and doing a lunge to stretch my hip flexors while standing and working, adductors that lead into my affected left hip flexors are noticeably tight as well.  I recently noticed a slight bump in my left hipflexor area, not sure what it is.  Wondering if I possibly have a sports hernia, going to get it checked out this week.  Heard something like that could contribute to guarding that area creating similar issues to what I’ve been seeing.

Kefu,

supine single leg bridge with knee to chest version gives a knot/spasm feeling in my hammy — I have to abort the exercise when I feel it.

Kefu, I’ve noticed a couple of the same things you have in regards to TFL activation.  When doing side lying abduction exercises with my knee straight and doing an isometric hold of an exercise ball against the wall I noticed TFL started firing a bunch once I got fatigued.  Have recently switched to side lying abduction with knee bent, seems not to recruit the TFL as much or X-Band walks. 

I am mostly pain free and IT band tightness has been much better for the last week after focusing on smashing lower body, but TFLs are both still very tight most of the time.  I’m also getting slight twinges of medial knee pain, which is new.  Think this might have to do with tight/weak adductors.  I’ve always felt my adductors have been tight so I just recently started focusing some more time on them, either foam rolling or lightly smashing, as they are pretty tender.  They are also the first muscle group that cramps up on me during or after a hard effort on the bike.  Smashing I have been focusing on vastus lateralis, rectus femoris, and anterior tibialis.  Need to start looking at the calves as well.  Have been leaving out squats for now as those seemed to irritate my lateral knee. 

I’ve also started adding some more core work in as I was only doing side planks previously.  Throwing a 12 lb ball against the wall then catching it in a situp position seems to really fire up the main core muscles/stabilizers.  Feel like I am making progress, but also finding other areas I need to work on as I go. 

https://www.youtube.com/watch?v=Qa0SHHIOyyg

Kefu,

What about couch stretch for tight quads?

I think of hip flexor as really high region of the quads.

Good luck Kefu.  Still seeing tightness in hip flexors and IT band.  Lateral knee pain hasn’t popped up since I started smashing lateral quad and tibialis anterior.  Smashing of the tibialis anterior seems to make the biggest difference when I start feeling the sensation I feel before the lateral kneecap pain sets in.  After my strengthening routine my hip flexors don’t seem as tight and the tighntess in my IT band and lateral quad seems to go down.  However, it’s a temporary fix.  If I miss a day or push too hard ski touring the tightness pops back up.

I’m still missing something.  I feel like standing in the same position all day at work is contributing somehow as well.  Heading to Alaska for a 3 week trip, getting dropped off on a glacier via bush plane and camping/ski touring expedition for 2 of those weeks.  Hoping that getting out of the office and changing up my routine for a while will help.  Will be bringing the softball to do soft tissue work on down days in the tent.  Maybe one of the small travel foam rollers as well.  Wish me luck.

Before work this morning

Kefu,

hmm.  So if your internal rotation is good, then when you perform a internal rotation banded distraction you don’t feel muscle tightness…?  Are you just going by the word of your physician? 

I was curious about internal rotation because I am experimenting with the idea that you have to at the very least “clean up” the areas.  However, if you have a leg length difference then I am sure no matter how much you clean up it will go back to how it was.  But…by cleaning up the area you can also see what that new range feels like.  

Hey Kefu,

re: FMS – i saw that in a previous post. what i was wondering about was the actual scores you got. Or did he not score you in the traditional FMS way?  These would be a score of 0 to 3 for every one of the 7 tests. some of the screens have both left and right components.

Quick update after my trip. As strange as it seems I had no noticeable pain during an 11 day ski expedition. Skiing every day except for one, big days with a lot of mileage(~10-15/day), vert, and steep bootpacking(kicking steps up couloirs) A little tightness, but nothing too noticeable.

Within a couple days of flying back to Anchorage and relaxing I started feeling tightness in my IT Band and slight lateral knee cap pain. Seems like when I am constantly moving it stops things from tightneing up, but as soon as I settle back into weekend warrior status the pain and tightness comes back. I feel like I am slowly getting better and learning how to manage it. But I am missing something that causes some pain and tightness to reoccur.

The pain is more of an annoyance now than being debilitating and stopping me from participating in the sports I’m passionate about. However, I’d like to fix it before it does any permanent damage.

Kefu,

Good to hear you are seeing some progress Kefu!  Sounds like all your work is paying off.  Have you tried smashing the tibialis anterior yet?  I feel like it was contributing the pressure I was feeling.  Just like you on the affected side my glute doesn’t seem to be firing as strongly as it should, notice it especially when doing one leg deadlifts. 

Went to the gym for the first time since I got back from AK, and I could tell my quads were tight when doing a couch stretch.  However, the tone in my TFLs seems greatly decreased after the trip. 

I’ve been trying to get out of my habit of standing at my desk all day without walking around, other than hitting the gym.  I’ve been using an exercise ball with a stool behind me to do a standing couch stretch.  Placing my knee on the exercise ball, with my foot resting on the stool that is placed behind the ball.  Feel better so far, but only been back at work for 3 full days now.  Anyone have any tips on making sure the tibialis anterior is working as it should? 

Great to hear you are seeing improvements with the work you are doing.
Identifying the cause is key and sounds like you have.
Yes, it can take time for an issue that is not a new one.
Keep chipping away at it.

Good to hear Kefu!  I’ve been fairly pain free the last couple weeks but have been on a regimen of stretching and smashing along with my exercise routine.  One legged deadlifts, hamstring curls, x-band walks,some light core exercises, along with smashing the lateral quad and tibialis anterior seem to help the most.  I feel ok as long as I continue the regimen, once I stop the issue seems to reappear.  I went ski mountaineering this past weekend and started to get some lateral knee pain on the descent when we had to hike down a trail with skis on our back.  I’ve noticed some tightness in my adductors, and they are also the first muscle group to start cramping after a hard effort.  Is it possible that the adductors are weak/tight and strengthening them could lengthen them, creating more balance between that group and the glutes.  Seems counter intuitive that strengthening the adductors would help?

Since you haven’t posted in a bit I’ll assume things are going well for you Kefu.  Have had some good results lately with some changes I’ve made to my bike fit and pedal stroke.  I noticed my affected knee was flaring out a bit at the top of my pedal stroke, so I’ve started to concentrate on keeping the knee tracking straight up and down during the rotation.  I also widened my q-factor a bit by moving my bike cleats in, which effectively moves my foot away from the centerline of the bike.  I also added some adduction to my strength routine, considering my knee was flaring out, it seems like adduction might help balance things and smooth out my pedal stroke.  On the seated hip abduction/adduction machine I can easily max out the stack for abduction(~200lbs, 3 sets of 5), but adduction I can only comfortably lift 120lbs(3 sets of 5).  Is there an agreed upon ratio of abductor to adductor strength?

Hey Kefu, I think you’re on the right track. Keep testing what works and change as needed to get results. After a couple sessions of doing some adductor strengthening I am feeling pretty good day to day. Tightness of my it band and lateral quad is no longer noticeable most of the time. I literally feel a release of tightness after I do some adduction, sort of like after a long stretch. I’ve been able to ride 20 miles with 3500 feet of climbing a couple times now without any pain after, the tightness returns just so I notice it, but goes away as soon as I start working my adductors. For me it makes sense that my adductors are much weaker. Skiing and racing a single speed mountain bike are all quad dominant activites. I overtrained on the single speed and it set off years worth of issues stemming from this imbalance. Not going to say I’m fixed yet, but pretty confident this may be a very big part of the puzzle. I was so focused on what everyone and the research was pointing to that I totally dismissed the thought of adding adduction.

Sorry to hear you’ve had a setback Kefu. I’m glad you’re still searching for answers, you will figure it out, but I’m guessing it’s a combination of things like it has been for me. I feel like my movement patterns were so jacked that it will take quite a while for me to get back to normal. It seems like I’ve been compensating for injuries I’ve had over the last 3-4 years. Strengthening my posterior chain has seeemed to be a huge help.

The lateral tightness and pain hasn’t come back since I started adding adduction and modifying my pedal stroke, however the medial knee irritation I was feeling a couple years ago came back. Adduction seems to set it off, it feels like it tightens up my vmo and pulls on my medial knee. Not sure if I have an osteophyte or something but it feels like once it tightens up there is some friction right at the medial knee, I’ll feel a pin prick sensation where the vmo attaches. KT Tape seems to help it from getting too aggravated, and smashing the top of my vmo literally stops the irritation from occuring. Also stopped adducting my leg during my pedal stroke and just try to make my knee track as straight as possible throughput the pedal stroke. Frustrating since I solved one issue mostly, but this new issue popped up.

Going to do very light adduction going forward, continue my strength regimen for glutes/hams and core and make sure I’m doing mobility work to address the areas that need it.

Yeah, seems like I need to take a slightly different approach as well. Lateral quad, itb tightness, and slight pain returned. I can keep it at bay by smashing, light adduction, and posterior strength exercises(one legged dls, hamstring curls, x-band walks, etc. I haven’t been focusing on my core much at all besides the dls and some isometric side planks every couple workouts.

Are you doing something like this:
http://m.youtube.com/watch?v=ONSH_vwvI50

Hey Kefu, I did have bilateral pain and tightness at one point. Lately it seems like its mostly my left leg. Which happens to be the side that my glutes feel a little weaker/inhibited on. I think I already mentioned this but after a couple PT visits I asked my PT to check my pelvis, sure enough my right side was posteriorly rotated, a quick adjustment and most of the itb tightness disappeared. Plus a functional leg length discrepancy was resolved. Right leg being shorter than the left. Granted that didn’t last, I came out of alignmemt and it came back until I started hitting the gym.

A bunch of people have mentioned to look at the psoas as well, but haven’t noticed that its weak or tight, maybe I don’t know what those muscles are supposed to feel like as I admit my core is probably very weak compared to the rest of my body.

Thanks for the thoughts and videos, keeps me motivated to find a fix. I know you know better than anyone, but after a while it’s hard to stay motivated and stick with a program if you aren’t getting results. 

Hey Kefu,

You need to look into the work of PRI (Postural Restoration Institute). with out assessing you i would say you are a typical Left AIC. your leg discrepancy along your “tight” IT band and patellofemoral pain are typical in this pattern.

clearly you have tried about every modality there is. if this doesnt fix you I would be very surprised.

here is some info on it.
http://chadwaterbury.com/align-your-pelvis-to-reduce-pain/
https://www.posturalrestoration.com/

Since you posted about the deep core muscles and posture I’ve been trying to pay more attention to it.  In the past I was mostly doing side lying planks with a isometric holds, 1 minute on 15 seconds rest, 4 times on each side.  I’ve started adding some more front planks with my arms out further than in the past.  I’ve also started to work on releasing my psoas, laying on a lacrosse or softball and breathing, bringing my leg up then straightening while pinning the psoas down.  After releasing the psoas I feel a release that flows down to my SI joint and down to the lateral quads.  On the bike I’ve been paying attention to engaging my core during my pedal stroke.  It’s easiest on the road bike, as soon as I suck in and engage my core I feel I can apply more power to the pedals and my knees seem happier.  Only been trying this for a couple rides, but I think neglecting my deep abdominals was playing into the screwed up movement patterns I am stuck in.  It’s hard because I feel like I start focusing on one thing that seemingly helps but then neglect some other piece that is key to getting better.  So far the exercises or movements that have helped the most:

Kefu,

Jtrue, Why would you want to do a PSOAS Release? IS he walking bending over or to the front or have some gait problem? Many of the suggestions here are mostly theoritical and on a should-work basis. have you ever wondered if many sports therapist or rather the fielf of sports therapy had made several wrong assumptions. If they had been correct, this poor guy had long been pain-free. Some of the exercise you guys recommended will aggraviate the condition. Sorry I did not read the later part. Your later therapist is smarter but not entire correct. Loosing up the Pelvic Floor with so much effort? It is not weak, just tight. Rolfing will not work either. What maintenance. In our place, the problem is entirely eradicted once and for all. If you know what you are doing and really sure what is wrong, you just fix it. No Excuse and can do without the needless dozens of technical jargons and all that complexity. Here we do it 30-60 minute session and everything is fixed. At most, we will ask you to return after a week to see how the correction is holding up and if the whole body had harmonised with the new structural dynamics. Once a while we do make our clients wear a a hip customised support. All in all you got some things right but you did not have the best treatment modality hence SO MUCH FOR SO LITTLE.(So much hassle, time, money, worry, so little progess). Fanciful but ineffective. Again, get the most advanced or best Chiro/Therapist you can find because the standard one will only be guessing. What you are having is a compedium of issues normally left untreated in most therapist since the do not know the issue well. Find one that will list down all the issues and who is able to peel the mater layer by later and walk you through what causes what and which comes first and to reverse the problem stage by stage. A complete reversal is possible if the only the diagnosis is correct. When more excuses than results are given, then it’s time to go to another therapist.

Was wondering how you were doing Kefu, glad to hear you’ve made some progress!  I’ve had my ups and downs, work has been crazy lately which hasn’t allowed me to get out and ride much.  Seems like sitting around makes things worse, so I’ve tried to stay active just taking my dog for a walk, going on short hikes, etc. A month ago I started back with my PT and right away asked him to check my pelvis. Appeared that on my affected side my si joint was “stuck”. He did a chiropractic adjustment and pushed that side down, which clunked back into place. A day later I was getting up off the couch and heard the other side clunk, it was out again.  Followed up my PT appt with another bike fit, this time with slow motion cameras and stick on sensors that measure angles between two different poimts. Most telling thing we saw was that on my affected side(tight it band, lateral knee pain) my so joint wasn’t moving freely like the other side. One side was moving 3.5 degrees up/down other side was moving less than 1 degree during my pedal stroke. Took that feedback and started hitting the core exercises, didn’t seem to help.  Went back and he did another full evaluation, re-adjusted my pelvis back to nuetral. We noticed that on my affected side my vmo was firing late and was much smaller than my other side.  He also continued to state that even though my glutes were relatively strong, they were weak compared to other muscles, quads, hamstrings, mostly.  I’ve only recently strengthened my hamstrings, they were weak as hell when I first started training them 4-5 months ago.  I started with some double leg squats with a band around my knees and have progressed to single leg squats, with a band around the inside of my knee pulling it laterally.  I think these are helping me the most as of late.  I feel like I can get my vmo firing and my knee feels more stable, I’m sure it’s helping my glutes as well.  I’ve gone on a couple quick rides and the tightness hasn’t come back like it has most other times.  I’ve also been massaging my psoas, iliacus, and ql which all seem to help.  I’m optimistic if I keep on my regimen of single leg squats, one legged rdls, hamstring curls, and core work that I’ll get back to 100%.  

Wow guys, this is one heck of a series of posts.  I’m floored by how much effort you’ve put into this.  I’m not nearly on your level but perhaps my experience can shed some light.  My quick background is that I’ve had patellofemoral knee pain for 7 yrs now, and over the last 3 years it’s significantly affected my quality of life.  No sports, no jogging/running, no sitting with my knees at 90 degrees for more than a few mins at a time, not able to walk down stairs at all.  I haven’t gone the extreme lengths you guys have to fix it, but I’ve gone to 4 different physical therapists for months at a time.  They all recommended a variety of the same thing… strengthening quads, hips, vmo, and rolling out IT band.  Everything seemed to marginally help, but nothing fixed it.  Over time it grew worse.  I began to fear taking flights (due to the long sit times), and I could no longer sit in an office chair at work, had to stand.  Inactivity made my knees worse, very quickly.  Walking for up to 30mins at a time always helped.  I’m writing because as of recently I’ve gotten a lot better.  I’m hoping it sticks and that i’m not posting this prematurely, but I feel ya’lls pain and wanted to share some of the things I’ve learned which have helped:  

Both knees were weak, but 90% of the pain came from my left knee.  My left knee has a patella tracking issue which my right knee doesn’t.  I suspect this additional underlying issue made my left knee more susceptible to patellofemoral pain, although i know that thoughtful doctors such as Scott Dye have refuted patella-tracking PFPS hypothesis.  

djrachman, sounds pretty similar to what I have going on.  Like you I started out where I could barely lift 2 plates on the hamstring curl machine single legged.  I’m now up to 10 plates singled legged 3×5, trying to build strength with high weight, low reps.  It does seem to help, but only for a day or two.  In general tightening up my posterior chain helps but isn’t a lasting fix, maybe my quads are still dominating my hamstrings?  Maybe I need to focus on my back?  I’ve found that just staying active helps me, it doesn’t allow my hip flexors to tighten up. When I go out for a big effort on the bike or ski touring and sit around after everything tightens up.  If I stay active and do some mobility work I am much better off.  Maybe that’s why walking is helping you?  I don’t think I walk enough, I do other sports instead.  Walking seems like such a fundamental movement, it’s probably not a bad idea to increase my mileage.

Its not about treating one area its about looking at the whole body
remember muscles don’t work in isolation, so its best to train them as you move in reality

To be honest functional patterns is making a change for the better in the fitness industry.. they are years ahead of the current fitness industry..

https://www.facebook.com/FunctionalPatterns?sk=wall

http://www.functionalpatterns.com/

https://www.youtube.com/watch?v=-MIweO9f23A

Kefu, what exercises were you doing beside pelvic clocks to help with posture?

My knee pain improved from the hamstring work, but after walking down a staircase last week the pain came right back.  Either the hamstrings are not the ultimate solution, or I’ve now fixed the imbalance but years of damage are not so easily undone.  

jtrue – when lifting weights, i’d avoid the high weight / low rep approach which is designed to build bulk muscle.  It often promotes bad form and it always places a lot of stress on the joints.  My personal trainer has me lift heavy sometimes, and it seems to result in more clicking and popping.  So I try to avoid that.  What works well for me is doug mcguff’s super slow lifting method.  What he believes in is 4-8 reps and 8-10 seconds in each direction with the weights.  By the end of that 2 minute set you should be completely at failure.   The benefits are that you won’t need multiple sets, 1 is enough.  By going to fatigue you’ll have made deep inroads in your muscles and you’ll gain strength similar to if you had lifted much heavier weight.  And the slow, controlled motion with the lighter weight puts the least amount of stress on the joint.  

Thanks Kefu, I thought the article on SI joint dysfunction was relevant seeing as how my pelvis is tilted anteriorly on my affected side, keeping my tfl tight.  Which seems to lead to my functional leg length discrepancy and tight it band.  I’ve been performing one legged rdls for a while now, they do seem to help but still missing something.  I’ll take a look at the videos you posted and start incorporating into the routine.

Kefu, Stuart is quite a bit behind on human biology now

Follow his page and his personal account on facebook and you will understand functional patterns. You will learn why deadlifts, crossfit is all irrelevant etc

Kefu or djrachman have you noticed any tightness or restriction in your external obliques or QL?

Maybe a little oblique tightness but not much.  Kefu and Jtrue, do ya’ll have forward head / thoracic kyphosis / computer guy posture?

Yeah, I do tend to slouch forward when sitting. Standing I feel like I tend to stand up much straighter. Been trying to pay better attention at all times. I have a standing desk at work. Been doing pelvic clocks the last couple days and do feel more in tune with how my pelvis is sitting. Just can’t seem to keep my tfl from tightening up, very frustrating.

Do you have a video of yourself walking/running? that might give some evidence what is going on..

I have not read the entire thread, but so far I have the basics about your runners knee/ITBS/leg length discrepancy.

I am a massage therapist with athletic experience as a professional modern dancer. I primarily use deep tissue, neuromuscular, and assisted isolated stretching techniques and specialize in diaphragmatic disorders, pelvic function (sacroiliac joint disfunction, piriformis syndrome), cervical spine, and TMJ.

First, I would like to address the “hip flexor”, which is the iliopsoas (or illiacus plus psoas major). It should not be considered part of the quadriceps. Many therapists are of that perspective, but I whole heartedly disagree.

Your iliopsoas is better seen as part of the diaphragm. Where one ends the other nearly seamlessly begins.

Diaphragmatic disorders can most commonly result in sacroiliac joint disfunction, thoracic outlet syndrome, piriformis syndrome, ITBD, pain throughout the hips, low back, spine, and ribcage. The reasoning behind why the diaphragm should be considered part of a whole body system of its own, instead of a piece of the muscular system, takes an entire paper to explain, but that concept is very important. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731110/ 

I saw many times repeated by folks here, “It’s like you’re missing the problem”, “the work I’m doing in my glutes, quads, etc… …only last for a little while before everything tightens back up”, “my foot tracks to the outside”, “my hips are rotating laterally and anteriorly”, “try to do the exercises in a way that does not activate your hip flexor”, “I do tend to slouch when sitting”.

An illustration:

The psoas connects on the lesser trochanter where some of the adductors attach. Tightness in the psoas will result in tipping the bowl of the pelvis forward to the trochanter, straining hamstrings, glutes, and rotating the femur so that the lesser trochanter presents forward and your toes point outward, which allows tightening in all of the deep hip rotators and glutes. Your upper chest will droop/slouch forward as it is pulled down by the psoas/diaphragm tightness.

Your psoas will tighten if you are chest breathing instead of breathing into the belly, stretching the transverse abdominis, and using the transverse ab. to compress the abdomen. The nerves which innervate the diaphragm will only activate and tell it to reset to its umbrella-like position if breathing is done correctly. Babies naturally belly breathe only. We learn to chest breathe in response to our need for fight or flight. The chest space opens to allow for more air, but if we do not return to the diaphragmatic breath (thanks to modern anxiety, stress, and sitting for too long), the transverse abdominis weakens, the diaphragm tips upward, cascading a shortness into the psoas which will in turn rotate and shorten the leg (usually left side, since the right side of the diaphragm has a 3lb liver holding it in place).

What I recommend:

Find a massage therapist who knows neuromuscular therapy and can release your diaphragm, your psoas major, and the illiacus. You can somewhat get at the illiacus on your own by touching the front of the hip (where it begins to point forward) and keeping your thumb on the bone slide down toward your spine so that you pinch the illiacus between your thumb and the interior of the hip bowl. However, it is better and safer to let an experienced practitioner release it for you to avoid organ and blood vessel trauma and the diaphragm release cannot be done on your own at all.

Then find a PT who knows diaphragmatic strengthening exercises (may come as part of sacroiliac joint disfunction treatment or not). These exercises should include having you lay on your back, feet on a wall at 90 degrees, activating your hamstrings, and inflating a balloon using belly A.K.A. diaphragmatic breathing.

You can smash the parts that hurt all you want, but if the pain you feel is a symptom instead of the source (likely), you will never improve for long. You may or may not have a leg length discrepancy. That is either caused by a diaphragmatic disorder or is exasperating and increasing the problem. I suggest wearing the taller heel wedge and getting the work I recommended for your diaphragm done. If things begin to clear up, try weaning off the heel wedge to see if symptoms return.
Also, stretch your psoas major. http://stronglifts.com/the-psoas-is-it-killing-your-back/

Thanks cmillercmt, I think most everything you state above rings true, at least with the issues I’ve been experiencing.  I’ve only recently started belly breathing, definitely a work in progress.  I’ve also started doing some more core work, stirring the pot seems like it works well, also incorporating some pelvic clocks while breathing correctly.  Maybe I’m changing too many things up, but I’ve also been doing some isometric holds that Naudi Aguilar recommends in some of this videos, making sure I’m concentrating on a neutral pelvis while doing them.  I’ve said this before, but I’m seeing some improvement.  I’ve also been dry needling myself, mostly get a twitch response from the vastus lateralis and rectus femoris on the affected side.

Hope everyone had a great holiday, happy new year!  No real change after implementing the exercises above.  Just noticing some things that I need to seem to work on.  Lateral knee pain and tightness came back after two long days ski touring in deep snow.  When I’m doing stir the pot I usually try to do 3 sets, one set consists of stirring 5 times one way then 5 times the opposite way.  After 2 sets of these I find that my core shuts down and I start feeling it in my lower back.  As soon as I start to feel it in my lower back I stop the exercise.  Going in for an FMS screen just to see if they can point out something that I don’t know already.

Since I tend to have issues after squatting can someone critique my squat?  Knees tracking too far forward?  Ankle dorsiflexoin? I fractured my left calcaneus(affected leg)  which can lead to limited ankle mobility.

JTrue- I’m no squat expert, but here are my 2 cents for what they’re worth.  

Thanks dj.  I usually don’t get pain upon squatting, but the tightness and pain return after.  I feel like maybe I’m compensating with some overactive muscles and then they tense up after.  I’ve been doing posterior and core strengthening the last couple days, seems to help, but always have that slight tightness that I know will come back once I stop.  I’ve wondered this before, but I’m really curious about a possible disc issue.  I don’t present with any back pain, although I’ve had a couple twinges here and there, never anything debilitating or something I thought I should have a doc check out.   I know most people have disc issues when they receive an MRI, but most have no symptoms.  I’m not sure an MRI would help anyways, am I going to have back surgery at this point, very unlikely. 

Another thread I’ve had going for a bit, with some different perspectives, think there might be some useful info in it.

http://www.tetongravity.com/forums/showthread.php/264615-ITB-Issues-What-Worked-for-You

Started incorporating controlled bodyweight back extensions into my workout, feel less tightness in the lateral knee than I have for a bit. Making sure not to hyper extend, but hitting a neutral.  Have an appt on Monday with a McKenzie diplomat that also backcountry skis and is an expert in biomechanics and how they affect sports performance.  Looking forward to meeting with her to see what her take is.

Thanks Kefu, very similar to the critique the mckenzie certified pt gave me, especially about the butt wink at the bottom.  Said that could be why squats seem to aggravate my condition.  Funny thing is that I have excellent hamstring mobility, so I’m missing it somewhere else.  I did purchase some of Naudi’s videos, just haven’t had a chance to watch them yet.

Went to go see the new PT again today, she thinks it’s an issue with discs near l1/l2.  The press-ups are definitely helping, if I feel tightness in my lateral knee I go do a pressup or standing back extension and am good to go for a bit.  My IT Band is the loosest it’s been in a long while when I palpate it.  She gave me some additional things to work on, including some movements to target right between the thoracic and lumbar spine.  Next step is to continue the pressups and other movements she gave me.  Trying to continue to stay out of flexion and the movements that are keeping my symptomatic.  She said if I can stay symptom free for a week we can start working on additional strengthening for my upper and lower back.  I never target the upper back.  But exercises that have targeted the lower back have seemed to help in the past.   She also had me practice keeping my transversus abdominis tight while doing bird dogs, which I don’t think I’ve done before. She taped my back again to remind me about posture.

Hey just found this post by fluke … I’m an avid runner and weight trainer and I have this exact same problem with leg length imbalance due to pelvic tilt …my hip is visibly lower than the other which in turn causes me a lot of pain … I have been dealing with this for over a year thinking of every cause under the sun … With no avail .. But recently I have discovered the relationship between my tight quad on the injured leg and the pelvic tilt . I never had pain in my quad , it was just always very tight . However after going to a therapist I began to realize I have literly a brick of muscle adhesions all through my quad hip flexor and it band which pill on the front of my hip dragging it down … This is why I cannot feel my glutes when squatting and why my hamstrings feel like they might snap … As I have been releasing my quad my hip levels have evened out and the pain is much less … I hope this may help you In Your journey I know as well as anyone how frustrating finding the answer to something like this is 🙂

Hey just found this post by fluke … I’m an avid runner and weight trainer and I have this exact same problem with leg length imbalance due to pelvic tilt …my hip is visibly lower than the other which in turn causes me a lot of pain … I have been dealing with this for over a year thinking of every cause under the sun … With no avail .. But recently I have discovered the relationship between my tight quad on the injured leg and the pelvic tilt . I never had pain in my quad , it was just always very tight . However after going to a therapist I began to realize I have literly a brick of muscle adhesions all through my quad hip flexor and it band which pill on the front of my hip dragging it down … This is why I cannot feel my glutes when squatting and why my hamstrings feel like they might snap … As I have been releasing my quad my hip levels have evened out and the pain is much less … I hope this may help you In Your journey I know as well as anyone how frustrating finding the answer to something like this is 🙂

Hey Kefu, I also noticed that on my affected side my deep abdominals didn’t seem to be firing as hard as my unaffected side.  Same thing for my glute med on the affected side.  My PT said that once I got the back issue under control the muscels should start firing again.  So far I’ve been pain free since starting the Mckenzie exercises, some tightness does comes back if I stay in flexion for too long, or slouch while standing during the day.  As soon as I notice it coming back I do some standing back extensions and it goes away in the next couple minutes.  The decreases in tightness seems to last longer each day as I continue to do the Mckenzie exercises and remind myself to stand with good posture at work.  Sitting is still tough for me and I have to overcompensate with a larger lumbar curve than natural.  I’m hoping this decreases as time goes on.  Not saying you definitely have the same issue, but since we seem to have similar symptoms I wouldn’t rule out the back.  Good luck and keep us updated.

Hey guys, obviously a long convo but I tried to read as much of it as I could. I have some of the same issues, but also some differences, and am just looking for some feedback. In 7th grade I got oshgood schlatter in my left knee. At the time I was a very active kid. Football, basketball, baseball, soccer, sports all year. I kept doing all these sports and played through the knee pain, but over the course of the next year, I started to compensate for this pain. I got pinched nerves around my sacral bones, starting on the left side but moved to my right. I did not know at the time, but it’s bexause I was rotating my femoral heads (left to right) on an axis. I did this consciencly and subconscienly because I was trying to take weight off of my left knee w/ O.S. Another consequence was that my left femoral head dropped, and thus that left Sacal bone dropped with it. This is where the pinching came in on that left sacral bone. The pinched nerves were absolutely awful, and I had to stop playing sports because of it. In response to the pain, I started locking out the muscles in lower back and top of the hip (like a band that goes across/around Sacral bones from hip to hip). I basically put my lower back in flexion and, next year, in reponse, began to sit on my hip joints. When I say this, I mean I began to tighten those outside quad and anterior hip muscles because it gave me stability. I had none, no matter what I was doing, becuase the hip and lower back tightening that gave me no hop mobility meant that those lower glute muscles were doing no work. I could barely get them to turn on. This obviously gave a anterior pelvic tilt, and like most people with Anterior tilt, wasn’t using my Lower an muscles. To try to describe this to you, I have a huge mound/mass of muscle that sits on the front side of my greater trocanter. Like it literally sticks out. It is my entire stability. For example, if I do a leg lift, i don’t feel my abs or gluten active at all. My lower back tightens and that big clump of muscle just hulks up. It looks like Popeye after he eats his spinnage. To further progress this, my patella’s are very tight, because of that clump of muscle directly in front of my trochanter, My legs(and thus knees) are turned inward from the hip. My knees used to feel like I was going to tear my ACL whenever I cut(quick shifting) of did squats. In response, I have tightened my patellas because, again, it seems to give me stability. If you don’t have glute activation and you flex your lower back, chances are your knees will start to feel an inward pressure( you can try it for yourself) the glutes are the muscles that should give you stability when you cut squat etc, and since they are very unactive, I am forced to tighten my patellas, and they are on fire. I am just hoping to get any feedback from you guys. Maybe some of you can apply this to your own problems and I would appreciate any advice back. Have any of you guys made progress? If so I would really like to know what it is your doing so I can try some of it myself. Thanks!

Jake, you didn’t mention whether you’ve seen a good PT.  Not all are created equal, so make sure you research and try to find one that will try to come up with a diagnosis and treat the cause of your imbalances vs just treating the local issues.  Sounds like you have a lot of layers to peel back and try to fix. 

How’s it coming Kefu? After focusing on my posture and staying out of flexion I’m 95% better. Just twinges here and there, but it’s a good reminder to pay attention to my posture and any tightness goes away. I’ve found that foam rolling my lumbar and thoracic spine also helps.

I haven’t been following the thread.  I just wanted to jump in and say that my pain is completely under control now.  Unfortunately, I still can’t squat down or walk down stairs or the pain returns.  But this is probably because I let this problem fester for about 5 years.  But whenever the pain starts returning, I know exactly what to do to.  It’s not hours of leg exercises every day – which like you guys, i did religiously at one point.  All I have to do is one thing:  Strengthening hamstrings.  And I’ve found that this is my favorite way to do it.  short video… https://www.youtube.com/watch?v=oAYtwM95-ug    The hamstring machines at the gym are garbage.  This swiss ball method is pretty good.  I know I’ve mentioned hamstrings before and you guys indicated it’s not likely your issue.  But thought I’d post with this one last time.  GL

djrachman, I’ve also found that hamstring work and posterior chain work in general helps my symptoms, but for me it seemed like it was a temporary fix.  So far doing the Mckenzie exercises seem to help the most, but aren’t a cure all.  I’ve been riding my mtn/road bike about 80 miles a week for the last couple weeks and my symptoms were under control, but a couple days back I did a 25 mile mountain bike ride with lots of vert and I started to get some lateral knee pain again.  I think I just overdid it and stayed in a position where my spine was in flexion for too long.  

Nice Kefu, how’d it go? AnAny insight gleaned from the seminar?

For a fraction of that price you could fly out to see Bill Hartman and the ifast guys and not deal with someone spouting pseudoscience from a youtube page.

Ok so reading through some of this and it seems this problem is still going on and it sounds like nothing is really helping. There is one thing that I think will help but it isn’t a quick fix its something that takes time and some dialing in. You most likely have some muscle imbalances that need correcting. Take a look at something called Muscle Activation Technique.  It is a great tool and there are so many checks and balances in there that you know it is something that helps. Here is the website find someone near you and give it a shot. Also give it time do not expect a quick fix because this has been a problem that has been going on for a while so it will take a while to fix. Hope this helps!!

Hi Kefu,

I apologise, I haven’t read your entire post or any of the comments on this thread. That being said, in response to:

“My IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them, especially my IT band. I have tried physiotherapy from multiple physiotherapists, ART, electrically stimulated trigger point dry needling (PENS/electroacupuncture), acupuncture, massage therapy, foam rolling (lacross ball, PVC pipe, rumble roller), suction cupping, strengthing glute medius and maximus, VMO strengthening, core strengthening, balance work on wobble board, orthotics, intra-articular prolozone injections, joint supplements, heel wedge for leg length discrepency (my right leg is 1.1 cm shorter which was confirmed on an x-ray).”

If you’re stretching a muscle and it’s not helping than that muscle isn’t the problem. Rolling, needling, massaging etc of your IT band is a waste of time. Trigger point your gluteals and you’re ITB will loosen up. That’s your short term fix, your long-term fix is to strengthen your gluteals.

A muscle will get tight because it’s being overworked. This can be for a number of reasons, the ones likely applicable to you are that the muscle is weak and it’s being overworked or it’s compensating for a movement dysfunction/other weak area/weak synergist.

The tricky part, without examining you, is what your movement dysfunction is. This will be a bit of a guessing game.

Let’s start with VMO retraining. The research shows a correlation between decreased VMO bulk and knee valgus. Unfortunately, almost everyone in the health care field has taken this to mean weak VMO=knee pain/knee valgus/chondromalacia patella. Weak VMO is not a cause of knee valgus it’s a symptom. What is knee valgus? What movement is occuring at the knee joint when your knees move medially (valgus). There is no movement at the knee, the movement is occuring at the hip. When your knees medially deviate your hips are internally rotating; therefore, if you cant hold your knees neutral your hip external rotators are dysfunctional (weak).

As for your hip flexor and quadriceps tightness this can be for several reasons. I’d sort out your weak external rotators first and see if this resolves your quads and hip F. I know you said you did clam shells but have you been doing them correctly? If your hips roll back your not doing anything. Are these the only gluteal exercises you’ve done? Are you only focusing on strength or have you done gluteal activation exercises?

Tight quads can be a result of your hip extensors not working properly OR they can cause your hip extensors not to work properly. If you’re stretching your hip F and the problem is getting better than it’s probably the latter. Otherwise you knee to get your hip extensors working/activating again. This will most likely be your gluteals and in particular glut max. Weak hip extensors force you to rely on other muscles – quads and calves to compensate.

Your anterior knee pain could also be patellar tendinopathy. I won’t go to much into this because it gets lengthy but if this is the case you need to start seriously rehabing it immediately.

Hope that gives you somewhere to start.

Daniel Matrone:

“Can you say a word or two about internal rotation banded distractions? I am finding that external rotation is impacted by internal rotation as well. When I internally rotate my leg while sitting I can feel a nice pull on my IT band (quads). I get instant glute activation as well. “

Stretching a muscle is not the same as activating a muscle. When you internally rotate your hips in sitting this IS NOT activating your external rotators (glutes), this is stretching them.

Lots of good information in this thread. I read all 7 pages and I’ve been dealing with a similar issue. I’d be interested to hear what the outcome was from the people in this thread.

I’ve had some luck managing my symptoms, but haven’t gotten to the root cause. Main things I do to manage the tightness are mckenzie pressups, foam rolling lumbar and thoracic spine, releasing the psoas on my affected side, and dry needling the lateral quad. I’ve put a lot of work into my core, glutes, and hamstrings with limited results. Seems like some movements cause tightness while others help, I need to focus on what helps going forward. Wondering if I need to do more single leg exercises as I think this is mostly stemming from a muscle imbalance that I continue to perpetuate.

Right now it feels like the psoas on my affected/tight side is getting overworked. I mostly notice it after completing an activity but sometimes during. It presents as a tight it band/lateral retinaculum and causes some lateral knee pain. I’m into endurance sports that involve lots of knee flexion, cycling and ski touring. I also feel like the glute on the affected side isn’t firing like it should because of the dysfunction so I’ve been trying to concentrate on it as well. Haven’t seen my PT in quite sometime as I wasn’t seeing results and it’s expensive, but might go back to have him check my leg length as I previously had a functionally shorter leg on my affected side.

Just started incorporating some more upper body work like horizontal rows and scap push ups to see if it’s something further up the chain that might be contributing to a movement pattern affecting my gait. The activities I participate in push you for a couple hours on end, I feel as though as I start getting tired my form suffers causing other muscles to take over that shouldn’t.

Just found out I have celiac, was feeling tired and having GI issues. This has been going on for a while, just never put two and two together. Had the blood test and endoscopic biopsy to confirm. Very anemic, currently supplementing with iron, b12, vitamin c, vitamin d, etc. Wondering if this has anything to do with the constant tension in my muscles, possibly causing some of the symptoms I’ve been dealing with. Only time will tell.

As crazy as it seems most of the tightness has gone away since I’ve gone on a strict gluten free diet and my body started taking in all the nutrients and electrolytes I was missing. Still get some weird fasciculations, but hoping these go away with time. I’ve been going pretty hard ski touring and cycling and while I get a little tightness afterwards it doesn’t really bother me or cause me pain. Kefu, any updates on how you’re doing?

Yes, sitting for prolonged periods of time will negate the benefits of mobs, exercise you do.
Break up your unnecessary sitting when possible. For example, every 30:00 takes a 2:00 break. Get up walk around the office or work place. Quick check in with a co-worker, deliver a message in person etc.

Begin transitioning to a stand up desk if possible. This allows non exercise movement throughout the day. This helps improve focus, productivity, and counter act the negative effects of sitting.

Create strategies for prioritizing mechanics when standing and sitting.
Understanding how to organize& stabilize your body in a good position is key.

Having a hard time posting because I can’t get to a mobile friendly page.  Anyways, I had the same pain many times in the past.  I highly recommend 1.5 squats with very slow eccentric phases.  Use lighter weight like 135 max or even bodyweight.  Do a few sets of 15 about 2 or 3 times a week.  Also, afterwards while your quads are pumped, roll your quads with a hard roller, not one of those rinky dink ones.  Roll your groin and hams.  Lacrosse ball your hip flexors, piriformis, and gluteus medius/minimus.  Couch/ wall stretch the beck out of your quads, the lean forward and stretch the hip flexors.  Stretch the glutes.  Lay on your back, keep one leg on ground.  Swing other leg across your body to touch your outstretched arms.  Do this dynamically left right left right for maybe 20 or 30.  Good luck.

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.

You may want to check out http://deepvibrationtechnique.com/. This is a great tool for any type of soft tissue adhesion.

Hi Guys,
I have a very similar issue with you.
Starting when I run too much too soon 1 year ago, one day after I run I tried flex my knee and feel sharp pain my left knee.
Got MRI and doctor said small lateral meniscus rupture and rupture of antero lateral ligament.
Since then both my left and right ITB tighten up severely.
I have a lot of adhesive knots or trigger point along my left ITB. I feel tingling sensation along my left ITB.
My right ITB does not have muscle knots however it is very tight, much tighter than my left ITB. This affect my walking gait and recently I feel medial knee pain in my right knee due to this improper alignment.
I feel my right pelvic is shifted anterior and my left pelvic posterior. And also a lateral pelvic tilt.
Recently my shoes are all wearing out at the outside rear both left and right since this injury.
I visited a PT and she did a deep tissue massage in my lower body that hurt like hell.
Has anyone in here try Yoga?
Similar with Kefu, I have tried many alternatives mentioned here but found no improvement.
I will update more later.

Very interesting Heyo, sounds like a very similar problem. Since being diagnosed celiac and going gluten free I have had a reduction in my symptoms. Still have a flare up every now and then. For me it seems to be certain movement patterns that contribute to the issue and tighten my hip flexors. We just had our first snowfall in UT and I went ski touring, I had a flare up and my psoas got super tight. I haven’t been hitting the gym but I think with the reduced muscle tone I’ve felt after going gluten free I’ll be able to workout and fox some of the muscle imbalances I’m always fighting. In the past everything would tighten up and cause a whole host of issues.

Does any of you guys have fascial adhesion along your IT Band?
I could not remove this fascial adhesion or scar tissue.
My pelvis is torqued.
I feel my legs are at different length and it hurts my knee and ankle.

I’d recommend having Instrument Assisted Soft Tissue Mobilization done along your IT Band.
This will break up the scar tissue, re establish sliding surfaces which allow your skin, muscles, and tissues to move independently of each other.
You may need an adjustment to re align your pelvis.

I have no access to graston in my country.
The scar tissue along my IT band wont budge and seem pulling my TFL and rotate my pelvis.
Is there any alternative beside Graston to remove the scar tissue along the IT Band?
It feels like a bumpy road with gravels along my IT band. I tried massaging it with no success.

Graston is a company not a technique. Graston tools are one type of tool for IASTM.
Message me the city, country you live may be able to connect you with a provider in your area.

Do you have or have access to a supernovito (80mm supernova), supernova or gemini? (Included the Rogue Europe links)
These are great tools that are much different from using a ball.

Have you watched episodes which address the TFL, resetting the pelvis, or quad?
Addressing areas up/down stream help feed slack to the area.

Check out Daily MIWOD Tuesday October 25th at the 4:00 mark Kelly talks about glute interface sucking up slack and being a big tentioner on the ITBand.
Diagnosis Series: Runner’s Knee Part 2 – IT Band Syndrome

Thank you Kaitlin.
I feel my IT Band is stucked to my vastus lateralis. Seems like adhesion between them.
Due to no graston provider, I tried doing it my self using metal spoon and oil. No progress so far.
Should I stretch or smash to break down this adhesion?

Voodoo band it and perform squats.
Smash it.
On your side peel away using big battlestar, or small supernova.
You can’t stretch the IT Band.
Have you watched the IT Band episodes?
How long are you working on it at a time?
Are you addressing it more than once during the day?

HI kaitlin, i already voodoo band my quad and do squat, but my left knee produce clicking sound when squatting.
I think if i can get rid of scar tissues in my left IT band, I can solve my problem.
But, the scar tissue wont disappear no matter how hard I smash them.
Is scar tissue reversible?

Have you done your high hamstring?
Adductors?
Psoas? This can change the position of your pelvis.
Have you worked up/downstream of the knee?

Instrument Assisted Soft Tissue Mobilization is very effective with breaking up scar tissue.
It is not a matter of how hard you are smashing. It is if you are effecting the targeted tissue?
I’d recommend using the 80mm supernova. It creates higher global shear pressures.

Yes, scar tissue can be broken up. I have an of incision which was opened twice and have no scar tissue in the area. Yes, I work on it regularly, however, this is what is required for it.
It’s learning what methods, tools result in the best results for you.

I work with a construction worker who has scar tissue along the IT Band area who has seen great results. I work on it weekly and it is progressing nicely. Starting at his hip and down the quad to the knee.

Hi Kaitlyn,
Thank you for responding.
I did foam roll all below my hips front and back. I used a smooth normal density foam roller.

I would love to try IASTM as you mentioned if there is provider in my area.
Right now, all I can do about it is using metal spoon and try to do it myself.

I did MRI of my thigh.
The summary is:

1)      Nodular surface of the distal ITB with few small nodules within the ITB substance, compatible with scarring/ fibrosis. This most likely corresponds to patient’s symptomps. The ITB remains intact and adherent to Gerdy’s tubercle.

2)      Mild muscle strain involving distal vastus lateralis muscle as well as the muscle-tendon junction. The distal quadriceps tendon is intact.

I can feel my tight ITB (the one with scar tissue all over it) pulling my hip and throw my pelvis out of balance.This is my issue. My ankle and my knee at opposite leg is painful due to wrong walking gait.

I browse online and read somewhere that scar tissue once formed can only be excised surgically to remove it.
This thing is also surprisingly not familiar among orthopedic doctor at least in my area.

Regarding the construction worker you mentioned, what kind of treatments you provide to him? Anything other than IASTM?
What happen to the scar tissue? Would it “dissolve”?

You are ready to change the tool that you are using to foam roll.
PVC is a one option, supernova is a great option for hip, QL etc.

You can learn to do IASTM to yourself.
I work on myself using HawkGrips. I’ve taken a HawkGrips course which was excellent.
The tools come with a cd and manual on how to use them. I can tell you more about them on email.
The tools have different types of edges and using different type strokes allows for different angles and vectors to address the area. Much different from using a dull flat edge of a spoon.

Having surgery to remove scar tissue creates more scare tissue from re opening the incision.
I have an incision along my collar bone that was opened twice. I had it worked on shortly after the second time it was opened and its been great. No restrictions.  I check in with it often.

You may have some tacked down skin as well.
Do you have a voodoo band or voodoo x band?
If not I recommend getting one.
Wrapping your leg is performing squats and other movements that are restricted can have a big impact.
Having someone move their hands in opposite directions (Indian sunburn) in the area frees up the tissue.

We combine a few recovery protocols.
I use mobility, IASTM, voodoo x band, estim depending on what we are addressing.
Scar tissue can be broken up. Addressing up down stream of where you see the problem is an important aspect. Restoring sliding surfaces within the impacted area is key. This allows the skin to move independently of the muscles and tissues and vice versa.

I think Jtrue already mentioned something similar, currently drinking electrolytes drink is the only thing that reduce my muscle tightness. My ITB, Quad, hip muscles feels a release soon after I drink the electrolytes. I feel the scar restrictions in my left ITB area are untangled. It is very hard to describe the nerve/muscle sensation. But I feel very loose after I drink it.

But it is only momentary. The next day, I will feel the tightness comeback again and the scar tissue restriction is back also. The electrolytes is like “muscle relaxer” pill. But it is quite effective in treating the symptom.

If you are dehydrated (which it sounds like you are) the quality of your tissues are compromised.
Connective tissue dehydration causes pain because
connective tissue is the supportive scaffolding of the body; when
dehydrated, it can’t support, protect or stabilize the body properly.

Drinking electrolyte water is a band aid to the bigger issue of dehydration.
I’d recommend getting The Right Stuff to address your hydration. It is a NASA developed electrolyte liquid concentrate drink additive.

Restoring hydration and the balance of electrolytes allows tissues to move in the ways they were designed to move and support the body during movement. Once your hydration is back in check your body is able absorb the work you are doing on the areas that need attention.

Psoas

I’m old and an amateur. My occupation required years of sitting. I have a variation of the problems mentioned but without severe pain. I work all the way up my left side: foot, calf, quads, hams, etc. BUT release of the psoas is the absolute best. I need to work it several times a day. It’s not a one time deal. It took 40 years to get screwed up. So, I imagine it will take awhile to relax. As you know it’s big and powerful. That’s my 2 cents and that’s probably what it’s worth.

Wow, big thread, with just about every treatment imaginable.  

Not sure, just sent Kefu a note. Still have occasional flare-ups and can’t seem to get to the root cause but hitting my psoas with a theracane whenever I feel myself tightening up works. I’m back to riding bikes about as fast as I was pre injury and ski touring without any issues.

I have similar issue with Kefu and Jtrue.
Recently, I have tried deep massaging my knee at the crossection between IT Band and Patellar tendon (Near IT Band insertion at the knee).
And I got some improvement.
I did it myself.
I actually use a cupping cup to massage it but without vacuuming it.
Just using it as a simple massaging tool, I find it effective at delivering pressure and shear to the area.
Maybe you guys can try it.