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  • 09/28/2015 at 11:40 am in reply to: Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years! #76201
    AvatarChris McLaughlin
    Participant

    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.

    09/28/2015 at 11:32 am in reply to: Chronic IT band/quad TIGHTNESS and knee pain (chondromalacia patella?) for 6 years! #76200
    AvatarChris McLaughlin
    Participant

    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.

    09/24/2015 at 2:13 am in reply to: Constantly Tight Hamstrings…..PLEASE HELP #76199
    AvatarChris McLaughlin
    Participant

    Hi Matthew,

    I realise this post is a bit old now and hopefully your issue has resolved; however, if it hasn’t or if anyone else is having this problem I hope the following helps.

    “Need some help here, as I have been plagued by consistently tight hamstrings for about 6 months now. Any movement which requires lifting a load (light) from the ground results in very tight and tender hamstrings. Even a session of mobility WOD’s that require stretching the hamstrings will result in soreness the following day. I’ve restrained from any kind of heavy pull from the ground for the last 10 weeks, and I’m still plagued by this problem. Heavy deadlifts and GHD back extensions are out of the question…..I cant go near either right now. At first, I thought I had a grade 2 or grade 3 strain, but I feel like there is something else going on here. Anyone else experiencing this? Please Help?”

    First off, I’d recommend going to see a good physiotherapist (physical therapist). That being said it does not sound like tendinitis (tendinopathy). If you’re constantly stretching a muscle and getting nowhere than flexibility of that muscle is not the issue.

    If we use your example of deadlifts, there are 3 main muscles you use to power this lift (as well as engaging your core). These are your gluts (gluteus maximus), hamstrings, and erector spinae (back muscles). Each of these helps lift you up from a bent position (think performing a deadlift). Your erectors should be contracting isometrically to stabilise your spine, while your glut max and hamstrings should be contracting concentrically (shortening against the load). What happens when one of these muscles shuts off is that the load gets transferred to the other 2. What is probably happening is that your gluts have shut off and the load is being passed onto your hamstrings and erectors to try to straighten you out or extend your hip. So now when you go to lift x amount of weight, instead of your gluts, hammies and erectors carrying the load it’s now only your hammies and erectors – thus they get overworked, sore and chronically tight.

    It doesn’t matter how much you stretch or trigger point them, until you get your gluts activating properly again they’ll just be tight the next day. If it’s bad enough you may even experience pain/soreness/tightness after ligther activities such as running, walking, stairs, hiking etc as your gluts are needed to carry out these movements as well.

    So why have your gluts (particularly gluteus maximus) shut off? It’s likely because you’re in anterior pelvic tilt. Signs of anterior pelvic tilt are an excessive forward curve through your lower back and your butt and/or stomach being more prominent (they stick out). When your pelvis (hips) are tilted anteriorly (forward) this puts gluteus maximus on stretch. When you put a muscle on stretch it tends to shut off. It’s not a strength issue, it’s an activation issue. You can’t activate the muscle because it’s constantly on stretch.

    So what’s causing your anterior pelvic tilt (APT)? A muscle imbalance can occur between the muscles that posteriorly (back) tilt vs anteriorly (forward) tilt your pelvis – this can be a strength issue or a tightness issue.

    Muscles that anteriorly tilt the pelvis
    -rectus femoris (one of the quadriceps muscles)
    -iliacus
    -erector spinae

    Muscles that posteriorly tilt the pelvis
    -rectus abdominus (“6 pack”)
    -external obliques (another core muscle)
    -hamstrings
    -gluteus maximus

    So if the muscles that anteriorly tilt the pelvis are much stronger than the ones that posteriorly tilt your pelvis than this will pull you into APT, ultimately shutting off your gluteus maximus, overworking your hamstrings and contributing to your hamstring pain. Alternatively, it may not be a strength issue but a tightness issue. If your APT muscles are tight, they will also pull you into APT.

    Correcting your APT. If the muscles that anteriorly tilt your pelvis forward are tight than you’re going to want to stretch them. If the muscles that posteriorly tilt your pelvis are weak than you’re going to want to strengthen/activate them. Some great activation exercises for glutes are clam shells, donkey kicks, bridges and for your rectus abdominus and external obliques these include reverse crunches, dead bugs, bug legs, supine leg lifts. Keep in mind that you can do these for days but unless you’re employing correct form you won’t get anywhere. With your clam shells DO NOT let your hips roll back. With your external oblique/rectus abdominus exercises, DO NOT arch your lower back. Keep your lower back flat against the floor – remember we’re trying to correct your APT, not make it worse. If you get to a rep and you can’t hold your back flat against the floor then you need to stop – we dont want to train the muscles in APT.

    Once your confident with these and you can correctly activate the muscles, you’ve built the strength and endurance up then you can gradually return to deadlifting. You will also have to stretch out any remaining tightness through your hamstrings and other areas but you should find any flexibility improvements you make will be there the next day. Remember when you’re deadlifting not to round your back (everyone knows this) but also not to excessively straighten your back out (anteriorly tilt your pelvis) as this will shut your gluts off. Also, if you can’t hold your core tight (rectus abdominus and external oblique) than your pelvis will go into APT after a few reps/sets and you’ll be on the path back to square one. So make sure you can feel your butt squeezing as you lift and make sure your tightening your core. A good cue for the core is to imagine a line from your belly button to your sternum/ribs. Your core should be tight enough that from the bottom of your lift to the top this line shouldn’t get any longer. Also, dont over extend at the top as your encouraging APT.

    I know this is a bit long and complicated for some but I hope it makes sense and helps you solve your problem.

    Trevor

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