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Let me preface this by saying right away that I am by no means a student of biomechanics, doctor or scientist in any way. I’m not even an exceptional lifter. This write up is based on self experimentation and personal observations over the last year of learning powerlifting and dealing with patellofemoral pain syndrome. A rundown on patellofemoral pain syndrome: patellofemoral pain syndrome (PFPS) is chronic (and sometimes acute) knee pain with no clear or single pathology, although a newer study points out that Q Angle may be worth investigating. The symptoms of PFPS follow consistent patterns (eg, ).
All in all, this means your knee(s) hurt, sometimes a lot, and no one can really pinpoint the mechanics of why. My chronic PFPS pain manifests as a dull ache of the knee cap and surrounding area (the chronic pain), and the top of the patella during weight bearing flexion with heavy quad recruitment (the acute pain). I’ve been through PT for this twice, with rounds lasting 6 and 8 weeks respectively.
Neither one affected the issue positively, with the second round managing to make it worse during the last week of treatment. After that, I resigned myself to the fact that it will most likely always hurt in some way, so I may as well learn to work around it. What Doesn’t Work: These are not absolutes, some things may work for others, your mileage may vary, etc. Leg presses: these made it worse, even with low weight and high reps (as per most PT recommendations). Varying foot placement made no difference.
Bulgarian split squats: Absolutely not. The most I’ve done is a 3x3 with 70lbs and that left me with acute pain for days. Lunges and lunge variations: Just as bad as split squats. Note: For some reason, Turkish Get Ups (which have a lunge component) do not aggravate it. Really, any kind of single leg work is a steaming bowl of NO.
Clinical level doses of ibuprofen: Very little, if any, effect. I seriously can’t recommend this to anyone, as ibuprofen toxicity can be a very bad thing. This makes sense seeing as how studies report almost no inflammation component to PFPS. Fish oil: Although this is great for a ton of stuff, I did not notice any perceptible difference in chronic occurrence or levels of pain.
Ultrasound, Infrared, TENS: Very short term positive effect on the chronic pain, but nothing worth making the drive to PT. Yoga and derivatives: Anything like Warrior Pose or Horse Stances are a no go. While they don’t particularly hurt while doing them, the increased intensity in chronic pain isn’t worth it.
Single leg stances will ache while doing it, but has no effect either way on the chronic pain. What is working:. Squats: Barbell squats, in of themselves, are not directly helping. Really paying attention to my form, I mean REALLY paying attention to it, does however. Squatting flat footed (in Converse or bare foot) makes the act of moving the weight easier, but it also aggravates the holy hell out of my knee.
Wearing Oly shoes and pulling up on my toes makes moving the weight seem more difficult, but also reduces the instances of aggravating my knee. It seems to be related to quad recruitment. When squatting flat footed, it becomes easier to bully up the weight with my quads. When wearing Oly shoes and pulling up on my toes, I am able to move more with my hamstrings and rely less on my quads. Pulling up on my toes is a huge cue for me, and really helps to keep the instances of acute pain and the intensity of chronic pain down.
When I am spot on with my form and get really good hamstring recruitment, it’s a beautiful thing and there is no knee pain whatsoever. On a variation of this, box squats under 185lbs seem to be fine, but once I approach 200lbs it becomes painful, regardless of footwear. The same goes for front squats, however the range for those is approximately 135-185. RICE: Rest, ice, compression, elevation. Rest only works if I can have my knee fully extended.
Any period of time with the knee flexed will start to hurt (theater sign). Keeping my leg elevated and straight has done wonders for the chronic nature of PFPS and may be one of the most potent techniques for preventing pain. As a desk jockey, the best that I’ve ever done is put my trash bin upside under the desk to I can rest my leg on it all day. Ice works on the chronic ache to a degree, but does not seem to help with the acute pain during flexion when it is present. Compression works very well with certain stipulations, more on this in a moment. Heat - Wrapping my knee in a heating pad and leaving it elevated and extended does help, but only for the chronic pain and not quite as well as icing.
Massage, foam rolling, etc: Massage and foam rolling work really well for short term treatment of flare ups of chronic pain. If my knee is aching from a long day of sitting or driving, this helps a lot. No effect on acute pain during flexion. The best technique I’ve found is to forget the foam roller and use a rolling pin. Using a rolling pin allows a much finer control on the pressure, which can mean the difference between hurt-so-good-relief and just outright painful, especially when working on the area around the IT band/vastus lateralis/femoral nerve.
Those areas in particular work very well to relieve the chronic pain. Another area worth mentioning is about an inch above the knee cap. This corresponds to a small muscle called the which may have some role to play in PFPS, but this is only my conjecture.
Stretching - Stretching, in of itself, is only mild and very temporary relief from the chronic pain. The better stretches I’ve found are the basic and. Probably the most useful thing I’ve found with stretching is to “abuse” the temporary muscle laxity (or whatever mechanism it is that interferes with force production) after static stretching by doing standing quad stretches between squat sets. This helps to reduce quad recruitment and encourage more hamstring activation. Knee sleeves - By far and away the best rehab I’ve found is also the easiest. Just putting on a knee sleeve and going for a walk.
Anywhere from 30-60 minutes usually relieves a massive amount of acute pain as well as the chronic pain. Wearing a knee sleeve while resting my leg in a straightened position works as well, but tends to annoy me after a while. Wearing knee sleeves for squatting aggravates it, regardless of how good my form is. Odds and Ends: Posture, sitting, etc: Standing posture seems to be able to exacerbate it. I’ve noticed I tend to stand with my knees locked, hips pushed back and chest forward. If I make it a point to stand with my back straight and knees slightly bent, the chronic pain will lessen a bit.
Sitting with the knee extended helps to control the chronic pain. Sitting cross legged is a big nope. Some further reading: (.pdf warning). As someone that suffers from PFPS and has had numerous other injuries over the years, your concern is valid, but misplaced in this particular instance.
It Band Syndrome Symptoms
When compensating for a weakness, such as chronically weak ankles (hamstrings are less common, but much more likely to lead to a permanent dependence on sleeves), your body learns to work WITH the brace or sleeve, instead of strengthening to work without it. In the case of PFPS, the sleeve/wrap/brace isn't being used to circumvent a weakness (at least not an identifiable one at this time). Instead, the accessory is being used to compress the knee in an attempt to reduce pain (swelling). Having competed with a number of college and professional athletes that became dependent on some form of accessory and couldn't perform without it I highly recommend avoiding them as much as feasible when rehabbing injuries, however with something truly chronic, you need to come to terms with the fact that you will never be able to train yourself to fix the issue, and instead need to work around it/mitigate the damage. A bit of research published in the Journal of Sport and Orthopaedic Physical Therapy over the last year or two has shown that strengthening of hip abductors and external rotators can help with PFPS (sorry that I can't link to the articles themselves, I'm writing this on my phone).
Is this something that was attempted when you saw a Physiotherapist in the past? That and orthotics to help prevent your foot from over-pronating. Weak hip stabilisers allow internal rotation of your femur, which can lead to altered biomechanics at the knee during flexion.
Over-pronation of the foot/ankle can also affect biomechanics, by changing the position of the tibia. These altered biomechanics are theorised to cause maltracking of the patella, leading to pain when a load causes compression of the patella against the femoral trochlea.
My clinical experience has shown me that addressing one or both of these factors usually plays a major role in resolving PFPS. Source: I'm a Physiotherapist who works primarily with athletes.
As a whole, no one really disagrees with that point, because the diagnosis itself is so nebulous. It's compounded by the tendency to look at all research on the topic, ignoring the evolution in our understanding of PFPS. Looking at studies from 15 years ago, you're going to see a lot more of 'we don't know what's going on and nothing works' than if you look at more recent research where you'll see a lot more support for hip abduction strengthening and correcting foot/ankle mechanics. Our understanding of PFPS is still evolving, but it's a little misleading to talk about current understanding if you're letting old research take precedence over the new.
It may feel like it, but it's not the IT band, and it ain't inflamed. Get the e-book: by Paul Ingraham, science writer & former massage therapist, Canada The 5tht myth is that IT band gets 'inflamed.'
Save Yourself From It Band Syndrome Ebook Readers List
The irritation associated with IT band syndrome is not actually in the IT band itself, nor is the pain inflammatory. The IT band is anatomically fixed to the femur and can't rub back and forth across the lateral epicondyle. The issue is actually with irritated structures UNDER the IT band.
Like most overuse injuries most of the time, there are no immune system cells involved — it's a cousin of inflammation, but quite different. They are irritated and degenerating: 'tissue rot'! I'm a science writer in Vancouver, Canada. I'm a runner and athlete, and I've had (and recovered from) a horrible case of IT band syndrome (AKA runner's knee).
I've spent many years now researching and writing about iliotibial bands, and other overuse and knee injuries too. Cgl 2018 admit card. My e-book does not offer any miracle cures, and most treatment options for IT band syndrome are not that great — but I do explain and review all the options in great detail. If you read my book, you will be extremely well-informed about this frustrating knee problem. Regards, Paul Ingraham Science-based information about common pain problems.