Knee Issue - Patellofemoral pain

Aretium

Hall of Fame
I haven't been to a physio, cant afford it atm. I'm pretty sure it is this and kneecap tracking issues. It isn't a terrible pain, I can play through it, but its too much at times in singles and for serving.

I have been icing it and doing hip/foot exercises and working on their flexibility. I suspect it is because I sit around a lot and my hips fall asleep. Also I have put on weight recently.

Anyone had similar issues?

I am 24, 200lbs. My healthy weight is around 185 lbs. I can lose it pretty quick though so I am working on that.

This pain has restricted me for around 7 months. Some days it is better but no matter what I do, around 10 mins into tennis, it hurts.
 

Aretium

Hall of Fame
Also, it is only in my right knee, which I suspect I use more when playing tennis. Left knee is 100% healthy.
 

sm01

Rookie
You seem to be doing the right things, but you don't mention foam rolling. Nor do you mention whether the pain is centered or to one side or the other of the patella/tendon. You might do a bit of exploratory rolling, you can do it with a rolling pin or a full bottle of water, to check for myofacial adhesions and muscle knots, not necessarily in the knee area. If your pain is lateral--more to the outside of the knee I'd look real hard at your TFL-tensor facia latae, IT band, and gluteus max. If any of those are too tight, you can untrack your patella and/or inflame the p tendon.

I am not a doc, but have had pat fem pain numerous times, and normally for me it has been the IT band being tight, but have had a couple bouts where the TFL was real tight and did not even know it. Tends to tilt the torso forward also if real bad.
 

Aretium

Hall of Fame
You seem to be doing the right things, but you don't mention foam rolling. Nor do you mention whether the pain is centered or to one side or the other of the patella/tendon. You might do a bit of exploratory rolling, you can do it with a rolling pin or a full bottle of water, to check for myofacial adhesions and muscle knots, not necessarily in the knee area. If your pain is lateral--more to the outside of the knee I'd look real hard at your TFL-tensor facia latae, IT band, and gluteus max. If any of those are too tight, you can untrack your patella and/or inflame the p tendon.

I am not a doc, but have had pat fem pain numerous times, and normally for me it has been the IT band being tight, but have had a couple bouts where the TFL was real tight and did not even know it. Tends to tilt the torso forward also if real bad.
Hmm, its usually just in the top of the knee cap but sometimes on the right side of the knee cap. I have been stretching my IT band too. How would I stretch the tfl? Same as hips?

Also, there is more popping in my right knee. How did you go about recovery, did you stop playing altogether? WHen should i ice it and when to use heat if needed?
 
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Aretium

Hall of Fame
Went for a run today, no pain when running. Now later on this evening, no pain at all. Might try some tennis soon haha
 

sm01

Rookie
Hmm, its usually just in the top of the knee cap but sometimes on the right side of the knee cap. I have been stretching my IT band too. How would I stretch the tfl? Same as hips?

Also, there is more popping in my right knee. How did you go about recovery, did you stop playing altogether? WHen should i ice it and when to use heat if needed?
Re stretching the tfl, it is the top front end of the IT band, the top rear end being the gluteus max. Best thing I can tell you is to look for stretches on youtube. And when you stretch it you need to be warmed up and need to hold the stretches for several minutes. Basically the tfl is about the size of a sandwich and is located at your front pants pocket. It is like a very tough piece of gristle.

You can gauge tightness/tenderness of the tfl by lying flat on the floor face down, and by placing a tennis ball under the tfl area and rolling around with some body weight on it. A harder ball like a softball actually works better if you happen to have one. You may find soreness right in the crease between your lower abdomen and front of your leg. I would try to massage that out if this is your problem.

I made a TFL/IT Band/Quad stretcher out of an old tennis shoe. I have a 4 foot strap tied to the laces, and lie on the floor facedown, leg in the quad stretch position, with heel against glute max, and pull the strap over my back and shoulder. I hold it quite a while before I see a stretch. You can use different over the shoulder, over the head, over the opposite shoulder angles to get max stretch.

I also use a couple of foam rollers. I made a heavy pipe roller made from an 8" dia. plastic drain pipe with socks filled with sand that I put in it. That is the best piece of massage equipment that I have. I roll on it, roll it over me, and rub it lengthwise across the area I want to massage. This is the best roller for the tfl.

I have had tight IT/TFL numerous times over 10 years or so. A few of the times I laid off a while. I don't find ice to be much help. Rolling with my roller and a soft ball has been the best therapy for me.

Really sorry you are having this problem, it can be a sticky one and not fun. Good luck and report back please.
 

Ronaldo

Bionic Poster
Is this problem the same as chondromalacia? Poor tracking patella due to a muscle imbalance?
 

Chas Tennis

G.O.A.T.
You should see a Dr. The patellofemoral area of the knee is one of the most common sites for developing arthritis. You should not stress it for months as the pain may be related to ongoing damage to the cartilage under your knee cap.

I have had issues there I believe because my rectus femorus was tight/short. I believe that this applies to me.
https://mrtherapy.com/articles/article3.html

There are many other possible injuries that might affect that area of the knee. You need a Dr to diagnose your injury.
 

Shroud

G.O.A.T.
Yeah, there is like 10 names for the same thing.
Chas's article helped me at least to identify the issue.

I thought it was a muscle imbalance and I started strengthening things but it never got better. I took a rolling pin and removed the pins and took the rolling part and with some pressure moved it all around the knee. the muscles at the top outside of the knee were super tight and basically were one big knot. I found some other areas too. I basically rubbed the crap out of them with the rolling pin and then a baseball. I would drive around with them and rub as much as it was safe.

Pain is gone and I am playing without a brace and or meds. I just have to do the stretches and the myofacial release.

Here is an example vid or two:

 

Coolio

Professional
I have had similar problem for the last 8-9 months and went to the physio 2 months ago, followed his programme and now I am at about 95% with my knee.

I didn't need to stop playing tennis. It won't do you damage. It will not heal with rest or ice, only specific exercises.

1) Single Leg Decline Squats: Stand on your injured leg, with heel on a book and squat as low as possible. 100times a day, (break it up into 10's) 2 days on 1 day off and repeat. It will be sore, but this is part of the recovery process. Trust the exercises. If it is easy hold weights.
2) Foam Roll and stretch hips and leg muscles.
3) Do 30 secs of Wall Ball Squats -10 Walking Lunges - 10 Single Leg Decline Squats. Do a few sets. (Single Leg Squats count towards your 100 a Day)

It takes a long time, be patient. You were injured a long time like me so it took me almost 2 months. Good luck!
 
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Chas Tennis

G.O.A.T.
I don't know the odds that the OP's injury is the same as the the injury of a poster but there are several common causes of knee pain on the front of the knee.

Some treatments might be counterproductive if, for example, the OP had loose bodies under the knee cap or a stress fracture.

[I believe that 'Chondromalacia' is an older term for the more recent 'Patellofemoral' Pain but I'm often not certain of how the terms are used.]
-------------------------------------------------------------
"Causes of Anterior Knee Pain
Cause Comment
Articular cartilage injury

May describe history of trauma; mechanical symptoms may occur if loose body present; may have effusion; may have tenderness of involved structure (e.g., femoral condyles, patella)

Bone tumors

Pain may be insidious; may have tenderness of bony structures

Chondromalacia patellae

Retropatellar pain; may have history of trauma; may have effusion on examination

Hoffa's disease

Pain and tenderness localized to infrapatellar fat pad

Iliotibial band syndrome

Typically presents with lateral pain and tenderness over lateral femoral epicondyle

Loose bodies

Symptoms variable; may have intermittent sharp pain, locking, or effusion

Osgood-Schlatter disease

Tenderness and swelling at insertion of patellar tendon at tibial tubercle in an adolescent

Osteochondritis dissecans

Symptoms variable; may have intermittent pain, swelling, or locking

Patellar instability/subluxation

Intermittent pain with sensation of instability or movement of patella; may have swelling; locking can occur with loose body formation; may have tenderness over medial retinaculum

Patellar stress fracture

May have tenderness directly over patella

Patellar tendinopathy

Tenderness of tendon; tendon may be thickened if chronic

Patellofemoral osteoarthritis

May have crepitus or effusion; characteristic radiographic findings

Patellofemoral pain syndrome

Anterior knee pain “behind” or around patella; usually no effusion; may have findings of patellar maltracking

Pes anserine bursitis

Pain usually described as medial rather than anterior; tenderness over pes anserine bursa

Plica synovialis

May be medial or lateral to patella; if symptomatic, tenderness can be demonstrated on examination

Prepatellar bursitis

Characteristic swelling anterior to patella following trauma

Quadriceps tendinopathy

Tenderness over tendon

Referred pain from the lumbar spine or hip joint pathology

Symptoms depend on origin of pain; knee examination usually normal

Saphenous neuritis

Pain usually medial but poorly localized; may have history of surgery

Sinding-Larsen-Johansson syndrome

Tenderness at patellar tendon insertion at inferior pole of patella in an adolescent

Symptomatic bipartite patella

May have tenderness directly over patella with characteristic radiographic findings

Information from reference 12."


------------------------------------------------------
Management of Patellofemoral Knee Pain, Sameer Dixot et al...
http://www.aafp.org/afp/2007/0115/p194.html

Imaging by X Ray or MRI can be very effective for knee injuries.

Google: patellofemoral knee pain images
https://www.google.com/search?q=pat...OGu55fKAhUB8z4KHfF_C7kQsAQIHA&biw=846&bih=521

This cartilage damage under the knee cap is the arthritis that you want to avoid. Sometimes pain does not occur in cartilage until damage has progressed.....


The tracking of the knee cap is a very complex subject that requires a well qualified specialist.

Last thought is to also never count out Lyme Disease. My 17 year old niece was having knee pain playing soccer. After some months of false diagnoses it was diagnosed as Lyme Disease.
 
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Aretium

Hall of Fame
I don't know the odds that the OP's injury is the same as the the injury of a poster but there are several common causes of knee pain on the front of the knee.

Some treatments might be counterproductive if, for example, the OP had loose bodies under the knee cap or a stress fracture.

[I believe that 'Chondromalacia' is an older term for the more recent 'Patellofemoral' Pain but I'm often not certain of how the terms are used.]
-------------------------------------------------------------
"Causes of Anterior Knee Pain
Cause Comment
Articular cartilage injury

May describe history of trauma; mechanical symptoms may occur if loose body present; may have effusion; may have tenderness of involved structure (e.g., femoral condyles, patella)

Bone tumors

Pain may be insidious; may have tenderness of bony structures

Chondromalacia patellae

Retropatellar pain; may have history of trauma; may have effusion on examination

Hoffa's disease

Pain and tenderness localized to infrapatellar fat pad

Iliotibial band syndrome

Typically presents with lateral pain and tenderness over lateral femoral epicondyle

Loose bodies

Symptoms variable; may have intermittent sharp pain, locking, or effusion

Osgood-Schlatter disease

Tenderness and swelling at insertion of patellar tendon at tibial tubercle in an adolescent

Osteochondritis dissecans

Symptoms variable; may have intermittent pain, swelling, or locking

Patellar instability/subluxation

Intermittent pain with sensation of instability or movement of patella; may have swelling; locking can occur with loose body formation; may have tenderness over medial retinaculum

Patellar stress fracture

May have tenderness directly over patella

Patellar tendinopathy

Tenderness of tendon; tendon may be thickened if chronic

Patellofemoral osteoarthritis

May have crepitus or effusion; characteristic radiographic findings

Patellofemoral pain syndrome

Anterior knee pain “behind” or around patella; usually no effusion; may have findings of patellar maltracking

Pes anserine bursitis

Pain usually described as medial rather than anterior; tenderness over pes anserine bursa

Plica synovialis

May be medial or lateral to patella; if symptomatic, tenderness can be demonstrated on examination

Prepatellar bursitis

Characteristic swelling anterior to patella following trauma

Quadriceps tendinopathy

Tenderness over tendon

Referred pain from the lumbar spine or hip joint pathology

Symptoms depend on origin of pain; knee examination usually normal

Saphenous neuritis

Pain usually medial but poorly localized; may have history of surgery

Sinding-Larsen-Johansson syndrome

Tenderness at patellar tendon insertion at inferior pole of patella in an adolescent

Symptomatic bipartite patella

May have tenderness directly over patella with characteristic radiographic findings

Information from reference 12."


------------------------------------------------------
Management of Patellofemoral Knee Pain, Sameer Dixot et al...
http://www.aafp.org/afp/2007/0115/p194.html

Imaging by X Ray or MRI can be very effective for knee injuries.

Google: patellofemoral knee pain images
https://www.google.com/search?q=pat...OGu55fKAhUB8z4KHfF_C7kQsAQIHA&biw=846&bih=521

This cartilage damage under the knee cap is the arthritis that you want to avoid. Sometimes pain does not occur in cartilage until damage has progressed.....


The tracking of the knee cap is a very complex subject that requires a well qualified specialist.
Chas don't come here with well thought out logic and science. This is an online forum, only miracle cures exist.
joking aside....

These last few weeks or so, I have done RICE and loads of hip strengthening and ankle mobility exercises. I also did a few sumo squats to strengthen my inner legs. I did a bit of running yesterday and there was no pain (to be honest there was only pain when bending like split steps and serving). Today woke up, no pain. Will keep going and see at the weekend if I can play a bit of tennis. Either way, stronger hips are freeing as I spend a lot of time at a desk. Also there is definitely a lot less popping (still more than my left knee).
 

Aretium

Hall of Fame
I have had similar problem for the last 8-9 months and went to the physio 2 months ago, followed his programme and now I am at about 95% with my knee.

I didn't need to stop playing tennis. It won't do you damage. It will not heal with rest or ice, only specific exercises.

1) Single Leg Decline Squats: Stand on your injured leg, with heel on a book and squat as low as possible. 100times a day, (break it up into 10's) 2 days on 1 day off and repeat. It will be sore, but this is part of the recovery process. Trust the exercises. If it is easy hold weights.
2) Foam Roll and stretch hips and leg muscles.
3) Do 30 secs of Wall Ball Squats -10 Walking Lunges - 10 Single Leg Decline Squats. Do a few sets. (Single Leg Squats count towards your 100 a Day)

It takes a long time, be patient. You were injured a long time like me so it took me almost 2 months. Good luck!
The decline squats are usually more for patellar tendinitis? Jumper's knee as its called. I really think that would ruin my knee.
 

Coolio

Professional
The decline squats are usually more for patellar tendinitis? Jumper's knee as its called. I really think that would ruin my knee.
Sorry, I must have misread. I had patellar tendinopathy and knee tracking issues.
 

Chas Tennis

G.O.A.T.
.................................

These last few weeks or so, I have done RICE and loads of hip strengthening and ankle mobility exercises. I also did a few sumo squats to strengthen my inner legs. I did a bit of running yesterday and there was no pain (to be honest there was only pain when bending like split steps and serving). Today woke up, no pain. Will keep going and see at the weekend if I can play a bit of tennis. Either way, stronger hips are freeing as I spend a lot of time at a desk. Also there is definitely a lot less popping (still more than my left knee).
Search: anterior pelvic tilt
One contributing cause of anterior pelvic tilt can be tight/short rectus femorus. I moved the top of my pelvis back about 3/4-1" by stretching my rectus femorus. I had noticed the anterior pelvic tilt years before, didn't like how it looked, thought that it was just normal aging, but did not know what it was or anything about it. In other words, anterior pelvic tilt may go along with short/tight rectus femorus muscles. Interior pelvic tilt is associated with older people - but it is not aging but being out of shape. Short rectus femorus is possibly caused by sitting too much which shortens the rectus femorus. It is very important to realize that the rectus femorus is the only quad that attached above the hip. It explains why tennis does not stretch the rectus femorus - we usually bend forward at the hips on the tennis court. Bending forward takes any stretch forces off the rectus femorus......

I have another very tight muscle hip-butt muscle, Piriformis, that is stretched by a "Figure 4" stretch. I find the 'Figure 4' stretch is difficult for my arm muscles. I found another stretch that uses my weight for force rather than muscles power (can't recall for now). Also, when I place my ankle on my knee and cross my legs it is not comfortable and I can't get the lower leg to horizontal. But I have improved my Piriformis range of motion when sitting by crossing my leg on my knee. I have a way to go and am not stretching seriously or regularly.

These muscles of mine got short & tight despite a great deal of tennis for decades.

I attribute reducing most of my patellofemoral pain to stretching my rectus femorus. But my MRIs have shown considerable damage under the knee cap.

I read that cartilage has few or no nerves and does not produce pain until damage reaches a considerable level. Please check this view as I did not find it repeated very often.
 
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Shroud

G.O.A.T.
Was IT tough to rub and drive? Seriously, ever use a strap?
not sure what you are asking.

As strap for what?

It was my left knee and with the left hand I could use the rolling pin (without the pins) and or the base ball while keeping my right hand on the wheel.
 

Shroud

G.O.A.T.
Ah. I tried all kind of straps and patella braces. The straps never seemed to do much. I did find a full knee brace with patella support that i could play with but it still hurt

Fwiw i THOUGHT i had an injury or that i was weak. But it wasnt an injury or weakness at all. It was tight tight muscles and no strap is going to help with that
 

Aretium

Hall of Fame
Ah. I tried all kind of straps and patella braces. The straps never seemed to do much. I did find a full knee brace with patella support that i could play with but it still hurt

Fwiw i THOUGHT i had an injury or that i was weak. But it wasnt an injury or weakness at all. It was tight tight muscles and no strap is going to help with that
In general research shows taping, orthotics, straps do not work for most people, this is largely because kneecap issues stem from a lot of different reasons.
 

Shroud

G.O.A.T.
In general research shows taping, orthotics, straps do not work for most people, this is largely because kneecap issues stem from a lot of different reasons.
Yeah i bet! Looking at the 2 vids i posted there are several muscle groups that can cause trouble.

Something about tennis too. When i was walking miles a day no knee issues but get back into tennis and viola knee issues!
 

Ronaldo

Bionic Poster
Yeah i bet! Looking at the 2 vids i posted there are several muscle groups that can cause trouble.

Something about tennis too. When i was walking miles a day no knee issues but get back into tennis and viola knee issues!
Odd, guy with the same problem looked at my inner thigh above the knee and saw it was weaker than the non affected leg.
 

Shroud

G.O.A.T.
Odd, guy with the same problem looked at my inner thigh above the knee and saw it was weaker than the non affected leg.
It certainly could be weak muscles. What little I know is that there is an imbalance in the muscles that causes the tracking to be off. That could be caused by weak muscles or in my case extremely tight muscles. It would be prudent to look at the outside muscles and see if any are knotted. You wont notice it unless you touch it, at least I didnt, and was really surprised that there was such a tight muscle there.

FWIW my tight tight muscle is on the outside of the knee and well you could say the inner muscles seem weak. I thought that and did a bunch of exercises but it didnt help because the real issue was the tight outside muscle.
 

Aretium

Hall of Fame
Sooo, first time on court in a week and a bit. A lot less knee pain. From my experience, actual resting does very little. But the exercises and stretches I've been doing has helped. I think in a week or 2 I will be ok. This is really good news, a year of pain, my footwork has gotten worse but today was moving a lot better. It's good that I got these issues at 24, you learn the weaknesses in your body. I had shoulder issues for a year before as well until I realised that sleeping on my side was causing the pain.
 

DuckServe

New User
1. Stop playing.

For me, what helped was:
1. Strengthening/stretching ankles/calves
2. Strengthening/stretching hips
3. Seeing a medical professional.

A simple thing for me to remember is that human knees are only suppose to bend and straighten one way. If your ankle and hip are weak, the knee gets unstable.
 

Aretium

Hall of Fame
Ok, update. After my run last week, the pain almost disappeared (possibly balancing muscles in my leg?). It came back after a few days, played tennis and it was a lot better than the last 7 months or so. Now, I have really tight thigh muscles, especially like a "knot" around my front right pocket (near the bottom of the pocket). I can't release it and it is so tight and a little bit painful (feels like a bruise)
 

sm01

Rookie
Reread my post #6 above. Really sounds like a tight tfl. It is an extremely tough piece of connective tissue and my recommendation based on my experience is to massage it with a hard ball or roller, body on top to use your body weight to work it. Try holding pressure on the tfl for several minutes--it is not fun. There are a number of youtube vids on this. And try my shoe stretcher or one of those green straps to stretch it.

Definitely not fun.
 

Aretium

Hall of Fame
Little update. After that strange 3 day honeymoon period after my run last week where my knee felt 100%. Pain came back. I started stretching the lateral side of my quads and started doing some sumo squats to improve the inside. Also tried some rolling to release the lateral side. Seems to be working.
 

California

Semi-Pro
Brutal injury. Been dealing with it off and on for over 3 years... Unfortunately mainly on. I feel like I am doing all I can and I can't get it to stay away. I lift weights, stretch, use a roller, have a softball, etc... Haven't been really able to play tennis in a while. Really frustrating. All started a couple of years ago when I started a job where I sat at a desk most of the day...

I try to remain positive that I can get over it, I hope I can. I keep working at it and trying new things. Never had an injury like this one that just won't go away.... I played a lot of sports growing up and have had a fair share of injuries and a couple surgeries, this might be the worst.
 

Aretium

Hall of Fame
I've discovered that my IT band and outside thigh is very tight. Stretching it helps, but very quickly it returns to being tight. I'm guessing there is something in the hips/glutes that causes this.
 

Aretium

Hall of Fame
!!!!!! SOLUTION !!!!!!!!!!!!
Very huge update.

Despite all my exercises, nothing really got better. I tried different orthotics, taping, rolling, rest etc. NOTHING works. The only thing that would "help" is gluteus medius work, but how can just working out the medius really help the knee overall?

I found an exercise by a Physio who specialises in knee injuries. You can search for a Mr Tim Keeley. He advocates a special type of lunge, which is . different to a normal lunge in that 80% of your weight is on the affected leg. Sounds terrible?!?!?! Interestingly with the way the lunge is executed, I can put my full weight to a 90 degree bend or even more (though its not needed) without pain. It greatly increases the use of the gluteus muscles and seemingly helps to use the inside leg muscles. It gives almost instant results. Amazing exercise. (sounds like i am selling something). Obviously, everyone gets this pain for different reasons. The exercise is called the "physio lunge". Plenty of help on youtube but I would find the videos done by Tim Keeley as I think he "created" this exercise. I'm flying all over the court now.
 

Aretium

Hall of Fame
Search: anterior pelvic tilt
One contributing cause of anterior pelvic tilt can be tight/short rectus femorus. I moved the top of my pelvis back about 3/4-1" by stretching my rectus femorus. I had noticed the anterior pelvic tilt years before, didn't like how it looked, thought that it was just normal aging, but did not know what it was or anything about it. In other words, anterior pelvic tilt may go along with short/tight rectus femorus muscles. Interior pelvic tilt is associated with older people - but it is not aging but being out of shape. Short rectus femorus is possibly caused by sitting too much which shortens the rectus femorus. It is very important to realize that the rectus femorus is the only quad that attached above the hip. It explains why tennis does not stretch the rectus femorus - we usually bend forward at the hips on the tennis court. Bending forward takes any stretch forces off the rectus femorus......

I have another very tight muscle hip-butt muscle, Piriformis, that is stretched by a "Figure 4" stretch. I find the 'Figure 4' stretch is difficult for my arm muscles. I found another stretch that uses my weight for force rather than muscles power (can't recall for now). Also, when I place my ankle on my knee and cross my legs it is not comfortable and I can't get the lower leg to horizontal. But I have improved my Piriformis range of motion when sitting by crossing my leg on my knee. I have a way to go and am not stretching seriously or regularly.

These muscles of mine got short & tight despite a great deal of tennis for decades.

I attribute reducing most of my patellofemoral pain to stretching my rectus femorus. But my MRIs have shown considerable damage under the knee cap.

I read that cartilage has few or no nerves and does not produce pain until damage reaches a considerable level. Please check this view as I did not find it repeated very often.
Interesting, I had a bit of pain this last week but it is different to the usual pain. Perhaps I have several issues causing the pain. I did the figure of 4 stretch and it gives instant pain relief. Why is that? Generic tight hips? Does a tight piriformis cause a biomechanical change or an incorrect muscle firing sequence or some other medical jargon explanation?
 

Chas Tennis

G.O.A.T.
Interesting, I had a bit of pain this last week but it is different to the usual pain. Perhaps I have several issues causing the pain. I did the figure of 4 stretch and it gives instant pain relief. Why is that? Generic tight hips? Does a tight piriformis cause a biomechanical change or an incorrect muscle firing sequence or some other medical jargon explanation?
I have to look up some of the stuff about the piriformis.

One thing that I have not experienced is that the piriformis can pinch the sciatic nerve and cause pain farther away from the brain than the pinch.
https://en.wikipedia.org/wiki/Piriformis_syndrome

My friend had a similar sciatic nerve pinch next to his spine (above the nerve pinch from Piriformis Syndrome) because of a back problem. It caused knee pain for him.

Writing from shaky memory I need to check this stuff when I have time -- I believe the piriformis can affect hip rotation and cause the leg to turn outward. I forget but this may have been my problem. ? My piriformis was short/tight, less so now. Walk around is a very relaxed manner and stop. Look down at your feet. I believe that my feet tended to turn outward because the hips did not rotate as well as they should. Don't rely on what I am recalling. Will edit.

There are videos that show how to measure the ranges of motion for each joint.
 
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Aretium

Hall of Fame
I have to look up some of the stuff about the piriformis.

One thing that I have not experienced is that the piriformis can pinch the sciatic nerve and cause pain farther away from the brain than the pinch.
https://en.wikipedia.org/wiki/Piriformis_syndrome

My friend had a similar sciatic nerve pinch next to his spine (above the nerve pinch from Piriformis Syndrome) because of a back problem. It caused knee pain for him.

Writing from shaky memory I need to check this stuff when I have time -- I believe the piriformis can affect hip rotation and cause the leg to turn outward. I forget but this may have been my problem. ? My piriformis was short/tight, less so now. Walk around is a very relaxed manner and stop. Look down at your feet. I believe that my feet tended to turn outward because the hips did not rotate as well as they should. Don't rely on what I am recalling. Will edit.

There are videos that show how to measure the ranges of motion for each joint.
If anything, my feet turn inward....
 

Chas Tennis

G.O.A.T.
If anything, my feet turn inward....
The knees work better when the hip joints have the proper alignment. This is a complex subject and needs a specialist. If you have knee problems study the alignment of your hips and all other posture issues, all connected.

I asked my knee Dr for a posture examine after recovering from a knee meniscus injury. A second Dr examined my knee and posture and prescribed certain corrective physical therapy. That was a great way to approach an injury that is so complex.

Can you do the same?
 

Aretium

Hall of Fame
The knees work better when the hip joints have the proper alignment. This is a complex subject and needs a specialist. If you have knee problems study the alignment of your hips and all other posture issues, all connected.

I asked my knee Dr for a posture examine after recovering from a knee meniscus injury. A second Dr examined my knee and posture and prescribed certain corrective physical therapy. That was a great way to approach an injury that is so complex.

Can you do the same?
I can't afford it. I do have wide hipsm thanks chas
 

Ronaldo

Bionic Poster
The knees work better when the hip joints have the proper alignment. This is a complex subject and needs a specialist. If you have knee problems study the alignment of your hips and all other posture issues, all connected.

I asked my knee Dr for a posture examine after recovering from a knee meniscus injury. A second Dr examined my knee and posture and prescribed certain corrective physical therapy. That was a great way to approach an injury that is so complex.

Can you do the same?
Anyone remember Posture Guy and this thread, http://tt.tennis-warehouse.com/index.php?threads/pain-free-by-pete-egoscue.446105/#post-7224161
 

Aretium

Hall of Fame
Well, I'm not quite sure what helped as I have been doing loads of different exercises. I have done Sumo/squats, wall assisted squats with a ball in between my legs which I squeeze with my knees, gluteus medius and glute work, physio lunges, rectus femoris stretches, calf stretches, hamstring stretches, hip stretches, figure of 4 stretches.... There were a lot of times when I thought something worked, but it only lasted 4/5 days or a week. Since I've started doing the figure of 4 stretch the pain is starting to disappear, I was flying around the court yesterday (still some pain). I know I have previously said the pain was gone, but this is the most convincing so far. I will carry on with these exercises every day. I attribute my pain to prolonged sitting.
 
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