My Experiences and Solutions to Knee Pain - Patellofemoral Pain and Maltracking

Aretium

Hall of Fame
First off, I am not a doctor, but I do have experience with writing scientific papers and research, so I have based all my discoveries on papers I have read in respected journals. I didn't however, keep the papers and articles where I read this information. These are all solutions to the problems I had.

I had knee pain from around January of 2015 to March of 2016 and more recently a month or so ago. In my opinion the source of this knee pain is sitting too much.

I only started to address the problem around autumn of 2015 as it wasn't that severe but around this time it started to always bug me whenever I bent my knees. I started doing hip exercises around this time, gluteus medius exercises, hip flexor stretches, abduction and adduction, VMO activation etc. They all gave temporary relief from this pain. I'm not saying they don't work, but they definitely prevented further damage and are great exercises as well. Among them I tried stretching and foam rolling the rectus femoris, the IT band, hamstring, TFL, and other muscles. None of these exercises helped in the long term.

Around January this year, I discovered an exercise which could allow me to do a lunge without pain and it is called the "Physio Lunge", involving putting around 80% of your body weight on the affected leg, which sounds bad, but it works. You can google this exercise or find it on youtube. It is great for building the quads and glutes without pain. This gave me around a week or so of painless tennis and it felt great. The pain then came back. I was getting pretty frustrated after trying so many exercises without success.

Then @Chas Tennis mentioned a figure of 4 stretch for the piriformis. I stretched this group for a few days and somehow to my disbelief I was pain free and my knee was 90%. I then played loads of tennis without any troubles at all, I even worried I was playing too much but after around a month, I was fine and very content. Problem solved, everybody laugh, roll on snare drum, curtains.

NOPE. I had assignments for my course and spent a lot of time sitting again, and a few weeks ago the pain was back. I then intensely did all those exercises again and the figure of 4 stretch only offered temporary relief, as soon as I hit the courts, the pain was back.

I started reading again, I read about the effects of sitting and picked up somewhere that the hips can start to internally rotate. I put this in the back of my brain. I then started reading about the VMO and how it is impossible to isolate and some paper indicated that the commonly prescribed exercises for building the VMO, did not work. I then read that the "Knee Valgus" is caused by internal rotation, again I was not sure how this helped me. Chas Tennis mentioned the importance of posture and alignment, once again this issues was too complicated for me to solve without the help of a physio/doctor.

Why was the piriformis stretch so successful? What does it do? It rotates the hip externally. So why don't I try external hip rotation exercises? Ok, so I did. I attached a resistance band to my ankle, bended my leg so that the shin was parallel to the floor, and then started rotation the hip externally so the ankle finishes at right angles behind my other leg. I then stretched the piriformis after. I did some bending exercises after, and my leg felt very light and the knee was not being stressed in anyway. I hit the court a few hours later, and there was 0 pain. A few weeks later and my knee is better than ever. I can perform single leg squats with no pain. I also measured the distance my knee was moving laterally, a month ago it was around 7 mm, now it is around 4mm. So I hope this is acceptable, but I will keep looking to improve it.

I know this is a long rant, but I searched hundreds of online forums, hundreds of scientific papers and dozens of online articles. Would only the external hip rotation exercise have fixed my problems a year ago? I can't say. But kneecap tracking issues are very complex and I hope anyone who can't find a solution can try this or even critique it and tell me if I am doing some damage or creating other issues.
 

moonballs

Hall of Fame
Wow, thanks for sharing! I read about the physio lunge here (could very well be one of your posts) and tried it, and it did cause no pain or discomfort as advertised. Now what is the band exercise you described? Are there other common exercises to strengthen hip rotation muscles? I do clams, band walk and hip abduction machine some time. I am not sure if they strengthen the same muscles as you are describing.
 

Aretium

Hall of Fame
Wow, thanks for sharing! I read about the physio lunge here (could very well be one of your posts) and tried it, and it did cause no pain or discomfort as advertised. Now what is the band exercise you described? Are there other common exercises to strengthen hip rotation muscles? I do clams, band walk and hip abduction machine some time. I am not sure if they strengthen the same muscles as you are describing.
Yeah they should do, I think they should be enough to be honest. Another thing to do is to stretch and release the inside muscles, the hip adductors. So basically, you are trying to reverse internal hip rotation which leads to knee valgus, the caving of the knees when you squat.
 

Lefty5

Hall of Fame
Is there a name for this excercise quoted below? For the life of me, I can't figure out what exactly you're doing here but I"m very interested.

"I attached a resistance band to my ankle, bended my leg so that the shin was parallel to the floor, and then started rotation the hip externally so the ankle finishes at right angles behind my other leg"
 

Aretium

Hall of Fame
Is there a name for this excercise quoted below? For the life of me, I can't figure out what exactly you're doing here but I"m very interested.

"I attached a resistance band to my ankle, bended my leg so that the shin was parallel to the floor, and then started rotation the hip externally so the ankle finishes at right angles behind my other leg"
Basically working on the external rotators in their full range. One thing that also really helps, is the "physio lunge" with a resistance band forcing the leg inwards so you have to use your hip abductors to work. You can also do a squat with a resistance band forcing the knees inward which I am doing right now to fix my left knee as it caves inwards.
 

Aretium

Hall of Fame
Basically to summarise.

I think people should also stretch the hip adductors and release them regularly.
Work on the hip abductors. Squats with resistance bands around knees, phsyio lunges (with resistance band).

I still doubt that ankle deficiencies can cause such problems, the hips and upper leg are so much stronger that they would correct any positional issues lower down right?

As a side note, I tried some "sissy squats" with my weight in the heel and they pose no pain up until a certain range, but I can actually feel the vmo tiring out, which I could not with any other exercise.

Also, when doing squats etc, make sure your knee is in alignment with your toe next to the big toe and always have all the weight going through the heels.
 
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