The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: infink on October 28, 2010, 04:26:53 AM

Title: knee extension and ITB or PT problem?
Post by: infink on October 28, 2010, 04:26:53 AM
sorry for the long post! I just tried to mention some things to give more of the picture. if you don't want to read it all, you can just scroll down to the question put in bold near the bottom of this post because I'm really interested in the answer.

my problem started in May this year - one day I noticed that I couldn't extend my right knee. I couldn't even pull it into passive extension by using my hand. simply because there was some resistance inside, if I remember right the resistance was laterally in or near kneecap, I cannot recall that so well anymore though. also, if sitting on the floor I couldn't push the knee into the floor. I also noticed that I couldn't stretch the quadriceps on that leg. however, I had no pain in the quadriceps and I cannot recall a traumatic event. except maybe that once I went up some stairs maybe too fast and I felt some pain for 1 sec, lateral to the kneecap if I recall right, but that was several days prior to this and I'm not sure when the extension stopped working so I'm not sure if related at all but I just can't find any other things.

I worked on it by basically just trying to do extension until it worked, the quad stretch also started working fine again. passive extension also improved to 100% where I mean passive = lying on bed and just keeping leg straight, I also could push the knee into floor 100% but extension while standing on the leg was still not great. I can do it to 100% extension and there is no more "resistance" thing but tissue around the knee just tightens up and it doesn't feel very nice. no pain, just tight and uncomfortable.

this is the thing that never really got resolved. usually in the morning it allows extension while standing 100% without any problems but it will tighten up after a few seconds of the extension being held. if I sit in a chair and lift the leg and straighten it that way that usually won't have the tightness, it's mainly just a problem while standing.

where it tightens up is the lateral side below the knee on the tibia, gerdy's tubercle maybe?, and sometimes the part below the kneecap too. the lateral part would be around where the IT band inserts... and the below kneecap in the middle is where patellar tendon is. I don't have any patellar tendon problems otherwise, but I've had ITB issues a few weeks ago (mentioned below), which I managed to resolve by fixing a form issue both in walking and in running (=inactive hip/gluteal muscles). I linked the ITB issue with this extension issue because I felt a very similar tightening up around the ITB insertion when walking with the wrong form. but then, why did my left leg never bother me with this tightening up? why only the right leg? both legs have been exposed to the same bad form... so that must be only part of the picture! maybe I stress the right leg more when walking/running and it's just luck the left leg didn't get the issue yet?

anyway this situation between May and August was kept at bay until one day I realized my gluteus medius muscle got partially inactivated putting extra load on the tensor fascia lata muscle... I don't know what caused it, maybe a quick sprint I did a couple days prior to it but I'm not sure! anyway, I found that the knee extension worked a lot better, dare I say it finally felt 100% natural. but the gluteus medius was painfully inactive causing issues with walking let alone running. and I couldn't figure out how to reactivate it. then a few days later, I did this idea of full knee extension while standing, this still worked great, then I tried to contract the gluteus medius as hard as I could and surprisingly enough it contracted okay but one second later, I couldn't keep the knee extension without the surrounding tissue getting tight. so I was back to square one but at least my gluteus medius got fixed!

then...a couple weeks ago the situation flared up in a new way... the area, lateral to knee, top of tibia, would tighten up at literally every step when walking, if I didn't pay attention to the walking form. that was so annoying! and I'm not sure what fixed it because it went away after 1-2 weeks, but I know that I could always get it untighten if I flexed&moved my toes for a couple of seconds, probably messing with the extensor digitorum longus or some similar muscle originating from near the ITB insertion point?!.

I forgot to say, a few weeks prior to the constant tightening problem I had a proper ITBS-like flareup also at the lateral top of the tibia, started to hurt during a run, wasn't tightness, was actual sharp pain at every step even when walking, this pain was occurring in forward swing phase only. that went away after 1-2 days, and it was what prompted the running/walking form fix. I did not have any ITBS prior to this or since then as long as I keep the running form good.

as for the patellar tendon tightening up in full extension, that's also a painless dull sensation, and I've never had any patellar tendon issues otherwise. but I'm just guessing it's the patellar tendon because there is nothing else under the kneecap is there? the thing tightening up is definitely above the tibial tuberosity and is in the middle under the kneecap and not deep in the knee. and, actually, lately it's more just this area getting tight, the ITB area doesn't cause discomfort so much anymore when knee is in full extension, but I can't be sure that it won't come back. maybe correct walking form helped though? however, the patellar tendon area does still bother me a lot for the knee extension so the original extension issue is not really fixed.

anyway, right now the situation is stable and functionality is not limited in any way, but I just can't wait to see (not!!) what muscle is going to get f*xxed next (sorry for language).

oh and yes I've seen a doctor with this and he didn't see anything on x-ray or via manual tests or otherwise (no MRI though, that wasn't available). so he just said to practice the standing extension because he noticed that I got used to standing with my right leg with the knee very slightly bent at 10-20 degrees or so (I'm just estimating the degree), and he said that was a bad idea to let it become used to that. well I can do the standing extension if I tolerate the uncomfortable tightness feeling but practicing that doesn't seem to improve it much. so I'm not really letting full extension because when it tightens up after a few secs, it just scares me too much, the feeling is pretty uncomfortable.

so basically my question is this: did you ever hear about ITB band being too tight(?) at its insertion point interfering with the last/terminal degrees of knee extension while standing? and could this be any way related to the patellar tendon tightening up too? and how come ITB would be so connected to other muscles: toe muscle, quadriceps/vastus lateralis, gluteus medius (I did have a few other little things too, calf, popliteus, but my post is too long already) if it is even to do with the ITB?! is it what you call scarred up tissue maybe?

Title: Re: knee extension and ITB or PT problem?
Post by: infink on October 30, 2010, 12:18:26 AM
I have another question that could be a bit simpler to answer maybe: am I right in thinking that the thing that gets stiff at full extension (and hyperextension) of the knee, in front, below the patella, above the tibial tuberosity, that thing can only be the patellar tendon? is there any other tissue there that could be it? thanks!