Chronic anterior knee pain // chondromalacia patella // patella femoral pain syndrome (PFPS) // Excessive Lateral Pressure Syndrome (ELPS) // Lateral Compression Syndrome // Lateral Facet Syndrome of Patella
Let me begin with some backround. I am 23 years old male currently living in Canada. I have had anterior knee pain in my right knee for over 6 years. It started when I played soccer, and it just got worse. I remember my right knee being really swollen for a few weeks 7 years ago. I rested the knee and returned to intense training. I overtrained leading to PFPS. Ever since then my IT bands, quads, and hip flexors are really tight. Nothing seems to really loosen them. I have tried physiotherapy from multiple physiotherapists, ART, osteopathic manipulations, 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, orthotics (which I stopped using), intra articular prolozone injections, joint supplements, heel wedge for leg length discrepency (which I stopped using) ->(my right leg is 1.1 cm shorter confirmed on x-ray).
I dont do any physical activity besides physiotherapy and self-myofascial work. My pain is at a constant 4/10 (it fluctuates, sometimes its lower, but sometimes like in rainy days, cold days, stormy weather, or extended periods of sitting its even higher. Basically all the physiotherapists are perplexed at my issue and they say that I should not be feeling so much pain. They think my overall mobility and flexibility isn't that bad (one of them said, hes never seen someone with so much pain with such good mobility). But when they massage they notice that my soft tissue is really tight with lots of "junk" or adhesive knots.
Sometimes the tightness is really painful and feels almost similar to cramp. If I massage, and self-myofascial release religiously for awhile and dont do any activities it will loosen up a little. But even a little bit of daily physical activity will cause it to tighten up (i.e., cleaning the house, sexual intercourse, moving large furniture, dancing, or physiotherapy exercises without lacross ball and Rumble roller rolling and stretching right at the end).
Joint supplements previously taken that havent helped:
1) NEM - natural egg shell membrane (500mg)
2) pycnogenol (100mg)
3) fish oil (2000mg)
4) krill oil (500mg)
5) curcumin (500mg)
6) Serrapeptase (270 000 IU)
7) Magnesium Biglycinate (200mg)

Vit D (2000mg)
9) Fortigel
Diagnostic imaging done:
1) X-ray on knee - showed nothing abnormal besides patella tilt (although when I examine it myself their seems to be a little less joint space when compared to the left knee, I asked the sports physician, he said that's because of the tilt)
2) ultrasound - showed mild inflammation in my right knee, nothing serious
3) MRI (taken in January)- showed no cartilage, ligament, meniscus or tendon damage. However it showed a possible ganglion cyst in the proximal tibiofibular joint. Sports medicine physician said it probably has not clinical significance and it isnt related to my pain because its in a different area than my symptoms.
4) X-ray for leg length - right leg 1.1 cm shorter (been adviced to wear 0.5 cm heel wedge under my right foot shoes from 1 PM&R physician, but other professionals told me that 1.1 cm is not significant and doesnt warrent a heal wedge. So I was wearing one for 1 month and it did not seem to help so I stopped)
Previous treatments:
1) Physiotherapists/Massage therapist/FMS certified strength and condition specialist- looked at mobility, muscular imbalances, glute medius, glute maxmus, VMO strengthening, core strengthening, stretching, self myofascial release, foam rolling, suction cupping, ART, massage therapy, orthotics, gait analyses, heel wedge for leg length discrepency, electrically stimulated trigger point dry needling, acupuncture, went to Fowler and Kennedy sports medicine clinic in London Ontario and many other places.
2) Dr Robert Banner (London ON) - 7 treatments of Prolozone injections, once every month.. Only noticed temporary relief of pain, maybe for 2 weeks after each injection (relief was dramatic, it decreased pain by 70%). Has recommended EMF (electromagnetic field) protective devices such as diodes. He says it may help since my symptoms are worse on rainy days. Seems very pseudoscience tho. Havent seen him since October. Sports medicine physician thinks the ganglion cyst could have been caused by the injections.
3) Osteopath - Currently seeing an osteopath. Had almost 10 treatments She has noticed that I am kypthotic, and lordosis (which I already knew). Also noticed that my right pelvis is shifted anteriorally (hip misalignment). She has made my back feel good thus far but has not relieved my knee pain and IT band muscle tension. She is not that experienced either but has a very cheap rate (shes only in school). She told me she doesnt think she can help my case and recommended me to see someone with more experience.
Possible Future treatments:
1) Botox (Dr. Gordon Ko in Markham) - into the vastus lateralis (any maybe hip flexor). This has shown to be effective in some recent studies for patients with refractory anterior knee pain. The idea is you shut down the vastus lateralis for 3 months, and you continue to do physiotherapy, this gives you a window of time for selectively strengthening and isolating the VMO. This will help with tracking and tilt issues, and can give symptomatic relief of muscle tightness during the 3 months. Its good for addressing muscular balance issues. Dr. Gordon Ko also does PRP, prolotherapy, hyaluronic acid, and botox into the joint.
2) HGH/testosterone/IGF-1/PSGAGS/hyaluronic acid/dextrose injections - have read this has helped some people. I am looking into injecting into my own knee to save thousands of dollars. This can help regenerate possible cartilage damage I might have.
3) Dr. Anthony Galea (Etobicoke/Toronto) - he is a prominent sports medicine physician infamous for treating athletes and giving them HGH. Don't know what kind of treatment he would give me. I know he does PRP, but I dont know if he can give HGH anymore since its illegal here in Canada and hes gotten in trouble for that.
4) Other possibilities (that probably wont help that help) – Chiropractor, Neurokinetic therapy, SFMA certified health practitioner, naturopath, egoscue method, neural therapy, Rolfing, Graston Technique, shockwave therapy.
Help me:
I am looking for some advice and how to proceed. My chronically tight IT Band, quadriceps, and Hip flexors just dont seem to loosen up! One of my more recent physiotherapist had me doing postural work/exercises. I have been going at it for about 1-2 months and they did not seem to help. He thinks that bad posture might be contributing. He thinks I am an unique case, he said I shouldn't be feeling that much pain since I am not even doing physical activity. Previously if I even tried to run my IT band would tense up right away. I havent tried running in months.