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Author Topic: My knee pain - is it IT band/tight hip flexors?  (Read 2045 times)

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Offline AWolf

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My knee pain - is it IT band/tight hip flexors?
« on: March 01, 2015, 06:41:30 AM »
I've been battling a knee issue for about four months that's been debilitating at times, and has kept me from my normal exercise regimen. I've seen a PT who didn't provide the feedback I was hoping for, and so I've come here seeking some advice.

The story:

I do a considerable amount of cycling and had never had any trouble in 3 years of almost daily riding with the outside of my knees. But one day, out of the blue, I developed an awful pain right on the outside of my left knee, that radiated above and below, and centered significantly on the fibula head and even around and down the upper part of the calf. The pain was so severe that I could hardly walk, and certainly couldn't climb stairs or exercise. After a week of ice and rest, I was able to heal. After a couple of weeks, I attempted to bike again, only to end with the same result. This cycle has gone on 2-3 other times, and I've often given myself 2-4 weeks between rides to allow the knee to completely heal before trying again.

In all of this, there a few observations that I've been able to make that might help lead to a cause:

1. It seems to be a use-pain only. Even while on my bike and in pain, if I stop pedaling, there is no pain or almost no pain at all. Likewise, if I'm standing still, or sitting in a chair and not moving the knee, it is completely pain-free. But when I move it, the pain is instantly present.

2. The pain worsens in the 15-20 minutes following a ride, even if I stretch immediately.

3. The IT band, in the area where it can be felt just above the knee, feels tighter/more pronounced than the right.

4. There was never at any point any pain in my hips or glutes. But when I decided to foam roll and use a tennis ball on them, a very sharp, stinging pain developed in the gluteus medius region, at the hip, and down into the very upper part of the hamstrings. The only way I can describe the feeling is that it mimics a sunburn. Not sure if this is indicative of trigger points or not?

5. The pain occasionally displays itself in the patella, but seems to come and go at random.

6. The focal point of the pain seems to be a little different each time. Sometimes at the fibula head, sometimes directly at the side of the kneecap, or in other bones/muscles right in that immediate area.

6. Even after healing, just normal daily use sometimes flares it up, albeit at just a "discomfort" level and not all-out pain.

7. With dedicated stretching, foam rolling, and massage with a tennis ball, I've been able to reduce not the severity of the pain during/after exercise, but the length of recovery time.

Does this sound like a flexibility and/or strength issue? The PT suggested IT band or perhaps cartilage loose somewhere. The fact that this didn't develop over several months, but just sort of came on out of nowhere has me somewhat baffled, but I really want to find a solution and get on the road to healing so I can get back to training.
« Last Edit: March 01, 2015, 06:45:08 AM by AWolf »

Offline Audice

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #1 on: March 01, 2015, 12:06:01 PM »
AWolf ~ I could easily have said just about what you did. I'm dealing with the same situation...ongoing pain/referred pain in my left leg. Tight IT band, tight quad, tight glutes, piriformis, sartorius, ql etc. Migrating pain into the knee & sometimes down into the foot. Like you, I have random pain coming & going for no specific reason that I determine.

Having had x-rays, it turns out my problems all stem from age related back issues. Yet I have negligible lower back pain. Chiropractic adjustment & therapeutic massage give me only temporary relief, in part because I go back to the activities that sapparently created the problem to begin with.

It might be time for x-rays or MRI to see what's happening to you leg. Wishing you well.
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline AWolf

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #2 on: March 01, 2015, 05:34:38 PM »
Thanks for the response. I haven't experienced any actual tightness feeling in my quads, hips, or glutes at any point, but foam rolling or using a tennis ball seems to aggravate those areas. I do deal with occasional back soreness like anyone else does, but at 31 years old, I'm not sure if my back has any serious age-wear on it that might b causing it. Then again, I could be totally wrong.

Offline Osiris

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #3 on: March 02, 2015, 02:30:02 PM »
I had similar from golfing, but it was torn cartilage in the left knee and caused by a lack of hip flexibility.

What helped me was a physio who understands Functional Movement Screening.  He had me do a bunch of stretches, motions and balance drills to expose my weaknesses, then used active release therapy to balance the muscles, then added sustaining exercises to keep them that way.  I'm now in the strengthening phase, and after two weeks I am so much better than before with knee brace, orthotics, ice and rest.  I no longer wear a knee brace, ditched my orthotics, and have virtually no knee pain.

Offline vickster

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #4 on: March 02, 2015, 02:44:28 PM »
I've just had an impinged fat pad and lateral meniscus tear excised, causing a very similar sounding anterior lateral knee pain.  The straightening and especially having a bent knee was the cause of pain, presumably pinching the fat pad.  The pain was referred a little way below my knee in the shin, not directly below the kneecap

Assuming you've seen a highly qualified sports physio (preferably one with a focus on cyclists), have you had an MRI of the knee?  If you've not seen the physio, that should be your first move really
Came off bike onto concrete 9/9/09
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LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline AWolf

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #5 on: March 04, 2015, 10:22:01 PM »
I have seen a physio, but did not have an MRI or X-ray, largely due to cost. As mentioned prior, little feedback was given, and I came away with nothing more than a prescription for some anti-inflammatories.

Since making this post, I have noticed further that if I religiously stick to foam rolling the leg and hip and using a tennis ball on the glutes, the knee pain diminishes much quicker after each ride. Unfortunately, the pain is still very present during and after a ride, and it's limiting me to about 25 miles, instead of the 60-100 I'm accustomed to.

I'm still curious...can there be trigger points in tight muscles that only become evident when poked and prodded on, as I have been? Perhaps I should be looking beyond just the gluteus medius and more into the back as the root cause?

Offline Osiris

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #6 on: March 05, 2015, 12:28:59 AM »
Pain can refer, and so can the cause of tension in given muscle groups.  My physio mentioned as much when my initial evaluation was complete.  At that point, he knew where there were restrictions, and determined the cause of them.  In my case, the pain (and cartilage tear) was in the left knee, but the cause was the left hip flexor, if not something else as well.  The physio worked for about an hour to actively release several muscles on the left side including the hip flexor.  Now that my pelvis is in balance, my knee pain is diminished even though I'm doing more work than prior to thy physio's treatment.  I used to be able to pull in my abs to straighten my pelvis (noticeably).  I could feel if not see the pelvic tilt when I relaxed my abs again.  Now when I clench my abs, nothing much happens as far as my pelvic tilt because it's in balance now.

Offline dal_knee

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #7 on: March 06, 2015, 08:13:15 PM »
Have you looked into dry needling?  In the U.S., it's now offered at some chiropractors and Physical therapists offices'.   You may not need very many sessions at all.   Try this, before investing in the MRI cost.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline AWolf

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Re: My knee pain - is it IT band/tight hip flexors?
« Reply #8 on: March 09, 2015, 03:12:08 AM »
Would some form of tear or loose cartilage not create a more constant form of pain, that's present all the time, or highly aggravated by even the simplest of movements?

The more I think I have this figured out, the more at a loss I seem to be. The pain seems to now be consistently centered at the side of the knee, but slightly below, all around the fibula head. And, as mentioned in the original post, it significantly increases after the workout. I'd say by 30-45 minutes after, of not sooner, it moves from slight discomfort to can't-hardly-walk. It still comes and goes from one minute to the next (sometimes even one step to the next), and I have noticed that sitting in a chair or recliner with a "normal" leg bend with feet flat on the floor really aggravates it when standing up.

The fact that this injury has gone from a week-long healing process to a day or two shows that either on it's own or through my own home-brewed therapy, that improvement has been made, but with the initial pain still at the same extremes as before, I guess it's not what I'd expect to have with IT Band problems.
« Last Edit: March 09, 2015, 03:22:28 AM by AWolf »