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It Band Syndrome Treatment
Let me preface this by saying right away that I am by no means a student of biomechanics, doctor or scientist in any way. I’m not even an exceptional lifter. This write up is based on self experimentation and personal observations over the last year of learning powerlifting and dealing with patellofemoral pain syndrome.
A rundown on patellofemoral pain syndrome: patellofemoral pain syndrome (PFPS) is chronic (and sometimes acute) knee pain with no clear or single pathology, although a newer study points out that Q Angle may be worth investigating. The symptoms of PFPS follow consistent patterns (eg, theater sign). All in all, this means your knee(s) hurt, sometimes a lot, and no one can really pinpoint the mechanics of why. My chronic PFPS pain manifests as a dull ache of the knee cap and surrounding area (the chronic pain), and the top of the patella during weight bearing flexion with heavy quad recruitment (the acute pain).
I’ve been through PT for this twice, with rounds lasting 6 and 8 weeks respectively. Neither one affected the issue positively, with the second round managing to make it worse during the last week of treatment. After that, I resigned myself to the fact that it will most likely always hurt in some way, so I may as well learn to work around it.
What Doesn’t Work:
These are not absolutes, some things may work for others, your mileage may vary, etc. etc.
Leg presses: these made it worse, even with low weight and high reps (as per most PT recommendations). Varying foot placement made no difference.
Bulgarian split squats: Absolutely not. The most I’ve done is a 3x3 with 70lbs and that left me with acute pain for days.
Lunges and lunge variations: Just as bad as split squats. Note: For some reason, Turkish Get Ups (which have a lunge component) do not aggravate it.
3a. Really, any kind of single leg work is a steaming bowl of NO.
Bruising From It Band Syndrome
4. Clinical level doses of ibuprofen: Very little, if any, effect. I seriously can’t recommend this to anyone, as ibuprofen toxicity can be a very bad thing. This makes sense seeing as how studies report almost no inflammation component to PFPS.
5. Fish oil: Although this is great for a ton of stuff, I did not notice any perceptible difference in chronic occurrence or levels of pain.
6. Ultrasound, Infrared, TENS: Very short term positive effect on the chronic pain, but nothing worth making the drive to PT.
7. Yoga and derivatives: Anything like Warrior Pose or Horse Stances are a no go. While they don’t particularly hurt while doing them, the increased intensity in chronic pain isn’t worth it. Single leg stances will ache while doing it, but has no effect either way on the chronic pain.
What is working:
Squats: Barbell squats, in of themselves, are not directly helping. Really paying attention to my form, I mean REALLY paying attention to it, does however. Squatting flat footed (in Converse or bare foot) makes the act of moving the weight easier, but it also aggravates the holy hell out of my knee. Wearing Oly shoes and pulling up on my toes makes moving the weight seem more difficult, but also reduces the instances of aggravating my knee. It seems to be related to quad recruitment. When squatting flat footed, it becomes easier to bully up the weight with my quads. When wearing Oly shoes and pulling up on my toes, I am able to move more with my hamstrings and rely less on my quads. Pulling up on my toes is a huge cue for me, and really helps to keep the instances of acute pain and the intensity of chronic pain down. When I am spot on with my form and get really good hamstring recruitment, it’s a beautiful thing and there is no knee pain whatsoever. On a variation of this, box squats under 185lbs seem to be fine, but once I approach ~200lbs it becomes painful, regardless of footwear. The same goes for front squats, however the range for those is approximately 135-185.
RICE: Rest, ice, compression, elevation. Rest only works if I can have my knee fully extended. Any period of time with the knee flexed will start to hurt (theater sign). Keeping my leg elevated and straight has done wonders for the chronic nature of PFPS and may be one of the most potent techniques for preventing pain. As a desk jockey, the best that I’ve ever done is put my trash bin upside under the desk to I can rest my leg on it all day. Ice works on the chronic ache to a degree, but does not seem to help with the acute pain during flexion when it is present. Compression works very well with certain stipulations, more on this in a moment.
Heat - Wrapping my knee in a heating pad and leaving it elevated and extended does help, but only for the chronic pain and not quite as well as icing.
Massage, foam rolling, etc: Massage and foam rolling work really well for short term treatment of flare ups of chronic pain. If my knee is aching from a long day of sitting or driving, this helps a lot. No effect on acute pain during flexion. The best technique I’ve found is to forget the foam roller and use a rolling pin. Using a rolling pin allows a much finer control on the pressure, which can mean the difference between hurt-so-good-relief and just outright painful, especially when working on the area around the IT band/vastus lateralis/femoral nerve. Those areas in particular work very well to relieve the chronic pain. Another area worth mentioning is about an inch above the knee cap. This corresponds to a small muscle called the articularis genus which may have some role to play in PFPS, but this is only my conjecture.
Stretching - Stretching, in of itself, is only mild and very temporary relief from the chronic pain. The better stretches I’ve found are the basic standing quad stretch and pigeon pose. Probably the most useful thing I’ve found with stretching is to “abuse” the temporary muscle laxity (or whatever mechanism it is that interferes with force production) after static stretching by doing standing quad stretches between squat sets. This helps to reduce quad recruitment and encourage more hamstring activation.
Knee sleeves - By far and away the best rehab I’ve found is also the easiest. Just putting on a knee sleeve and going for a walk. Anywhere from 30-60 minutes usually relieves a massive amount of acute pain as well as the chronic pain. Wearing a knee sleeve while resting my leg in a straightened position works as well, but tends to annoy me after a while. Wearing knee sleeves for squatting aggravates it, regardless of how good my form is.
Odds and Ends:
Posture, sitting, etc: Standing posture seems to be able to exacerbate it. I’ve noticed I tend to stand with my knees locked, hips pushed back and chest forward. If I make it a point to stand with my back straight and knees slightly bent, the chronic pain will lessen a bit. Sitting with the knee extended helps to control the chronic pain. Sitting cross legged is a big nope.
Some further reading:
It Band Syndrome Hip Pain
http://rehabeducation.com/main/wp-content/uploads/downloads/2012/06/Jun2012-PatellofemoralPainRetreat.pdf (.pdf warning)