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  1. #1
    Join Date
    Jan 2005
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    661

    Patello-femoral tracking syndrome?

    Did a lot of distance running this summer, but started to tone it down as September approached. About a month ago I did a 10k and started to feel a 'pinching' (not really intense pain but definite discomfort) on the inside/upper area of my kneecap - went away in a couple days.

    Did another 10k a week later and got the same thing, it's been 2 weeks since then and it hasn't gone away - the knee is now clicking/grinding a lot and I can feel a tendon on the outside of the knee 'popping' over the bone as I go past a certain point of extension (about 65-70deg).

    Sitting for a long time at a desk makes it uncomfortable, walking long distances makes it uncomfortable.

    Went to physio and she told me my hamstrings were very tight, as well as other muscles around my knee, so she's got me doing various stretches to loosen it up. But beyond that she seems less than capable of making a definite diagnosis, and with the season fast approaching I want to get this thing resolved.

    Talked to a chiropractor friend briefly and he suggested it's possibly PFTS - basically told him what I've stated here. I was thinking about making an appointment, but it's not covered under my insurance and I don't want to impose on the friendship by expecting any sort of freebie from him.

    As of right now I'm stretching, and have just started with the leg weights in the gym - nothing too crazy, extensions, squats, ham curls, etc.

    Basically, how long should I give this before I take the next step? Can I expect stretching + strength training to deal with it, or is it more likely a case of 'get to a doctor'?

    Haven't ever really had knee problems before so this is sort of uncharted territory for me.

  2. #2
    Join Date
    Nov 2003
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    Well to me it sounds like you have multiple things going on.

    The first is likely PFTS. Tight hamstings are liekly the cause if you are really that tight.
    So for this stretch as much as possible, 3-4x/day even if it is just for a few minutes at a time. But atleast one of those sessions should be 5-10 minutes long. Ask you physio to let you heat your hammy's before you stretch. Warm muscles stretch easier.

    The second sounds more like a tight IT Band. The description of the tendon popping back and forth over the bone is the key here. This should also be dealt with by stretching, and ice of heat depending on how long the pain has been there. If it has been more than a few days heat and stretch. Ice after activity when sore, this goes for both areas.

    I would say give the stretching/strength routine a few weeks. It will take at least 3-4 weeks before the stretching will begin to really have an effect on your hamstring flexibility. If it is getting better stick with it. If it is not getting better or getting worse then go see your orthopedic doc.

    Good luck
    fighting gravity on a daily basis

    WhiteRoom Skis
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  3. #3
    Join Date
    Jan 2005
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    661
    Thanks Vinman - I wasn't doing as much stretching as you're suggesting, so I'll definitely up the duration and frequency and see how things go.

  4. #4
    Join Date
    Sep 2005
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    81

    Patellofemoral syndrome

    From your history, it sounds like either a patellofemoral joint syndrome or possibly a meniscus problem. The pain at rest is often part of patellofemoral joint syndrome and uncommon with meniscus injuries.

    Bottom line: see an orthopedist. If that is impossible, go to the following very reputable website and read the physical therapy sections to devise your own program.

    http://www.emedicine.com/sports/topic96.htm

    http://www.emedicine.com/pmr/topic101.htm

    Remember, patellofemoral problems rarely resolve if the causitive activity is continued. This differs from meniscus injuries were you can continue activity as long as you can stand the pain.

    Patellofemoral problems require a thoughtful PT strategy to avoid recurrence, so seek medical advice or do your homework. Your can PM me with any questions, or for help with terminology (not to assume you need help, just don't know your background).

    Good luck.

  5. #5
    Join Date
    Oct 2002
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    Shadynasty's Jazz Club
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    I was diagnosed w/ PFTS back in HS. The doc prescribed a series of exercises that would basically serve to more evenly strengthen my quad muscles. I did the exercises for a while and the pain subsided. However, running give me many other problems, so quitting running was the final move to end the pain. In place of running, I started biking, which is not only lower impact, but (I'm told) also is good for preventing PFTS. I picked up running again a few years ago and haven't had a problem. I'm not sure if it's the biking, or reduction in the amount I run that has helped...probably a combination of the 2.

    Do a search, you should be able to find the stretches and exercises that are designed to reduce problems related to PFTS.

    Vinman (et al.) feel free to chime in if there's anything I've missed or gotten incorrect.
    Remind me. We'll send him a red cap and a Speedo.

  6. #6
    Join Date
    Apr 2006
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    114
    I was just diagnosed with pfts. The doctor gave me a list of exercises to do and said that she could write me a prescription for a brace to wear when I ski. Have any of you worn a brace and had good results? Before I spend my money on one, I'd like to find out if they really help.

  7. #7
    Join Date
    Aug 2008
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    PNW
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    Quote Originally Posted by bagtagley View Post
    I was diagnosed w/ PFTS back in HS. The doc prescribed a series of exercises that would basically serve to more evenly strengthen my quad muscles. I did the exercises for a while and the pain subsided. However, running give me many other problems, so quitting running was the final move to end the pain. In place of running, I started biking, which is not only lower impact, but (I'm told) also is good for preventing PFTS. I picked up running again a few years ago and haven't had a problem. I'm not sure if it's the biking, or reduction in the amount I run that has helped...probably a combination of the 2.

    Do a search, you should be able to find the stretches and exercises that are designed to reduce problems related to PFTS.

    Vinman (et al.) feel free to chime in if there's anything I've missed or gotten incorrect.
    ^^^This is pretty much me as well. Too much skiing and football in HS had my patella tracking slightly anterior of where it should. Cycling was just about the best thing to strengthen my inner thigh and my symptoms subsided over the course of about a year. Never gave up running, never any popping/cracking just discomfort and limited flexion so it sounds like you have more going on than just PFTS.

    Vinman & pd's advice pretty much covers it.

    best o luck

  8. #8
    Join Date
    Apr 2010
    Posts
    8

    PFTS Taping

    Guys and Gals with PFTS,

    Post ACL surgery, I was experiencing PFTS pain during my PT and actually afterwards for a day or so. The PT used kinesio tape (KT) on my leg and the pain was dramatically improved instantly. Used the tape anytime it came back (three times total), and now I am PFTS pain-free (12 weeks post surgery). Get your PT to show you how to properly place it, it is a bit complicated.

    The KT taping sounds like voodoo, but if it is going to work for you, it will work instantly. It is certainly worth a try, and short of losing a few leg hairs, there is no downside. Plus, my understanding is that it is not just a treat the symptom thing, the tape supposedly provides some neuro-muscular learning such that your VMO learns to keep the patella tracking correctly. Worked for me, and I am now a believer.

    Mark Powell

  9. #9
    Join Date
    Nov 2005
    Location
    Whistler
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    203
    To add to this topic:
    Long story short for me, I had knee pain at the start of the ski season. I only skied 8 times in November before giving in to the pain and seeing a doctor. Was lucky enough to see the knee specialist in my town. Had x-rays taken. Doc diagnosed me with Patellar Tendinopathy (Jumpers Knee). I never had point tenderness on my patellar tendon which led me to believe that my diagnosis was wrong. Saw multiple physios with no luck until finally one physio pointed out that it was possibly a mal-tracking patella. Did some research and started doing exercises that isolated the VMO and bam! No more pain! Thought for sure my ski season was over. I attributed my mal-tracking patella to all the running I do in the summer.
    What I did to get rid of my pain:
    -Stretch multiple times a day
    -Saw physio to loosen up IT and other ligaments around the knee with deep tissue massage (hurt like hell but feels so good afterwards)
    -Hip strengthening and flexibility exercises (the hips stabilize the knee and absorb more shock than the knee...I did not know this before!) ->think Jane Fonda type exercises
    -Hamstring and calf exercises (straight leg dead lifts, calf raises etc)
    -VMO specific exercises (swiss ball wall squats while squeezing a ball between your legs and terminal knee extensions, there are many more. I feel squeezing a ball between your legs really helps for some reason)

    Conclusion and lessons learned:
    I missed the first 2 months of this ski season based on a misdiagnosis from a well regarded orthopedic knee specialist in my town. He made his diagnosis mainly from my x-rays. See more than one doc!
    Getting that VMO to wake up! I didnt start to get better until I starting thinking about my injury as an imbalance in my quad muscle. The outside is stronger than the inside and I must fix this!

    I hope this bit of info helps anyone who comes across this, because this 'injury' seriously sneaks up on you and can be extremely frustrating and scary.

    One last thing to add. My pain was characterized as dull and achy, mostly on the medial side but occasionally on both sides. I guess best described as discomfort around the perimeter of my patella. My knee would sometimes feel stiff or tight on both sides of the patella when I stretched the quad.

  10. #10
    Join Date
    Jan 2008
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    SLC
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    103
    I have frequent knee pain from skiing, running, triathlons the military etc... and have noticed the following helps. Of course, a couple of days chasing younger friends around the hill, hucking off small cliffs usually causes it to return. But try these out.

    For those with tight Hamstrings/glutes/IT bands etc.. Get a foam roller and message them often. Lay on the thing- and rock back and forth. Its a cheap deep tissue massage.

    Also, I have found that being overly quad dominant (which most of us are) can also cause pain in and around the knee caps. For example, in squatting, if you balance off the ball of the foot, the knee moves forward of the toes and too much of the load is carried by the quads, which in turn puts a large load on the knee cap. This applies to many daily activities as well: sitting down/standing up, picking things up from the floor, etc... When squatting, concentrate on pressing off the heels, keeping the back straight and thrusting the hips forward and back. You should feel the glutes and hamstrings engage. They are bigger, stronger and won't load the knee joint as much. Box squats and kettlebell swings really reinforce this motion and teach you to engage the hamstrings in other activities. I used to never squat with my knees bent further than 90 degrees. Following the above I can almost touch my ass to the floor without knee pain.

    Also, don't let the knees collapse in while squatting, sitting, or going up steps. This adds pressure to the knee and causes the patella to track wrong.

    Finally, reducing the ramp and forward lean of ski boots and bindings can also help reduce pressure on the patella. All of these tip you forward which tends to load up the quads more. Power lifters wear flat soled shoes for this purpose.

  11. #11
    Join Date
    Aug 2015
    Posts
    4

    Unhappy PATELLOFEMURAL Pain syndrome

    I was diagnosed with PATELLOFEMURAL Pain syndrome in my right knee in January 2018 and am about 5 weeks in now. I think it is a pretty bad case as my knee is pretty unstable compared to how it felt before the injury and I am not able to walk down stairs yet. Got MRI and no meniscus damage showing as well as X-ray which did not show any cartilage damage. I did have ACL reconstructive surgery on that knee 20 years ago with the graft coming from my tendon on the same leg.

    What are other forum members finding works to heal this now? A number of the posts I have seen are 10 years old. It seems what has worked for other forum members are:

    - Back off on activities that caused the syndrome. This is hard for me to identify though. The week before symptoms started I went skiing on Saturday in heavy Sierra cement snow, then short mountain biking ride Sunday then gym workout Thursday. No symptoms until Friday night so that tells me something in the gym workout caused it. I suspect squats with bad form or running on treadmill or jump rope or all of the above. I windsurf too and am hoping I can start that by April 2018.
    - Get the muscle imbalance corrected - strengthen quads especially VMO? But some threads say VMO is less issue than bad body mechanics
    - Supplements: I am taking fish oil supplement and considering trying another supplement "Instaflex Advanced" that I can buy at GNC store. Also tried TReatwell CBD tincture to help reduce inflation.
    - Frequent Stretching (multiple times a day) and foam roller to loosen IT band
    - Get my mountain bike pedals/seat dialed in to make

    Thanks for any recommendations and sharing of your experience!

  12. #12
    Join Date
    May 2002
    Posts
    28,673
    Go get some bodywork.

  13. #13
    Join Date
    Aug 2015
    Posts
    4

    PFPS

    Thanks for the quick response. You mean like a massage?

  14. #14
    Join Date
    Sep 2016
    Location
    NH
    Posts
    697
    Start rehab with a sports specific PT.
    Hiking at a slow pace worked wonders for me.
    Hard foam roller on it band.
    I backed way off intense running, and replaced with low intensity hiking. Zone 1 and 2 if that means anything. Wicked boring but effective.
    I am faster now on the uphill which I credit solely to the hiking.


    Sent from my iPhone using TGR Forums

  15. #15
    Join Date
    Jun 2009
    Posts
    634
    ditto the above. I'm no expert, but was diagnosed with Patellofemoral syndrome 20+ years ago. Fast forward 10 years and learned that really I also had IT band syndrome. Do not underestimate the role of a weak gluteus medius and stretching of the hip flexor also. It's all related. And lack of taking all of that into account 20 years ago has left me constantly trying to get ahead of it. Running is the worst for me. (I was never a runner, but the little I do causes immediate flare up (if I'm not doing the proper exercises and keeping up with them) and was the initial cause of the patella issues originally). Hiking long distances also can cause a flare up, so strengthening the glute (specifically the medius, not just the maximus) is key for me. And lots of hip flexor stretching as I get older. It really sucks.
    Quote Originally Posted by My Pet Powder Goat View Post
    Come for the poo-slinging, Save a fortune on a plumber.

  16. #16
    Join Date
    Jan 2007
    Posts
    42
    I’m 56 now and I was diagnosed with Weak VMO - Patella Femoral syndrome in 2012. I worked with many physical therapists and got advice very much like what you listed. Didn’t help much.

    In 2013, I couldn't ski or Mtn bike. The knee pain was really bad.

    This year, right now, I am skiing Snowbird with a vengeance! Nearly 700,000 vertical feet over 28 days! Moguls, trees and the steep stuff. My knee is not 100% and requires a lot of TLC, but I am very active.

    I will list my recommendations for strength training, diet and stretching. A lot of stuff, so I will put together a series of posts. Good luck!

    History...

    My pain is located mostly in the lateral patella area (left leg) and trying to exercise my way to recovery only made the pain worse… loading the quad to strengthen it puts a lot of stress on the patella and Femur cartilage. I probably damaged my cartilage trying to get stronger.

    When the pain is acute you have to get mostly pain free by resting, icing and supplements. Avoiding things that cause the pain. If you don't, you may develop Chondromalacia. I think I had this back in 2013.

    Hard to believe, but while acute, also avoid stretches that bend the knee (quad stretches). Bad for soft cartilage.

    Its a long, unbelievable story, but stop all Vitamin D usage while acute. This includes sun exposure.

    So, start with rest, icing, supplements and minimal exercises for the quad while not loading the patella. Believe it or not, I benefited by reading about Lindsay Vonn's recovery. She did a bunch of Quad sets, hundreds every day. Strengthen the quad without bending the knee. Read about her recovery and start there.

    Next... Supplements

  17. #17
    Join Date
    Jan 2007
    Posts
    42
    Supplements.

    Finding the supplements that lubricate the knee is a personal journey that you will have to endure. I tried the Glucosamine and MSN and other popular joint supplements. None worked for me. I also tried the hyaluronic acid injections (expensive). No help either.

    What worked for me is Liquid Collagen. I have no idea why. But for me, this stuff is knee lube! And not just any brand. The only stuff that works for me is Lifetime Collagen. I take 1 1/2 tablespoons daily.
    https://www.allstarhealth.com/f/life..._vitamin_c.htm

    Fish oil is always recommended. I take 4 of these every day. But I have never observed any knee associated benefit.
    https://www.costco.com/Nature-Made-O...100351311.html

    As mentioned before, avoid Vitamin D for the next 12 months.
    I am a big fan of Vitamin D. But, I strongly believe high blood levels of Vitamin D was a significant part of my knee problem back in 2013. It is a long story without supporting research by the medical community.

    next... stretching

  18. #18
    Join Date
    Jan 2007
    Posts
    42
    Stretching

    Problems like this that are not caused by trauma or injury are most likely caused by imbalances.

    For me, I have often experienced pain caused by imbalances between strong and weak muscles. I also experience imbalances between tight (short) and normal muscles.

    While your knee pain is acute, you have to avoid any stretching that involves bending the bad knee. When the knee is bent, the patella will be significantly out of position and the loaded patella will be injuring cartilage.

    Start with the basic stretches that you can do with a straight leg. Get a stiff (black) foam roller and use it. Use it on the quad, the IT band and the hamstring. I actually use a 6 inch PVC plumbing pipe from Home Depot.
    Get one of those green straps with the loops in it. Use it to really stretch your hamstring.

    The stretches that put me over the top are the following. Before these stretches, I was researching Youtube videos and trying things.

    I started doing this set of stretches in the summer of 2016 and was able to really start mountain biking again.

    Here is my stretch routine I perform several times a day;

    lay on your back and pull knee into your chest. Hold for 15 seconds.
    pull your foot into your butt with knee straight up. Hold for 30 seconds.
    ***** This was the winner for me***** Lateral quad stretch. On your back, pull your foot into your butt and then to the outside. Lie your knee down such that the knee is close to the other knee and the foot is still outside your butt. Now, take your other leg and put it on top of your bent knee… and force that bent knee down. Your tight lateral quad will make it difficult for the bent knee to touch the ground. Hold for 45 seconds.
    Lateral hamstring stretch - laying on your back, lift your partially bent leg upwards and grab outer foot with opposite side hand. Pull your foot across your body and feel the stretch in the outer hamstring area.
    Piriformis Stretch - open window - 45 second hold (arm though hole formed by bent knee)
    Piriformis Stretch - closed window - 15 second hold (arms wrapped around the legs)

    Also, I did deep tissue massage for a year. Expensive and never helped.

    next... strength training

  19. #19
    Join Date
    Jan 2007
    Posts
    42
    strength training.
    While you are acute, you are limited.
    Strengthen the quad using quad sets. When you are standing around, stand on your injured leg and squeeze the quad. Hundreds of times a day.

    Strengthening the glute is important and possible while acute.
    I do the 3 way clam shells with a pair of 5# ankle weights on one leg (10# total). I do 30 reps for each position and I do the 3x30 set 3 times (270 total reps).

    Squats- leg press - leg extensions are certainly helpful, but they can be too much. You should consider the curtsy version of these exercises at first to load the quad without overly stressing the patella.

    I have had great success with a workout DVD called Cathe’s gym style legs. It’s a 20 minute lunge oriented workout with modest weight. It is a high rep workout and is nearly isometric at times.
    I started with body weight only and now do the workout with a 15# weighted vest and a pair 20# dumbbells.

    As I get stronger, I transition my leg workout to the P90X leg and back DVD. This workout involves a bunch of single leg exercises. Highly recommended for this condition and for general ski and mtn biking activities.

    A for good measure, I'm always up for a 3 minute wall squat. I do this Mostly when it is not ski season. I ski 3-4 days a week and have to give my quads and my injured knee some rest.

    Also, while you knee is acute, avoid the hot tub. The heat is the opposite of icing and does not allow my knee to reduce any existing swelling. I cannot visually see that my knee is swollen, but the clicking activity inside my knee is much greater.

    TMI I'm sure. Hope it helps!

  20. #20
    Join Date
    Nov 2007
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    Eburg
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    PF tracking problems suck. If it gets bad, the patella can subluxate. A sublux knocked me out of prime spring/summer ski touring season last year.

    My PF problem (left knee) is the result of cysts and bone spur growth related to patello-femoral osteoarthritis. After trying injections and therapy over the years with virtually no success, I'm having total knee replacement surgery in the fall.

  21. #21
    Join Date
    Feb 2008
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    koots
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    I got this during acl post op for a few months. It's been gone for six weeks. It can be very tenacious, i.ve talked to friends who.ve had it for years which made me take it more seriously. All those twinges are causing damage eventually, it.s self perpetuating. If you can get diagnosed by a pt to find out what the imbalance or cause is that would help. Mine was being pulled laterally by outer quad which seems common (weak vmo).

    My pt said:
    -don.t do anything that makes it hurt. For me that was anything that put my knee at 45* including squats lunges etc. Even walking up stairs hurt.
    -strengthen vmo and med glute, the main knee stabilizers. Of course squats etc are good for that so had to back off to things like isolated vmo contractions, super slow/eccentric straight leg raises, clam shells, mini one leg squats (on affected leg)...
    -keep your knee warm, i wear a cut off long john leg on mine all the time
    -release work on it band and outer quads as they were contributing to pull it out of alignment
    -kept my patella taped for 3-4 weeks. I think this was key, it always felt better taped up, more stable and less pain. Always tape for work outs. There is a specific way to do it.
    -warm up leg before doing any workout. I spin on the bike for ten min. Bike is also good for knee.
    -try not to be mad at knee. That stress and tension doesn.t help. Sometimes almost every step would hurt. Wtf do you do with that? Lay on the couch a while with ice.

    All that and it went away. Once it calms down you can move into more muscle building but slowly build up and back off if it returns.

    Stretching.... I.ve totally backed off on that and am doing better for it. Tight muscles are weak and need to be strengthened. Work on building up the weak spots. It.s easy to overstretch and fuck it up.

    Good luck! It sucks but you can totally deal with it.

  22. #22
    Join Date
    Aug 2015
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    4
    Thanks for sharing your experiences and all the great tips folks! I feel better and hopeful I will be able to get back to skiing and my other activities after reading your posts. But definitely going to make sure I am ready first as this seems like something that is a persistent issue.

  23. #23
    Join Date
    Sep 2010
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    Quote Originally Posted by mel221 View Post
    Get a stiff (black) foam roller and use it. Use it on the quad, the IT band and the hamstring. I actually use a 6 inch PVC plumbing pipe from Home Depot.
    Lacrosse ball for trigger-point release is better than any foam roller for loosening the lateral quad, IMO. After working hard at it*, I can get my lateral quad, anywhere from the knee to the hip, to spasm and release -- which has almost totally fixed my issues with the ITB and PFS.

    *by hard work, I mean I had to learn how to get the lax ball in the correct place (aka move it slowly from somewhere that doesn't hurt to the place that causes the most pain) while simultaneously relaxing my quad. You also have to regulate the amount of body weight on the ball so you never tense up the muscle. The mental aspect of relaxation is key, and it require an immense amount of concentration. I can't have a conversation, look at my phone, or listen to music -- I need to channel all of my concentration on relaxing the muscle. I know little about meditation, but I've talked to people who meditate and it seems the experience is similar. I personally like to visualize the muscle on my leg absorbing the lax ball -- as if the muscle were soft foam instead of a knot.

    A similar experience can be achieved with dry needling (or to a lesser degree, acupunture), but those are expensive. I've never felt anything similar with massage.

    Totally agree with sparkle that any short muscles should be addressed with strengthening, sometimes instead of stretching/tissue work and sometimes in conjunction with them.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

    photos

  24. #24
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    Aug 2015
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    Does anyone who has had patello femoral pain syndrome have suggestions for how soon to get back into my favorite activities after the worst symptoms have gone away? I came down with PFPS in January 2018 and it is now April 7. My physical therapist said I am ready to try mountain biking and windsurfing. Also I have a brace that keeps the kneecap tracking properly but I don't really want to use it for windsurfing as it will make it very tiring to waterstart.

  25. #25
    Join Date
    Dec 2014
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    I originally posted this to Tech Talk - treating my injury as anecdotal to ski selection (as I mention in the first quoted post below).

    https://www.tetongravity.com/forums/...Leg-(Quad)-Man

    Well, a lot of great stuff was posted (validating the approach my PT is taking to strengthen my gluteus medius), and it made sense to post it to this thread. Note - that thread is still seeing some action.

    Quote Originally Posted by galibier_numero_un View Post
    This could go in Gimp Central (Padded Room?), but I think it's more valuable here, with respect to ski stance (centered vs. shin driving) as it relates to ski type preferences.

    The last couple of seasons, I've been struggling with patellofemoral pain syndrome (PFPS), or in layman's terms - irritation under the kneecap. I've tried numerous therapies with only minor improvement. I was referred to a local PT who diagnosed my muscle imbalances as primarily stemming from weak glutes, although there are numerous other imbalances and exercises which are too detailed for the purpose of this thread.

    One takeaway (apart from doing all of the prescribed exercises) is that my resistance to adopting a more centered stance stemmed from both habit (old dog/new trick) as well as these muscle imbalances. My thinking went along the lines: "this has worked for me in the past, why bother to reeducate my muscles to adopt a new stance?" Well, I now know that some of my problems are due to it no longer working for me.

    I got a hint of this being the solution (ski more centered) when I adopted boots with a flatter stance two years ago (Lange XT 130 Freetours). I noticed less quad tiredness, but didn't connect the dots with respect to skiing more centered and knee pain.

    My PT is working to get me more glute focused (we're not talking Padded Room material here, although a nice butt is a thing of beauty).

    All of this is to say that I'm really interested in how I respond to my Qs this Winter after mixed results in the 10-15 days I spent on them last Winter

    ... Thom
    Quote Originally Posted by rod9301 View Post
    I think having strong glutes is really good for a number of sports, including skiing, mountain biking and climbing.

    The best exercise i found for glutes is the hip thrust where you have your shoulders on a bench, feet straight in front of you on the floor, weight bar one the pelvis and lift your butt off the floor and back down. A few hundred pounds of weight once you get the hang of it.
    Quote Originally Posted by hafjell View Post
    I have the same diagnosis which was greatly improved by twice-a-week (at most) strength exercises in the gym (the ones from House and Johnston's book) and a lot of low intensity aerobic trail running and hiking
    Quote Originally Posted by galibier_numero_un View Post
    This is the first bit of encouragement I've had in three years, and it might even have the benefit of my fully bonding with my Qs. I've been googling for that book but am coming up empty. Do you have the title?
    Quote Originally Posted by Slow 'n Steady View Post
    “Training for the New Alpinism: A Manual for the Climber as Athlete”
    Quote Originally Posted by riff View Post
    I’ve got these problems too, and I’m working my way back from a back injury last year. I spent a decade patrolling, and stacked up lots of knee issues along the way. I’m using a combo of trail running and yoga to get some balance back in those muscle groups. So far I feel better than I have in a long time, and lost 20 pounds this summer too.
    I’ve been edged closer to an upright stance as well, and digging it. I’m not all the way there yet, but Planning to give it more attention this season.
    Quote Originally Posted by galibier_numero_un View Post
    Maybe that light at the end of the tunnel isn't an oncoming train after all ;-)
    Quote Originally Posted by I've seen black diamonds! View Post
    I've got glute imbalance issues that, along with some arthritis I earned over a few decades of wreatling, have cause a lot of back pain. After years of tinkering and working with PT's I'm in a pretty good place. I'm happy to share what has worked. Have a basement gym set up.
    Quote Originally Posted by anything View Post
    go glutes definitely.
    crushed a couple of vertebrae a few years ago, but i still chase the endless winter. by the end of the season with superman quads of steel i still couldn't make it through the day without some back and knee pain. even short uphill bootpacks were something that took determination. with so much exercise and muscle tone i was pretty disappointed with my recovery.
    eventually went to a fancy expensive sports physio who had me diagnosed and pointed in the right direction within seconds. glutes. solution started with a bunch of squat related exercises.
    im not saying im cured, but i am a whole lot happier with my performance nowadays.
    Quote Originally Posted by theetruscan View Post
    It's worth thinking about glute engagement as well as glute strength. Strengthening muscles and fixing imbalances is great, of course. It's also worth some warmups to make sure you are consistently using the muscle.

    Things like glute band walks and glute-ham bridges won't do too much to strengthen the muscles. They will get them firing/engaging and help correct only using quads. Worth making sure that's part of your warmup if you have issues.

    I broke my pelvis a while back, have some issues with my hip on that side. The muscles are all plenty strong (I weightlift and some other things), and I still get pain and imbalance issues if I stop adding in the proper warmups to remind my body how to move.
    Last edited by galibier_numero_un; 10-31-2018 at 12:01 PM.
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