Cure for Patellofemoral pain syndrome (PFPS) and ITB Friction Syndrome (ITBFS)
You see a motivational picture. I see a girl who potentially has PFPS or ITBFS. She has a left hip control problem!
This post is because I am sick of all the wasted time I see in gyms where people roll out for hours each week and not get better. This post is for all those knee myths out there that hurt my brain.
For most people, there is a simple solution.
But first a few facts.
1. The ITB is a passive structure and responds to the forces placed on it. If it is rubbing somewhere it shouldn't, go find out why. There is something over active or something under active or both. Usually TFL is over active. But why? More on that later.
2. The patella is a bone that is at the mercy of the forces around it. There are 2 theories about how to control the patella - the train and the track theories.
a.The train theory is where the patella is the train and you try to move the train to a better position - usually via a "weak" VMO. I think this is garbage. Just try this - extend your legs without your VMO. Now try with your VMO. Feel the same? That's because your body recruits the muscles it needs to do the task. Rarely is the problem a "weak" VMO, which only works in the last 20-30deg of extension anyway!
b. The track theory is where the train sits on a track or groove in your femur. You control the position of the patella by controlling the femur. Much more logical theory which applies through the whole range of motion. That means that only the foot/ankle complex and hip are the main culprits and they usually are.
What does the ITBFS and PFPS have in common? They both are worse with poorly controlled hip rotation!
If you have ITBFS, I will bet my house you have a hip rotation control problem. When you allow your hip to internally rotate during knee flexion and extension, you allow the ITB to flick over the bony condyle more. Combine that with an anteriorly translated femoral head which will increase the protective spasm of your hip flexors and TFL and suddenly you have a passive structure rubbing away on a bone. Smash the TFL and ITB all you like, if you don't solve the hip rotation problem, you will keep getting the pain.
PFPS is similar. Internal rotation at the wrong time will not only pull your ITB anteriorly but your patella laterally. When your patella pulls laterally (to the outside), it grinds on the lateral surface of your femur more than the inside (medial) surface. This imbalance over time can become a problem. You cannot solve this problem with tape on your kneecap or doing VMO terminal extension exercises! Solve the problem and get the hip rotational control fixed.
"But the McConnell protocol says to tape and do VMO exercises." Yes. But it also says check the hip. Trust me, save time, save money, save your skin and just solve the problem.
Poor hip rotation control has also been linked to an increase in ACL injuries and back pain.
This works for the majority of my patients. Obviously, some people actually need better quads (not just VMO) and hamstrings and gluts. Some even need the tape to help them get through the painful stage of their problem. Ultimately, they still need to control the femur - the track.
Sadly, people are sometimes given the right exercises but poorly taught - don't worry - keep trying to learn the correct form!
Tomorrow, I will show you just one of many exercises you could do for hip control <click here to see it>. Please share and subscribe to the blog 🙂
What solutions have you tried for your knee pain? Leave a comment below with your story or if you have any questions!
Great post, Antony! I’ve been paying attention to the internal and external hip rotation of my clients recently, too, and have noticed that fixing the asymmetry and incomplete ranges of motion alleviate a lot of the LBP they experience. I will be looking for tomorrow’s article!
Thank you. It is only a simple exercise but done right, it is very effective. There are so many exercises you can do 🙂
Hi Anthony! Good thing i checked your site and its exactly the type of pain i’m experiencing. I hadn’t thought to check my hip rotation (PFPS pain is more severe on the eccentric phase of my squat especially as i approach full depth). After MRI’s etc, they concluded that I have a ‘mild marrow oedema within the Patella.’ This possibly explains the – “Internal rotation at the wrong time will not only pull your ITB anteriorly but your patella laterally. When your patella pulls laterally (to the outside), it grinds on the lateral surface of your femur more than the inside (medial) surface. This imbalance over time can become a problem.”
I’ve been told to rest up which I have done to an extent but frustrating as its been approx 6 weeks with little improvement. Would you recommend any extra exercises, corrective patterns to try fix me up (I like the Hip Control article too!)
Not sure where you are from etc. You should be able to find someone to help teach you how to control that hip.
Most exercises are fine for learning how to control the hip but knowing whether you are doing it right or not is the tough part!
Thanks Anthony. Its Callum here from Gold Coast Weightlifting Club. I’ll have Linzey keep a close eye on my hip movement patterns and hopefully with some small progressions i’ll be back squatting in no time!
Apolgies Anthony I was logged on on a different computer. Its Callum here from Gold Coast Weightlifting Club. I’ll have to get Linzey to keep a close eye on my movement patterns and hopefully be back in no time.
No problem. Let me know how you go 🙂