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  1. This was a fantastic video! You demonstrate so clearly how everything is connected. My question is, how long does it typically take for IT band pain to go away… forever? Ha! If only šŸ™‚ I seemed to have strained mine during a marathon on a very canted, curvy road. Never had issues with my knees before that marathon. I’ve seen an ART therapist with amazing success for other strains and pains but it hasn’t quite remedied this one. I’ve switched to a primarily paleo way of eating, I’ve cut back on training, get better sleep… the works, but I still have an issue after running over 6 miles, or during speed work. I have a few weeks before starting my next training cycle and want to go into it feeling recovered and strong. Any other suggestions? Oh, and because of you, I am giving no stretching a shot! Hard for me seeing as I have a 12 year classical ballet history! But so far I feel absolutely fine without stretching!

    • Thanks there Green Girl. Not sure if you saw the ITB post and video ( How long? Depends on what is causing it. As you can see (read) from the link in the ITB post I helped the runner in one day who had it for months. That’s the Sock Doc skill :).

      Glad to hear you’re not stretching. Ballet is one of those exceptions though, but not if you’re injured.

      • I did watch/read the IT and video/post (another great one!) but I still can’t figure out what’s causing my IT band symptoms. If only you could be cloned and sent to CA! šŸ™‚

  2. Dear Sock-doc,

    Do you mind dedicating one article or video on explaining muscle imbalances in the lower limbs, esp around the knee? Being as imperfect as we are as humans, i think all of us have varying degree of imbalances in our muscles. For some, the imbalances are minor and caused no problems. However, for others like myself where the imbalances are major, it results in injuries. Trigger point therapy does not seem to help much in this case.

    Is there any generic exercises we can do to ‘correct’ these imbalances? Or you need customised exercises for specific kind of imbalances? For me, my right knees bends slightly inward (valgus). I believe it’s likely due to my weak glutes muscles. I am just wondering if i keep working on my glutes, will i one day regain the normal shape of my knee?

    How are the exercises we can do to prevent muscle imbalances, and if these imbalances have developed, what sort of exercises can we do to correct them?

    Thanks so much for your time!

    • Thanks for the suggestion, but it would be too individualized and that’s something left for the office. As I mention in the Trigger Point post and video, trigger points are there for a reason and they surely don’t fix everyone. In my practice I might spend one hour on correct muscle imbalances using trigger points. On another patient that might be spent using nutritional therapies; and on another a combination of both as well as others.

      • Dear Sock Doc,

        I have had chronic outer knee pain for years now and have been misdiagnosed all this time until just recently. I am an avid surfer and martial artist (aikido) which are both physically demanding and weight bearing and the sharp pain has become so bad I can barely do either until now. Since recently seeing another orthopedic Dr. I finally know I have IT band syndrome. Apprehensively I did receive a cortisone shot and have taken 2 weeks off from all activities. The pain in my knee has subsided quite a bit, but my entire leg mainly buttocks and hamstring area, and also the muscles on top just below the knee that run down to your foot, are always hurting. A constant dull aching pain and I am at my wits ends trying to find out the cause. Unfortunately, I have been icing the knee and stretching the it band a lot thinking that would help. Where should I go from here?

        • Hi Clay – A diagnosis is good but it does nothing to fix the problem. Check out the SD ITB Video here. The reason your glutes ache is because they’re a huge part of your ITB. And of course I think stretching will only make your ITB worse and the ice will only help alleviate the pain temporarily.

  3. Sock-Doc
    My daughter is 17 and does competition cheerleading. For almost a year now she has had pain just below her knee on the outside of her leg. Two yrs ago she had issues with under developed scapular muscles (bilateral) went through physical therapy for about 2 months and all her shoulder pain was gone. She dislikes going to physical therapy, she mainly has pain in the right lower leg usually because of the multiple jumps she must do. She tells me the pain eases when she has a few days off but that is far and few in between. She practices 5 days a week for a total of approx 15hrs. She had only some relief with cortisone shot in her knee (about 2 weeks) then the pain was back. She has had an MRI to make sure she has no damage (it was clear). What suggestion would you have us try at home to help with this.

  4. Sock Doc, Thank you! Your trigger point videos rescued me from agony! When my doctor advised me to wear a really uncomfortable arch support for intense PF pain in my right foot, I got online and found your site. Working a trigger point in that calf sent an electric sensation from ankle to hip, and instantly removed the worst part of the pain. What a miracle! Thank you! I have a bit of a story and then a question about pronation for you.

    The residual pain healed steadily over the next couple of weeks and the foot now feels normal. But I’ve (re)developed patellar pain around and sometimes behind the left kneecap the past few days. It comes and goes. I had it a year or so ago, and working with a physical therapist made it go away, though that knee remains intolerant of side planks, and side lunges and single leg squats (the final exercises prescribed by the LPT) are uncomfortable on that side. Last night I found a trigger point in the outer calf just below the knee that sent a wild sensation like a 4th of July sparkler running the length of my calf and around to the bottom of the foot, just as you described the muscle path in the video. That relieved a large part of the pain. A foam roller on the front of my thighs is incredibly uncomfortable but also relieves part of the pain for awhile. But that leaves a nagging pain that alternates between the groin crease where the front of the thigh joins the trunk, and the inside edge of my kneecap. I’ve dug around in the groin as you illustrate in the video without finding anything that feels like a trigger point. The only thing that relieves it is a stretch that a chiropractor taught me, in which I lie on the edge of something elevated and let the leg dangle down and slightly turned out. This groin pain was the original pain before my knee started hurting the first time the runners knee developed, and preceded the return of the knee pain this time too, but this time I’ve only been walking, not running (when it restarted I had been working very slowly on the elliptical for 20 minutes for the first time since the PF).

    So to the question: It seems from what I’ve read that there are two polar views on the issue of pronation. One says that a certain amount of pronation is normal and serves as shock absorption. The other (which is my LPT’s position) says that pronation causes knee strain. Is there a degree of pronation that is not okay, or perhaps pronating at the wrong time, or is pronation totally a red herring? When I stand still and don’t think about it, my feet roll in, but my shoes without arch support show a balanced wear pattern, my shoes with built-in arches show a supinated wear pattern (Brooks Ravenna and Altra Instinct), and the only way I can walk without ending up in pain right now is barefoot or in five finger shoes. I want to be prepared if I go back to the LPT to find out what in my movement is causing this, because he is going to insist I need arch support, but the supported shoes I have are uncomfortable to me. Thank you!

  5. I’ve recently gotten knee pain just below the knee cap which I assume after watching your videos is the Patella Tendon. This is a new pain area for me as I’ve never had this one before. I’ve been adding in more hill work for an upcoming 25K trail race that has a serious elevation profile up and down!

    I’ve been checking for trigger points and sore spots but so far I’m not finding much. I bought one of those straps that goes around the lower leg to I assume hold the patella tendon in place. I managed about 3 miles just fine and then it started hurting again and shut the run down at 3.8 miles and walked the last quarter mile back to the Y.

    Can the strap help or will that just cause more problems? Anything else I should be doing?

    I sure wish you would put a donate button on your site to help at least off set the cost of the site itself. But perhaps that’s more trouble dealing with than it’s worth. Thanks so much for sharing your knowledge and wisdom!

    By the way I just started last night in my first zero drop shoes. I’ve been running in 4mm drop for the last year and these new Merrell Bare Access 2 shoes were awesome. It felt so effortless!

    • I don’t use those straps because they don’t correct the problem – but if they keep you out of pain I can see using that for a bit. But then again, if you need it to run w/o pain then that’s not healthy.

      If the pain is there (or worse) when you go up stairs or hills then think more glutes or calves. If it’s worse going down then think more quads or ITB.

      Hope that helps. Good to hear you’re zero-drop; that’s awesome.

      I have thought of the “donate” button before. I don’t know, maybe I will do it. One part of me says it’s cheesy and nobody will give a dime anyway and other sites have it. The other part says – hey I answer around 20-30 questions each week for free and no other site that I know of does that, and I’ve spent $15,000 of my own money to get this site up, managed, and supported since March 2011. šŸ™‚

      I think this is a good Tip of the Week!

      • Doesn’t hurt at all going up stairs coming down I notice it slightly more but still not really pain. I’m going to try running a bit tonight and I’ve got some hills I can run up and down and see it it makes a difference. Thanks again!

      • Ran a route last night that had a decent hill in it. Going up hill it hurt a bit, going down hill actually felt better than even running on the flats. I’ll be checking my glutes and calves. Thanks!

  6. Hi Steve, hope you as a Doc, Athlete and MCT can give me an advice how to behave with my toren inner meniscus. I’m also an MCT and as you know we need a perfect funktion of joint, muscles etc. A Year ago both knees start with crepitation behind the patella and a MRT showed a torne inner meniscus in my right knee. I tried to develop my deep squat, to keep crepitation minimal and I managed to keep it in check. My meniscus makes no problems at all. A new MRT showed the meniscus sligtly got worse but I still have no problems with it. The crepitation is still there but not worse. Since 3 weeks I have no pain on both knees but they are “talking to my” i.e. there is no pain but ther is somthing. My distal quad medials insertion aches when squeezed, that is the only hot spot, the rest is just difuse all over the knee.
    Do you have any advice for treatment, nutrition, massage, exercises, triggerpoints? Would be very important to go on ad a good MCT!
    Best Regards from Munich, Germany

  7. Hi Doc,

    I came across your web site a few weeks ago. I love it! Thank you so much for what you do.
    I had knee (left knee) surgery for a torn meniscus in 2006. I’ve had good days and bad days but I have never been w/ pain. Last year, I developed ITB on my right knee. I’m doing the trigger point therapy and it has helped a lot. I am also making vegetable shakes on a daily basis and I switch my protein shake.
    I’ve been doing pretty good since I found your web site. But, yesterday we had a very humid and foggy day. All of sudden had a lot of pain on both knees. I had pain on the bone and sharp pain on the inside where the meniscus tear was. The pain on the right knee was dull but both where more noticeable when I walked.

    I hear people say how this can happen when their is humidity in the air. It seems silly to me that weather could have such an effect. I don’t understand what went wrong. Doc could this be happening because of the weather?

    Thanks for your help Doc!

  8. Sock Doc,

    My knee history is quite lengthy – numerous knee surgeries on the same right knee, including most recently cartilage allograft transplant a few years ago. After my original injury (broke small pieces of cartilage off of my femur), the pain I had then is the same I have now. It’s a very sharp pain near the patellar tendon region – any kind of loading of the joint past 30 degrees – such as going up stairs (and down – although not as bad). Medically I have full thickness cartilage again with no other structural issues – yet the pain persists. Along the way my lower back has become painful on a daily basis – of which I contribute to a lack of being able to be as active as I once was. My goal is to be as pain free as possible – and to a much higher activity level such as jogging (instead of simply the bike/elliptical).

    I’ve been doing of lot of self-research in the past months and especially after your videos and articles it appears there could very well be another source of my pain – particularly tight/weak hips/glutes.. My glutes are nowhere near as strong as they once were – in fact they (for lack of a better way to describe) have flattened out. Only recently have I learned how hip/glute issues contribute to knee pain. I’m currently using the rumble roller for quads along with a lacrosse ball for glutes which does help. The results always seem short lived – I will stretch, foam roll, use the lacrosse ball and my back/knee feel better – but hours later tighten up again. Considering going to a chiropractor as well. What recommendations can you make as far as next steps to try? I realize my situation may be unique/complex but I feel like I’m on my own here. While my knee surgeon is amazing, I don’t think there is anything further he can do to help. Thank you!

  9. Hi Sock Doc,
    I have this chondral lesion on my trochlear groove of my left leg and it’s left me useless. I was going to play college volleyball but I can’t jump, let alone climb stairs on the leg anymore. I was told that the cartilage damage is permanent and I need to strengthen and fix my patellar tracking. By the way, my left foot is flat. I ditched my orthotics and have been trying your minimalist footwear approach to fix this. As for trigger points, medial cuneiform is one. No surprise as I had tenderness in my peroneus longus and Brevis. My articularis genu and glut max also were trigger points. I also had trigger points on the inside of my tibia and the arch of the foot. Any sort of advice to help the situation or my tracking (which doesn’t seem to be all that bad) would be greatly appreciated. I think you’re awesome and I greatly respect your work and hope to be a doctor like you some day.

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