knees

Question
Hi Nick!

Approx 5 weeks ago I was walking at work and suddenly it felt like something came out of my inside of my left knee and went back and i could not squat down due to my knee feeling like it was coming apart and cracking and had pain ever since.  Previous to this I was doing jumping interval workouts that lasted 15 min total as well as doing my regular leg workout routine.  I have been doing these jumping interval cardio workouts on and off since February sometimes missing a week or two and doing no more than 1 a week.  
About 4 days into my pain, mostly the left side i began to have pain travel up my IT band and into my hip as well as down my outer shin into my foot.  The right knee did not have the same knee thing but is sore just like my left side.
I stayed off my feet, iced, stretched, took hot baths and tried some fascia stretches but things seem to be moving really slow.
I have now been to two physio sessions but i feel as though no one is really understanding what to do for me or what the problem is. I have a leg raise exercise, a stretch for my quads and some exercise for my left IT band where I lay on my right side and lift my head at the same time as i lift my left from the knee down keeping my knee touching the other and hold for 5 seconds.  I do have an MRI appointment on the 15th for my left knee too.
I went for a bike ride three times and each time gets better as long as the tension on the bike is low however my knee cracks a lot during the 30 min session.

I hope i have given you enough detailed information and that its not too confusing.

Thanks,

Carrie

Answer
Carrie, Thanks for the question. If everything is as straight forward as it seems I think we'll be able to see quick, positive change in your pain quickly. You seem to be experiencing the classic patella femoral pain. This is good news. It can be treated easily, effectively, and with lasting results.

Perform the clamshell exercise as demonstrated in this video. https://www.youtube.com/watch?v=CiqvDV8pzRk. Perform them slowly (2 seconds up, 4 seconds down) and on each side. Perform 5 sets of 6-10. If you don't have an elastic like Mike does in the video then you can either buy one or have someone push on your knee to create resistance.

The benefit of the above exercise is that it maximizes glute activation (particularly the glute med) while minimizing TFL activation. The TFL turns into the IT band so if there are symptoms there then this is an especially effective exercise.

If these improve your knee pain then there is no reason to have an MRI. If it doesn't then an MRI may be beneficial.

I always recommend that if you're not happy with the effects of treatment with any health care provider that you should always seek a second opinion. Thank you for doing so and reaching out to me. Please let me know if you have any further questions. Your pain should be improved quickly with this exercise, but if it's not we'll just need to figure out what else is going on.

While the following 2 articles may not interest you they are the science behind my recommendations. It demonstrates how important the clamshell exercise is to your recovery if everything is as it seems. These 2 articles are found in the highly respected Journal of Orthopaedic and Sports Physical Therapy and both are published within the last 2 years.

The Effects of Isolated Hip Abductor and External Rotator Muscle Strengthening
on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain:
A Randomized Controlled Trial.

Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes