Chiropractic / Musculoskeletal / Joint pain Q & A...

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    Quote Originally Posted by ryansm View Post
    Thank you sir. Ya you pretty much said what my ortho did, the injections are expensive so I am hoping for some new, more permanent options become available. I think at this point I am going to pursue the Neurostimulator as opposed to any back surgeries. I currently visit my chiro on a weekly bases, and have good relief for a few days. My problem is I still lift heavy, and my ortho wants me to quit lifting period, but there is no way that is happening lol. I appreciate the feedback!
    IMO the implanted neurostimulater is not your best option unless you've exhausted all other options first. It's a last ditch resort when ALL other options have failed.

    In my experience, I've never seen a stimulator completely alleviate pain. Just making a rough guess, I'd say it can cut pain by 20-40% to allow for function. Again with a rough guess, I'd say most patients say that it does help most of the time though. Keep in mind that the stimulator can reduce pain, but it will not solve your structural problems whatsoever... in which case, you're heading for surgery anyway.

    It is my opinion that over the past 5-10 years, back surgeons have improved their methods and technology (including diagnostics) has improved. Simply "avoiding" back surgery is an old wives tale that comes from people who got hacked up 10-15 years ago.

    Finally, you mentioned that you can't get surgeries covered. That being said, I'm confused as to how you can get the stimulator implant covered?

    I understand that you feel handcuffed by your situation. At the same time, your posts give me the impression that you aren't headed toward a solution yet.

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    Thanks for the post
    I am covered for surgery by insurance certainly, I was referring to the cost of the knee injections with synvisc are costly. I have been told by my insurance that they will not cover a knee replacement at this time due to my age and the average knee replacement lasting 10-20 years based on activity level. I haven't even pursued the implanted stimulator yet, so I don't know if insurance will cover it or not.

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    Quote Originally Posted by celc5 View Post
    IMO the implanted neurostimulater is not your best option unless you've exhausted all other options first. It's a last ditch resort when ALL other options have failed.

    In my experience, I've never seen a stimulator completely alleviate pain. Just making a rough guess, I'd say it can cut pain by 20-40% to allow for function. Again with a rough guess, I'd say most patients say that it does help most of the time though. Keep in mind that the stimulator can reduce pain, but it will not solve your structural problems whatsoever... in which case, you're heading for surgery anyway.

    It is my opinion that over the past 5-10 years, back surgeons have improved their methods and technology (including diagnostics) has improved. Simply "avoiding" back surgery is an old wives tale that comes from people who got hacked up 10-15 years ago.

    Finally, you mentioned that you can't get surgeries covered. That being said, I'm confused as to how you can get the stimulator implant covered?

    I understand that you feel handcuffed by your situation. At the same time, your posts give me the impression that you aren't headed toward a solution yet.
    Celc5 poses a very good point, how is that you can get the stimulator covered by insurance, but not the surgery? I'm not the biggest advocate of surgery by any means, but they have advanced the technology and it is way better now than it was 10-15yrs ago, completely agree on that, just it is not always the answer. Not sure with the statistics of 20-40% relief of pain with a stim, but, it is definitely not fixing the problem either, only masking the symptom, or blocking the pain at best. So you say your seeing a Chiro, what is his/her opinion on your condition? As in they should be able to make a better diagnosis of your problem than me since they get the luxury of seeing your x-rays and and performing the various, necessary orthopedic tests to get the big picture. Last, but not least, I kinda have to agree with your orthopedist somewhat. I'm not saying give up lifting all together, that would be nonsense, it is a use it or loose it game when it comes to osteoarthritis, but if you are still powerlifting, you are only going to make it worse on your joints (low back & knee). Ultimately, you will have to make the decision and realize that if you continue to power lift, things will only get worse and celc5 is right you are not ready to resolve your problem yet, or you could start to lighten up the weights and change directions. I noticed your weight/height ratio, that is huge. I used to lift heavy as well, not quite power lifting, but followed my old College football regiment and all it did was get me injured years down the road. I tore my left Pec muscle about 5yrs ago and since I have shifted gears, lost about 50lbs of unnecessary fat, I lift in the 10-15 rep range, still extremely strong for my size/weight, but no longer lift crazy heavy and I look and feel way better than I ever have. Believe me, I know how hard it is to change your mind set on this, I always knew I was lifting too heavy, but it took the injury to actually make me change and I not saying I am glad I got injured, but I am glad I made the change. It truly was the best thing for my overall health!

    Please don't take this post/reply the wrong way, I'm just offering my opinion with your health and injury being my number one concern, not in any way trying to rip on you.
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    Quote Originally Posted by vidapreta View Post
    ScottyDoc a few years ago i had a buldging disc in my neck that was pinching a nerve which was causing this pins and needle feeling running from my neck down my arm to my thumb and back up again throughout the day. I did the physical therapy thing for awhile and it eventually went away for the most part. My neck is always sore and feels cracky/crunchy. I always have the urge to crack it but my chiropractor only wants to put me on that machine that pulls my chin back to open the space between the discs. Should i go to another chiropractor to get a neck adjustment?
    ScottyDoc, sir did you not like my post??
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    Quote Originally Posted by vidapreta View Post
    ScottyDoc, sir did you not like my post??
    Holy $hit, I'm sorry, I honestly totally missed your post... I even had to go back and look for it to see, LOL. My bad, thank you for bringing this back to my attention.

    Now for your question, there is nothing wrong with going to another Chiropractor for a 2nd opinion. What your chiropractor is doing is great, he is opening up the disc spaces, I personally adjust everyone in my clinic unless there is a contraindication to do so (rare). So to tell you what I would do with your case is hard without seeing your x-rays, doing a little palpation and checking your ROM (range of motion).

    So the only answer/advice I can really give you is to seek a 2nd opinion. Because your symptoms are a classic case of nerve impingement. I can even tell you the nerve that is impinged, it is your C6 nerve, it exits the spine between your C6 & C7 vertebra. That is the nerve responsible for your thumb & index finger.

    Hope that helps a little, again sorry for missing your original post, definitely was not intentional.
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    Quote Originally Posted by ryansm View Post
    Thanks for the post
    I am covered for surgery by insurance certainly, I was referring to the cost of the knee injections with synvisc are costly. I have been told by my insurance that they will not cover a knee replacement at this time due to my age and the average knee replacement lasting 10-20 years based on activity level. I haven't even pursued the implanted stimulator yet, so I don't know if insurance will cover it or not.
    On a non-professional note, I got a buddy who I play racquetball with and he gets those injections in his knee like 2 x's a yr and he says they hurt and cont. to hurt for like a day or so, but after that he says he's good to go, he swears by them. So costly or not, if I had knee troubles, that is definitely the route I would continue on until I was left with no other options, but surgery or knee replacement. It is funny the way he described how much it helps, he compared it to having a rusty hinge in his body grinding, squeaking, and hurting, and the injections being the oil and lubrication on that hinge needed to lubricate it and then it doesn't grind, squeak or hurt.
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    Ya my chiro is inline with the ortho about seeking some type of surgery, I basically just get adjustments and TENS work. As far as training I have already stopped squatting and doing heavy pulls, and have also lowered the weight I'm using. Thing is I still lift more than most but it's not necessarily heavy to me. I'm in the process of dropping the unnecessary mass I am carrying, but I am still a large guy even if I was sitting at 8-10% bf. Basically I am still in denial over the whole situation, and I recognize this. At some point I am going to have to come to the realization that things need to change. When I sit down and recollect on my issue it really defines the word insanity, lol.

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    Quote Originally Posted by ScottyDoc View Post
    Holy $hit, I'm sorry, I honestly totally missed your post... I even had to go back and look for it to see, LOL. My bad, thank you for bringing this back to my attention.

    Now for your question, there is nothing wrong with going to another Chiropractor for a 2nd opinion. What your chiropractor is doing is great, he is opening up the disc spaces, I personally adjust everyone in my clinic unless there is a contraindication to do so (rare). So to tell you what I would do with your case is hard without seeing your x-rays, doing a little palpation and checking your ROM (range of motion).

    So the only answer/advice I can really give you is to seek a 2nd opinion. Because your symptoms are a classic case of nerve impingement. I can even tell you the nerve that is impinged, it is your C6 nerve, it exits the spine between your C6 & C7 vertebra. That is the nerve responsible for your thumb & index finger.

    Hope that helps a little, again sorry for missing your original post, definitely was not intentional.
    No problem at all, and I appreciate your responce i think what your doinv here is great. I assume he's afraid that a neck adjustment could possibly make the disc buldge out again. I'm not sure what to think the pinched nerve went away with physical therapy 3 years ago and never came back. I am left with a pretty regular urge to crack my neck, sometimes it feels tight and sore and when i self crack by turning mg neck left to right i can feel and hear that it's a little cracky and crunchy if that makes any sense. Thank you again
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    Quote Originally Posted by vidapreta View Post
    No problem at all, and I appreciate your responce i think what your doinv here is great. I assume he's afraid that a neck adjustment could possibly make the disc buldge out again. I'm not sure what to think the pinched nerve went away with physical therapy 3 years ago and never came back. I am left with a pretty regular urge to crack my neck, sometimes it feels tight and sore and when i self crack by turning mg neck left to right i can feel and hear that it's a little cracky and crunchy if that makes any sense. Thank you again
    I wish I could help you more, but without being there to personally examine you and see your x-rays I can only tell you that it is very rare that I won't perform an adjustment on someone. If a past bulging disc is the only reason why he is reluctant to adjust you, I think he is being a little over cautious. But, again, remember he may have seen something on your x-ray or something that I obviously cannot see. So again, I would go see another Chiro for a second opinion. Well my friend, I'm signing off to get ready for a New Years Eve party with the Wifey, have a safe and Happy New Years Eve. I'll talk to you more next year! LOL, I love saying silly $hit like that!
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    Ryan,
    the synvisc would be a reasonable option. I see mixed results with those injections as well. Some respond like Scotty's racquetball partner, others don't really get any lasting relief. At the same time, your insurance is one of many that doesn't cover it because of those mixed results.

    Cortisone, chiropractic, physical therapy, anti inflammatories are more reasonable options for your knee. Then it's time to at least try to get it/them scoped. With your aggressive history, maybe cleaning up some scar tissue and arthritis can get you some relief.

    Finally, have you had an MRI on your back?

    Scotty,
    you're right about relief percentage for the stim implant. I was totally guessing based on subjective reports that I've heard (I'd guess somewhere between 5-10 reports over the past few years).
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    Quote Originally Posted by celc5 View Post
    Ryan,
    the synvisc would be a reasonable option. I see mixed results with those injections as well. Some respond like Scotty's racquetball partner, others don't really get any lasting relief. At the same time, your insurance is one of many that doesn't cover it because of those mixed results.

    Cortisone, chiropractic, physical therapy, anti inflammatories are more reasonable options for your knee. Then it's time to at least try to get it/them scoped. With your aggressive history, maybe cleaning up some scar tissue and arthritis can get you some relief.

    Finally, have you had an MRI on your back?

    Scotty,
    you're right about relief percentage for the stim implant. I was totally guessing based on subjective reports that I've heard (I'd guess somewhere between 5-10 reports over the past few years).
    Ya cortisone, chiro, pt, and anti-inflammatories have been my life over the last couple of years, lol. They all provide transient relief, which is great while it lasts. The whole process gets old, and the longer this goes on the more pain I tend to feel from just doing even the simplest of things. Part of my problem is I have a high pain threshold, and if I am feeling decent one day I will go out and flip tires, or push a sled, or something else that is simply not a smart idea and usually lands me in bed. It's very hard for an athlete to realize they are no longer at their prime, but it's something altogether more difficult to accept at 30yrs old you can no longer do things that most people even in their 60's can do.
    I had my knee scoped last year and cleaned out a lot of crap which definitely helped, problem is the condition is constantly degrading, and the pain again is becoming more prominent. It doesn't help that I continue with strenuous activity. As far as my back I have had an MRI, but it was right after my injury, have only had x-rays since. The x-rays show degradation of the spine as far as arthritis, from what I understand osteoarthritis will present in previously injured areas, especially if the area is consistently stressed.

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    Quote Originally Posted by ryansm View Post
    Ya cortisone, chiro, pt, and anti-inflammatories have been my life over the last couple of years, lol. They all provide transient relief, which is great while it lasts. The whole process gets old, and the longer this goes on the more pain I tend to feel from just doing even the simplest of things. Part of my problem is I have a high pain threshold, and if I am feeling decent one day I will go out and flip tires, or push a sled, or something else that is simply not a smart idea and usually lands me in bed. It's very hard for an athlete to realize they are no longer at their prime, but it's something altogether more difficult to accept at 30yrs old you can no longer do things that most people even in their 60's can do.
    I had my knee scoped last year and cleaned out a lot of crap which definitely helped, problem is the condition is constantly degrading, and the pain again is becoming more prominent. It doesn't help that I continue with strenuous activity. As far as my back I have had an MRI, but it was right after my injury, have only had x-rays since. The x-rays show degradation of the spine as far as arthritis, from what I understand osteoarthritis will present in previously injured areas, especially if the area is consistently stressed.
    You kind of answered your question, in order to make a real recovery where you can even think about doing the things you want to do that you say someone in their 60's can do is if you actually do all those therapies while also giving your body the necessary time to heal. Not going to heal if you go flipping tires or relive the power-lifting glory days just because you are having a good day and not feeling pain. Think of pain like this... when an injury occurs over time it is the last thing to happen, as in it just gets a little worse and a little worse and all the while your tolerance for this pain builds as the pain progresses. Therefore, you get all these treatments & therapies and you get some relief, that does not mean the problem is gone, just means it is getting better/healing.

    I'm not saying this is you, but I will tell you I have a great many patients, both weight lifters and non-weight lifters alike who will come into my clinic get some treatment, go home take a pain pill, wake up the next morning feeling great and then go continue doing whatever it was that caused their injury in the first place and come back into my office complaining that it felt better, but now suddenly and for some unknown reason the pain is back and even worse??? I look at them and say "Really... Honestly... You don't know why the pain is back?" That is a problem of mine though, because as you know (psychologically) when we feel good, we feel healthy and when we feel healthy it is only in our nature to push our boundaries.
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    Oh you are absolutely right, and I'm not pushing myself to the point I was when competing. I guess what I have been doing is thinking that if I only lift x amount of weight, or flip a tire x amount of times then that will be enough. Basically downgrading the output, however I am coming to the realization that this is not working, and I need to make a serious change. But it's like you state "Psychologically" it is much easier said than done.

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    Quote Originally Posted by ryansm View Post
    but it's something altogether more difficult to accept at 30yrs old you can no longer do things that most people even in their 60's can do.
    .
    Unfortunately as bodybuilders/powerlifters there's a constant wear and tear from pushing our bodies to the limit everyday. The passion that we love is making our joints,cartilage,discs and tendons age alot quicker than your regular guy walking the streets. Our joints ect..ect.. are probably older than our actual age. IMO.
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    Quote Originally Posted by ryansm View Post
    But it's like you state "Psychologically" it is much easier said than done.
    I am not saying that just about you, I am saying we are all like that no matter what the sport and no matter who we are. If you are an athlete, which is about 99.99% of the people on this site, then pushing it to the limit is a mind-set (psychological) issue that is not easily broken. I will be the first to admit that I am personally 100% guilty of this!

    No worries bro, you'll figure this out, I can tell from our conversations you are a very intelligent guy, no need for me to beat a dead horse on this issue, LOL
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    I completely understand doc, and appreciate the help.

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    Quote Originally Posted by vidapreta View Post
    Unfortunately as bodybuilders/powerlifters there's a constant wear and tear from pushing our bodies to the limit everyday. The passion that we love is making our joints,cartilage,discs and tendons age alot quicker than your regular guy walking the streets. Our joints ect..ect.. are probably older than our actual age. IMO.
    I agree with what you are saying for the most part, I mean you are right, just wanna make sure that people know that just because we rode our bodies harder when we were younger with extreme sports/lifting doesn't mean we need to quit all together. It just means we need to listen to our bodies and switch gears in the way we lift and/or exercise. As I have stated before in my case it was to lose excess weight and start lifting lighter and for higher reps.
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    Quote Originally Posted by ScottyDoc View Post
    I agree with what you are saying for the most part, I mean you are right, just wanna make sure that people know that just because we rode our bodies harder when we were younger with extreme sports/lifting doesn't mean we need to quit all together. It just means we need to listen to our bodies and switch gears in the way we lift and/or exercise. As I have stated before in my case it was to lose excess weight and start lifting lighter and for higher reps.
    I'll never quit, but i do hate the idea of going lighter,it goes against everything that i started lifting weights for.
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    Quote Originally Posted by ryansm View Post
    I completely understand doc, and appreciate the help.
    Anytime bro, anytime! On a different note, when you were competing what exactly were you competing in? I ask because you originally stated you power lifted then mentioned flipping tires, were you entering strong man contests? I love watching that $hit on TV, my big head tells me.. "I can do that," but my logic knows I cannot, LOL. I remember from some of the older ones, the way they man handled.. and I mean MAN-HANDLED those full kegs... and I helped a buddy set up for a Christmas party and felt like a total weakling struggling to carry a full keg up a flight of stairs all alone. With that kind of stuff... the word cumbersome is the best way to describe it, because it wasn't all about the actual weight, but the size/weight that was the issue. I find the same thing is true whenever I have the joy of helping a friend move furniture, which unfortunately I am the first one they all call, this happen to you?
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    Diversity in life is a blessing, there is a reason moderation is advised in more than just the simple things. Athletes, especially professional, have or develop a perfectionist mindset. The key is to define yourself by many different things, and not hold your eggs in one basket. ^^^I'm trying to follow this outlook, lol.

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    Dr. Scott, I had arthoscopic surgery on my knee about 10 years ago due to a meniscus injury. They fixed it and cleaned up the cartilage a bit and ever since then, I have had an achy knee. I have tried everything and nothing works for it. I have just learned to live with it for the most part and lost all hope of it ever feeling better. I have tried ibuprofen, glucosamine chondroitin, fish oil, numerous joint support supplements and so on. Do you have any roccomendations as to what else I could do to eleviate the constant pain? I also was diagnosed with IT Band syndrom recently and think that may have been caused by my injury or atleast played a factor. Any thoughts would be greatly appreciated doc.
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    Who diagnosed IT band syndrome? What are you doing to address it? And where is your pain exactly?

    Btw,No intent of stepping on your toes Scotty Just playing along
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    Quote Originally Posted by drinkyboy View Post
    Dr. Scott, I had arthoscopic surgery on my knee about 10 years ago due to a meniscus injury. They fixed it and cleaned up the cartilage a bit and ever since then, I have had an achy knee. I have tried everything and nothing works for it. I have just learned to live with it for the most part and lost all hope of it ever feeling better. I have tried ibuprofen, glucosamine chondroitin, fish oil, numerous joint support supplements and so on. Do you have any roccomendations as to what else I could do to eleviate the constant pain? I also was diagnosed with IT Band syndrom recently and think that may have been caused by my injury or atleast played a factor. Any thoughts would be greatly appreciated doc.
    Well, it is possible that the IT band played a role in your injury, and it is possible that it is continuing to play a role now, really hard to determine 100% to be honest. There are a few tests, but to be honest, they are not all that easy without someone who kind of knows what they are doing... I will list a few and you can look them up on the internet, will probably find a better explanation and possibly a picture of even a youtube video or something describing how to do them and what to look for, but here goes:
    1) Nobles Test
    2) Ober's Test
    3) Iliotibial Syndrome Test
    I would say if you pass all three of these tests, which are only slight variations of one another, then it would be fairly safe to say it is not currently your IT band at least. If it is your IT Band, again there are some really good stretches on youtube, but also I recommend some good deep muscle massage therapy, can't say you will enjoy it, will probably hurt like a MF, but will make a world of difference if that is indeed your problem.

    The only other recommendations I would have made, but you beat me to the punch as in you have already tried them is the Chondroitin, Glucosamine, & MSM along wish fish oils (omega 3-6-9, EFA's) I don't really know what else to say. Have you gone back and spoken to your surgeon about this? I mean, he has access to your x-rays, MRI's, he is the one who went in there and saw it all personally, I would love to hear his thoughts on this to help make a better conclusion. Sorry to say, but that is about all I have for ya, other than one more question... what do you do on a regular basis exercise-wise to improve it... strength, ROM, flexibility?
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    Thanks for addressing my problem. My doctor sent me to a physical therapist a few months back and thats when i was diagnosed with ITBS. I roll on my hard foam roller 2x a day for my hip flexors, IT band and quads and do RF/TFL stretches, lunge stretches and seated 90's. I can manage my IT band, its just the darn pain in my knee. Phys therapist said the meniscus injuries rarely return to normal after surgery. Its never really quite the same she says. I refuse to live on pain meds or anit-inflammatory meds by all means, so I guess I just have to talk to my doc again or suck it up. Thank you for your input doc.
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    And I forgot to mention that I went to phys therapy for my IT band when I addressed my knee problem. I did phys therapy after my surgery also but went into the military after that, and anyone who is currently serveing or a vet will tell you that the docs are nothing to brag about. That is why I took some years to get REAL help from REAL doctors.
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    Quote Originally Posted by drinkyboy View Post
    And I forgot to mention that I went to phys therapy for my IT band when I addressed my knee problem. I did phys therapy after my surgery also but went into the military after that, and anyone who is currently serveing or a vet will tell you that the docs are nothing to brag about. That is why I took some years to get REAL help from REAL doctors.
    Damn... Sorry to hear that, I have heard that about a lot of the doctors in the military... weird too, you think they would be really good, but I have heard a few butcher stories as well. I wish there was more I cold tell you or do for you, but minus the pain meds and anti-inflammatories, etc. PT is the best thing you can be doing for it to keep it from getting worse. As far as getting back to 100%, very true that is rare, but to live with constant aggravating pain for the rest of your life doesn't sound right either, so there must be something. I might not have the answer for you, but I would not give up and I will continue to do a little more research on meniscus injuries and recoveries, etc. on my own as well, see what I can't dig up for you!
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    Quote Originally Posted by celc5 View Post
    Who diagnosed IT band syndrome? What are you doing to address it? And where is your pain exactly?

    Btw,No intent of stepping on your toes Scotty Just playing along
    Don't worry bro, I don't mind at all. I have met quite a few people on here that are easily as knowledgable as myself, so by all means, chip in!
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    Drinky, do the TFL stretches give you any relief?
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    They do because my IT problem has caused me to have a tight hip flexor. My range of motion has improved and the throbbing in my thigh while seated has eased up quite a bit. It gets pretty bad if I dont do that stretch...it will tighted up all the way up to my buttox. It also helps to roll on a tennis ball on my butt cheek also to relieve the tension. Hurts like a mofo, but very effective in my experience. I use to not be able to squat for some time, but since doing some stretches and such, im back to squatting. I can def tell a difference. Liniment works wonders also, which I apply pre workout and post.
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    Quote Originally Posted by drinkyboy View Post
    They do because my IT problem has caused me to have a tight hip flexor. My range of motion has improved and the throbbing in my thigh while seated has eased up quite a bit. It gets pretty bad if I dont do that stretch...it will tighted up all the way up to my buttox. It also helps to roll on a tennis ball on my butt cheek also to relieve the tension. Hurts like a mofo, but very effective in my experience. I use to not be able to squat for some time, but since doing some stretches and such, im back to squatting. I can def tell a difference. Liniment works wonders also, which I apply pre workout and post.
    I would really look into some really good deep tissue massage on the TFL. Also, I've met a few really good massage therapists that will incorporate PNF stretching with their massage, that is really awesome!
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