Hi JBL.

You've listed quite a few issues here, which sound like they are all related. Before I come onto any of these, I must stress that your physio is dealing with them, and it would be wrong for any of us to butt in and possible negatively impact her treatment programme. Having said that, I will offer a little of my insight using the information you have given. Please note though, that without examining you myself I am not getting the whole picture...

You sound like a very active young man, which is not a bad thing considering most people of a similar age are fairly sedentary. However, you do sound like you're overdoing it, and probably have been for a while. Without meaning to sound patronising, you are only 19 years old, and as such you are still developing and growing. Let me explain what I'm getting at: your bones can often grow quicker than the soft tissues (eg. muscles, tendons, ligaments, etc), and often this leads to an imbalance between these soft tissues and your bones. This means that when you are exercising, your muscles and tendons are working in a shortened position and have trouble working at those lengths. This is especially true for what we call "two joint muscles", eg. your hamstrings. Without going into too much detail, these muscles will be working at a mechanical disadvantage, and with repeated loading over a length of time will become more prone to "failure", thus causing a range of possible symptoms. Now your body works as a unit, meaning that all the tissues are connected, so imbalances in one area will cause problems in another. So starting with your hamstrings (I like to start from the ground up), these are connected to your pelvis by not only tendons, but also a sheet of tissue called fascia. This fascia is a link between your hamstrings and your lower back (have a look at Anatomy Trains | KMI | Welcome! for some more info, and especially http://www.anatomytrains.com/uploads...nsOverview.pdf). This tightness is likely to be pulling on the "myofascia" in your lower back, as well as causing your pelvis to rest in a position of "posterior tilt", which means the back part (the arse side) is lower than the front side, which amongst other things also results in tension in your lower back muscles. If you think of how gravity acts on you, this means that in effect you are falling backwards. So how does the body react to this? Well obviously it tries to compensate by activating the muscles on the front of your body to regain some kind of equilibrium. This includes your abdominal muscles, especially your six pack ones, which can tighten and shorten as a result. Now let me catch my breath before I continue...

The reason your knees feel better after running is because running warms up the soft tissues and therefore makes them more stretchy. Stretching before running is unlikely to help (it may make things worse in fact), and when you have cooled down the problem returns. If you insist on running, then I would suggest stretching as part of the warm down (you do a warm up and a warm down don't you?). You have said that exercise is surely good, but this always depends on what the exercise is, and how you are doing it. Just bear in mind that your knee problems return when you stop exercising, so the underlying problem is, as your physio has said, likely to be the shortness of the hamstrings. You must also remember that symptoms often do not start when you are actually doing the aggravating exercise, but there is often a delayed reaction.

As an additional point, you have said that rolling your ITB helps the limping. This suggests that you have some ITB trigger points, which will affect the biomechanics of the kneecap on that side. This problem may be caused by some weakness in your gluteals, which seems even more likely when considering that you have probably been compensating for this by using your hamstrings, for example when doing dead lifts. The gluteal weakness may also be causing the sacroiliac problem that dibrace has suggested, or vice versa. As she has said though, this is only a possibility!

I would also like to make a point about weights too. I will stick my neck on the line here and say that they probably are a major contributing factor to your problems. Whether your technique is correct or not, the actual amount of weight you are lifting, the frequency, reps, etc, play a big role here. As I have said before, symptoms often occur afterwards, not during the exercise itself. Muscle fatigue and spasm can set in hours or even days after lifting, and if you are doing weights frequently then it has a cumulative effect. I would like to stress again that I think you are probably overtraining, and also not giving your body enough of a chance to recover either. It would be really useful to get some more insight into what the goals you have mentioned are, as well as your specific training regime.

Now moving on to your upper body, again these are likely to be linked to the problems in the lower half. Doing some of the exercises you have listed is likely to be overdeveloping some of the powerful muscles in your back, such as your lats (lattissimus dorsi) and you upper trapezius, at the expense of the stabilising muscles in your shoulder. Let me explain what I mean: the shoulder joint is very mobile, but this mobility comes at the expense of stability. While most joints are stabilised by powerful ligaments (eg. the hip joint), the shoulder has weak ligaments, and as such is kept stable by the muscles. These muscles are the Wikipedia reference-linkrotator cuff in the shoulder joint, and other muscles (eg. serratus anterior), which stabilise the shoulder blade (scapula). These muscles are often weak, especially in weight lifters. This may come as a surprise to you, considering all the training you do, but please realise that when you are training, you are unlikely to be working these muscles. Instead you are using other muscles (eg. lats and upper trapezius) to do the work of stabilising the shoulder. Unfortunately, these powerful muscles are meant for powerful activity, such as climbing, and in short bursts (they contain fast twitch muscle fibres), but are not very good at slow sustained contractions, which the rotator cuff muscles are (they contain slow twitch muscle fibres). When you are doing weights, the power muscles are working overtime trying to stabilise the shoulder and lift the weights! They therefore fatigue very quickly and cause pain and instability. To relate that to your symptoms, the lats are connected to your shoulder blades. The collar bone is attached to your upper traps, plus you are probably overworking your pectoral muscles, a sign that you may again be overdoing the weights (think amount, reps, frequency, etc).

Onto the neck: stick to the strengthening exercises your physio has given you. These are likely to be strengthening the right muscles (ie. stabilising muscles in your neck), rather than just working on the power ones. Doing the exercises that you researched (they sound like prone neck extensions - lying on your front and lifting your head) will just develop muscles such as your upper traps, which don't sound like they need any more help! Overworking the power muscles will actually make your neck posture worse, not better.

Regarding your elbow problem - TELL YOUR PHYSIO ABOUT THIS! Please always try and give health professional the whole story, and not just fragments of it. Telling us about everything gives us a fuller picture, and as I have said, problems are often connected. If your elbow is clicking, then I would be very wary of doing weights. It might be worth getting your elbow scanned just to check that you have not injured the cartilage, which can be a problem for people (especially male) of your age.

I hope that what I have said makes sense. I do understand you have many goals, and you sound like a very driven individual, but sometimes you can be your own worst enemy. The important lesson is always to listen to your body. Although you have no problems in your back and neck on X-ray, these problems do develop over time, and can cause you some nasty symptoms when you get older. Training and exercise should be at the right pace, and if you overdo it you are taking one step forward but two steps back. If you train too hard ("just five more minutes", "just 0.5kg more"), then you can trigger an injury that can take months to heal, meaning that you can't train at all. Do tell me your thoughts on this, and keep us up to date on your progress. I'm sure that other physios will add their thoughts on the subject too.

I hope I haven't discouraged you in any way. Like I said, just remember to train right and listen to your body. Give yourself time to recover and vary your training programme. Pain is usually a warning sign when it starts, and often means you are doing something wrong and need to correct it.

Anyway, take care and stay healthy!

Mike (musculoskeletal/rheumatological physio)