Hi everyone,
I'm suffering knee pain from tight trigger points in my TFL, Hip Flexors, and Piriformis. Progress in improving these issues has been very slow & I'm hoping someone has ideas on how to speed things up. I've been working hard with a good physical therapist to try & resolve the issue and get back on my bike. Here is what I have been doing to resolve the problem since early October 2016. My physical therapist has tried deep massage (twice monthly) & dry needling (once without much result; it's similar to acupuncture) on me to loosen things up. A doctor has used a hypodermic needle poked into tight spots to loosen things up. I've tried uncountable hours using a lacrosse ball, baseball, and massage star on the tight spots. I've done lots of bridges and leg abductions and crab walking and stretching of the hip flexors and IT band. The piriformis has loosened up maybe 25% but the hip flexors & TFL have only improved 5-10%. Worse, if I don't hit them hard on a regular basis, they all just tighten back up again. I sit all day long for work & have for the past 30~years (including college). All of this only makes me tighter. My PT thinks I should try to see the doctor again for more needling of the tight spots. That worked well but only for a few days. I should add I lead a very stressful life & that likely doesn't help. (I've tried meditation a few days a week but I can't report improvement.) Recommendations to relax the trigger points?

I've had and still have issues with trigger points. I think the best way to get after them aside from everything you are doing now is to work on them briefly but many times throughout the day.
I found a good overview and treatment guide is found in the Trigger Point Therapy Workbook. https://www.amazon.com/Trigger-Point...K1XKMMWN78NKSY
I'm sure you already know this but many times trigger points are not located at the location of the pain but referred pain from another location. I found that book to be really helpful in tracking them down and how to treat them.

IME none of that stuff works. You're treating the symptom, not the cause, which is weakness probably from sitting in a chair for 30 years. Weights, heavy weights. Here's an article with some decent opinions, at least IME: https://www.t-nation.com/training/ti...d-lift-heavier

Of course there's a lot more to it than just messing with the particular muscles which are giving you trouble. Full-body workouts will fix you up. If you don't feel good about doing it yourself, get a gym membership at at top gym which has personal trainers you can hire. The gym membership is not optional, it's necessary for your health. I have an 83 y.o aunt who now lifts heavy at her gym after a lifetime of being sedentary. Fixed her right up.

I'm 71 and squat more than I did at 21, and I was quite athletic then too. I'm not a big guy, 5-6" and 147. Weight training has enabled me to fix every skeletal, bursa, muscle, and tendon problem I've had in 60 years of cycling, skiing, hiking, etc. We're not supposed to sit. We're supposed to run with a deer on our shoulders.

Here's my Introduction to Strength Training thread, complete with PDFs of periodized workouts for a whole year:
https://www.bikeforums.net/training-n...e-athlete.html

I have the same tight muscles, and have been doing many of the same things with limited success. I sit a lot as well.

Even weights aren't helping, and I've lifted for decades.

What has helped the hip flexors open up is simply walking.

Shoot for 2-5 miles per day. You'll see a difference.

Weight training without a doubt is beneficial but that alone is not the answer. BTW treating Trigger Points is not treating the symptom. Many times the pain is located some distance from the actual trigger point that's why I mentioned referred pain.
I used to lift weights four days a week but these days I focus as much on flexibility as strength. I do yoga once a week and use Steve Maxwell's Encyclopedia of Joint Mobility which is a set of DVDs that focus on body weight exercises that work on strength and flexibility simultaneously. I also try to work in a couple of light kettlebell workouts but mainly I ride my bike.

Hi everyone,
Thanks for all your responses! This is awesome information! Just to give some background, way back in 2002, I was a lifter of heavy weights: rows, behind neck presses, squats, deadlifts, dips, leg curls. At that point, I developed knee, Achilles tendon, and rotator cuff problems that plague me to the present. I have a wiry frame & I'm not sure I'm built for lifting heavy weights (in the same way someone who is short & squat might not be built for running marathons even if they have good endurance). My physical therapist's theory is that the trigger points have caused muscle spasms that have partly or almost shut fully down a lot of my secondary and core muscles. For example, my TFL trigger points have my TFL in permanent spasm so they prevent my medial gluteus muscle from firing & doing its job of stabilizing & supporting. Does this information change anyone's recommendations?

I'd still recommend exercise. Form and training complementary muscles is important. It's actually not necessary to lift heavy weights. What is necessary is to lift to exhaustion. You have to tire the muscles which will fire before the recalcitrant muscles will pick up the slack. The number of reps is relatively unimportant. More reps just takes longer. I used 3 sets of 30 done circuit style for many years, all sets with the same weight, calibrated to produce failure before 30 reps on the last set. I'd talk to another personal trainer, get another opinion. Another thing that works for many people with similar problems is Pilates.

Thanks for following up!

All I would add is that if the issue is trigger points they should be dealt with before stretching or anything else. The trigger point will cause the muscle to shorten so stretching the knoted muscle can actually make things worse even further damage the muscle.
I always begin my workouts with a few minutes on the foam roller and the Thera Cane along with the lacrosse ball to get things loosened up.

Thanks very much!