[Hencredible Casanova]

Prophylaxis - Great thread bro. Very timely as I just had an hour-long massage this morning. There was quite a lot of tension in my rotator cuff and other parts of my upper back. I've neglected stretching in my weightlifting regimen which was a mistake in hindsight. Relaxed, loose muscles are better and healthier muscles. Going to incorporate a lot of stretching /calisthenics and sauna therapy in my daily routine. +1.

[Prophylaxis]

(08-31-2013 12:52 PM)Hencredible Casanova Wrote:  

Prophylaxis - Great thread bro. Very timely as I just had an hour-long massage this morning. There was quite a lot of tension in my rotator cuff and other parts of my upper back. I've neglected stretching in my weightlifting regimen which was a mistake in hindsight. Relaxed, loose muscles are better and healthier muscles. Going to incorporate a lot of stretching /calisthenics and sauna therapy in my daily routine. +1.

Thanks man.

The people I rarely see in the clinic are the ones who stretch regularly and progress their lifting regimes appropriately. As you said, by keeping muscles at their optimal length (i.e. stretching) they function better and literally allow you lift more/run faster etc. Good stuff!

Let me know if you have any questions re: exercises.

[Vaun]

(01-27-2013 08:57 AM)Prophylaxis Wrote:  

Roosh V forum has given me an incredible wealth of knowledge. Now it's time for me the give a little back.

hey man, thanks again for this contrib, great and very useful info. Being from Australia, what are your thoughts on the McKenzie method for back work? I would figure its more popular down there as it hails from NZ. Its worked fantastically well for a reoccurring shifting disc problem I have. Its really the only thing that has helped me recover and prevent it from happening. Thanks!

[Prophylaxis]

(09-01-2013 08:44 PM)puckman Wrote:  

(01-27-2013 08:57 AM)Prophylaxis Wrote:  

Roosh V forum has given me an incredible wealth of knowledge. Now it's time for me the give a little back.

hey man, thanks again for this contrib, great and very useful info. Being from Australia, what are your thoughts on the McKenzie method for back work? I would figure its more popular down there as it hails from NZ. Its worked fantastically well for a reoccurring shifting disc problem I have. Its really the only thing that has helped me recover and prevent it from happening. Thanks!

Mckenzie method is a fantastic paradigm for treating back pain when there is a clear directional preference or it centralises pain. For example, if you have pain radiating down the leg and repeated movements (bending forward/back/side) take the leg pain away. Then Mckenzie approach is fantastic. I also often use Mckenzie approach for acute lower back pain - (As you mentioned it can be great to taking pressure off discs - which I often see in young to middle age males).

However, a lot of physios have bastardised the Mckenzie method and unnecessarily prescribe repeated movements. I've seen clients who have been told to continue repeated lumbar extensions, despite having no centralisation of their pain, or any relief from the exercises.

There are many methods/paradigms to treat back pain, this is just one of them!

[Vaun]

(09-01-2013 09:23 PM)Prophylaxis Wrote:  

(09-01-2013 08:44 PM)puckman Wrote:  

(01-27-2013 08:57 AM)Prophylaxis Wrote:  

Roosh V forum has given me an incredible wealth of knowledge. Now it's time for me the give a little back.

hey man, thanks again for this contrib, great and very useful info. Being from Australia, what are your thoughts on the McKenzie method for back work? I would figure its more popular down there as it hails from NZ. Its worked fantastically well for a reoccurring shifting disc problem I have. Its really the only thing that has helped me recover and prevent it from happening. Thanks!

Mckenzie method is a fantastic paradigm for treating back pain when there is a clear directional preference or it centralises pain. For example, if you have pain radiating down the leg and repeated movements (bending forward/back/side) take the leg pain away. Then Mckenzie approach is fantastic. I also often use Mckenzie approach for acute lower back pain - (As you mentioned it can be great to taking pressure off discs - which I often see in young to middle age males).

However, a lot of physios have bastardised the Mckenzie method and unnecessarily prescribe repeated movements. I've seen clients who have been told to continue repeated lumbar extensions, despite having no centralisation of their pain, or any relief from the exercises.

There are many methods/paradigms to treat back pain, this is just one of them!

Thanks for the info! Thats my problem, I still have to do these extension movements to alleviate the L5 that moves to the right, or bulges to the right side. It flairs up when I am seated for long periods, and the movements are the only thing I can do to keep it under control. I will do 200-300 a day if it starts, and all together that only takes no more than 5 minutes. The only problem is that the problem isnt solved, it just goes away for a while when I do the extensions, and I dont know if anything will ever fix it. Not going to do a fuse surgery, or the disc shaving surgery.

[Prophylaxis]

(09-01-2013 09:42 PM)puckman Wrote:  

Thanks for the info! Thats my problem, I still have to do these extension movements to alleviate the L5 that moves to the right, or bulges to the right side. It flairs up when I am seated for long periods, and the movements are the only thing I can do to keep it under control. I will do 200-300 a day if it starts, and all together that only takes no more than 5 minutes. The only problem is that the problem isnt solved, it just goes away for a while when I do the extensions, and I dont know if anything will ever fix it. Not going to do a fuse surgery, or the disc shaving surgery.

There is no evidence to suggest that surgery has any affect on reducing purely lower back pain symptoms, and I'd only recommend surgery if there was obvious nerve compression which is not relieved by exercises or physiotherapy.

Sounds like the extensions might be relieving the pain, but I'd be looking at your hip range of motion, how well you activate your gluts, whether you can tilt your pelvis correctly and how well your nerves are gliding from the back. Sooo many potential drivers of back pain - what works for some people, will often not work for another,

Super hard for me to assess without seeing you, but I'm currently working on a project which may have the answer

[Hencredible Casanova]

(09-01-2013 04:14 PM)Prophylaxis Wrote:  

(08-31-2013 12:52 PM)Hencredible Casanova Wrote:  

Prophylaxis - Great thread bro. Very timely as I just had an hour-long massage this morning. There was quite a lot of tension in my rotator cuff and other parts of my upper back. I've neglected stretching in my weightlifting regimen which was a mistake in hindsight. Relaxed, loose muscles are better and healthier muscles. Going to incorporate a lot of stretching /calisthenics and sauna therapy in my daily routine. +1.

Thanks man.

The people I rarely see in the clinic are the ones who stretch regularly and progress their lifting regimes appropriately. As you said, by keeping muscles at their optimal length (i.e. stretching) they function better and literally allow you lift more/run faster etc. Good stuff!

Let me know if you have any questions re: exercises.

Any streches/exercises you recommending for reducing tension in the upper back muscles?

[Prophylaxis]

(09-02-2013 12:07 PM)Hencredible Casanova Wrote:  

Any streches/exercises you recommending for reducing tension in the upper back muscles?

The most common reason for tension in the upper back is due to poor posture (unless you are goin' to town on shrugs).

This often leads to a 'crossed syndrome' (below) - you can see that it leads to certain muscles becoming tight (traps and pecs) - and certain groups becoming weak (lower traps and deep neck flexors).



So what do we want to do? - Stretch the tight muscles (pec) and activate the weak muscles.


I've posted this exercise previously in the thread, but it's perfect for activating the weak muscles (deep neck flexors and lower traps).

Also I'd strongly recommend stretches that loosen up the thoracic (upper back) joints.





Here's a sweet routine you can try out if you have a foam roller:

If you target muscle imbalances and reduce thoracic stiffness, you'll find the tension will eventually begin to go.

Let me know how you go!

[Teedub]

Hey man, so I finally got round to getting an MRI scan done on my lower back, and a thorough examination. These are the results (compressed), if you can make sense out of them.

"On examination his lumbar flexion was to mid shin level with "tightening" of hamstring. Extension was slightly painful. SLR was between 60-70 degrees with severe tightness of the hamstring.

An MRI scan of the lumbar spine was arranged and this has reported L4/L5 right-central disc protrusion touching but apparently not compressing the right L5 nerve root. L5/S1 broad-based left-central to left-subarticular disc protrusion mildly displacing and flattening the left S1 nerve root"

I haven't seen my GP yet, but what does all that mean? Is that why my hamstrings are tight? What can I do to get the protrusion to go away etc? Will it go away in time, as it's been a year now?

Thanks in advance.

[Prophylaxis]

(09-03-2013 06:57 AM)Teedub Wrote:  

Hey man, so I finally got round to getting an MRI scan done on my lower back, and a thorough examination. These are the results (compressed), if you can make sense out of them.

"On examination his lumbar flexion was to mid shin level with "tightening" of hamstring. Extension was slightly painful. SLR was between 60-70 degrees with severe tightness of the hamstring.

An MRI scan of the lumbar spine was arranged and this has reported L4/L5 right-central disc protrusion touching but apparently not compressing the right L5 nerve root. L5/S1 broad-based left-central to left-subarticular disc protrusion mildly displacing and flattening the left S1 nerve root"

I haven't seen my GP yet, but what does all that mean? Is that why my hamstrings are tight? What can I do to get the protrusion to go away etc? Will it go away in time, as it's been a year now?

Thanks in advance.

Hey Teedub,

Scans for back are tricky. Often people can have disc protrusions and not experience any pain or symptoms.

Regardless, how is your back going? Is it getting any better? Are you still getting pain down the legs? Are the symptoms predominately down the back of your left leg? Tingling or pins/needles or numbness?

[Teedub]

Back pain when I bend over, often worse in the morning. Very tight hamstrings in both legs, very slight numbness in right shin.

What does all that stuff in the report mean, what exercises can I do?

[Prophylaxis]

(09-03-2013 07:43 AM)Teedub Wrote:  

Back pain when I bend over, often worse in the morning. Very tight hamstrings in both legs, very slight numbness in right shin.

What does all that stuff in the report mean, what exercises can I do?

It sounds like the right shin numbness might be correlated with L4/5 disc bulge. In saying that, don't freak out - these are very common. As I've mentioned previously, because you've had the pain for a while now, it would be wise to see a good musculoskeletal physio and fork out a bit of money for it. I can't prescribe exercises for this type of back pain, without assessing you in real life (?unless you're in sydney haha).

Basically the numbness in the right shin should be the barometer for how irritated the L5 nerve root is. Whatever brings on the numbness, you should stop, and whatever eases the numbness you should continue. Also - give the hamy stretches a rest - these will only irritate the nerve more.

[Vaun]

(09-02-2013 03:21 AM)Prophylaxis Wrote:  

Sounds like the extensions might be relieving the pain, but I'd be looking at your hip range of motion, how well you activate your gluts, whether you can tilt your pelvis correctly and how well your nerves are gliding from the back. Sooo many potential drivers of back pain - what works for some people, will often not work for another,

Super hard for me to assess without seeing you, but I'm currently working on a project which may have the answer

Yep, I do Skypes with my PT in Maui, and have done phone consults and have seen Kelly Starrett many times.

I am over flexible. I can put palms on the floor when I bend over and touch toes, my shoulders and back are super flexible. I dont do yoga, and even without stretching I stay more flexible than most people I see. Currently I am a power lifter, its what I am focused on. I stretch hard after every workout. I know how to activate my glutes but was quad dominate until about 6 years ago. I have worked hard to not be.

Can you talk a little bit about over flexible people? Problems, or why they are this way? All I know is that McKenzie is the only thing I have tried in 15 years that has worked.

[Prophylaxis]

(09-04-2013 05:55 PM)puckman Wrote:  

Can you talk a little bit about over flexible people? Problems, or why they are this way? All I know is that McKenzie is the only thing I have tried in 15 years that has worked.

Hey puckman,

There is evidence to suggest that flexible people or those who are younger than 40yo, increasing episode frequency of back pain and can perform a Straight Leg Raise >90degrees (below) would benefit from stabilisation exercises (core strengthening/activation).



These exercises include activating Traversus Abdominus and multifidis (the core muscles). Essentially you want to focus on improving the muscle activation around the back, rather than loosening up joints and muscles. Any exercises which improves force closure (e.g. gluts and lat strengthening) may also be of benefit.

Talk to your PT about possibly integrating these exercises in with your Mckenzie stuff!

[Vaun]

(09-04-2013 09:52 PM)Prophylaxis Wrote:  

(09-04-2013 05:55 PM)puckman Wrote:  

Can you talk a little bit about over flexible people? Problems, or why they are this way? All I know is that McKenzie is the only thing I have tried in 15 years that has worked.

Hey puckman,

There is evidence to suggest that flexible people or those who are younger than 40yo, increasing episode frequency of back pain and can perform a Straight Leg Raise >90degrees (below) would benefit from stabilisation exercises (core strengthening/activation).



These exercises include activating Traversus Abdominus and multifidis (the core muscles). Essentially you want to focus on improving the muscle activation around the back, rather than loosening up joints and muscles. Any exercises which improves force closure (e.g. gluts and lat strengthening) may also be of benefit.

Talk to your PT about possibly integrating these exercises in with your Mckenzie stuff!

thanks man! I can do the raise, and this is the reason I have always shyed away from the constant deep stretching and things like yoga because I can do it fairly quickly and easily but it never really solves anything. I squat, press, deadlift and do pullups 2-3x per week, for heavy reps. If I get a bulge I have to start my progress over again. I have super strong abs and lats. At 185 I can do 15 unbroken pullups and currently deadlift over 400lbs. With a sit up test I am usually around 50-60 in one minute. I dont think weakness is my issue, thats why this is fucking confusing I had a few bad accidents as a kid, one where I landed on my back and was temporarily paralyzed. Will talk to my PT for sure. great stuff again!

[Onto]

I just started woking out with a trainer and he was pushing me to do some heavier wieght than I would've liked in some back excercises. Now I feel a slight spasim in the right middle part of my back. If I make a sudden movement where I bring my elbow back behind my back I'll feel a very sharp, painful burn.

Did I overexert? What's going on with it? What should I do from here? I've worked out twice since then (Back/Bi's, Chest Tris) and did so very slowly and was able to get through it without making it burn but I feel it's still slightly tight/spasaming at rest.

I started taking Naproxin (OTC) yesterday but it doesn't seem to do much. Thank you for any advice you can give. I'm 42 yrs old and my muscles don't bounce back like when I was younger.

[roylalflush]

First I'd like to say, that a physiotherapist helped me cure my runners nee by learning a stretch 6 years ago and never had it again! so I love your profession and the natural help you give...

I got a elbow/tricep sprain doing lot's of pushups 3 months ago. it's still there and I can't do many pushups without it hurting again. I can do dumb bell presses for some reason without it activating up. Any solutions to make this heal faster so I can start training chest hard again?

Also, what stretches should I do to make sure I don't get another injury? Thanks in advance!

[faznine15]

Hey Prophylaxis I've got a fun puzzle for you. This has been quite a bit of hell for me figured I'd get another set of eyes on it.

Body Chart: Pain and clicking in anterior knee both sides. Inflamed adductors. Left side worse for both issues. Snapping hip on right side. Both femurs tend to want to externally rotate when lying down.

Age: 30
Mechanism of injury:

This was a slow onset. Was blasting along in the gym after a 2 year break due to shoulder sugery making huges gains working with a strenght coach. Then one day it just started with knee clicking while squatting but no pain. Then led to classic patellafemeral pain. Which out of know-where one morning turned into inflamed adductors near their insertion and overall general unstable feeling in my knees.

Aggravating factors: Walking or standing for extended periods of time. Walking down stairs, squats of any kind with weight, traditional deadlifts.

Easing factors: Lax ball trigger point work on RF, Hamstrings, Medial Knee, adductors, and gastroc.
Holding onto a restraint and holding a deep squat helps the adductor burn.

I've been doing soft tissue work almost daily, clams and glute bridges almost every other day for about 2 months now. I'm now able to walk around for a decent amount of time but still deal with the adductor issues and have clicking in both knees although a majority of the knee pain has subsided.

I suspect some sort of complicated kinetc chain mess brought on by poor glute and hip function. Any ideas?

[Prophylaxis]

(09-05-2013 09:12 AM)Onto Wrote:  

I just started woking out with a trainer and he was pushing me to do some heavier wieght than I would've liked in some back excercises. Now I feel a slight spasim in the right middle part of my back. If I make a sudden movement where I bring my elbow back behind my back I'll feel a very sharp, painful burn.

Did I overexert? What's going on with it? What should I do from here? I've worked out twice since then (Back/Bi's, Chest Tris) and did so very slowly and was able to get through it without making it burn but I feel it's still slightly tight/spasaming at rest.

I started taking Naproxin (OTC) yesterday but it doesn't seem to do much. Thank you for any advice you can give. I'm 42 yrs old and my muscles don't bounce back like when I was younger.

Hey Onto,

I need some more information.

I assume the pain is between the shoulder blades? (on the right side) Do you have pain when you move your neck? Any pain down the arms? Or numbness/pins and needles?

What specific movements aggravates and makes the pain worse?

[Prophylaxis]

(09-05-2013 11:14 AM)roylalflush Wrote:  

I got a elbow/tricep sprain doing lot's of pushups 3 months ago. it's still there and I can't do many pushups without it hurting again. I can do dumb bell presses for some reason without it activating up. Any solutions to make this heal faster so I can start training chest hard again?

Also, what stretches should I do to make sure I don't get another injury? Thanks in advance!

Hey Roylalflush,

I'm going to assume that there is no swelling and you haven't had any previous elbow injuries.

Sounds you have a tricep tendinopathy (similar to what Roosh had)

This is when small tears occur in the tendon of the tricep due to becoming overloaded (as with most other tendinopathies) .

Here's what I told Roosh!

(11-19-2012 06:43 PM)Prophylaxis Wrote:  

Tricep 'tenditis' or tendinopathy can easily be treated by a good physical therapist.

Just lay off heavy dips or narrow grip bench press or anything requiring excessive tricep activation in the meantime.

Roosh, you want to 'eccentrically' strengthen the tricep to allow the tendon to heal.

Do this tricep stretch reguarly


Gentle eccentric strengthening can include these:



But focus on only LOWERING the arm from an extended position

When the irritation settles give gentle dips and pushups a shot:



Again focus is on the eccentric component.

As long as deadlifts aren't painful they should be fine.

Also do plenty of soft tissue work on the tricep muscle to ease the load through the tendon

[Prophylaxis]

(09-05-2013 11:53 AM)faznine15 Wrote:  

Hey Prophylaxis I've got a fun puzzle for you. This has been quite a bit of hell for me figured I'd get another set of eyes on it.

Body Chart: Pain and clicking in anterior knee both sides. Inflamed adductors. Left side worse for both issues. Snapping hip on right side. Both femurs tend to want to externally rotate when lying down.

Age: 30
Mechanism of injury:

This was a slow onset. Was blasting along in the gym after a 2 year break due to shoulder sugery making huges gains working with a strenght coach. Then one day it just started with knee clicking while squatting but no pain. Then led to classic patellafemeral pain. Which out of know-where one morning turned into inflamed adductors near their insertion and overall general unstable feeling in my knees.

Aggravating factors: Walking or standing for extended periods of time. Walking down stairs, squats of any kind with weight, traditional deadlifts.

Easing factors: Lax ball trigger point work on RF, Hamstrings, Medial Knee, adductors, and gastroc.
Holding onto a restraint and holding a deep squat helps the adductor burn.

I've been doing soft tissue work almost daily, clams and glute bridges almost every other day for about 2 months now. I'm now able to walk around for a decent amount of time but still deal with the adductor issues and have clicking in both knees although a majority of the knee pain has subsided.

I suspect some sort of complicated kinetc chain mess brought on by poor glute and hip function. Any ideas?

Hey faznine,

Sounds like you've been through the ropes with your rehab - you could be mistaken for being a physical therapist with your knowledge.

My biggest concern with clicking in the knees is to make sure you don't have any meniscal or cartilage damage which could be causing the clicking. What have the physical therapists said is causing your pain?

Do either of the knees lock up or give way? Is there much swelling associated with either knees? Have you had any MRI scans of the knee?

Does this test (below) bring on the pain? (you can do this just holding onto a chair or table)

[Onto]

(09-06-2013 03:51 AM)Prophylaxis Wrote:  

(09-05-2013 09:12 AM)Onto Wrote:  

I just started woking out with a trainer and he was pushing me to do some heavier wieght than I would've liked in some back excercises. Now I feel a slight spasim in the right middle part of my back. If I make a sudden movement where I bring my elbow back behind my back I'll feel a very sharp, painful burn.

Did I overexert? What's going on with it? What should I do from here? I've worked out twice since then (Back/Bi's, Chest Tris) and did so very slowly and was able to get through it without making it burn but I feel it's still slightly tight/spasaming at rest.

I started taking Naproxin (OTC) yesterday but it doesn't seem to do much. Thank you for any advice you can give. I'm 42 yrs old and my muscles don't bounce back like when I was younger.

Hey Onto,

I need some more information.

I assume the pain is between the shoulder blades? (on the right side) Do you have pain when you move your neck? Any pain down the arms? Or numbness/pins and needles?

What specific movements aggravates and makes the pain worse?

The spasims are occuring around the shoulder blade, but the burning pain occurs in my lat. A movement that causes it is when I sleep on my side facing left, and in the morning if I jut my right arm quickly backwards to roll over on my back I'll feel that sharp painful burn in my right lat. I don't feel any numbness or needles and no pain when I move my neck. I have some soreness above my right elbow but I think that's unrelated because I injured that months ago.

[faznine15]

Yeah I've been thinking if I can ever get better I might look into actually going to school as I find the more I learn about human movement the more interesting it gets. It's frustrating getting to the root cause of this negative feedback loop. Thing is school is insane $$$ wise. Those are some serios loans if you want to go somewhere legit.

I've have had hands on evaluations from 2 PTs and both checked extensively for any damage to the supporting ligaments. I can complete the test you uploaded without any pain and pretty much any test I've been given that deal with checking the knee for tears.

The knee itself has never actually become swollen and only on occasion will seem unstable if I stand for longer period. I can feel my adductors pulling it medially and dont' think there is any actual real instability as I can still squat without anything odd going on other than the clicking.

Chondro was the diagnosis which makes sense, but that is more of the symptom and less of the issue. Great the lining of my patella is inflamed / wearing away due to my knee not tracking properly, but you know why?
And everyone worth there salt these days knows its not the VMO's fault.

So that's put me at activating the glutes and lengthening the hips. Which was working for awhile but now it seems I'm getting extra tight internal rotators that have that itchy feeling so I'm still at a loss.

[Prophylaxis]

(09-06-2013 06:54 AM)Onto Wrote:  

The spasims are occuring around the shoulder blade, but the burning pain occurs in my lat. A movement that causes it is when I sleep on my side facing left, and in the morning if I jut my right arm quickly backwards to roll over on my back I'll feel that sharp painful burn in my right lat. I don't feel any numbness or needles and no pain when I move my neck. I have some soreness above my right elbow but I think that's unrelated because I injured that months ago.

Hey Onto,

Sorry for the delay - been a crazy weekend for me!

Burning pain typically means nerve pain.

There could be a number of reasons what is giving you pain. The following could potentially be irritating the nerves:

* Referred pain from upper back joints (getting jammed up)
* Poor posture/positioning of the shoulders and shoulder blade
* Nerve being pinched

Unfortunately this type of pain is too difficult for me to diagnose and treat your problem over the internet.

I'd suggest going to a good musculoskeletal physiotherapist

But Feel free to PM me if you have any more questions!

[Prophylaxis]

(09-06-2013 11:53 AM)faznine15 Wrote:  

Yeah I've been thinking if I can ever get better I might look into actually going to school as I find the more I learn about human movement the more interesting it gets. It's frustrating getting to the root cause of this negative feedback loop. Thing is school is insane $$$ wise. Those are some serios loans if you want to go somewhere legit.

I've have had hands on evaluations from 2 PTs and both checked extensively for any damage to the supporting ligaments. I can complete the test you uploaded without any pain and pretty much any test I've been given that deal with checking the knee for tears.

The knee itself has never actually become swollen and only on occasion will seem unstable if I stand for longer period. I can feel my adductors pulling it medially and dont' think there is any actual real instability as I can still squat without anything odd going on other than the clicking.

Chondro was the diagnosis which makes sense, but that is more of the symptom and less of the issue. Great the lining of my patella is inflamed / wearing away due to my knee not tracking properly, but you know why?
And everyone worth there salt these days knows its not the VMO's fault.

So that's put me at activating the glutes and lengthening the hips. Which was working for awhile but now it seems I'm getting extra tight internal rotators that have that itchy feeling so I'm still at a loss.

Hey faznine,

I'd suggest you not learn TOO much about the human body - otherwise paralysis by analysis might take hold (haha).

Mate, if the knee is cleared I think you hit the nail on the head with the kinetic chain being a bit out of whack.

What is your single leg squat like?

This was the best video I could find (even her 'good' single leg squat is pretty shitty - but you should get the idea)

Basically you need to identify what in the chain is causing your deficit.

Watch if your hips hitch up
Watch if your knee buckles in (should be in-line with 1st/2nd toe)
Watch if your feet pronate/arch collapses

Do a few in front of the mirror and compare both sides.

Is it weak hip abductors? (sounds like you are strengthening them already which is awesome) they have done studies that show strengthening these muscles on their own reduces pain associated with the patellofemoral joint.

Is it tight hip adductors? (want to release the groin muscles - get your missus to do these ones ;-))

Do you feet overly pronate as you come down from the squat? - this causes huge internal rotation of the tibia which can predispose you to patellofemoral pain. You can try this while doing a squat without shoes and then with some shoes with good arch to see if this corrects your form.

Or is it just poor neuro-muscular control and balance?

Let me know what you find in the single leg squat!