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Tuesday, November 9, 2010

A common cause of knee pain.

I have been reading up on my problem with my knee and I thought I'd share my findings ... although most will probably be bored silly - someone may find it useful!! LOL

The vast majority of patellar tracking problems are related to tight iliotibial band or strong, tight vastis lateralis (outside quad) and a weak VMO (inside quad).

The vastus medialis (VMO) is a TERRIBLE muscle, it is the first one to become atrophic whenever you have knee pain. It is the most difficult to recover because it is the most difficult to isolate. There is lots of debate over whether or not it is possible to isolate and strengthen the VMO, and whether this will even help.

The specific role of VMO is to stabilise the patella within the patella groove and to control of the 'tracking' of the patella when the knee is bent and straightened. When the VMO is weak the patella becomes laterally displaced with the pull of the vastus lateralis. Mis-firing and weaknesses in the VMO cause mal-tracking of the patella and subsequent damage to surrounding structures and aching pain. Greater pain is usually experienced during leg extension activities in which the knee is a greater than a 20 to 30 degree angle.

To fix the problem:
- stretching and massaging the glutes, outer quad muscle(vastis lateralis) and ITB.
- strengthening the VMO (inside quad muscle).




Standing ITB stretch.
Place the leg you want to stretch behind the other one.
Keep the foot on the floor and push your hips out to the other side.
Hold for 30 seconds, repeat 5 times and do this at least three times a day.






Sitting ITB stretch.
Start in a push up position on your hand and toes.
Slide your right knee forward toward your right hand. Angle your knee so the outer ankle is touching the floor (see picture).
Slide your left leg back as far as comfortable.
Keep your hips square to the floor.
You should feeling a deep stretch in your right hip and the outer thigh.
You can either stay up on your hands, or fold forward and let your forearms rest on the floor in front of you or fully extended your arm in front of you.
Repeat on the other leg.




Glute stretch.
Lay on your back with one leg flat on the floor.
Pull the other knee up to your chest.
Then pull it across your body until you feel a stretch in the buttock and outer hip.
Hold for 30 seconds





Using Massage to stretch.
Use a foam roller. Lie on your side with the foam roller positioned under your ITB and roll backwards and forwards on it. Roll over and do the same with your quads. WARNING: This may hurt!!

To foam roll the quads and hip flexors, lie on your stomach, supporting yourself with your elbows. Place the foam roller directly on your quad. Roll back and forth 10-20 times. Be sure to concentrate on any “sticky” points. Turning your foot in and out will help to get all the areas of the quad.

Some strengthening exercise ideas for the VMO.
1. Sit in chair, put fist between knees, squeeze together knees. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

2. Lie on floor on your right side, shoulder and hips aligned. Use your right hand to prop up your head. Place the left hand on floor in front of you to help balance yourself. Bend left leg and bring it to the floor in front of you. Slowly raise your right leg about 10 inches off the floor then, hold for a second, then slowly lower leg to ground. Lift 10 times on each side.


3. Sitting on a chair with the knees bent, palpate the VMO. Start to slowly straighten the knee and ensure the VMO contracts. Maintain the contraction throughout the movement as you fully straighten the knee and bend it again. Repeat this twice daily until you can maintain a strong constant contraction 10 times in a row. Turning your toes and pointing them out can help.

4. Using the weight machine at the gym - get on the leg extension machine and do the same as above. Begin on a low weight. Turn your feet outwards to engage the VMO fully. This same exercise can be done with a resistance band also - either standing or sitting.

5. Once you can hold the contraction of the VMO, start to integrate this into functional movements such as lunges.
With a split stance initially place one or two fingers on the VMO of the front leg
Perform a lunge by bending the front knee and dropping the back knee towards the floor
Maintain VMO contraction throughout the lunge
Initially perform as many as you can while maintaining a strong constant contraction and gradually increase the number up to 20
Repeat this process in step-up exercises too (although you may not always be able to reach to feel the muscle contract!)


6. Try performing a squat against a wall by sliding your back down the wall until your knees are at a right angle (your shins should remain vertical)
Place a large ball (such as a football) in between your knees and squeeze it
This activates the Adductor muscles and because VMO arises from the tendon of Adductor Magnus, also stimulates VMO to contract
Hold for 3 seconds and repeat 10 times, gradually increasing to 5 second holds and 20 repetitions

7. Fit ball squeeze. Lie on your back with the fit ball between your knees/legs. With straight legs, lift the fit ball off the ground and squeeze it between your legs.



8. The Peterson Stepup is a backwards step-up. It begins with one foot on a low platform. Lift the heel of the foot on top of the platform and position the toes so they are just behind the heel of the opposite leg as shown in the first picture. Now lift the toes of the foot you're standing on, as this will increase the emphasis on the working leg. From this start position straighten the leg on top of the platform while lowering the heel as shown in the second picture.




9. Backwards sled pulling (can use a tyre) gets them working as well, in a non-isolated way, with contribution from other muscles, but still works quite well.






10. To perform a Terminal Knee Extension, you must first wrap a band around a power rack or another stable object at knee height. Wrap the other end of the band around your knee. Walk back so that the band is pulling at the back of your knee. With your heel on the floor, bend and flex your knee. When you flex, make sure to contract your quad as tight as you can for a one or two count. Perform 15-20 reps for 2-3 sets each leg.


http://www.youtube.com/watch?v=xrUOEwTDbqA
http://www.youtube.com/watch?v=xrUOEwTDbqA&feature=related

http://www.t-nation.com/free_online_article/sports_body_training_performance_repair/18_tips_for_bulletproof_knees

http://ericcressey.com/fixing-the-flaws-weak-vastus-medialis-oblique-vmo

http://www.floota.com/vastus_medialis_and_knee_popping.html

http://www.physioadvisor.com.au/8290850/quadriceps-strengthening-exercises-vmo-strengthe.htm


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