Help Clients with Knee Pain
During the Module II of the Certified Neuromuscular Conditioning Specialist program we discussed improving lower extremity function and the kinetic link between the deep, sacral fibers of gluteus maximus, the VMO, and the medial column of the foot. This relationship is key to preventing and maintaining the control necessary to prevent many problems of the low back, hip, knee, and foot that plague and limit so many of our clients. Check out this video how to centrate the hip and knee while improving VMO recruitment during closed kinetic chain exercises. The latter part of the video demonstrates a refinement for those clients that cannot stabilize sufficiently in order to optimally connect the foot, knee and hip complexes.
Historically, terminal knee extensions (TKE) have been used to improve vastus medialis obliquus (VMO) activation. This came from the fact that VMO is most active in the last few degrees of knee extension during the gait cycle. While this last point can't be argued, using TKE beyond the early stages of knee rehabilitation can. And what about VMO in the first place? Does it really need to be isolated? While there are a myriad of studies that contemplae the latter point, there are several studies that conclusively demonstrate both altered activation and control strategies of the VMO and vastus lateralis (VL) in individuals with knee pain as compared to individuals without knee pain. The first study demonstrates that Individuals with knee pain have altered VMO vs. VL reflex response time where the VL contracts prior to the VMO (1). Ideally the VMO should contract prior to the VL much the same way transversus abdominus contracts prior to arm movement. A second study looked at contraction times between VMO and VL during knee flexion in individuals with and without knee pain and noted no change in timing of contraction between the 2 muscles. However what they did note was a change in the eccentric control of the patella that favored lateral tracking in the individuals with knee pain (2). So what's the take-home message? 3 very key points come out of these studies: 1. Clients that have knee pain will likely develop timing and/or motor control issues of the VMO. 2. They will likely demonstrate lateral tracking of the patella as well as eccentric control issues of the knee. 3. Performing TKE are likely to be ineffictive because they will not change the timing issue or the eccentric control issues. CONCLUSION: Clients with a history of knee surgery or knee pain will likely demonstrate functional deficits in VMO. Remember the key corrective exercise strategy from last edition of FITNESS INSIDER - make exercise harder, not easier. This DOES NOT MEAN load them up more or make them do it more explosively. IT DOES MEAN have them do it with greater control and with more refinement. 1. Witvyrou E, Sneyers C, Lysens R, Victor J, Bellemans J. Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome. J Orhtop Sports Phys Ther. 1996 Sep;24(3): 160-5. 2. Owings TM, Grabiner MD. Motor Control of the vastus medialis oblique and vastus lateralis muscles is disrupted during eccentric contractions in subjects with patellofemoral pain. Am J Sports Med. 2002 Jul-Aug;30(4): 483-7. Both references accessed February 6, 2010 via http://www.ncbi.nlm.nih.gov/pubmed/. Dedicated to keep you thinking bigger about your role as a fitness professional,
Dr. Evan Osar
www.fitnesseducationseminars.com
Coming next edition of FITNESS INSIDER: MYTH #5 FRONT AND LATERAL RAISES - GOOD FOR SHOULDERS?
