The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: likewoa2007 on August 06, 2011, 05:56:34 PM

Title: VMO gone
Post by: likewoa2007 on August 06, 2011, 05:56:34 PM

My VMO deflated since ACL Surgery 15 months ago.  My knee no longer holds me up when going down stairs or hills. I canít cut my lawn anymore due to the hill.  Iím only 28 and I have significant functional deficits.  Anyone out there that never recovered from
ACL surgery because of severe muscle loss (VMO)?????

I am physically impaired off ACL surgery

Title: Re: VMO gone
Post by: kscope09 on August 06, 2011, 10:40:43 PM
What exercises are you currently doing?

Don't give up hope, I've heard of people who havn't walked for about 2 years getting their vmo strength back.  Mine took me over a eyar to get to a decent level and is OK but I need it stronger still in order to do everything that I want.
Title: Re: VMO gone
Post by: Fathead D on August 07, 2011, 01:40:26 PM
Don't give up hope.  Work at getting the strength back.  It is going to take work and time.  Might be a good idea to get back into PT to get them to help you with building strength.
Title: Re: VMO gone
Post by: likewoa2007 on August 07, 2011, 07:18:17 PM
Iíve been doing exercises for 15 months.

I still canít use the leg extension machine because of the amount of sharp shooting knee pain.

I use my Total Gym to do single leg press. 

I do SLR with foot tilted out.

I do resist hip abductor sideway LR

I squeeze stability ball and bring it up to my head and back down.

I do box steps.

I do single squats but canít go down that far because of the sharp shooting knife stabbing pain.   When I do them you can clearly see my hip is holding me up.  The patella just doesnít want to hold me up

All the exercises I do with my PT I get the same results. My hip, glutes, and groin are sore the next day. Even when I do SLR I feel sore in my groin and hip.  When I do SLR with my good leg my quad is sore after workouts.  He has his head scratching and canít figure out why I cant target my quad ever.  However when I do my good leg, my quad is sore the very next day.  My PT will be dropping me because we havenít seen results in 15 months!
Title: Re: VMO gone
Post by: Fathead D on August 07, 2011, 07:38:27 PM
Sounds like you should have dropped your PT a while ago.  If you are not getting results you need to change things up.
Title: Re: VMO gone
Post by: likewoa2007 on August 07, 2011, 08:18:40 PM

Wha do u mean by change things up...I've been down every road.

I saw an orthopedic twice since acl / lateral meniscus surgery (may 2010) and both orthopedics went in 2 more times , the recent being July 13,2011 and removed scar tissue off the acl

So I dont really have options here

The orthopedics say to live with the deficits I have

I cant even carry my own kid down the stairs the correct way or carry anything down the stairs to say the least.  I go down one leg at a time which looks quite strange to people in the publics eye

Title: Re: VMO gone
Post by: kscope09 on August 08, 2011, 10:35:08 AM
If your using weights and trying to do single leg squats then it sounds like your doingtoo many of the hard exercises which your knee doesn't like and you don't actually ahve the strength to do which isn't going to help.  If your knee doesn't like what it is doing then it will suppress the vmo to stop yo from using it.  I would try something easier like normal standing squatts, maybe holding onto somthing, go down very slowly and stop at 90 degrees.  When they are too easy go to lgentle lunges, then you can progress to single leg squatts.  As for weights I think they are too advanced, just take a step back and do something easier to give the bad knee a break while still exercising it.

I'm the opposite to you, I've been doing mid level exercises for too long and am too timid for the advanced ones like single leg squatts which I just don't have th balence for.

Having said all that I would get a pt's advice on exercises.
Title: Re: VMO gone
Post by: Fathead D on August 08, 2011, 04:11:53 PM
I understand your frustration.  What I meant by changing thing up is to try taking a different approach.  Maybe go see a different PT that has a different view on things. 

I am dealing with some VMO deficiencies as well.  My ortho had me doing one legged squats and I had no results.  I was dooing 200 a day and no results.  I went looking around for options and found electronic miscle stimulation last week.  I bought a until and tried it over the weekend.  My VMO has never had such an intense workout.  I can feel that the muscle is fatigued from use.  I couldn't be happier right now.

I suggest you do some research into alternative options.  Worst case, it will alleviate some frustration from continuing to do something that isn't working. 
Title: Re: VMO gone
Post by: kscope09 on August 08, 2011, 04:46:12 PM
Did you do the one leg squatts fast or slow.  I do all my weightbearing closed chain exercises really slow.  If you can take 45 seconds to get to 90 degrees in a sqatt then you will really feel the vmo wrk.  Go slow on the way down and come back up in your own time.  Do between 8 and 12 reps 3 times a day.  You can do the same with squatts, two legs and one leg and also with lunges.
Title: Re: VMO gone
Post by: likewoa2007 on August 09, 2011, 03:30:38 AM
What do you mean by normal standing squats?  I have tried normal squats if you mean both legs?  However when I do those normal squats I can tell Iím fatiguing my good leg and that all my body weight seems to be on the good leg.  I will try doing them again and see where that takes me, Lunges have never worked for meÖ body weight doesnít hold me up on lunges.   Anything else you know of that could help?

When you use your e-stim do you use it while doing SLR?

Title: Re: VMO gone
Post by: Fathead D on August 09, 2011, 01:11:48 PM
When I use my EMS I do it laying or sitting with my knees bent.  I am getting 300 contractions a second and it is really helping me build muscle.  I have noticed the difference after only a few sessions.
Title: Re: VMO gone
Post by: hinata42691 on August 10, 2011, 12:15:40 AM
I would also suggest using e-stim if you can either find a PT that uses it or get one on your own. I tore my MCL badly in December and am currently recovering from surgery to fix it (7 weeks post-op now). Both times, my VMO has been so weak that I couldn't get it move or engage. My PT used the e-stim on it and within a few sessions there was definite improvement. I won't say it's necessarily the most comfortable thing to use (it gives a strong pins and needles feeling where the electricity is going in and sometimes the muscle will cramp a bit) but I would definitely give it a try. Also, finding a PT with a different approach can definitely help. Maybe look for a PT that specializes in knees. Or if you injured your ACL in sports, maybe try a PT that specializes in sports injury patients. I killed my knee in ballet and am currently going to a PT that specializes in dancers. Good luck! Don't give up yet!
Title: Re: VMO gone
Post by: smillie on August 10, 2011, 06:48:12 PM
I am in the process of getting my quads to come back from a huge deficit. My PT has been hooking me up to a little e-stim unit, but the other days when I work with his assistant, she hooks me up to the big machine and toes Russian stim, I think. It has made a big difference for me. At first I couldn't do a SLR without a lag. So we've been working on quad sets, SLRs, and a few other exercises with the stim in place and it has finally trained my muscles to work again--especially my VMO. I have now gotten stronger than the machine, so we will be discontinuing it and adding weights. I could have continued doing all of my exercises without the stim, but I wasn't progressing. Getting my muscles trained and firing properly is speeding things up a lot.  So if your PT hasn't been doing this, see if you can work with one who does. It's worth a shot!
Title: Re: VMO gone
Post by: likewoa2007 on August 11, 2011, 12:41:48 AM
I guess I must be one strange patient. I've used the E-stim for 5 months and no improvement from any of those sessions!

Title: Re: VMO gone
Post by: likewoa2007 on August 11, 2011, 12:45:04 AM
I'm not the norm. Ive seen 4 different PT's and all of them don't understand my weird situation. I've seen 6 Orthopedics and all of them are scratching there heads. 

I have significant functional defecits and my bone already has signs of osteopenia(bone density loss) which is not good!

Title: Re: VMO gone
Post by: kneeboy on August 11, 2011, 04:49:16 AM

Have you been checked for nerve damage?

Title: Re: VMO gone
Post by: smillie on August 11, 2011, 04:59:53 AM
I guess I must be one strange patient. I've used the E-stim for 5 months and no improvement from any of those sessions!

There is definitely an art to it, in my experience. Do you use 2 pads or 4? Do you know what kind of stim they're using?

Or you could just have a different problem altogether. Nothing was helping my quad strength at all until I had my LPFL reconstruction. In fact, if I did very much in PT, my quads would shut down from irritation. I couldn't lift my leg at all.
Title: Re: VMO gone
Post by: Stasha83 on August 11, 2011, 10:16:29 AM
I'm the same. No decent VMO since last June. Have tried everything, the e-stim did nothing for me either. Also tried APOS therapy which is meant to get muscles working but again this didn't work on me.

I'm having another surgery next week so back to the drawing board after that I guess....
Title: Re: VMO gone
Post by: likewoa2007 on August 13, 2011, 03:46:15 PM
I saw the Orthopedic and was discouraged by the fact Iíve made no progress from a conservative approach in Physical Therapy.
He told me just now that my Arthritis is indeed severe.
Apparently Iím between Grade 2 and Grade 3 knee cap arthritis.
Grade 4 is the worst and I asked the DR if my arthritis can reach grade 4 and he says you can.
He is going to try giving me a series of Sylvan Halogen shots in the knee. It has the opposite effect than a cortisone shot that we tried before. Cortisone shots are to help with inflammation.  Sylvan shots are to help with cartilage loss and to help unload some of the arthritis.
We will try that for 3 weeks once my insurance approves those expensive shots.
If no relief from that there will be a surgery done on the knee cap to hopefully realign the cap so it can unload on some of the arthritis.
However the surgery can have the opposite effect because of my severe quadriceps loss. This surgery is very complicated to recover from and it could make the girth of my quadriceps worse since the strength in my muscle is really severe. The VMO which is the strongest of 4 muscles in the quadriceps has lost 4 cm of muscle loss. That muscle will definitely worsen after this procedure. The VMO is key to patella tracking, stability, and pain relief.
He tells me everyoneís stereotype thinks surgery will correct someone but it can have the exact opposite in cases like mine. 
I have to wait 7 days to find out if my insurance will approve these sylvan shots and go from there.  My knee cap along with my other complications is definitely contributing to poor quality of life
Title: Re: VMO gone
Post by: likewoa2007 on August 13, 2011, 03:48:35 PM
I did have the EMG/ Nerve Conductor test done. Everything was normal.