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Offline Macca

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VMO weakness
« on: February 10, 2004, 02:53:15 PM »
Having been told by my OS that my patella tracking is out on both knees I have been on a strengthening program for approx 6 weeks. This doesn't seem to have helped much. Does anyone know how long it should take to strengthen the VMO? Also I have heard that tracking problems can result from a VMO that does not fire properly? How can a muscle not fire properly if put under stress? If is this case what can you do to obtain a functioning VMO?

Any info would be greatly appreciated

Macca

Offline Macca

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VMO weakness
« Reply #1 on: February 10, 2004, 02:53:15 PM »
Having been told by my OS that my patella tracking is out on both knees I have been on a strengthening program for approx 6 weeks. This doesn't seem to have helped much. Does anyone know how long it should take to strengthen the VMO? Also I have heard that tracking problems can result from a VMO that does not fire properly? How can a muscle not fire properly if put under stress? If is this case what can you do to obtain a functioning VMO?

Any info would be greatly appreciated

Macca

Offline ATsoccergirl

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Re: VMO weakness
« Reply #2 on: February 10, 2004, 08:35:53 PM »
The neuromuscular  control of the VMO is not the greatest and can easily be inhibited.  Swelling is the most common cause for VMO inhibition since a relatively small amount of fluid causes this.  What is very common is that the Vastus lateralis becomes over developed as compared to the VM/VMO complex.  This pulls the kneecap laterally and then the VM/VMO is not being used.  The VL will take over somewhat.  The VL can also fire too soon causing the knee cap to pulled laterally.

The key to VMO strengthening is to regain proper neuromuscular control.  This can be done using either Russian stim or biofeedback training.  I prefer biofeedback since it is much more functional, and can allow for simultaneous monitoring of the VL.  Once the VMO and VL are firing in the proper ratio then aggressive strenghtening can begin.  There has been some speculation about whether is it possible to directly target the VMO over the VM.  The jury is still out on that but as long as the VM/VL ratio is correct you will be strengthening all muscles.  
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline ATsoccergirl

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Re: VMO weakness
« Reply #3 on: February 10, 2004, 08:35:53 PM »
The neuromuscular  control of the VMO is not the greatest and can easily be inhibited.  Swelling is the most common cause for VMO inhibition since a relatively small amount of fluid causes this.  What is very common is that the Vastus lateralis becomes over developed as compared to the VM/VMO complex.  This pulls the kneecap laterally and then the VM/VMO is not being used.  The VL will take over somewhat.  The VL can also fire too soon causing the knee cap to pulled laterally.

The key to VMO strengthening is to regain proper neuromuscular control.  This can be done using either Russian stim or biofeedback training.  I prefer biofeedback since it is much more functional, and can allow for simultaneous monitoring of the VL.  Once the VMO and VL are firing in the proper ratio then aggressive strenghtening can begin.  There has been some speculation about whether is it possible to directly target the VMO over the VM.  The jury is still out on that but as long as the VM/VL ratio is correct you will be strengthening all muscles.  
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline Heather M.

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Re: VMO weakness
« Reply #4 on: February 10, 2004, 09:54:56 PM »
ATsoccergirl,

Can I ask you a question about swelling and VMO firing?  I'm in between PTs right now as I'm moving to a new home, and haven't lined up the new one yet.

I've got a goose egg sized lump of swelling in what my OS said is the suprapatellar pouch.  He feels there is intra-articular swelling that is pushing out at this spot.  I'm going in for an MRI, but we already know my knee is trashed.  This is new swelling following being tackled by a large dog, whose shoulder hit my bad knee from the side and behind while he was running at top speed.  

In the meantime, I'm noticing that my knee is catching and grinding an awful lot.  It feels like it's not tracking well at all.  I'm wondering if this kind of swelling is what you referred to when you said that swelling can inhibit the VMO.  I've had a lateral release, so I know that about the only thing holding my knee in proper position is my quad...I was wondering if this new subluxing could be due to the new swelling...either that, or I tore something when the dog hit me and that might be what's catching.

Is this the type of swelling you were talking about affecting the VMO?

Thanks.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Heather M.

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Re: VMO weakness
« Reply #5 on: February 10, 2004, 09:54:56 PM »
ATsoccergirl,

Can I ask you a question about swelling and VMO firing?  I'm in between PTs right now as I'm moving to a new home, and haven't lined up the new one yet.

I've got a goose egg sized lump of swelling in what my OS said is the suprapatellar pouch.  He feels there is intra-articular swelling that is pushing out at this spot.  I'm going in for an MRI, but we already know my knee is trashed.  This is new swelling following being tackled by a large dog, whose shoulder hit my bad knee from the side and behind while he was running at top speed.  

In the meantime, I'm noticing that my knee is catching and grinding an awful lot.  It feels like it's not tracking well at all.  I'm wondering if this kind of swelling is what you referred to when you said that swelling can inhibit the VMO.  I've had a lateral release, so I know that about the only thing holding my knee in proper position is my quad...I was wondering if this new subluxing could be due to the new swelling...either that, or I tore something when the dog hit me and that might be what's catching.

Is this the type of swelling you were talking about affecting the VMO?

Thanks.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ATsoccergirl

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Re: VMO weakness
« Reply #6 on: February 10, 2004, 10:47:00 PM »
The VMO is pretty effected by swelling, it takes a minimal amount of fluid for it to shut down.  Off the top of my head I believe it's around 30cc and the rest of the Quad muscles are around 70cc.  The swelling interferes with the neuromuscular controls of the muscle.  

I'll try to find some more precise numbers and mechanisms and I'll get back to you,
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline ATsoccergirl

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Re: VMO weakness
« Reply #7 on: February 10, 2004, 10:47:00 PM »
The VMO is pretty effected by swelling, it takes a minimal amount of fluid for it to shut down.  Off the top of my head I believe it's around 30cc and the rest of the Quad muscles are around 70cc.  The swelling interferes with the neuromuscular controls of the muscle.  

I'll try to find some more precise numbers and mechanisms and I'll get back to you,
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline lizl

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Re: VMO weakness
« Reply #8 on: February 11, 2004, 02:52:24 AM »
Macca,

I've had tremendous trouble with VMO, like almost everybody who has ever had knee problems. My current PT taught me a new way to do quad sets. I put a small ball between my legs, press inward on the ball, and then press down while tensing the quads. I can feel the VMO fire.

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March

Offline lizl

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Re: VMO weakness
« Reply #9 on: February 11, 2004, 02:52:24 AM »
Macca,

I've had tremendous trouble with VMO, like almost everybody who has ever had knee problems. My current PT taught me a new way to do quad sets. I put a small ball between my legs, press inward on the ball, and then press down while tensing the quads. I can feel the VMO fire.

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March

Offline Heather M.

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Re: VMO weakness
« Reply #10 on: February 11, 2004, 07:34:57 AM »
Macca--apologies for hijacking your thread, hopefully you'll find some useful stuff.

AT--I was wondering if you knew how much swelling it took (in cc's) before the capsule started to bulge out.  My OS was more than a little concerned, saying there must be a LOT of swelling inside the knee to make such a big lump come out on top of it.  I also got the strangest sensation yesterday--right in the middle of the goose-egg I felt a really irritating, tickly, painful tingling.  Like when your tooth is waking up after a filling at the dentist.  This is brand new, and I have to say my knee has never been as swollen as it is now except for the time immediately after my lateral release (when it was filled with blood).

Just wondering if I should hit the panic button.  I was packing and found my crutches in the garage today.  I actually brought them inside, figuring if my quad and VMO aren't working then I'm about one step away from a fall at any time.  Very scary thought.

I may have to go back to see my current surgeon in Vail if this keeps up, but during the ski season that is tough....

Thanks again for the information.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Heather M.

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Re: VMO weakness
« Reply #11 on: February 11, 2004, 07:34:57 AM »
Macca--apologies for hijacking your thread, hopefully you'll find some useful stuff.

AT--I was wondering if you knew how much swelling it took (in cc's) before the capsule started to bulge out.  My OS was more than a little concerned, saying there must be a LOT of swelling inside the knee to make such a big lump come out on top of it.  I also got the strangest sensation yesterday--right in the middle of the goose-egg I felt a really irritating, tickly, painful tingling.  Like when your tooth is waking up after a filling at the dentist.  This is brand new, and I have to say my knee has never been as swollen as it is now except for the time immediately after my lateral release (when it was filled with blood).

Just wondering if I should hit the panic button.  I was packing and found my crutches in the garage today.  I actually brought them inside, figuring if my quad and VMO aren't working then I'm about one step away from a fall at any time.  Very scary thought.

I may have to go back to see my current surgeon in Vail if this keeps up, but during the ski season that is tough....

Thanks again for the information.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell















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