Hi guys just thought Id add a little to what everyone has said… again, in my humbled experience of these sort of things, you tend to find that the debate for CMP still rages, and tends to only exist in young teenagers, as it is softening of the bone.. the evidence out there still does not say yes or no for this type of diagnosis and so in my thought prosesses I never use when looking at some of my athletes..
you are 100% correct in terms of the quads being the problematic area.. whether of not its a weak or dysfunctional VMO (which may I also say research on cadavers suggests only 35% of people have one..) or another part of the quads.. patella tracking is also part of it, but again is influenced by the quads.. The process that tends to happen for AKP is this. the quads all form the pre-patellar and the patellar tendon. the patella itself is actually enveloped by the tendon and the tendon then inserts into the tibial tuberosity, where alot of the CMP arguement comes from, well just superior to it. now my understanding is that as the quads become hypertonic/dysfunctional/weak, they start to tighten up like most muscles do, this then pulls on that tendon, causing the tendonitis like Ashley mentioned, but more importantly it drives the knee cap posteriorly into the structures below, mostly condyles of the femur and tibia, this casues irritation and an inflammatory process around that area and is why most people complain of pain in and around there..
as apposed to addressing the problem, I also like to look at why this has come about.. I tend to look for answers in the pelvis (which can cause strain on all the musculature) and also the lumbar vertebrae. Reason why is that if you think of the spine simply as a power supply or mains box to the muscles. now if you go to mains in a house and turn it off, it doesnt matter how many times you turn light switch on/off, lights wont work and same thing happens in body.. if the quads are only getting 60% of overall out, yet the athlete continues to put the same demands on the quads as he normally does when 100%, then over time they will tire out… tired muscles become time/weak and then you start to get problems… so I tend to ensure that poewr supply to these areas are fully functionally while rehabbing them, cus if not, no point rehabbing a muscle if can only get to 60% power output…
just thought I’d throw a little of my knowledge in there and see what people think.. sorry if came out all confusing, have just been talking to myself and typing haha…
keep up good work guys, loving the debate!