What do rugby guys and powerlifters do for anterior knee pain?

[fergus]

Good point about the Lumbar vertabrae and the shorting of the power supply as I have only heard is referred to when people are looking at hamstrings.
Interesting comment on the VMO and the suggestion that only 35% of people might have one, I never heard that before either.

[onspeed]

Drluke

are you sure on that figure regarding VMO? I know there is much in the literature suggesting termination position of VMO is hugely variable – but I have never come across any published papers suggesting that only 35% of the population have a VMO. Could you direct me to that lit please? I would greatly appreciate that!!

The 35% must be all sprinters- because I have yet to find a sprinter who doesnt show VMO!!

That aside – total agreement with you regarding the importance of lumbar region – from a practical perspective any lumbar impingment L1 through L5 produces subjective feelings of weakness and poor control across the quadriceps and almost cerrtainly some discoordinated firing patterns!

What is your take on the small pelvis – long femur early onset hip arthritis and labral tear risk? Most sprinters on x ray show early hip wear and tear and there is a larger than predicted occurence of labral injury … obvioulsy the force they are applying through the chain is high – although not as repetitive as endurance

[ashley]

Thanks Luke for your contribution to the forum it is wonderful to get a medical viewpoint and th einformation you have added to my knowledge bank is great, cheers, and feel free at all times to put your ideas forward, I would extend that to you all who are reading these pages as although we have some 75 active members so far only a few of you are writing, remember the only “dumb” is one you do not ask, and everyone then learns from everyone else, as I have said quoting someone else, “that after 30 years in this industry I am just starting to learn what questions to ask”, cheers, ash

[onspeed]

Ash

I couldnt agree with you more!!!

I have a few more gray hairs than you young fella – and have learnt more in the last few weeks off this forum and be challenged more in my own thinking than in the last few years!

The best questions are those simple ones because they can rock your world a little!

So please guys ask and post away

I have worked all around the world and this is potentially one of the best “communities” I have seen!!!!

[andy_mac]

Hi guys, thought I would add to this from my experience working in rehab in the British Military.

I deal with AKP on a daily basis and have found that around 80% have atrophy in the VMO on the side they c/o pain, compared to the ‘normal’ side. Also glute and hamstring weakness (weakness is being kind- lack of conditioning) is apparent in every case.

My main focus is on posterior chain work and getting the glutes and HS to work properly as well as the heavy 1/4 squats and Peterson steps- the latter is what really works well, especially when they have mastered the technique and add some weight.

We have looked at many factors like Leg length, flexibility, previous training etc, and the weak glutes, HS and reduced VMO have came up time and time again!

Sorry last one- it always seems to be in the early stage of military training; heavy load carrying at Week 8 no problems!!

Taping the patella can also be a big help too.

[onspeed]

hey andy

thanks for the insights mate!

Do you tape both above and below patellar or do you vary individually?

cheers mate

[drlukemccabe]

hey onspeed…

now you’re asking me a question lol… this is something I remember from studies as it came as quite a shock to me.. but dont forget that we are talking about the Vastus medialis oblique and not the bulk of the vastus medialis which your sprinters will all have… I did a quick google of VMO and the first this up I clicked on which was wikepedia… in here they said the following..

Some authorities maintain there is a separate aspect to the Vastus Medialis muscle – the “Vastus Medialis Obliquus”[1] or more commonly the “VMO”[2] which is reported to have a more oblique or horizontal orientation to the bulk of the remainder of the muscle thereby disposing it to be better able to ‘pull’ the patella medially. Unfortunately careful inspection of many cadavers reveals that the fibres of the Vastus Medialis are largely parallel and there is no significant separate aspect of the contractile fibres fitting this description which would suggest it is time to lay this clinical myth to rest.

The VMO in essence was always a really small oblique aspect of the VM muscle, which was supposed to add extra stability to the knee…

Im sorry for this rough and not so text book example, and to be honest Ive not even looked at its references and who its been done by, but leave it with me and I’ll get all my notes out and start searching again as this must have been about 7 years ago when I learnt this.. like I said, was one of those things where you go wow, hmmmm so why do people really go on about rehabilitation of the VMO is it doesnt solely exist on everyone…

anyway, I go on to much, hope this has helped..

thanks guys

Luke

[drlukemccabe]

ps: really agree with you Andy, there is only one way to learn.. and thats to pick other people’s brains!

have learnt so much from all your guys (esp in my rugby training regimes) in only about 2 weeks of being here, so everyone if you’re reading but too scared to say sometime dont be, just ask or input your knowledge, only through asking questions can we seek knowledge

cheers

Luke

[andy_mac]

Luke, interesting stuff there. In terms of rehabilitation of AKP or any injury I tend to rehab and plan the exercise on what I see in front of me; majority of cases VMO is a problem and I have always trained it hard. I wouldn’t like to leave it out to try and see if it would make a difference because I am potentially stopping someones career!

OnSpeed- taping is individual to the patient. I will often tape it in a ‘pain free’ position and then gradually reduce the pull as they progress.

My recent VMO deficient patient was a guy who split both his patellas playing football- awesome scars but now back to full fitness and carrying packs after a gruelling 23 weeks!!

[onspeed]

Good man Luke!

What I like about this forum is we are a community – so we can all share, question, debate and learn for each other

we need to encourage students of all ages :))) to participate

So Luke – if I understand you what you suggest is that the idea of VMO may be mor myth than reality!

Clearly we all have VM (!) but the VMO may simply have been some anatomical variation of VM present in the no doubt wide array of variaitons – that some smart anatomist probably Dr Vernard Michael Oden “ah maybe its a different muscle”???

That makes sense to me! I am yet to see an x-ray (or MRI) of an athlete that looks normal … if we worried about every anatomical variation…hahah

I am too scraed to get my brain scanned because I am sure the rsults woudl be depressing

if in passing you find the reference my friend that would be great but dont let your training time suffer looking for it :>>>> Train hard and well

andy thanks to for the taping feedback – it helps confirm what we do – whether its placebo or whether its real – we still get pain relief!!

thanks guys – love the posting and the discussion!!!

[ashley]

Guys, there is an extensive article on Anterior Knee Pain on the Elite FTS web site this week which is a good read as well,

http://www.elitefts.com:80/documents/knee_pain.htm

enjoy, ash

[molonyjim]

Just thought i’d add a little.

Poor ankle mobility as mentioned in the article posted by Ash is I believe a massive contributer. Has the athlete a history of ankle sprains and therefore compensating at the knee?

Articles written by Mick Boyle and Gray Cook are very useful. Shirley Sahrman also mentions poor ankle mobility as an issue.

Exercises are simple and could be done in a minute in the warm-up.

Just another thought.
Jim

[diehards]

I will also put my 2 cents worth in.

Rather than look at the glutes as a whole, there is some more research from Steve Saunders that is showing the value of strengthening the Quad Fem (and other deep hip lateral rotators) which stops the femur from internally rotating and also the posterior fibres of Glute Med which when under active cause increased pelvic obliquity or a Trendelenberg gait.

Both those 2 movements cause increased stress through the VL/ITB/Lat Ham which then increases force through patella.

Also look at feet – footwear/? need for orthotics

Really enjoying reading everybody’s input!!

[scottr99]

Hi everyone, first post for me, currently on the 7-day free trial.

I’ve enjoyed reading through the posts on this topic, as well as other information contained on this forum. Fantastic stuff and I am grateful.

Well my son is currently being treated for anterior knee pain with PRP, or platelet-rich-plasma, injections. There’s plenty on the net and even Youtube on this fairly new medical procedure for those interested in learning more. He’s already had 3 treatments and will be getting a forth in a few weeks. His pain was quite severe and debilitating before the treatments and since receiving them his pain appears to have reduced from about a “9/10” (when called upon for high intensity work) to about a “2/10”.

I hope this information is useful to someone.

Cheers to everyone.

-Scott

[fergus]

How old is he and does he suffer from any other conditions (e.g. Osgood’s)?

[Author]

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