I do know when I get someone to do a functional exercise like a squat, and just identify the “weak” points, and then figure out how to “train the movement”, have them do it and then everything falls into place. Like DK says, train the movement with controlled load along while training the neuromotor system, people get better and you usually find a reduction of pain. No sense with trying to isolate although open chain stuff have their place of course. Just keep it that simple. I guess I have learned over the years to do this thanks to Kelsey. Of course, always learning new and better ways.
My knees have been doing very well since starting Fusion and incorporating “on your feet” training.
I have no idea why a stronger VMO (relative to the other quad muscles) helps patellar tracking anyway. But if I wanted to focus on it, couldn’t I rotate my foot and hip in a way to lengthen that muscle more than the others, so that, while they may all be contracting together, I could put more strain on it during the contraction? Not that THAT sounds like a good idea at all 🙂
Omar –
The thinking is that because of the line of pull of the VMO (the vectors produced by the muscle fiber angulation), it would counter the lateral movement of the patella. But even if that were true, an isometric contraction performed in a non-weightbearing position would do little to counter the force experienced during something like a squat or stepping up a step.
Hi Doug,
Heidi Armstrong forwarded this to me. Thought I’d say hi. Love this article.
Last time I checked, we don’t walk or squat in isolated isometric movement patterns. Training a single muscle or muscle segment without training that muscle into the larger movement pattern is antiquated.
In my experience with many surgeons is they are very well trained in the structure, but not the movement. They fix structural problems. They are not movement specialists. Movement is outside of their realm of expertise. Which means that they should stay out of the movement therapy conversation entirely, unless they are also trained as movement therapists. Just like the rest of us, when it comes to something outside our realm of expertise… refer out.
I get so many clients with severe movement dysfunction post surgery, whose surgeon said “this is a simple recovery, you don’t need physical therapy;” or “just do some isometric leg extensions.” These are physical therapy protocols and should be provided by an experienced movement therapist.
Jesse James
Hello Jesse –
Thanks very much for your comments. From my view, removing the movement “threat”, which in most cases is pain, almost immediately changes a movement pattern but some ideology takes a very long time to change.
I’m glad that you emphasized multiple times the requirement of training on your feet. While there is a place for quad sets and similar base strengthening exercises, true function for most people includes being on their feet.
Not only is it impossible to isolate the VMO, but it’s counterproductive proprioceptively to train the VMO without considering what the rest of the body is doing during the exercise.
Thanks for continuing to teach me, DK!
Mike –
Thanks for reading and for your comments! Keep learning…it never ends 🙂
“I guess he hadn’t stopped to think it through.”
*This* is what separates you from the rest. And this is why I continue to follow you/your blogs through the years – I learn how to be a better thinker.
“Thinking it through” is a largely a lost skill, I have sadly realized. And “it” seems to be every field and vocation. Where have all the thinkers, creators, innovators gone?
Thanks Lacey for following my writing and also for your comments. I really appreciate it.