CAT STAT: April 2024

Feb 6, I leaned to one knee - OMG-the warmth , the pain that eminated from behind the left knee cap- I thought for sure I broke a blood vessel. Literally lasted 5 minutes straight. Like no other pain- but mysteriously - there was no bruising- but one tiny vein seemed far more turquiose then all the rest- there was very little swelling but there was no denying that this weird sensation was linked to the knee cap and directly to the outside of the knee- behind the knee as well was pain- persistent until i put it up- I iced it etc - took half a prednisone and went to sleep . The next day I wore a sock for support- cut the toe and heel out- perfect support-like two weeks later, I went to see a vein Dr. ....nope my veins are draculicious- A week later I Went to the ortho- knee dr- duh- and sure enough my knee cap is gliding off track to the left by millimeters- he said it was "patellar femoral syndrome" when muscles are stronger on the outside and needed stregthening on the inside of the leg- I followed thru for once - PT and lowered a level at Pilates- doing much better- so the age thing- well whatever that is- I don't really want to acknowledge it- but its "there"- truly understand that repetitive movements in a revolving door type of exercise arena- what would one expect- however, if the teachers are trained to look for misalignment- some people don;t take well to instruction- I was raised on it- You got it from the ballet teachers wether you liked it or not. I look for it- I had no idea my brain was shutting off cause it already understood the misalignment was occuring so I began over compenstating and stopped enaging all of my quad Not just part of it. I am confused by the lack of connection I felt from the PT peoples- as well as some of the pilates teachers- I know they are just doing their job- but connection in the manner of a better explaination of the muscles and how they need to activate and how -I only thought of this after I read the article- but going into the whole experience back in Feb -Only now am I connecting the DOTS- because of my disiullusionment with still not feeling better- I am very good at slow- not just in my thinking - in my movement- in my waiting- in my ways- Turtle pace wins the race- the lack of understanding where exactly my knee was not acitivating- SO NOW I KNOW alittle bit better, I think, thanks to this ARTICLE THAT TRULY HELPED ME CONNECT THE DOTS! Pilates , ummm it sadens me to not be able to do the every day visit- but I am just not that person anymore and I rather keep going 3 times a week then not at all. But tell my spirit this- Truly feeling depressed- my spirit whispers to me- there are so many more things to do to keep fit beyond Club Pilates. But I love it so much. :( slow and steady is my pace. slow an steady keeps a smile upon my face. but the way I am such a shut in is a true disgrace. I do so love isolating in place - all around me- like a whale deep down in a watery space. MY dad had water on the knee all the time- the apple and the tree line. What is the VMO? The VMO or Vastus Medialis Oblique is part of the Vastus Medialis Muscle. There is debate among anatomists as to whether the VMO is an independent muscle or part of the Vastus Medialis. The Vastus Medialis is 1 of the 4 muscles that make up the Quadriceps. The quadriceps are the muscles in the front of the thigh that straighten the knee. The muscles come together at the quad tendon, which attaches to the patella or knee cap.

The 4 muscles that make up the Quadriceps are: Vastus Medialis Vastus Lateralis Vastus Intermedius Rectus Femoris Anatomical diagram of the VMO or vastus medialis oblique with arrows and labels to the components of the quadriceps VMO Anatomy The VMO is the lower part of the Vastus Medialis that runs in an oblique direction toward the knee cap.

What Happens When the VMO is Weak? Weakness or decreased activity of the VMO can lead to abnormal tracking of the patella at the knee. When the quadriceps fire properly and in the correct sequence, the patella is balanced in the middle of the groove where is sits at the end of the femur at the knee. This allows the knee cap to glide easily up and down as the knee straightens and bends. When the VMO is weak, the other quadriceps muscles pull the knee cap to the outside part of the groove. This can lead to rubbing and excess wear and tear of the joint surfaces in the outside or lateral patellofemoral joint region. What Makes the VMO Weak? The VMO gets weak when it does not activate as much. This tends to happen when there is pain or swelling in the knee. Swelling inside the knee joint capsule can cause the brain to stop normal muscle activation in the quadriceps. This can affect the order or sequence that the 4 muscles of the quadriceps contract or fire. This leads to weakness and atrophy of the VMO. How Do You Make the VMO strong? The VMO can become stronger with specific VMO strength exercises. It typically takes awareness and isometric exercises to activate it. Can You Isolate the VMO for Strength Training? This topic has had much debate, but It is not possible to isolate just the VMO. The brain also send a message to the rest of the muscles to contract. There are ways to make the VMO fire better and more efficiently when tightening the quadriceps. This includes: Manual Biofeedback - Place a finger on the VMO and try to make sure the muscle feels firm while contracting. Electrical Biofeedback - Electrical Biofeedback is a machine that detects the electrical activity in the muscle and allows the user to tighten harder to increase the signal detected. There are usually lights or sounds that respond the the muscle activity. Electrical Stimulation - Electrical Stimulation uses an electrical impulse to stimulate the muscle to contract. This is not a replacement for the normal self activated contraction but it provides sensory input to the brain to be more aware and efficient with VMO contractions. Will VMO Strength Exercises Fix Knee Pain? Increasing the activity of the VMO can help fix knee pain in many cases. The VMO can help to balance the position of the knee cap and normalize movement and mechanics in the knee. The VMO is not the only cause for lateral patellofemoral pain though. Other causes include: Excessive Knock-kneed position (Genu Valgum) Weakness in the Gluteus Medius IT Band Syndrome/Tightness Both of the these issue alter the normal mechanics of the patellofemoral joint and can contribute to knee pain and dysfunction. Image of a patient with a weak Left gluteus medius and Trendelenberg pattern or dropped pelvis on the RWeak Gluteus Medius Strengthening the Gluteus Medius can help to manage some types of knee pain. Click to learn how to learn the 4 Best Glute Home Exercises. VMO Strength Exercises VMO strength exercises are used with most knee physical therapy programs. The VMO is an important part of balancing movement of the knee cap. Most people with knee pain have some weakness in the VMO. But isolating the VMO for strength training is tough. Top 3 VMO Strength Exercises 1. Quad Sets - With the knee extended, contract the muscles in the front of the thigh as tightly as possible. Hold 10 seconds, 10 X. Image of quad contraction with label showing VMO with Quad set 2. Straight Leg Raises - Lying on your back with the leg straight and the opposite leg bent, tighten the thigh and lift the straight leg about 12 inches off the surface. Hold 3 seconds, repeat 10 x 2 sets. image of a man lying supine on elbows doing a right straight leg raise for vmo strength exercises 3. Squat - Stand near a support surface and slowly bend the hips and knee into a squat position. Make sure the quadriceps are tightened through the exercises. Keep the knees behind the toes and keep the knees apart. Do not push through pain. repeat 10 x for 2 sets. MAn performing a squat with proper technique with side view and labels showing knee position and back curvatureSquat (Side View) Read Here to learn more about Proper Squat Technique. The Quads Quadricep in Latin means 4 heads. The quads are 4 long muscles on the front of your leg that extend your knee. They all come together to form a common tendon that attaches and encompasses the knee cap (the patellar tendon). So if you have any pain in the front of your knee, or around your knee cap the culprit is probably a tight quad. Most sports overuse the quadriceps, particularly the lateral quadriceps. Running, dance, biking (if you aren't maintaining proper knee alignment pointing over the middle toe), and any high impact sports that involve the legs tend to overuse the lateral quadricep and underuse the medial quadricep. The exceptions are yoga, a good Pilates or Barre class (one that keeps the legs in parallel rather than in turn-out), swimming, ice skating, horseback riding. Knee pain, particularly lateral knee pain can be due to the imbalance of the lateral v. medial quadriceps. VMO: Vastus Medialis Obliquus New research shows that working the quadriceps as a group with the hip in proper alignment is more effective than focusing on the VMO in isolation. The medial quadricep is responsible for pulling the knee cap medially at the end range of knee extension. Because many sports use the legs without fully straightening the knee, the medial quadricep may become atrophied or underutilized and basically "turn off". VMO is an acronym for the vastus medialis obliquus which is the small oblique fibers of the medial quadricep that are right above the knee cap. These fibers are particularly responsible for pulling the knee cap medially at end range of extension and maintaining proper "patellar tracking". There are many medical terms for the imbalance of the quad group; patellar femoral syndrome, patellar tracking problems, etc. IT band syndrome is another diagnosis that also causes lateral knee pain (see below for more info about the IT band). All of these issues are due to the imbalance of the lateral and medial muscles of the knee. Releasing the lateral quad (and the IT Band) followed by strengthening the quads, allowing all 4 quads to fire in balance. The IT Band The iliotibial band emerges from the Tensor Fascia Lata (TFL) in the front of the hip and the gluteus maximus in the back. It forms a long, connective tissue band that acts as a lateral stabilizer of the knee and hip. When it becomes too tight and overused it can create inflammation and pain in the lateral knee. Thus "IT Band Syndrome". IT Band compensates for a Weak Gluteus Medius Often the root of IT Band overuse is that the IT Band compensates for a weak gluteus medius. The gluteus medius is also a lateral stabilizer of the hip and holds the pelvis level while standing one foot, (or walking). If the gluteus medius "turns off" the IT Band does the work of the gluteus medius, but over time the IT Band will shorten and get cranky from overuse. So part of the rehabilitation process should be strengthening the gluteus medius. There are many ways to do this, but I have chosen Single Leg Bridge since it mimics gait. When in Doubt, Roll it Out! The more tight it is the more it will hurt. Again, like childbirth, you need to look pain straight in the eye and go into it. It’s the only way out! Don't Cry Rolling out your IT band can be very painful. Use a soft roller (MELT roller). I prefer these rollers for myofascial release. Start by rolling slowly up and down the lateral thigh going all the way from the top of the hip to right above the knee joint. Never roll over a bone. Next, add "cross fiber" release by rolling your thigh side to side slowly as you roll up and down. You want to do a 3-dimensional release to get at the "web-like" structure of the fascia. If you can handle it, try also bending and straightening the knee while you roll up and down. This is a killer!

There are 3 main trigger points on the IT band. In Chinese medicine, this is Gall Bladder Channel or GB for short. You want to focus on GB 31, 32, and particularly GB 33 if you have lateral knee pain and IT Band Syndrome. GB 33 will be excruciating if you are suffering from IT Band overuse. But as they say, no pain no gain. If it doesn't hurt you haven't found the trigger point! Lateral and Patellar Knee Pain Strategy Release/Roll out your Quads, Roll out your IT Band Strengthen VMO and hamstrings. Exercises VMO End Range Knee Extension 1: Lie on your back with your knee over the roller, allowing the knee to be bent, heel on the floor. Straighten your leg, thinking of pulling the knee cap to the inside of your thigh. Flexing your foot can help. Repeat 10-20 times, twice a day. VMO Straight-Leg Raise in Turn-Out: Turn out leg and lift up a few inches, keeping knee straight. Repeat 10-20 times, twice a day. Footwork Sleeper (Side Lying Footwork) Single Leg Bridge on mat, reformer, yoga block combo Bridge with feet together Leg Springs first on thighs, on Reformer or Springboard/Cadillac in parallel (use ball between ankles) keeping knees soft, also work external rotation. Squats, Side Splits on Reformer with light spring/ heavy spring