A More Sophisticated Approach to Correcting Knee Dysfunction. Posted February 1, 2. Todays awesome guest post comes from Brent Brookbush, DPT, a physical therapist from New York who has an amazing resource for trainers and clinicians to learn more about anatomy, corrective exercises, and a bunch of other golden goodies. Plus, hes included a special offer but youll have to read the article to find it. By Brent Brookbush, DPT, PT, MS, PES, CES, CSCS, ACSM HFSPresident of the Brookbush Institute of Human Movement Science. Join Brent. Brookbush. Get Dean. Somerset. Discount Codes BelowIn my humble opinion, the knee is a victim joint. That is, the knee is rarely the source of dysfunction, but rather the unfortunate victim often painfully so of alterations in hip andor ankle motion. The knee is just the monkey in the middle. Vastus medialis obliquus VMO strengthening has been the go to intervention for improving knee pain, dysfunction and pathology, but I believe there is a growing number of human movement professionals PT, DC, ATC, LMT, CPT SC who have been disappointed with outcomes from this intervention alone. Further, many compelling arguments have been made regarding the practicality of VMO activation. For example, can we truly isolate the VMO from the other muscles of the quadricepsNumber 0172. Policy. Aetna considers systemic hyperbaric oxygen therapy HBOT medically necessary for any of the following conditions Acute air or gas embolism. Kilauea Mount Etna Mount Yasur Mount Nyiragongo and Nyamuragira Piton de la Fournaise Erta Ale. And, why would you squeeze a ball between your knees to activate the VMO when this may also increase functional knee valgus and contribute to further dysfunction By no means is this article meant to discourage human movement professionals from increasing quad strength, especially at the end range of extension. However, evidence is building for a more sophisticated approach to this issue, with the potential to optimize movement patterns throughout the lower extremity, increase performance, and decrease our risk of injury. Excessive Internal Rotation and Adduction of the Hip Studies examining individuals with patellofemoral pain syndrome, iliotibial band syndrome, ligament rupture, and even achilles tendinopathy, most often present with excessive hip internal rotation and adduction moments, commonly observed as knees bow in a. Functional Knee Valgus during functional tasks. Based on this research, there are multiple factors contributing to this excessive internal rotation and adduction, and MULTIPLE FACTORS IS A GOOD THING. Anytime you see multiple factors contributing to a dysfunction do not think WOW thats complicated, instead think look at all the potential issues I could address. More factors could mean more potential interventions, which could mean more opportunities for success. Some of this research suggests weakness, latent firing, and alterations in motor control of the gluteus maximus GMAX and gluteus medius GMED4, 7, 1. The eccentric function of the GMAX and GMED is eccentric deceleration of adduction and internal rotation, so, inhibition of these muscles should come as no surprise but, it is always nice to have a little research to back our logical assumptions. These findings are a huge plus for practical application, as we may not be able to do as much as we would like about VMO activation, but glute activation, we can handle that discussed below Some studies related to knee valgus also imply over activity of hip adductors. Again, this is a big win for practical application. Downside, these studies did not examine the over activity of hip internal rotators except for the adductors. This is surprising in the case of the tensor fasciae latae TFL, which is a strong and superficial internal rotator of the hip. Two studies have noted increased TFL size and activity in the presence of hip dysfunction. Although this is not direct evidence that TFL over activity contributes to knee dysfunction, this evidence may be worthy of assessing the TFL during practice. One area that needs further study is the effect of excessive internal rotation and adduction on arthrokinematics effects on glide and roll of the hip. It has been theorized that anterior glide of the femoral head may be part of a movement impairment syndrome. I know some trainers and strength coaches are wondering why I have headed down this path, but it is important that we have an understanding of arthrokinematics if we are going to mobilize joints a. Without research on arthrokinematics, do we really know which way to mobilize a joint With the introduction of self administered joint mobilizations into the fitness, strength and conditioning, and clinical realms we must be honest with our current knowledge and supportive of our researchers who may bring clarity and optimization to our interventions. I will make recommendations for hip mobilizations below, although at this point, I could not call my recommendations for hip mobilization evidence based, only found to be clinically effective. Example of Functional Knee Valgus Hip Internal Rotation AdductionThe Ankles Contribution to Knee Dysfunction Although, I believe that footankle complex dysfunction and the resultant motion of the tibia plays a large role in knee dysfunction, more evidence is needed. We do have a few references, with a few implications for practice. What They Don&Amp. The most indirect of those references is a study by Frannettovich et al. GMAX and GMED. As discussed above, the inhibition of the GMAX and GMED are also associated with knee dysfunction, potentially implying a link between achilles tendinopathy and future knee issues. Shank 1 Activation Serial Number' title='Shank 1 Activation Serial Number' />A biomechanical link between calcaneal pronationeversion and hip internal rotation has been noted by Souza et al. Powers et al. 15, the correlation between pronation and knee dysfunction was not found to be as strong as the correlation between knee dysfunction and hip internal rotation. The most direct evidence I have found relating footankle complex dysfunction to knee dysfunction is as study by Padua et al. The exciting implications of this study are actually demonstrated in a follow up study by this group, in which release and lengthening of the adductors, calves and peroneals, along with activation of the invertors of the ankle resulted in reduced knee valgus. Although none of these studies are directly correlated with knee pain, they are associated with a pattern of compensation commonly associated with knee dysfunction hip internal rotation and adduction. I think there is certainly enough evidence to warrant our attention in practice, and my prediction is more research linking the footankle to knee and hip impairment will be published in the near future. At the very least, these studies imply ankle mobility and activation of the invertors may improve lower extremity mechanics, adding a few more tools to our repertoire. A look at ankle kinematics http www. KinesiologyKINlowerFoot. Easy Keysi Game. Caracteristicas Del Programa Easy Diagram Software. STJclosed. Kinematics. A Little Icing on the Cake The Biceps Femoris The biceps femoris has been noted as over active in those with knee valgus. It is interesting to note that the short head of the biceps femoris flexion, external rotation and valgus force may be the functional antagonist of the VMO extension, internal rotation, and varus force. In a study by Hasegawa et al., stretching the biceps femoris actually increased the relative activity of the VMO1. Biceps femoris release and active stretching was included in a study mentioned previously that showed a reduction in knee valgus using selected exercise interventions.