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  1. sazahko is offline

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    Posted On:
    4/08/2013 10:27am


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    Quote Originally Posted by blackmonk View Post
    There were a series of studies in one of the SCJournals from the NSCA a few years ago. I have the print copies, but would have to do some internet research to see if the abstract is online somewhere.

    The usual VM exercise for rehab purposes is doing wall squats with a swiss ball in the small of your back, while squeezing a medicine ball between your knees.
    Interesting. If it's not too much trouble, I might be able to use the citation to find it through my university's connections, since I'm pretty sure we have access to most of the NSCA's publications.

    Right, I've seen that application clinically, but wasn't sure whether there was much research aside from anecdotal reports to support the efficacy of such an approach.

    Quote Originally Posted by TheRuss
    Gastrocnemius and plantaris, sure, but the glutes don't come anywhere near the knee; the hamstring muscles, on the other hand, do cross the knee joint (or at least their tendons do). Was that what you meant?
    Anatomically, you're right - they have nothing to do with each other. Biomechanically, the glutes play a huge role in supporting the knee; blackmonk mentioned their role in deceleration specifically, and they're heavily involved any time you're standing on one leg (walking, running, etc.), since gravity would normally pull your knee in towards the midline, and your glutes help to fight that.

    -Sazzy
  2. TheRuss is offline
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    Posted On:
    4/08/2013 11:31am

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    What source does the NSCA cite for reduced gluteal strength being a contributing factor to knee injury in athletes?
    Quote Originally Posted by Emevas View Post
    Downstreet on the flip-flop, timepants.
  3. Omega Supreme is offline

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    Posted On:
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    You guys need your own thread.
  4. jnp is offline
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    Posted On:
    4/08/2013 1:39pm

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    Removed from: http://www.bullshido.net/forums/showthread.php?t=120092

    Quote Originally Posted by Omega Supreme View Post
    You guys need your own thread.
    Done.
  5. Omega Supreme is offline

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    Posted On:
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    This is some great stuff guys keep going.
  6. ChenPengFi is online now
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    Posted On:
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    Quote Originally Posted by TheRuss View Post
    What source does the NSCA cite for reduced gluteal strength being a contributing factor to knee injury in athletes?
    Are you skeptical of, or just unfamiliar with, the concept?
    Just curious because i thought that was a pretty commonly accepted line of thinking.
  7. elipson is offline
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    Posted On:
    4/08/2013 3:47pm

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    Awesome thread.

    I'm currently trying to rehab my knee from I'm pretty sure is my patella femoral syndrome acting up. While having zero background in sports physio, my simple research has shown that there is pretty strong debate for the causes of general knee pain like PFS. One side says its related to poor glute function, while the other side blames the Vastus Medialis.

    I've just compromised by trying to work both extensively, but I've also found conflicting opinions on how to work the VM. One side says things like wide stance squats and walls squats, like described in this thread, while other sources try to say those are a waste of time and that unilateral exercises are better at activating the VM.

    Just putting this all out here to see what the educated opinions are on the subject.
  8. Gypsy Jazz is offline
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    Posted On:
    4/08/2013 5:09pm


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    Quote Originally Posted by elipson View Post
    Awesome thread.

    I'm currently trying to rehab my knee from I'm pretty sure is my patella femoral syndrome acting up. While having zero background in sports physio, my simple research has shown that there is pretty strong debate for the causes of general knee pain like PFS. One side says its related to poor glute function, while the other side blames the Vastus Medialis.

    I've just compromised by trying to work both extensively, but I've also found conflicting opinions on how to work the VM. One side says things like wide stance squats and walls squats, like described in this thread, while other sources try to say those are a waste of time and that unilateral exercises are better at activating the VM.

    Just putting this all out here to see what the educated opinions are on the subject.
    Disclaimer: I am not a physio, but this stuff is of great interest to me.

    Let's be very clear that pain and injury are very different things. When speaking of knee pain, weakness in any muscle group can't be accurately described as the cause of the pain. You may notice a correlation, although such correlations are up for debate between camps as mentioned. It is equally (or more) plausible that muscle function is inhibited as a defensive mechanism to protect against perceived threat.

    As for injury prevention, most of what we have on most things is hearsay, but ACL stuff is actually starting to add up. Take a look at some of the commonalities between the programs cited in this review: http://smrlunc.wordpress.com/2012/04...ining-program/ Single leg stance, low level plyometrics, and overall lower body and trunk strength and awareness are the big guys in the pool.

    Lastly, the assumption made by the both crowds is that valgus forces on the knee (flexion, internal rotation, adduction) are going to be controlled by their favorite muscles of the week. It makes sense to care about what muscles prevent those actions, but as a practical matter, why not just do things that challenge that position and leave the muscles to the research crowd?
  9. PsychoMongoose is offline
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    Posted On:
    4/08/2013 6:06pm


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    Quote Originally Posted by elipson View Post
    pretty strong debate for the causes of general knee pain like PFS. One side says its related to poor glute function, while the other side blames the Vastus Medialis.

    Just putting this all out here to see what the educated opinions are on the subject.
    Speaking as a qualified, if junior physiotherapist, with no particular specialist knowledge of PFS...

    The reductionist approach of trying to classify PFS as being caused by a single factor is unlikely to hold water. There are a range of identified and speculated risk factors that contribute towards PFS and the likely truth of the matter is that all off them have a role. A decent physiotherapist will assess and clinically reason which are likely to be the contributing factors on a PER PATIENT basis.

    According to Brukner and Kahn (Clinical Sports Medicine 4th ed 2012) risk factors include: increased femoral internal rotation, increased knee valgus, subtalar pronation, decreased muscle flexibility, patella position/tracking, soft tissue contributions and neuromuscular control of the vasti muscle complex. Treatment options that are supported by clinical trials or meta analyses include patella taping, foot orthoses, hip muscle re-training, strengthening exercises, mobilisations and accupuncture.

    Again, the precise contribution of any particular treatment option will depend on the particular patient, the contributing risk factors and the like.

    With regards to the role of the glutes in PFS. The theory goes that a decrease in the strength/control of the external rotators and abductors of the femur leads to an increase in internal rotation and adduction. This alters the angle of the knee, increasing knee valgus, when the foot is planted during high-force postural activity, like single-leg squats and balancing and the like, which is a risk factor in developing PFS. It should be noted that you can get a similar effect by increasing subtalar pronation i.e. if your ankle has a tendency to collapse in during standing.
  10. sazahko is offline

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    Posted On:
    4/08/2013 6:35pm


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    Quote Originally Posted by PsychoMongoose View Post
    Speaking as a qualified, if junior physiotherapist, with no particular specialist knowledge of PFS...

    The reductionist approach of trying to classify PFS as being caused by a single factor is unlikely to hold water. There are a range of identified and speculated risk factors that contribute towards PFS and the likely truth of the matter is that all off them have a role. A decent physiotherapist will assess and clinically reason which are likely to be the contributing factors on a PER PATIENT basis.

    According to Brukner and Kahn (Clinical Sports Medicine 4th ed 2012) risk factors include: increased femoral internal rotation, increased knee valgus, subtalar pronation, decreased muscle flexibility, patella position/tracking, soft tissue contributions and neuromuscular control of the vasti muscle complex. Treatment options that are supported by clinical trials or meta analyses include patella taping, foot orthoses, hip muscle re-training, strengthening exercises, mobilisations and accupuncture.

    Again, the precise contribution of any particular treatment option will depend on the particular patient, the contributing risk factors and the like.

    With regards to the role of the glutes in PFS. The theory goes that a decrease in the strength/control of the external rotators and abductors of the femur leads to an increase in internal rotation and adduction. This alters the angle of the knee, increasing knee valgus, when the foot is planted during high-force postural activity, like single-leg squats and balancing and the like, which is a risk factor in developing PFS. It should be noted that you can get a similar effect by increasing subtalar pronation i.e. if your ankle has a tendency to collapse in during standing.
    ^This, all the freakin' way. Physio's unite!

    I actually went to a lecture at the Combined Sections Meeting of the American Physical Therapy Association in January on "The Butt vs. Foot Bias" in treating PFS. One presenter put forth evidence, etc. from either camp. You can attack the problem from either end (orthotics and strengthening to address excessive subtalar pronation + strengthening to address abduction/external rotation weakness at the hip), and both have research and clinical success to back them up.

    As for VM/VL in PFS, the imbalance question is still definitely up for debate, as is selectively targeting/firing VM. All the physio's I've talked to have one guaranteed way to strengthen VM: Just strengthen your quads, and work on controlled functional movement.

    -Sazzy
    Last edited by sazahko; 4/08/2013 6:39pm at .
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