Thanks for your comments. Yes, the research on firing patterns with the VMO does suggest that there is a disturbance or a delay in the firing of the VMO compared to the VL in people with PFPS. I've not seen any research that shows the VMO atrophies more or sooner than the other quadriceps muscles but because of the VMO location, it appears to atrophy more. The innervation is supplied by a branch of the femoral nerve and since strength is a function of fiber recruitment and the VMO cannot be recruited separately from the remaining quadriceps, what is needed is overall strengthening of the quads which will then improve the VMO function.

Thanks for taking time to comment and share the link on mechanics and emotions...makes complete sense. Your question about how to improve movement with weak joints (cartilage) is a common one and something we deal with frequently. I'll post something soon about that. Several other people have had a similar question recently.

Thanks Missy for making the effort to visit us. I hope what we delivered was helpful to you and your daughter. Clearly, video is an important thing to people and thank you for sharing your views.

Thanks for the note Ben. I understand the issue and your point. I'll consider it and look into it. Thanks for reading the View...I hope at least the content even without video is helpful to you.

Doug, I would like to offer you my and my husband's professional experience in this case. I am an orthopedic based physical therapist and have practiced for 18 years in Houston Texas. My husband is an orthopedic surgeon and has performed the partial knee replacement on several select patients. I say select because the uni/partial/arthrosurface is for patients with specific issues. The partial knee replacement or Arthrosurface (brand name) does not require a high tibial osteotomy because it replaces the space lost from the meniscal removal. In patients with isolated unicompartment disease this is a perfect solution to buy some function and time. It may not prevent a total knee down the road but the road is definitely made longer. I have rehabilitated several and you are right, they do rehab similar to a total knee but a little faster, with less pain and a little better motion. My husband stated he would not recommend anything but this for this patient given the information presented. A meniscal allograft will not do well even in the combination of a high tibial osteotomy if the lateral femoral condyle had Grade IV changes in the articular surface with a patient this size. High Tibial osteotomies are best done in patient's with early deformity and early pain. Not advanced disease. Weight reduction is key no matter which way this patient goes. My choice is the partial knee replacement as long as his grade III to IV disease is isolated to the lateral compartment. Still a good choice for mild patella chondro if he has it. Kim Wright, PT, ATC James E. Butler, MD

Good for you Tom! Glad to hear you're doing well....stay healthy.

Hi Sloan - Did you mean Flexor Hallucis Longus perhaps? With pain on the ball of your foot that seems to make sense as opposed to the extensor which is on top of your foot. I would have someone check your motion at the Great Toe (for extension) and the general mobility of your forefoot. Sometimes a lack of motion can create the pain.

Marshall - Great question...thanks for asking it. I use the low load, high volume squats primarily as a means to rebuild strength in weak joints. But, in people who have rebuilt their strength and now tolerate above body weight loads, I also will rotate low load, high volume squats into a regimen, often once every 2 to 3 weeks, to help maintain joint integrity and to stress the system in a different way than running or jumping or cycling does. Usually the loads are somewhat higher than 20 or 30% of bodyweight. It just depends on the person and their load tolerances. Something else I urge people to consider is the mechanics of the squat. While a Total Gym provides nice control over the load into the leg, the angles of the hips and knees are not ideal (the trunk is flat on the board instead of angled up a bit) and with higher volume, small deviations in flexibility can translate into a lot of force delivered through the fascial network. So, just make sure you have adequate flexibility in the ankles, hips, and lower back. If you're not symptomatic then you may not require the low load, high volume work because your joint surfaces are sturdy. I would pursue as much symmetry as is possible in the biomechanical realm, include lower impact drills (cycling, swimming, etc.) on a regular basis to improve blood flow and nutrient exchange and load your legs through the primary movement planes (flexion-extension, rotation, sidebending). Basically, load and move your joint through it's available range with consistent inconsistency - mix it up. Here's an article I wrote on this subject with more detail that might be helpful. http://sportscenteraustin.blogs.com/the_view/2009/01/joint-protective-exercise.html

Daun - Not sure if this is what you're looking for or not: http://tomdufresne.com/radio/pubdoc.html I didn't study the drill set. I'll put that in my action list and when I have something, I'll post it.

Maybe this will help.... http://en.wikipedia.org/wiki/Rectus_femoris_muscle

HI Giovanni - Thank you for your comments and opinions. Here are my thoughts. In a voluntary muscle contraction, the muscle contracts when the nerve supplying that muscle causes an action potential. In the case of the quadriceps, all four heads are supplied by one nerve - the femoral nerve. This is why you cannot create a voluntary muscle contraction of any one of the quadriceps muscles by itself. When the nerve creates an action potential, the muscle contracts and since there is only one nerve, all of the heads of the quadriceps will contract. In the case of an involuntary muscle contraction produced by electrical stimulation, the stimulus bypasses the central nervous system and creates an action potential in the muscle that is supplied by the nerve or nerves being stimulated. So, you can, by adjusting the intensity of the current, force the VMO to contract by creating an action potential in the VMO branch of the femoral nerve with little overflow to the other muscles but if you turn the intensity up high enough, the entire quadriceps will contract.

Thank you Lynn...your suggestions were great and a nice little nudge too. Gotta' go play now :)

Thank you Lynn...your suggestions were great and a nice little nudge too. Gotta' go play now :)

Right on Ken.... It's very much a "blue pill" mind set that we must overcome. But this seems to me to be the same kind of problem environmental groups faced and it wasn't until the word "green" became accepted as standing for something for the greater good that ideas like reducing emissions, paying attention to energy utilization, etc. gained some traction. Green is now a verb. I think we need a verb; a word to focus on; to mobilize people. Maybe we need to go "clean" and "green". DK

Right on Ken.... It's very much a "blue pill" mind set that we must overcome. But this seems to me to be the same kind of problem environmental groups faced and it wasn't until the word "green" became accepted as standing for something for the greater good that ideas like reducing emissions, paying attention to energy utilization, etc. gained some traction. Green is now a verb. I think we need a verb; a word to focus on; to mobilize people. Maybe we need to go "clean" and "green". DK

Thanks Ken - PRP is a good point and an alternative too few people know or understand. Appreciate the vote too! DK

Thanks Ken - PRP is a good point and an alternative too few people know or understand. Appreciate the vote too! DK