Knee subluxation and squatting

[Philbert]

Some of my favorite PT mythology. Weak VMO. Not to pick on Hunter, cause he's a good guy, but would someone please explain how one of the three vastus muscles in the quads gets weak while the others stay strong enough? Perhaps I just don't understand how their common insertion and innervation would permit this heinous abrogation of duty.

I'm not saying it happens, but if it does I am blaming half squats and machines. Per this anatomy paper, the distal vastus medialus is in fact separately innervated. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257075/

[Mark Rippetoe]

From the abstract:

Therefore, whereas the upper portion of the human vastus medialis muscle is closely aligned with the vastus intermedius, the lower third of the muscle has a richer innervation and also shows a distinct gross morphology that, among primates, may be unique to humans.

Interesting. The medial head may be more richly innervated, but is chronically weaker in a large percentage of the population that sees a Physical Therapist. Well, okay.

[tnumrych]

I've always been curious about this patella tracking diagnosis. This thread reminded me of a plausible explanation of why the tracking theory is BS I read when flipping through my Trail Guide to the Human Body (3 ed.) book one day some time ago. On page 302 the author states:

The angle of the femur, combined with the pull of the quadriceps, causes the patella to track laterally. This is prevented, however, in two way: First, the edge of the lateral condyle of the femur is elevated, forming a lateral wall, and secondly the distal fibers of vastus medialis are set at an angle, pulling the patella medially.

I am also discussing this with a friend of mine in his first year of PT school (he comes from a good strength training background, is a competitive powerlifter and soon Olympic, and he is a member on these here forums, so he takes the PT disseminated Kool-aid with a much-needed boulder of salt) who just finished his Gross Anatomy course. He says that the VMO is much bigger than people actually realize and that the lateral structures, lateral retinaculum and IT band, could be the culprit in the "mis-tracking" for lack of a better term. He prefaced this by making it clear he is a "green clinician" and that he's just theorizing for the sake of our discussion.

[Mark Rippetoe]

I have a question: How common is Patellar Tracking Syndrome actually, really and truly, vs. how commonly is it diagnosed by PTs et al?

[51M0n]

A PT dignosed me with Patellar Tracking Syndrome when I had knee pain when I first began lifting (before I discovered this site). Funny enough, my knees only got better after I stopped doing his crappy rehab excercises, brought some weightlifting shoes, wore some knee sleeves and learned to shove my knees out.

[tnumrych]

I have a question: How common is Patellar Tracking Syndrome actually, really and truly, vs. how commonly is it diagnosed by PTs et al?

I was diagnosed with it several years ago by an AT when I developed knee pain during a particularly heavy volume squat program (high bar, at the time I have not seen the light yet). I was told to do some pre and re-hab exercises. Continued squatting and the pain went away once the volume reduced.

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