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truthseeker -> Re: Static contraction training (November 4, 2005 6:14:00 PM)
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There has been evidence of many things. I believe it was in 1986 that Edward Grood wrote a paper on the biomechanics of the patelo-femoral joint. I wish I had the article here at home or had the time or inclination to look it up and cite it for you but I have neither. EMG studies show that the VMO is most active where all of the other quads are most active at or around 90 degrees. Physics tells us that the amount of force needed to generate open kinetic chain extension force in the last 30 degrees of extension is massive, and this occurs when the contact surfaces are the smallest. This vastly increases the compression between the patella and the femur which is exactly the reason they are in your office in the first place.
Jason, I respect your opinion, you always seem to have very reasoned, and well documented responses to posts on all types of opinions but I truly do not think that the evidence for open chain exercise is valid. It is reliable, yes, but not valid. Remember, at one point everybody was into isokinetics because it was a new gizmo and George Davies said that he could diagnose what type of meniscus tear you had by the shape of your curve. At one point, our profession massaged everything. At one point there was evidence of (forgive me for drama) the world being flat.
It seems to me that the body of valid evidence supports higher speed activity specific rehab for most orthopedic problems. I have followed this paradigm of rehab/exercise prescription and have really had outstanding success. Thinking of movement in functional terms rather than anatomical terms has shifted my view of what I learned in school and read today.
Much of the basic science of what we learned in school is valid, but how we decide to apply it is what makes us different from professions or professionals that do not re-examine the dogma of what was done before.
Example: When people are told to lift an object with two hands from the floor and know their therapist is watching, they think to themselves "keep my back straight and use my legs". These words are very true, however, what the person does is they keep their backs vertical and squat straight down with their knees in front of their toes. What they find is that they can't reach the ground to pick up the object without bending their backs which defeats the whole purpose. Further, their squat posture eliminates or nearly eliminates the contractions of the hamstrings and gluteals. Further still, their balance is poor.
I do inservices for lifting technique all of the time as do many of us in these posts and what people don't do is stick their butt out, keep their knees behind their toes, and maintain neutral in their spines.
The point of all of this is that we are taught to do things that made sense to us at the time, or perhaps we learned to do it because we wanted the good grade on the practical exam in PT school but we didn't process and think about if it was right.
Think about it, the best examples of physical performers are athletes, they all strike roughly the same pose (think linebacker, basketball player on defense, shortstop, volleyball player etc . . .) The best lifters in the world and perhaps more importantly the worst lifters in the world use the same technique. Grandma in the walker uses a squat like this to pick up the letter from the kids in the only way she can, butt back knees behind toes. 1 year olds pick up tootsie rolls the same way because if they don't do it the most efficient way possible, they can't get it done.
I may become famous for the rants I go on but we not only have to look at the current literature for interesting conclusions, but we also have to determine if it is valid for our patients AND if there are more logical ways to spend a finite amount of our time and our patient's time doing exercise. If we give them specific exercises that isolate each muscle so that they will have 1 full hour of exercise that we expect them to do, their next question will be "which ones are the most important?" which translates to "I am not going to do these. Give me something that I can spend a little time with and get the most benefit." I suggest that perhaps exercises that look like the target activity with regard to speed and angle are much more likely to give more rapid and more meaningful results if for no other reason that the patient will do them because they are familiar.
End of rant.
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