Question
Is the new research finding that the VMO is not as important as we once thought it was?
Answer
I agree with that, and the reason for that goes back to the question "Can you selectively strengthen the VMO?" Some people say you can, and some people say you can't. In the whole scheme of things, if you strengthen the quadriceps, people get better. If you look at it historically, the evidence says strengthen the quads, but make sure you do it in a pain-free manner. The beauty of going through Dr. Dye's theory of tissue homeostasis is that it just makes sense. [Dye SF. Therapeutic implications of a tissue homeostasis approach to patellofemoral pain. Sports Med Arthrosc Rev. 2001;9:306â 311.] If something is inflamed and you keep inflaming it, it's probably not going to get better. But if you can incrementally apply loads in an pain-free manner, then the tissue is going to be able to tolerate more.
There was an article that came out in 2002 that was called "Physical Stress Theory". [Mueller MJ, Maluf KS. Tissue Adaptation to Physical Stress: A Proposed "Physical Stress Theory" to Guide Physical Therapist Practice, Education, and Research. Phys Ther. 2002;82(4):383-403.] It really emulates what Dr. Dye says in that if you have an injured area and you give it no stress at all, that will lead to tissue death. If you give it too much stress, then that can lead to tissue death. If you have an injured area that you can incrementally stress, it will strengthen it so that it will continue to improve and will be able to handle the increased stress.
Again, it is thinking about how tissue responds and knowing the biomechanics of the tissue. It's about knowing "what do I need to do to make it respond favorably?"
