ADDuct for the ACL

Recently...attended a [student] seminar put on...........who could come up with the best rehab program for a complete ACL tear in a female basketball player . The three teams were to present on the specif surgery that would be done and how they would handle the case. One of the common themes amongst every one was the use of isometric hip adduction while performing dynamic squats. Essentially they recommended performing a squat while squeezing a ball between there legs.

This is very foolish and old school.1) The dated research that links ADDuctor isotonics to VMO cross-sectional area was 1) studied with open-chain movements, and 2) I believe was second to poor soft tissue quality in regards to binding of the ADDuctor Longus to the VM and VMO. That poor soft tissue quality is likely what led to the injury in the first place that warranted a belief for VMO attention.Keep in mind that the VMO is a player in PF stability, as all knee structures are, however, it's dysfunction is 100% reactive. A healthy neuromuscular system marked by centration never has a deficient VMO. Focusing on training it up is benign at best.  It is inhibited as a part of pain/injury/threat and recovery there of, while other muscles like the ADDuctors and RF become facilitated. Releasing or relieving the reasons for facilitated tone is the answer for restoring the VMO, not investigated local approaches. This does not work.The VMO is not the problem before injury, and it is not the problem after injury. It is just the expression to get you to stop hurting yourself.I mean is there anyone without an old school physical therapy or bodybuilding background that even still talks about the VMO?2) If you aggressively ADDuct with something in between your knees and feet apart, try to visualize where the femur and midfoot would "want" to go if you removed the ball or pillow. You are cranking into valgus collapse, but there is an illusion of alignment because of the ball in between the knees. This is just straight out dumb.We know in fact, we should probably be doing the opposite, banding the knees and demanding the valgus collapse be reacted to and met with femoral external rotation and mid-foot rotation.There are times in which activating the ADDuctors in an effort to prime the core to stabilize prior to a pattern is useful. This hopefully temporary use of a high threshold strategy is supported by the Superficial and Deep Front Lines of Thomas Myers' Anatomy Trains, mainly he Deep. The ADDuctors have concurrent neurological pathways through the fascia with many of the abdominals, so there is irradiation as a result.However, in a technique such as the Toe Touch Progression in the FM System, the feet are as close together as possible to create a bony block against pronation and further valgus collapse. This brief approach is also used sparingly, and is reloaded with glute activation as soon as the hip hinge is satisfactory.Maybe interested in pre- and post-VMO EMG with this................[youtube]https://www.youtube.com/watch?v=zEgnd3FV9zU[/youtube]3) Researching concurrent ADDuctor and glute medius activation is not interesting to me. It is typical contrarian nonsense to try to be a renegade and prove everybody wrong. Not everybody needs to be Galileo.More importantly than that, the laws of reciprocal inhibition will dominate such a study, and dumb people will look at the research and make some silly attempt to rekindle ADDuctor isotonics just because they are "dimmed" when the glute medius is heavily activated.  In fact, we would want the opposite.  Luckily, this notion hasn't really fallen into the hands of the Champions of the Stupid as much as some other things.Just make the move look right and have good underlying mobility and stability. Don't try to reinvent the wheel.  A centrated hip joint will have comparable muscle activation around all aspects of the joint.  A big EMG isn't always a good one.And how or why this equates to the VMO does not click to me.4) Squatting wide with toes out puts the ADDuctors into a better line of pull to be hip extenders and cover up for inhibited glutes. This may be desirable in unique static situations like powerlifting or some versions of KB swings. But this does not support the original idea of more ADD = more VMO.  In fact, it may support bigger glutes, which is really where the money is at in training after an ACL.To bottom line it, if the knee hurts, and the VMO is soft, leave it alone and use what you know to limit the pain. In the mean time, spare the knee with hip-dominant patterns and core work.  Obviously post-surgically, there is room for Russian NMES and standing TKE, but not much more than that as I see it.I think Coach Boyle wrote an article that ACL prevention, which is ACL rehab after the ACL is fixed), is just Good Training. I guess the students at the conference must have missed it.