VMO retraining or graduated loading programme for patellofemoral pain: different paradigm with similar results?

Our early research identified imbalance in vasti activation in people with patellofemoral pain (PFP) and that vasti retraining programmes could restore motor control and improve outcomes.1 2 For around a decade, many patients benefitted from this research and its translation into practice. However, it might be time to revisit this paradigm. Consistent evidence from cadaver and modelling studies confirm that imbalance in medial (vastus medialis obliquus (VMO)) and lateral (vastus lateralis (VL)) quadriceps’ forces affect patellofemoral stress (ie, if the medial vasti force is relatively lower, there will be greater lateral patellofemoral stress).3 The evidence supporting an imbalance in vasti motor control is less clear. Although VMO onset delay is evident in many people with PFP, it is not present in everyone with this condition.4 5 Additionally, we have no evidence that altered vasti onset timing changes the muscle forces, and we cannot measure patellofemoral force in vivo. While the clinical relevance of subtle medial vasti …