Back to Barbell Sports Rehabilitation and Performance

Back to Barbell Sports Rehabilitation and Performance Performance rehabilitation for athletes

Use NMES to overcome inhibition, recruit high threshold motor units, and mitigate atrophy. Complicated mechanisms cause ...
12/30/2025

Use NMES to overcome inhibition, recruit high threshold motor units, and mitigate atrophy.

Complicated mechanisms cause inhibition but the application of NMES is relatively simple.

Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. 2010 Dec;40(3):250-66. doi: 10.1016/j.semarthrit.2009.10.001. Epub 2009 Dec 2. PMID: 19954822.

Just wrapping up a day in the clinic and feeling incredibly fortunate to get to help people the way I do. Its a bit trit...
12/30/2025

Just wrapping up a day in the clinic and feeling incredibly fortunate to get to help people the way I do.

Its a bit trite to say, but injuries really are opportunities.

And one of the most important things we can do as a rehab professionals is to clearly communicate the opportunities there for the taking.

Combine that with hard, meaningful work built on sound understanding of training principles and the success will inevitably come.

The foremost reward is simply being a witness to and partner in the journey.

Occasionally though, we're rewarded with cool gifts.

Pictured: a must have for any self-respecting sports PT.

As little as 20mL of swelling has been shown to cause around 30% reduction in quadriceps force output in a healthy knee....
12/21/2025

As little as 20mL of swelling has been shown to cause around 30% reduction in quadriceps force output in a healthy knee.

After injury (or surgery) swelling is significant.

Eliminate swelling by promoting active motion and controlled stress.

Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. 2010 Dec;40(3):250-66. doi: 10.1016/j.semarthrit.2009.10.001. Epub 2009 Dec 2. PMID: 19954822.

Swelling, inhibition, joint instability, sensory nerve ending injury and joint injury in general causes athrogenic muscl...
12/21/2025

Swelling, inhibition, joint instability, sensory nerve ending injury and joint injury in general causes athrogenic muscle inhibition.

This interferes with muscle activation. Less activation mak a it harder to rebuild muscle and strength of the quad and, importantly, the stuff attached to it (quad tendon, patella, patellar tendon).

NMES bypasses this process and directly activates the muscle.

If you get over the discomfort from the strong muscle contraction that it causes, it usually helps the knee feel better too.

Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. 2010 Dec;40(3):250-66. doi: 10.1016/j.semarthrit.2009.10.001. Epub 2009 Dec 2. PMID: 19954822

Injuries can be devastating.But if you show up, work hard, and have someone in your corner to help you guide you through...
10/03/2025

Injuries can be devastating.

But if you show up, work hard, and have someone in your corner to help you guide you through the ups and downs you may be surprised at what you can achieve.

Happy PR Friday to all who celebrate.

Thoughs on dealing with uncertainty as conveyed by words and memes.
09/24/2025

Thoughs on dealing with uncertainty as conveyed by words and memes.

Them - "You can't isolate the VMO" Me - "Hold my Chattanooga Continuum" Somewhere along the way, well intentioned argume...
07/17/2025

Them - "You can't isolate the VMO"

Me - "Hold my Chattanooga Continuum"

Somewhere along the way, well intentioned arguments against the need to isolate the VMO as a necessary strategy for overcoming patellofemoral pain became overgeneralized.

Multiple things can be true at once:

1. We may not be able to significantly isolate the VMO with purported "VMO" exercises.

2. VMO isolation is not be necessary to address knee pain.

3. Quadriceps atrophy is non-selective.

4. NMES can preferentially bias the VMO.

If you doubt this is the case, just put NMES pads preferentially on the medial quad and you will see/feel a much stronger contraction of the medial quadriceps compared to the lateral quadriceps.

That said, "Why in the world you would do that?" is a totally legitimate question. But it's a different question entirely.

Honestly, idk where I was going with this aside from wanting to make a meme.

Don't just zap the VMO, zap the whole quad for maximum rehab gainz

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