| The VMO, or vastus medialis obliquus, is the large | | | | contracting the quadriceps, as hard as you can, for |
| tear drop shaped thigh muscle, that lies just above | | | | six seconds. This is particularly important when you |
| and on the inner side of the kneecap, or patella. It is | | | | have a fresh injury, or in the first few days after |
| one of the four quadriceps muscles in the front of | | | | knee surgery. It adds strength, but without any |
| the thigh, but it is the only one that attaches directly | | | | movement of the joint. |
| to the inner (medial), upper margin of the patella. | | | | Similar in effect is straight leg raising. Lying on your |
| For this reason, it pulls inward on the kneecap and | | | | back, with the opposite leg bent up (to straighten |
| opposes the slightly outer (lateral) pull of the other | | | | your spine, and relieve stress across the lower back), |
| three muscles. The VMO is most active in the last 30 | | | | you tense your quads, and, while maintaining the |
| degrees of extension, meaning that it helps to lock | | | | contraction, then slowly raise the straight leg up, to |
| the knee out, fully straight. So, you can see that this | | | | about 45 degrees. Then, slowly lower it again. To |
| one muscle has a strong influence on both the | | | | start with, try for 3 sets of 15-20 repetitions. This, |
| kneecap and knee stability, as a consequence of its | | | | too, is an exercise that is very useful in the |
| anatomy. | | | | immediate aftermath of an injury, or surgery. |
| Pain behind the kneecap usually results from a direct | | | | Isotonic exercise is muscle contraction with |
| blow or a fall, or it may result from maltracking, | | | | shortening and what we normally think of as |
| meaning that the kneecap is pulled off its normal | | | | exercise, with overt movement of the joint. This |
| path, usually to the outside (lateral side), and often | | | | type of exercise can utilize the resistance of |
| because the VMO is weak and can't counteract the | | | | bodyweight only, or additional external resistance, like |
| pull of the other three quadriceps. Usually, this is | | | | free weights, or an exercise machine. |
| accompanied by tightening or contracture of the soft | | | | The simplest exercise is a quarter squat. With or |
| tissues on the outer side (lateral side) of the | | | | without weights, with your back against the wall, |
| kneecap, which makes it much harder to treat and | | | | simply squat down just a quarter of the way, |
| correct the problem. | | | | approximating about 30 degrees of knee flexion, |
| Some combination of these factors is usually involved | | | | then stand straight and tense the quads strongly. |
| in kneecap pain, which can also be accompanied by | | | | Even full range movements, like Full Squats or Hindu |
| instability, or giving way of the knee. Over time, | | | | Squats, can be converted to VMO strengthening |
| these factors can result in degenerative softening of | | | | exercises by that isometric tensing of the quads, |
| the cartilage under the kneecap, a disease called | | | | with the knee fully straight, with each repetition. |
| chondromalacia patellae. | | | | My personal favorite for working the VMO is the |
| The other major source of pain in the knee comes | | | | Hack Squat. In this exercise, you hold a barbell or |
| from within the joint, either from a twisting injury | | | | two dumbbells behind your knees and leaning |
| that may injure a meniscus, one of the cushions | | | | backward to put maximal stress on the VMO, do |
| within the joint, or a sprain of one of the ligaments, | | | | quarter squats. It's helpful to have a wooden block |
| or an effusion, or "water on the knee," which results | | | | under your heels to help with balance. |
| from inflammation of the lining membrane of the | | | | Machine exercises are also useful, but leg press |
| joint, the synovium. And, in the older population, | | | | machines are probably better for your knee than leg |
| degenerative arthritis within the joint is also a source | | | | extension machines, because the leg press loads your |
| of knee pain and instability. | | | | knee from above, and is more physiological (a "closed |
| In every case, strengthening the VMO is critical to | | | | chain" exercise). This is especially true if you have |
| relieving knee pain and restoring knee joint stability. | | | | kneecap disease, like chondromalacia patella, or |
| So, what exercises are best for doing that? Here | | | | patellofemoral arthritis. Here again, you can handle |
| again, we take our lead from the functional anatomy. | | | | very heavy weight eventually, because you're using it |
| Since the VMO muscle fully straightens the knee, and | | | | for a very short arc, just 30 degrees. |
| is most active in the last 30 degrees of extension, | | | | Whatever exercises you choose, you will begin to |
| we want to load the muscle within that range of | | | | notice an improvement in your pain and your stability |
| motion, to strengthen it. | | | | within about 10 days, and real improvement within 30 |
| Isometric exercises, technically defined as muscle | | | | days. As the VMO becomes stronger, your patella |
| contraction without shortening, those done with the | | | | tracking will improve and your knee will subjectively |
| knee fully straight, can increase VMO tone and | | | | feel more stable. Although this regimen can't cure |
| strengthen its tendinous attachments. For example, | | | | everything, it can go a long way toward making your |
| quad setting is done by tensing the straight leg, | | | | knees feel better and stronger. Give it a try. |