VMO Strengthening/Activation Exercises (Necessary/Possible to Isolate the Vastus Medialis Obliquus?)
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- čas přidán 18. 05. 2024
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VMO Specific Strengthening/Activation - not possible or necessary for rehab, performance, or aesthetics!
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Intro (0:00)
Anatomy (0:12)
Patellofemoral Pain (1:28)
Performance/Aesthetics (3:57)
Takeaway (5:25)
___
Research:
pubmed.ncbi.nlm.nih.gov/32735...
pubmed.ncbi.nlm.nih.gov/19212...
pubmed.ncbi.nlm.nih.gov/19090...
pubmed.ncbi.nlm.nih.gov/24978...
pubmed.ncbi.nlm.nih.gov/21487...
pubmed.ncbi.nlm.nih.gov/19997...
pubmed.ncbi.nlm.nih.gov/28264...
pubmed.ncbi.nlm.nih.gov/28210...
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Disclaimer: The information presented is not intended as medical advice or to be a substitute for medical counseling but intended for entertainment purposes only. If you are experiencing pain, please seek the appropriate healthcare professional.
Thank you so much for watching! Check out our newest video on what to do for patellofemoral pain! czcams.com/video/K3HxB6rAeDo/video.html
Do you have the link to this study?
Please, do a separate video on patellofemoral pain syndrome! My knee just doesn‘t get better... :(
Well interesting topic and I’m trying to figure out a recent injury running to first base. I injured my lower quad area about 4 inches above the center of my kneecap. I’m not sure what muscle or tendon it is that made a light popping noise. Your thoughts would be appreciated? Thank you
valgus knee injuries, adductors, deep 6 muscles, rectus femoris please!
I believe you addressed VMO strengthening very professionally. Most of exercises advised are difficult to perform initially. Is there a routine you can start with and gradually increase range or strength?
Thank you in advance for your response
Oscar Diaz from Chicago
One problem with that advise is if you already have patella pain you physically cannot do any of those deep knee squats, weighted step ups or deep sissy squats. You have to start out at wherever your knees allow you to without pain. Which means less bend and shorter range.
agree
Try the Reverse Step ups with elevated heels.
czcams.com/users/shortsBzvbBrS3zOQ?feature=share
@@jojomunz4790 can you elaborate? I’m interested.
@@mamawelder I do them myself, mind you Im not native speaker.
Theres 3 versions of the reverse stepups. Basically its a unilateral stepping downward motion replicated specifically to target the VMO, meaning vastus medialis obliquus which is rarely well stimulated though crucial for healthy knees.
The most applicable and pragmatic way is doing it on any stairways available. One leg rests on the stair, toes pointed straight forward (no tibial rotation meaning toes to left or right).
The other leg is raised and flexed permanently, so that you train extention on the working leg as well as flexion on the passive leg.
Contract your glutes and extend your working knee (the one that you unilaterally stand on) until the flexed passive leg‘s heel touches the next lower step of the stairway.
Always keep your working knee over the 3th/4th toe meaning your toes/foot supinated.
This is the first progression.
4 sets per 10-15 reps, rest 2 min in between.
For the second progression you need some kind of wedge or shim which is shown in the linked video. ATG does sell very well factured ones.
The oerformance is the same except that now your extending knee’s foot rests on the wedge/shim so that your dorsiflexion exhibits a different angle, so that your knee inevitably goes way over your toes in a very very comfortable manner. Youll notice an insane activation of the vastus medialis if 1. you keep your knee over your 3/4th toes 2. Keep your glutes engaged all the time and your upper body as upright as possible (if you hinge you lose the activation of VMO immediately and your rectus femoris and vastus lateralis get targeted) 3. do the extension at least 3 seconds, slowly and always with an engaged core and breathing (long exhale 4-6 seconds, short inhale 1-2 seconds) and flexion 1 second.
A very useful location to orsctice this variation is a slope or hillslide so that you do not require this specific wedge or shim to apply under your foot.
The 3rd version is the hardest one cuz it targets your profound muscles which stabilize you against rotation and other lateral forces. You combine both progressions so that you
1. stand unilaterally and raise other leg
2. raise the calf muscles of your standing leg whilst extending the knee with an upright torso and flexed glutes
so that your heel is off the stair and your whole body weight rests on your forefoot
3. keep extending and balancing until your other flexed leg‘s heel touches the lower stair in front of you and immediately return to the basic stance.
This is the Poliquin (?) reverse stepup.
Terms might be messed up.
Man, you saved my life. I love your channel. God bless you! For real.
You guys provide some of the most insightful and professionally produced content on the Web! Thank you so much
Thank you!
You just stopped me right in my tracks of researching how to preferentially isolate and activate my VMO to combat tendonitis on the medial, posterior side of my knee. Thank you for the good work and you just earned a sub
what exercises are you doing in your rehab for knee pain?
nice. How are you doing now?
Did you have knee cap popping??
Now....get some specific exercises by watching the "knee over Toe guy", on UTube.
You're welcome!
Did you end up figuring out what was wrong with you knee? I stopped running 2 months ago because of some pain in my medial, posterior section of knee. Well I believe I have figured it out. Pes Anserine Tendinopathy. It is where three hamstring muscles connect over the pes Anserine Bursa in the knee. I have just started Romanian DL, laying down hamstring curls (light) and Bulgarian split squat and so far I think it is helping. Still a dull pain after going for a walk but I’m hoping to get back running soon.
I’d research Pes Anserine Tendons and see what comes up
@@tommyshebell2645are you back to running?
Absolutely love when you bust long-standing myths and gives us more-correct information (until that’s busted as newer-still research emerges). Thank you !
What a great video. You are conveying the message in a very efficient way. With the references you are using and displaying it's obvious that you have done your research, super solid content mate. Thank you for taking the time to do this. It feels like you got my back.
I have subscribed and will look through your other videos and look for tips on how to fix my lateral meniscus tear + anterolateral extra-articular ganglion cyst pain.
You are simply amazing and so underrated! Love you videos and thank you so much for your research and and efforts! This is what I am looking for! Keep up the great work and stay AWESOME!
The knees over toes guy does huge rage of motion in his exercises
Thank you for that concise and informative presentation! The best video on the subject I have seen backed by science.
EXCELLENT video! Thank you for putting work in and making this thorough.
OMG!Thank you so much I have been waiting for a video on this. Could send me the video on reverse NordicTrack, and quad strength building. Happy new years to you .
Great video. Ive been dealing with VMO problems for several years, and get the same opinion. Thank you
thanks a lot, your info is really great and your timestamp videos and overall comprehensive
Fantastic video. I really appreciate your evidence-based approach!
Progressive knee pain / limited ROM that seemed to be untreatable is now more functional (it’s better at 50 yrs than it was when I was 45!) with big muscle-group lifting. I appreciate your video confirming this!
Great. I got injured because of lifting. Feels like I could have been very healthy if I had never lifted
Was looking to strengthen VMO to prevent cramps after very active snowboard sessions. Thanks for all the advice.
I really like how this channel present information. I'm going to start doing reverse nordic after seeing your other video!👍
very informative. thank you! keep uploading you deserve a subscriber
Such excellent research based information!
Thanks for the knowledge
great video as always
Great content! Thank you!
Thank you for your video! Really helpful
Damn, such solid video! Lot of effort behind it. I'm glad I found your channel. Definetly gonna follow it for more EBM knowledge :) Thank You
As a long leg/short torso guy, i solved my knee pain by focusing more on quads like lunges, front squats, leg extensions, etc
What was your pain from?
@@Twistedbullsh1t basketball
@@slee2695 i should of been more specific. What was your injury?***
@@Twistedbullsh1t i dont think he had an injury. It was just wear and tear on the knees from having long levers and not properly compensating for it.
Love this video, huge help!
Thank you, this was a very helpful video!
Great presentation thank you.
Well done!
Thank you so much for the scientific research evidence on this topic.
I had an ACL surgery one year ago (pattelar tendon graft) and i am being unable to build my VMO - Phisioteraphy and gym are not showing expressive results on it.
As a skateboarder since a child i always had my left leg weaker than the right leg, even before ACL accident, so i think this might be even another reason for struggling to build VMO again, but i won't give up - thank you again for hte motivation !!
How is your knee? Have you strengthened your VMO ?
this was great, thank you
Great info! I’m a runner and have developed knee cap issues.
Would you recommend the same approach? (Bigger range of motion movements)
Great Post
great video!
AWESOME CHANNEL!
Will watch tomorrow
Excellent information but I’ve been diagnosed with condromalacia patella and my knees hurt with squatting and lunging not to mention adding weight , all the things I did up until the pain was unbearable and the MRI confirmed the damage of the cartilage behind the patella. The VMO strengthening exercises that my PT has recommended are working and I’m in less pain and better mobility
Amazing video.thanks
Trying to recover from a quad tendon re- rupture in my left leg. I did both at the same time 20 years ago, but had a small mountain bike accident a year ago ( tried to do. Wheelie ) and ended up rupturing the left one again. This time in having some patellar tracking issues. When doing lockouts with a band behind my knee, my patella " clunks " back over into its groove. It only happens if I lockout my knee and then start to bend. I do have alot of atrophy and I need to get this under control. Im about 10-15 degrees off from being able to fully extend my leg to 180 degrees. I could use all the help I can get, thanks.
I hope you do a video about " patella alta rehab"
I have no injuries. I just like these physical science breakdowns
Great content as always, guys.
Thanks, David!
@@E3Rehab CZcams says you need comments I'll give you comments!
Super physical therapist 😘😘
Hi! i am currently experiencing alot of pain around my left knee, especially when bent. I had stretched the inside ligaments 15 years ago and went for reconstructive surgery. i went for rehab and have always been pretty active post opp, doing everything at low impact. i have however jumped off rocks 2 weeks ago om a hike and now I am experiencing ligament and knee pain. should I be exercising or resting the knee completely? i thought to strengthen the muscles more in quads would support and eliminate pain
Hi, we have 4 muscles but do we also have 4 different quad tendons attached to the knee ? If so, what is known about them ?
TKE squats are also often prescribed to “bulletproof” the knees. I was curious if you had any opinions on that and whether training terminal knee extension in general is really as important as current theory suggests.
I'd be wary of anyone who claims that an exercise can "bulletproof" a joint (whatever that means). If you're recovering from an injury, training terminal knee extension might be helpful. Training terminal knee extension in isolation (like with a banded TKE) probably isn't all that important for most people.
Your studies may show one thing but I can confirm that wide stance leg press and pushing the knees outward during the contraction does preferentially target mine and others vastus medialis. Likewise, a narrow stance, with foot and knee turned slightly inward, preferentially targets my vastus lateralis.
I was very optimistic about your approach when I first discovered your channel! Citing papers and data is really helpful. However, I am NOT able to perform any of the exercises that you have demonstrated because of my knee issue! Where does that leave me??
Nice video doctor thanks🎇🗽
Great video... Got a wicked case of PFPS from cycling and was given a release VL/strengthen VMO protocol from my physio to no avail. One day I said screw it and went back to the gym and did full barbell squats, deadlifts, and the like legs day. Knee mechanics felt immediately better afterwards! Releasing and stretching the rectus femoris (couch stretch) and knee swings to circulate the fluid were a huge help also.
This is happening to me.. I have lateral patella tracking and my pt wants me to strengthen vmo and release tension from lateral muscles.. should I just start doing normal compound movements with good form?
@@joshhazel742I didn’t have any success with the “strengthen vmo, release VL” protocol. What helped me overcome this is 1. Avoiding triggers (mostly sitting for too long) 2. Knee swings sitting on edge of kitchen counter multiple times per day (100s per day) 3. Releasing the rectus femoris via barbell quad smash (roll it up and down) (foam rolling was too intense for me) and regular couch stretches for 2+ minutes 4. Looking for strength and flexibility imbalances up and down the chain (found I had a really tight outer hip on the problem knee side) Good luck 👍
@@joshhazel742 also, walking more (10k+ steps per day), consistent hydration, good nutrition, etc seemed to help
I tore my patella tendon over 2 years ago and the VMO’s atrophy has been a constant battle. Thanks for this video to stop me from just trying to isolate the VMO. Question I have no is, post surgery my patella is now higher. What can I do to get it to its original position. The pain from the pinch where the repair is tells my brain to deactivate my quad.
Any thoughts on how to accelerate building VMO mass after a TPF injury and VMO atrophy ?
Always good to see someone actually substantiate with research! Great advice
Thanks Dr 😊.
Actually I need it for kneecap problem . and my muscles are weak. So how many times should i repeat each exercise ?
Thanks.
This is all great except all of the strength building exercises you suggested hurt my knee ….. so where do I start? I’ve tried working through the pain and that only made things worse
I do find when I do super deep squats, heel elevated etc. I get an amazing pump right in my VMO teardrop area, so from experience I'd personally say its probably doing a better job of targeting my VMO.
Platz Squats are devastating for that purpose! Need to do more of those.
Me as well, for me it does target my VMO alot more with my heel elevated as I feel it burning.
Thanks
Hi there, nice video mate. Just wanna ask can leg Press (toe to toe) can target the VMO muscle in an efficient way? THANKS & KEEP IT UP
SUPER THANKS FROM PHILIPPINES 💕✌️🥰🇵🇭 for this video is this applicable for a stroke patient?
Hi E3. A few weeks ago I ran down a hill and immediately noticed some VMO pain in my right leg. Later that week I also noticed some knee pain when bending at the knee. I also have Ischial “sit bone” pain, so, unfortunately, I tend to avoid squats and movements that compress the ischial tuberosity at the moment until my rehab with that progresses. Anyway, until I get to the point where I can squat low without pain again, can my VMO rehab suffice with exercises like Sissy Squats and the Reverse Nordics?! Thanks for the great information.
thank you a lot
Great resource presentation and explanation ❤️, Subscribed 👍, a final year physiotherapy student from India ❤️.
Thank you!
Wow you researched the crap out of that. well done. Quick question - knees over toes program - what are your thoughts?
Love the video. What are your thoughts on the Sled Pull to strengthen the knees as popularised by Ben Patrick aka knees over toes guy?
Hello thankyou for this video, please how do i fix my muscle's when im bone on bone
great vid
This is great informative video. Thank you so much for sharing evidence based information🙏
Thank u so much for this v d o
super thanks from Philippines 🥰✌️💕🇵🇭 is this applicable for a stroke patient? i can put a strength in my knee but when im trying to make a normal straight leg its popping/buckling
I just didn't "feel" like what my PT was saying was true. Trying to do air squats with a ball between my legs or foot rotated out straight leg lifts. It didn't seem right for sports conditioning. Glad I could get educated today.
I like your videos shall I both legs? In 2018 Due to my acl ligament injury my right leg vmo is weak please advice me
Thanks for this video. I have constant pain and stiffness in my vmo . I do streching every time when I do the vmo strengthening exercises (intermediate) . Should I do icing for hot water bottle massage for the pain ?
But my fear is that when I do squats/lunges/steps, my knee makes a grinding/clicking noise. There’s no pain most of the time (sometimes on the inner knee), but I don’t want to make it worse. 😢
yh bro I can relate, its like you seem to know its getting better so you ignore the fact of doing squats etc... really bc of the fear it might start playing up again in the long run. I had a MRI scan they said there nothing wrong with my knee
@@tsepomarobani9085 my MRI was fine too but my knee still buckles and I feel my VMO is weak. How is your knee now?
@@user-fu5ib8no3b My doctor said my MRI results looked fine but I insisted on taking the images to a surgeon and found out there was an injury. If you haven't done so yet, I suggest taking it to a good orthopaedic surgeon. All the best.
@@laurarhodes7193 aw okay. My physio just said I can either see how time heals it or be referred for surgery because apparently the positioning of my knees is slightly out but I’m not really fussed on having surgery. I get a sharp pain in my medial/inner knee that comes after walking for a while but I kind of have given up now and I’m going to continue doing some strengthening exercises and hope for the best and that this pain will go away with time although it has been a year
@@user-fu5ib8no3b knees over toes guy on youtube might be able to help, he has a pretty good program too
Does imbalance or weakness in any one of those 3 quad muscles cause pain while extendening kne
Men/women and kids....start "walking backwards to strengthen the front or anterior chamber of the leg....the "shin" area....as related to walking and running over time.
I have mild Osteoarthritis on my right knee . I was advised all those exercises what u call low level .
Can I do running again if I perform the exercises recommend by u in this video ? Thanks in advance.
pls make video on supraspinatus tendinosis, can it heal with PT or is it chronic for life? i had my tendinosis in my supraspinatus because of falling on it in overhead position pls pls help
I work as an orthopedic PA. I noticed in most of the exercises your knees riding are over the toes, which is contrary to the form I've been taught. Now you have WAY more knowledge in rehab than I do for sure, so I'd just love your thoughts on that :) Thanks for your informative, evidence-based video!
That myth was based on 1 study in the 70’s and was debunked about 20 years ago. Scary you don’t know that as a PA
Hi, Kai. Thank you so much for approaching the topic in such a professional and respectful manner. It is okay for the knees to the pass the toes while squatting. If I'm really trying to emphasize loading the quads and/or patellofemoral joint complex, I'll actually encourage someone to drive their knees forward more. If someone has a symptomatic knee, temporarily reducing the amount of knee flexion is one strategy that may be helpful. Summary - yes, it's fine/normal. Depending on your goals, you may want more or less.
@@Mikebenson141 what myth?
That's a dumb myth.
@@Mikebenson141 what's even scarier that ure tryna sound smart without even linking ur source. Dude's a PA, not a Doctor or Physical Therapist ffs
Can you do a video about knee and elbow Hyperextension and how to fix it/if it’s even a bad thing when lifting?
never lockout your joints. keep constant tension on the muscle
Interesting that you cannot isolate the VMO, yet I noticed that I can flex my right quad and can feel my VMO defined yet on my left quad I don't seem to get the same "activation" or definition.
And of course my left knee is where I have the most pain due to patella not tracking properly. I wonder how that's possible.
I've been having a lot of issues pertaining to PFPS and I gotta say I'm lucky to have found you.
Hip tracking is most definitely important (helped me so far), so I'll keep everything you said in mind!
What did you do for hip tracking and how have you improved pfps
@@samuelgez I think you just helped my knees. Found that I had pelvic tilt. Toes didn't want to stay under my ankles when I lay on my stomach. The top of my pelvis was too far forward. Fix that. You may fix your knees.
@@samuelgez That might just be ur patella tracking through places it shouldnt be, placing excesive stress to femoral cartilage. No damage or signicant damage are usually show after sessions (just that popping and slight swell), but the cushioning may slowly wear out - and when thay process is advanced enough there comes pain. Ive also suffered myself from patellar maltracking (turned into severe chondromalacia patella overtime) and its hard usually hard to solve because of the many reasons that could be causing it. First, technique wise: make sure you are tracking ur knees properly over toes. Sounds obvious, but even the slightest deviation (to either varus or valgus) can become a problem when under repeated loading. No matter how wide ur stance is, aim to get knee over between 2nd to 3rd toe, pushing through lateral sole while keeping 1st toe on the floor. Film urself from the front of the foot to better see, since the upper perspective usually makes us think the path isnt where it really is (ur head is lateral to ur knees). If thats hard at ur usual depth, it may be because of some mobility decifiency: check ankle dorsiflexion, tibial rotations and hip rotations (total amount and simetrically-wise). If it didnt solve through limb alignment correction and find some weakness/ assumetry, work on what is deficient. If nothing works and specially if the click/pain is lateral, it may just be VMO weakness (tho ive found its not as common as the aforementioned reasons - yet most times mentioned as such cause its the "easy solution"). Best exercises to try to isolate it are terminal knee extensions, letting ur tibia to externally rotate in last 10° (open chain) or ur femur to internally rotate in last 30° (closed chain). Remember knee isnt a pure hinge joint and needs rotation to happen in order for the proper mechanics to take place on last extension degrees. If it keeps clicking on VMO exercises considering ur tracking upper and lower leg properly, its rather too weak or u cant activate it properly. Try regressing to an easier exercise (you can do that as pre-activation before harder ones or as main exercise). If that doesnt work neither, then electrical stimulation can be ur way until you can make the VMO strong/controllable enough to pull that patella medially. Care with overdoing the "weak side" correction, since pain and clicking can come if u go too far to the other side. Hope it helps to keep those knees healthy and let me know if ud like further explanation. Take care!
@@PPGC1998 thanks so much for the detailed response man i appreciate it, have you had success in rehabilitating your chondromalacia? if so what movements/ranges have helped you the most?
@@samuelgez in my case it was because of the foot, causing problems all the way up. I have structural (bone wise) relatively high arches, which increases pressure among tarsal joints and holds the arch passively (not much muscle action needed). That made me unable to separate tibiotalar and subtalar movements (tibial rotations and pronation-supination, respectively - ill get back to this later). Whenever i wanted to go deep squatting, i seeked for dorsiflexion, for which pronation is required. Since my foot werent used to need muscle arch control because bones did so, i usually overpronated and pivotted through my 1st metatarsal, loosing heel contact (or pushing most weight to the toes) and ending into tibial external rotation (toes out). I realized that because my toes always ended pointing wider than they started every set. Dorsiflexion and pronation are paired with tibial internal rotation, but i didnt have the coordination to separate those joint movements, neither the toe strength to control the arch from overpronating. Result: since foot were fixed on the ground, that tibial torsion pushed me into knee valgus many times, causing patellar lateralization and increased pressure cause hips were externally rotated trying to avoid the valgus - leading to chondral damage and pain over time. If i tried to internally rotate tibia to avoid knees collapsing, i was over supinating feet (remember i had anke joints stuck), leading to lateral stress and causing self-induced cuboid syndrome/dislocation. Moving on, since when in closed chain leg´s proper mechanics (walking, squatting) every tibial movement is paired with the opposite hip one (internal rotation from hip goes with external rotation from hip), my body adapted to not needing hip internal rotation and i relied - badly compensating - on excessive tibial external torsion during gait, showing up through duck feet (this also led to my knee pain and exacerbated the causes). I had to first adress feet (toe flexor strength for active arch control, tibiotalar and subtalar joint dissociation for proper tarsal mechanics, tibial internal rotation strength + integration of all those on dorsiflexion exercises). Then i had to get some hip internal rotation (IR) since my excessive tibial external rotation (ER) made me left that unused and not having this was making me rely on the dysfunctional tibial ER - the snake who eats its own tail (capsular mobilizations with bands into IR passively, active hip IR strength among all degrees of hip flexion and some external rotator stretches - on a side note, i personally found psoas stretching was quite useful, since i spend a lot of time sitting due to work and college, and it pulls pelvis into apt and promotes hip external rotation, both the opposite of what we want for working IR). Meanwhile, i tried to integrate all new unlocked degrees into daily tasks that i realized i did dysfuntionally: foot work on car pedals, gait, gym squat-like exercises... As for reps, sets and frequency: for control/ coordination drills you can do them every day, several times (as much frequency as possible since they are usually not performed to fatigue). Strength ones maybe 3 times a week is a good point since you wont really push them that close to failure and will mostly work on "feeling the muscles working" through high repetition sets focusing on form and not compensating. Nowadays (im 25) i can do every movement pain free (just some cracking from time to time) and am working towards pre-injury PRs, but had to do A LOT of "dirty work". I know that i may have irreversible chondral damage on that side knee due to wear and tear with my previous dysfunctional patterns and maybe will get some surgery in the future if pain arrives. But till that day i will enjoy doing what i do love the most which is beating my ass off, lifting heavy sturdy metal objects from the floor LOL. Jokes apart, hope something here helps and consider this is my case, which may be quite different to yours. I strongly suggest reaching to actual health care practitioners next to you, and wish u get better anytime soon. Any doubts, do not hesitate asking! Take care
Thank you for this information. Any chance of a video outlining what exercises you would recommend, based on current research, to resolve PFPS?
Yes, we will make a video on that eventually.
@@E3Rehab Great! I look forward to it.
@@E3Rehab Please man make that video.
@@E3Rehab Agreed. Please make that video. My understanding is it is the most common cause of knee pain and something I'm personally struggling with right now for the past year. Finally saw a physical therapist today and was not all that helpful as he only gave me a few stretching exercises that I have already been doing.
@@marcushunt2078 That might just be ur patella tracking through places it shouldnt be, placing excesive stress to femoral cartilage. No damage or signicant damage are usually show after sessions (just that popping and slight swell), but the cushioning may slowly wear out - and when thay process is advanced enough there comes pain. Ive also suffered myself from patellar maltracking (turned into severe chondromalacia patella overtime) and its hard usually hard to solve because of the many reasons that could be causing it. First, technique wise: make sure you are tracking ur knees properly over toes. Sounds obvious, but even the slightest deviation (to either varus or valgus) can become a problem when under repeated loading. No matter how wide ur stance is, aim to get knee over between 2nd to 3rd toe, pushing through lateral sole while keeping 1st toe on the floor. Film urself from the front of the foot to better see, since the upper perspective usually makes us think the path isnt where it really is (ur head is lateral to ur knees). If thats hard at ur usual depth, it may be because of some mobility decifiency: check ankle dorsiflexion, tibial rotations and hip rotations (total amount and simetrically-wise). If it didnt solve through limb alignment correction and find some weakness/ assumetry, work on what is deficient. If nothing works and specially if the click/pain is lateral, it may just be VMO weakness (tho ive found its not as common as the aforementioned reasons - yet most times mentioned as such cause its the "easy solution"). Best exercises to try to isolate it are terminal knee extensions, letting ur tibia to externally rotate in last 10° (open chain) or ur femur to internally rotate in last 30° (closed chain). Remember knee isnt a pure hinge joint and needs rotation to happen in order for the proper mechanics to take place on last extension degrees. If it keeps clicking on VMO exercises considering ur tracking upper and lower leg properly, its rather too weak or u cant activate it properly. Try regressing to an easier exercise (you can do that as pre-activation before harder ones or as main exercise). If that doesnt work neither, then electrical stimulation can be ur way until you can make the VMO strong/controllable enough to pull that patella medially. Care with overdoing the "weak side" correction, since pain and clicking can come if u go too far to the other side. Hope it helps to keep those knees healthy and let me know if ud like further explanation. Take care!
Does taping really not work? My patella has slipped over to the outside of my leg 3 times in my life - (once turning a weird way, second when a little dog ran into it and third when a lower cabinet handle caught it when I was turning). My knee started clicking/popping with every single squat and going downstairs - clicks on flexion and extension. I want to stop it before there’s real damage. Doesn’t taping help stop the clicking for many?
So what should we do if we have quad shutdown after injury/surgery? Quad exercises that don’t re-injure the knee?
I use NMES on VMO with ankle weight and last 15 degrees of leg extension to train VMO and keep it firing and strong. Works very well.
How do you know?
@@hcp0scratch Personal experience
That's what I thought. No value to a one person, non-scientific study.
@@hcp0scratch You're welcome!
I have been to two docs. One advise isolating the vmo and recommended exactly the same exercises you debunk. The other recommended stretching the outer thigh muscles as he felt they were too tight in relation to the vmo hence the propensity for the patella to mistrack.
I have noticed that whenever the patella mistracks often a minute or so of stretching the thigh muscles restores normal functioning until the next time.
I wonder now if there are three avenues to be explored for rehab...muscle strengthening, muscle stretching and proper neural firing.
Wld love to hear your thoughts. Ty.
You should have received the same info from each doc. The outer muscles being tight, those bands, does contribute to the tracking issues & interestingly, to much of the "knee" pain from runners knee. I find when my physio works on the bands, my knees loosen greatly. the foam roller is a good way to achieve that, shown in the video. However, as someone with a significant imbalance in those vmo muscles being so weak, plus knee pain, I can't even approach most of the exercises above. I think that the exercises he suggests as not useful, are very useful, if you have low to no conditioning or a big imbalance or bad pain. Then I would graduate to the others, cautiously and move up very slowly. I have almost no cartilege left under my knee and so it's a whole different ballgame. I think that advice should be qualified a bit, because we are not all starting with the same intact body parts, lol! Per the comment above, about biking, it's funny. I can bike with the seat up very high. But absolutely cannot if the seat is low. You need to get as much leg extension as possible. That takes a lot of pressure off the knee and works other important muscles. I will never run again, for sure. I hadn't in decades and soon as i tried, very cautiously, knee blew up like a balloon and the next 6 weeks were spent recovering and trying to get down stairs normally again.
They both are right, since most leg problems come from unproper alignment and/or muscle balance issues. First, if u feel u have to be stretching frequently, get ur daily posture in check, as well as ur lifting/exercising technique: thats not supposed to happen - stretching/massaging may help temporally until u solve the underlying causes (most commonly limb dinamic misalignment, mobility issues, muscle imbalance or a combination of them 3). One problem can reinforce the others, so you may have several aspects to check, but trust me its worth. I elaborate on next comment ⬇️
That might just be ur patella tracking through places it shouldnt be, placing excesive stress to femoral cartilage. No damage or signicant damage are usually show after sessions (just that popping and slight swell), but the cushioning may slowly wear out - and when thay process is advanced enough there comes pain. Ive also suffered myself from patellar maltracking (turned into severe chondromalacia patella overtime) and its hard usually hard to solve because of the many reasons that could be causing it. First, technique wise: make sure you are tracking ur knees properly over toes. Sounds obvious, but even the slightest deviation (to either varus or valgus) can become a problem when under repeated loading. No matter how wide ur stance is, aim to get knee over between 2nd to 3rd toe, pushing through lateral sole while keeping 1st toe on the floor. Film urself from the front of the foot to better see, since the upper perspective usually makes us think the path isnt where it really is (ur head is lateral to ur knees). If thats hard at ur usual depth, it may be because of some mobility decifiency: check ankle dorsiflexion, tibial rotations and hip rotations (total amount and simetrically-wise). If it didnt solve through limb alignment correction and find some weakness/ assumetry, work on what is deficient. If nothing works and specially if the click/pain is lateral, it may just be VMO weakness (tho ive found its not as common as the aforementioned reasons - yet most times mentioned as such cause its the "easy solution"). Best exercises to try to isolate it are terminal knee extensions, letting ur tibia to externally rotate in last 10° (open chain) or ur femur to internally rotate in last 30° (closed chain). Remember knee isnt a pure hinge joint and needs rotation to happen in order for the proper mechanics to take place on last extension degrees. If it keeps clicking on VMO exercises considering ur tracking upper and lower leg properly, its rather too weak or u cant activate it properly. Try regressing to an easier exercise (you can do that as pre-activation before harder ones or as main exercise). If that doesnt work neither, then electrical stimulation can be ur way until you can make the VMO strong/controllable enough to pull that patella medially. Care with overdoing the "weak side" correction, since pain and clicking can come if u go too far to the other side. Hope it helps to keep those knees healthy and let me know if ud like further explanation. Take care!
My ortho diagnosed me with patellar tracking disorder and recommended physio therapy. I have a crunching sound when bending my knee completely but no pain. I had an ACL surgery last year and found this crunching sound when I returned to the gym after 8 months. What should I do? I want to be able to lift weights in the gym again.
Awesome
Enjoyed the video, question for you. My patella suddenly started clicking, Ortho Doc said it wasn't tracking AND my knee cap is not straight on the leg that is not tracking (he says this is how I'm built) I'm 56 and mountain bike 3-4 days a week. Are you suggesting I train legs with heavy weights to correct the tracking? Thank you!!
Not necessarily. The video was stating that trying to pick specific exercises to improve tracking is not necessary. Instead, it's better to just focus on improving overall function (which is specific to the individual and task).
I have had patellofemoral syndrome for over a year after a slight tear of the quadriceps tendon. I was doing PT for ages but it wouldn't go away. I recently noticed that my VMO is very reluctant to fire on the affected leg vs the good one. I have been consciously concentrating on making it fire, when resting as well as when; active, and that is slowly working. It seems to be waking up.
Is it plausible that a very inactive VMO (rather than a weak one) could cause the problem. Or do you think it's irrelevant?
Thank you! If I have a little bit of dissipation of my medial meniscus due my partially torn ACL, its probably best I avoid knee heavy compressing exercises.. What would you recommended to get my vastus medialis big again? I've noticed the muscle has atrophied a little.. After doing knee rehab last summer and cycling a ton my vastus medialis was better and tighter which made the overall knee area more stable.. Any recommendations to tighten those muscles again (especially the vastus medialis)? Thanks!!
Just general quad strengthening.
Please make a video of recovering thigh atrophy after acl reconstruction
Have you found any good ones?
Will these exercises help get rid of the clicking with patellofemoral pain syndrome?
so for someone with a pelvic imbalance and miserable malalignment, should i just focus on large motor function exercises?
Any studies found on contractive NMS to assist in re-educating/strengthening a VMO?
Can a weak VMO/ quads in general put more pressure onto the patellar?
I’ve got one leg significantly weaker than the other and a tight feeling in the patellar on the weaker 🤞🏻
Toughts about different dominantnvastus activation during open/closed kinetic chain exercises?
So when you are below 90 degrees at the knee what muscle of the quad activates first! Say a catcher in baseball
I got pain on the inside of my knee and specifically the vmo i guess, and it hurts or get annoyed when I sprint and when i do a 20 min run im17 and im a soccer player any tips?