There remains controversy over whether the vastus medialis can be divided in to vastus medialis longus and vastus medialis obliquus (VMO) (Smith et al 2008). Nonetheless in rehabilitation we frequently attempt to bias our strengthening exercises towards the medial portion of the quadriceps over the lateral, with mixed success.
Research in to exercises for the vastus medialis has in general been disappointing. For example, Kushion et al (2012) found that altering the foot position from neutral to external rotation had no effect on vastus lateralis to vastus medialis ratio in straight leg raise or knee extension in supine. As you would expect knee extension outperformed the straight leg raise in activation of the vastus lateralis and vastus medialis.
My practice has progressed over the years and I have collected a number exercise that can be used which i have listed below in progressing order of effect based on clinical experience.
Whilst a corrective exercise specialist back in 2004 I would frequently use squats with greater than 90 degrees knee flexion to activate the VMO as suggested by Charles Poliquin.
Doing orthopaedic rehabilitation placements in the National Health Service in 2007 as part of my physiotherapy degree I was instructed to use terminal knee extensions to fire the VMO. Where you press the back of the knee down in to the towel.
In 2009 as part of my CHEK pracitioner level 2 course I was introduced to the modified lunge by Mark Buckley. In this version of the static lunge you palpate the VMO and pulse up and down in the range you can feel the VMO fire.
Later in 2012, Guy Voyer taught me his VMO exercise as part of his soma training diploma. Which is incredibly effective.
In 2013 I was introduced to the oblique half sit taken from infant development by Pavel Kolar as part of his dynamic neuromuscular training course. You start in the lunge position with your hips 120 degrees open, from here you rotate back on the back leg and load the VMO of the weight bearing knee.
Later in 2013 I found progressing Guy Voyer’s VMO exercise to side lying produced better activation. This has not been measured by EMG but is just from consistent reports from patients.
In practice now I use a different exercise depending on the patient.
Hopefully this gives you some ideas of exercises biased towards the VMO. Give them a try and see which you find most effective. If you have any exercises you find effective please share them!
If you have any questions feel free to email me on kieran@kieranmacphail.com or comment below.
References
Kushion, D., Rheaume, J., Kopchitz, K., Glass, S., Alderink, G., & Jinn, J. H. (2012). EMG Activation of the Vastus Medialis Oblique and Vastus Lateralis During Four Rehabilitative Exercises.
Smith, T. O., Bowyer, D., Dixon, J., Stephenson, R., Chester, R., & Donell, S. T. (2008). Can vastus medialis oblique be preferentially activated? A systematic review of electromyographic studies. Physiotherapy theory and practice, 25(2), 69-98.
Tags: vastus medialis obliquus, vastus medialis obliquus exercises, VMO, VMO exercise, VMO exercise pictures
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