In several years of my practice, I have had patients come in with chronic knee pain.  Whether the diagnosis is patellafemoral  pain syndrome, chrondomalcia patella, patellar tendonosis, or arthritis rehab exercises for the knee focus on the quadriceps.  The VMO is a small and often ignored muscle of the quadricep complex.  There are certain exercises that are given to target the VMO, but how good are they at really activating and isolating the muscle?

When I started to practice at UP-PGH Sports Clinic that’s when I first learned about VMO protocols. I now look back to those years with deep gratitude for the capable leadership and mentoring of Dr. Edgar Eufemio, one of the most respected experts in the field of sports medicine in the Philippines, and Mr. Allen Dwight Guieb, PTRP, one of the best PT’s in the Philippines. Through the practice of the protocols and techniques I learned from them, I noticed the vast improvement on the part of my patients, something which I believe could not be achieved by the more traditional approach practiced by most PT’s in the country. I have patients who will attest that 10 sessions at expensive rehab clinics and still there is no noticeable improvement on there part, but with the VMO protocols that I use one or two sessions and there is already a noticeable improvement. I thank God for having given me the opportunity to work with the best in the field and the expertise I have learned from them I wish to share with you to greatly improve the quality of your life

What is VMO?

The fibres of VMO have a more oblique alignment than the other fibres of Vastus Medialis. It arises from the tendon of Adductor Magnus and converges to join the other Quadriceps muscles inserting via the patella tendon, to the tibial tuberosity at the top of the tibia (shin bone). The picture below shows the relative position of VMO, just above and to the inside of the knee cap.

Why is the VMO important?

Patellofemoral pain is often the cause of a muscle imbalance or timing problem between the muscles of the quadriceps; vastus medialis oblique (VMO) and vastus lateralis (VL).  This imbalance can lead to patellar maltracking problems and improper biomechanics of the knee-joint leading to pain and dysfunction.  In individuals with normal patellar tracking the vastus medialis oblique (VMO) fires first. When the VL fires before the VMO, the patella is more likely to track laterally. To correct the patellar tracking problem and strengthen the VMO, the patient should perform exercises that recruit more muscle fibers of the area.  That is to say, an exercise that targets the weakened VMO over the predominant VL muscle.

How Can I Strengthen VMO?

First you must ensure that VMO is contracting properly. Long-term injuries such as Patello-femoral knee pain are a result of VMO malfunction, however some acute injuries cause the inhibition of VMO (e.g. Anterior Cruciate Ligament rupture, Patella dislocation & Meniscal tears).

To check the contraction of VMO:

• Sit with your legs out in front of you and a rolled up towel under the injured knee (the knee should be slightly bent)
• Put your fingers over the area of VMO
• Push your knee down into the towel (so that your knee straightens and the foot lifts off the couch)
• You should feel a strong contraction under your fingers

If the muscle does not contract, continue to practice whilst pressing down gently on the muscle and concentrating on contracting the fibres underneath your fingers.

If the muscle does contract, you can continue with strengthening exercises:

Holding the Contraction:

• Sitting on a chair with the knees bent, palpate the VMO
• Start to slowly straighten the knee and ensure the VMO contracts
• Maintain the contraction throughout the movement as you fully straighten the knee and bend it again
• Repeat this twice daily until you can maintain a strong constant contraction 10 times in a row

Functional Exercises:

• Once you can hold the contraction as above, start to integrate this into functional movements such as lunges
• With a split stance initially place one or two fingers on the VMO of the front leg
• Perform a lunge by bending the front knee and dropping the back knee towards the floor
• Maintain VMO contraction throughout the lunge
• Initially perform as many as you can while maintaining a strong constant contraction and gradually increase the number up to 20
• Repeat this process in step-up exercises too (although you may not always be able to reach to feel the muscle contract!)

• Try performing a squat against a wall by sliding your back down the wall until your knees are at a right angle (your shins should remain vertical)
• Place a large ball (such as a football) in between your knees and squeeze it
• This activates the Adductor muscles and because VMO arises from the tendon of Adductor Magnus, also stimulates VMO to contract
• Hold for 3 seconds and repeat 10 times, gradually increasing to 5 second holds and 20 repetitions

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