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Vastus Medialis Oblique (VMO) and Tibial Internal Rotator Exercises (Activations) Audio

Vastus medialis obliquus (VMO) and tibial internal rotator activation exercises for improving movement dysfunction, posture, patella tendinitis, knee pain, and sports performance. Great quad set, terminal knee extension (TKE), and tibial internal rotator activation variations for the VMO.

Vastus Medialis Oblique (VMO) and Tibial Internal Rotator Exercises (Activations)

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

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I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

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I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

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This course describes vastus medialis obliquus (VMO) exercises (commonly referred to as vastus medialis exercise, VMO muscle exercise, VMO activation, and end-range quadriceps muscle exercise). Performing terminal knee extension with the addition of hip external rotation, and tibial internal rotation may improve recruitment (isolation) of this muscle. This may be particularly true when performing closed kinetic chain exercises that combine terminal knee extension, hip extension, and ankle plantar flexion. The relative tibial internal rotation discussed in our variations of VMO exercises may also aid in reducing recruitment of the commonly over-active biceps femoris. (Note, our variations do not include hip adduction which may contribute to functional knee valgus and increase the activity of the commonly over-active adductors). Technically, VMO exercises are end-range quadriceps muscle strengthening, as it is unlikely that the VMO can be isolated. However, research has shown that muscle activity of the VMO increases relative to other quadriceps muscles during terminal knee extension, for individuals who have “healthy knees” (no anterior knee pain, knee cap pain, or soft tissue injury).

It is common to include these exercises in a program designed to address 

; however, these exercises may also be recommended to reduce feet turn out, and may be beneficial for addressing some issues related to lumbopelvic hip complex dysfunction (LPHCD) and lower extremity dysfunction (LED). Addressing these signs has been correlated with improving and reducing the risk of knee pain (especially anterior knee pain), patellar tendinopathy (knee cap pain), VMO pain, patellar tendinitis, runners knee, jumpers knee, iliotibial band syndrome, and improving sports performance. Movement professionals (personal trainers, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should add these exercises to their repertoire to improve the outcomes from their integrated exercise programs and therapeutic (rehabilitation) interventions. Further, this course discusses why exercises that include resisted hip adduction are likely a poor choice for addressing movement impairment, postural dysfunction, and optimal alignment.

Last, it is important to integrate the increase in vastus medialis activity into functional exercise. The Brookbush Institute accomplishes this with intrinsic stabilization subsystem and posterior oblique subsystem integration. Some example movements for these purposes include:

Dr. Brent Brookbush Demonstrating VMO Activation

Course Description: Vastus Medialis Oblique (VMO) Exercises (Activations)

Vastus Medialis Oblique (VMO) and Tibial Internal Rotator Exercises (Activations) Study Guide

Course Study Guide: Vastus Medialis Oblique (VMO) and Tibial Internal Rotator Exercises (Activations)

The Vastus Medialis Obliquus (VMO)

The Semitendinosus, Semimembranosus, Gracilis, and Popliteus

The sign feet turn out during an overhead squat assessment indicates underactivity in the tibial internal rotators

Signs Of Under-Activity & Length In Weak VMO/Tibial Internal Rotator Muscles

Introduction to the VMO and Tibial Internal Rotators

These muscles commonly become synergistically dominant when the vastus medialis obliquus (VMO) is inhibited. These muscles should be released and stretched before activation techniques, and during activation techniques joint motion should be cued to reciprocally inhibit these muscles.

Vastus Lateralis Self-Adminsited Static Release

The TFL, a hip flexor muscle, becomes synergistically dominant (shortened or overactive) when the gluteus medius doesn&rsquo;t properly activate

Overactive Synergists

Optimal neuromuscular activity (tone) and function are not only affected by the strength of individual muscles but optimal length and activity of their functional antagonists and mobility of the joints they cross. It is recommended that the appropriate release, lengthening, and joint mobilization techniques are done prior to the activation and integration techniques discussed below.

Optimizing Motion (Best Practice)

Vastus Medialis Obliquus (VMO) Muscle Exercises

A common sign of dysfunction of functional valgus, or knee bow in, during squatting, running, and jumping

Semitendinosus, Semimembranosus, Gracilis, and Popliteus Exercises

Research on the VMO and Tibial Internal Rotators

Static Lunge with Resisted Terminal Extension

Quad Sets and Progressions

Terminal Knee Extensions (TKE)

Static Lunge with Resisted Terminal Knee Extension

Best Exercises for the Vastus Medialis Obliquus (VMO) Isolated Muscle Activation

Tibial Internal Rotator Activation

Quick Tibialis Anterior & Tibial Internal Rotator Activation

Best Exercises for the Semitendinosus, Semimembranosus, Gracilis, and Popliteus Isolated Activations

For additional progressions please see the articles on:

Single-leg Balance and Reach

Resisted Single-leg Balance and Reach

Single-leg Deadlift Touchdown 

Integrated Stabilization

Tibial Internal Rotator Taping provides the practitioner with the opportunity to reinforce tibial internal rotator activation techniques for hours and possibly days after a session. The intent is to use taping as a kinesthetic stimulus via skin receptors, which results in an increase in tibial internal rotator activity for the period the tape is on.

Tibial internal rotator taping is a combination of 

Ends over the belly of the medial gastrocnemius

Ends mid-way up the anterior/medial thigh, ensuring the tape stays over the vastus medialis and not the adductors.

Tibial Internal Rotator Taping

Perform each exercise for 12-20 reps with a weight that is challenging, but ensures that ideal form will be maintained. Perform in a circuit (without rest between exercises) 1-3 times through.

Release and stretch short/hypertonic structures first:

Tibialis Anterior Activation with Quad Set

Single-Leg Balance and Transverse Plane Reach

Alternating Single Leg Hop to Stabilization

Frontal Plane Step-Up to Balance to Curl & Press

Dr. Brent Brookbush demonstrating a loaded hip bridge for gluteus maximus

Sample Activation Circuit: Vastus Medialis Obliquus (VMO) Exercises

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. 

Dos Reis, A. C., Correa, J. C. F., Bley, A. S., Rabelo, N. D. D. A., Fukuda, T. Y., & Lucareli, P. R. G. (2015). Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain. journal of orthopaedic & sports physical therapy, 45(10), 799-807.

Noehren, B., Scholz, J., Davis, I. (2011) The effects of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome. Br Journal of Sports Medicine. 45:691-696

Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676

Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. 

Smith, J. A., Popovich, J. M., & Kulig, K. (2014). The influence of hip strength on lower limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. 

Journal of Orthopaedic & Sports Physical Therapy

Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. 

Journal Of Strength And Conditioning Research / National Strength & Conditioning Association

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Bell, D. R., Oates, D. C., Clark, M. A., & Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. 

Ramskov, D., Barton, C., Nielsen, R. O., & Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. 

journal of orthopaedic & sports physical therapy

Snyder, K. R., Earl, J. E., O’Connor, K. M., & Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. 

Van Tiggelen D, Cowan S, Coorevits P, Duvigneaud N, Witvrouw E. Delayed Vastus Medialis Obliquus to Vastus Lateralis Onset Timing Contributes to the Development of Patellofemoral Pain in Previously Healthy Men. Am J Sports Med June 2009

Andersen, L. L., Magnusson, S. P., Nielsen, M., Haleem, J., Poulsen, K., & Aagaard, P. (2006). Neuromuscular Activation in Conventional Therapeutic Exercises and Heavy Resistance Exercises: Implications for Rehabilitation. Physical Therapy, 86(5), 683-697. Accessed March 16, 2016.

Tang, Simon F.T. et al., Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: An electromyographic study 

Archives of Physical Medicine and Rehabilitation, Volume 82, Issue 10, 1441 - 1445

Hasegawa, K. T., Hori, S., Tsujita, J., & Dawson, M. L. (2001). Effects of Stretching Exercises on Vastus Medialis and Vastus Lateralis.Medicine & Science in Sports & Exercise, 33(5), S10.

Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. 

International Journal of Sports Physical Therapy

Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. 

Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., & Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. 

Medicine and science in sports and exercise

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Bibliography

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Vastus Medialis Oblique (VMO) and Tibial Internal Rotator Exercises (Activations)

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