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

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 knee bow in (functional knee valgus) ; 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.

Isolated Muscle Activation Exercises:

• Quad Sets and Progressions
• Terminal Knee Extension
• VMO Activation Progressions

Subsystem Integration Exercises

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:

• Quadrupeds (ISS)
• Quadruped Progressions (Gali Pedis)
• Squat To Row (POS)
• Step Up To Row (POS)
• Reverse Lunge To Row (POS)

Caption: VMO activation exercise (terminal knee extension exercise)