Orthopedic Dr - The Vmo - The Key to Patella Tracking, Knee Pain Relief and Knee Joint Stability
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The Vmo, or vastus medialis obliquus, is the large tear drop shaped thigh muscle, that lies just above and on the inner side of the kneecap, or patella. It is one of the four quadriceps muscles in the front of the thigh, but it is the only one that attaches directly to the inner (medial), upper margin of the patella.
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For this reason, it pulls inward on the kneecap and opposes the slightly outer (lateral) pull of the other three muscles. The Vmo is most active in the last 30 degrees of extension, meaning that it helps to lock the knee out, fully straight. So, you can see that this one muscle has a strong affect on both the kneecap and knee stability, as a consequence of its anatomy.
Pain behind the kneecap regularly results from a direct blow or a fall, or it may follow from maltracking, meaning that the kneecap is pulled off its normal path, regularly to the outside (lateral side), and often because the Vmo is weak and can't counteract the pull of the other three quadriceps. Usually, this is accompanied by tightening or contracture of the soft tissues on the outer side (lateral side) of the kneecap, which makes it much harder to treat and accurate the problem.
Some blend of these factors is regularly involved in kneecap pain, which can also be accompanied by instability, or giving way of the knee. Over time, these factors can follow in degenerative softening of the cartilage under the kneecap, a disease called chondromalacia patellae.
The other major source of pain in the knee comes from within the joint, whether from a twisting injury that may injure a meniscus, one of the cushions within the joint, or a sprain of one of the ligaments, or an effusion, or "water on the knee," which results from inflammation of the lining membrane of the joint, the synovium. And, in the older population, degenerative arthritis within the joint is also a source of knee pain and instability.
In every case, strengthening the Vmo is principal to relieving knee pain and restoring knee joint stability. So, what exercises are best for doing that? Here again, we take our lead from the functional anatomy. Since the Vmo muscle fully straightens the knee, and is most active in the last 30 degrees of extension, we want to load the muscle within that range of motion, to progress it.
Isometric exercises, technically defined as muscle contraction without shortening, those done with the knee fully straight, can increase Vmo tone and progress its tendinous attachments. For example, quad setting is done by tensing the right leg, contracting the quadriceps, as hard as you can, for six seconds. This is particularly foremost when you have a fresh injury, or in the first few days after knee surgery. It adds strength, but without any movement of the joint.
Similar in follow is right leg raising. Lying on your back, with the opposite leg bent up (to straighten your spine, and ease stress across the lower back), you tense your quads, and, while maintaining the contraction, then gently raise the right leg up, to about 45 degrees. Then, gently lower it again. To start with, try for 3 sets of 15-20 repetitions. This, too, is an practice that is very useful in the immediate aftermath of an injury, or surgery.
Isotonic practice is muscle contraction with shortening and what we regularly think of as exercise, with overt movement of the joint. This type of practice can apply the resistance of bodyweight only, or added external resistance, like free weights, or an practice machine.
The simplest practice is a quarter squat. With or without weights, with your back against the wall, naturally squat down just a quarter of the way, approximating about 30 degrees of knee flexion, then stand right and tense the quads strongly.
Even full range movements, like Full Squats or Hindu Squats, can be converted to Vmo strengthening exercises by that isometric tensing of the quads, with the knee fully straight, with each repetition.
My personal popular for working the Vmo is the Hack Squat. In this exercise, you hold a barbell or two dumbbells behind your knees and leaning backward to put maximal stress on the Vmo, do quarter squats. It's helpful to have a wooden block under your heels to help with balance.
Machine exercises are also useful, but leg press machines are probably great for your knee than leg postponement machines, because the leg press loads your knee from above, and is more physiological (a "closed chain" exercise). This is especially true if you have kneecap disease, like chondromalacia patella, or patellofemoral arthritis. Here again, you can cope very heavy weight eventually, because you're using it for a very short arc, just 30 degrees.
Whatever exercises you choose, you will begin to consideration an revision in your pain and your stability within about 10 days, and real revision within 30 days. As the Vmo becomes stronger, your patella tracking will enhance and your knee will subjectively feel more stable. Although this regimen can't cure everything, it can go a long way toward making your knees feel great and stronger. Give it a try.
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