I have a client whose doctor most recently and her physical therapist years ago gave her the task of strengthening her quads, particularly the VMO. I looked at her old PT program and the exercises were pretty common activation exercises for the VMO, i.e. slight external rotation at hip, tighten VMO, lift leg. After assessing her, the way her knee and ankle are diving in, I agree with the current doctor and I think her old PT exercises are still relevant.
Here’s the issue.
She also tends to lock out her knees in standing, coming up from squats, etc. She is having trouble tightening the VMO without hyper-extending the knee. If she weren’t already a “knee locker,” I might not be so concerned, but I’m trying to teach her how to stabilize around the knee without also locking it. I can fire my VMO without locking my knee joint, and I’m trying to teach her how to do the same. Her body awareness is a little less than mine, so it’s a challenge for her to know what she is feeling and tell me back.
What are some of the tricks or cues, please, that you’ve used to help someone be more aware of whether the VMO is tensing, and then how to do it without locking and hyper-extending the knee?
First of all, can she selectively contract the vastus medialis? You can do all the exercises possible to activiate the muscle, but if it is not in the motor unit loop,so to speak, it won’t do much good. I suggest you look up VMO activation.
And there is some argument that the VMO is a psuedo myth. That the vastus medialis is not functioning well as a whole in some individuals. There are multidirectional fibers in the v.m., but as to selectively activating or if just the VMO is the issue is not clear as far as I know.
Either way, look into get the vastus medialis to contract overall.
Hey there Nancy,
If concerned about keeping in knee flexion (avoiding hyperextension) , the client may try kinesio tape behind the knee. That said, nothing is wrong with terminal knee extension exercises with a band to help try and promote quad/vmo awareness. This might help them turn on.
Other than ideas mentioned I would try these which may/may not have been done in PT.
~have her foam rolling that area and feel that trigger spot.
~side lying adductor leg lifts with ankle weights.
~when doing 1 bridge squeezing a ball between thighs lying (can also be done seated) use your hands and try moving the ball for 15-30 seconds straight (hammer on it!) and ask her to stabilize through the movement you are causing.
~sitting in chair,lying (supine, toe turned out) or standing single leg adduction with ankle weight. Start without a weight!
~be sure to perform VMO step downs (or drops, dips) too.
With cuing less is more. 1 word. Have her close her eyes during the exercises and put a hand on that area. Ask if she is feeling it.
If so, the exercise is working, if not, try another 🙂
There are a few things I’ve done with clients to create awareness and engage the VMO that may help you (although I’ve not had the issue of hyperextending the knee).
You could try a foam roller under the knee and have your client just contract the quad muscle. Guide her with where she should feel her VMO contract, and have her hold for about 10 seconds for about 12 reps or so.
Another exercise I’ve done to engage VMO is to have the client sit upright in a chair and place a small ball between her knees. Her VMO will contract as she squeezes the ball. Static holds help here.
One more exercise is a bridge with a ball between her knees to engage the VMO. Static holds for about 10 seconds and 12 reps.
Once she has the awareness of her VMO engaging, you could progress her to multi-joint exercises that engage the VMO. I would also cue her to keep her knees “soft” for what it’s worth. Hope these help you.