The VMO muscle. It’s the teardrop shaped muscle on inside of knee. Sadly, when I heard about this muscle about a year ago, I couldn’t find it on myself…mine were non existent!
The VMO has an inverse correlation to knee pain. In general, the bigger the VMO, the less knee pain we’ll have.
VMO is the most fast-twitch, and first to contract of the quads.
It is trained most effectively when knees go over toes, OR when knee is fully bent. How ironic that most of us totally AVOID those two positions.
The VMO also helps to efficiently track the patella (kneecap), and therefore helps guide and seat the patella properly. Many of us have weird shifting and floating of the kneecap. This, along with dislocations can feel cruddy and helpless!
You can see that my the VMO on my right knee (the one with 3 surgeries), is smaller than my left. I have work to do there, in effort to become more structurally balanced.
A question to consider especially for an athlete would be, what do we think the cause would be if we built up upper quads, and added mass/weight in the upper body, before or without addressing the VMO?
I actually don’t really care about studies. I care more about what’s working for you or me today. But I know it matters to some so I’ll include a few below that I’ve read. To me, the science matters, but real life application matters more. For example, the third link – study on patellar maltracking concludes that rest, a knee brace, and anti-inflammatory drugs (these break down cartilage) are commonly used non surgical treatments. AND that there are about 100 styles of surgery to TRY to correct this, resulting in NO gold standard amongst medical professionals. Good lord. Fortunately, it does mention range of motion and strengthening of the VMO.
The lightest form of knees over toes training is walking backwards. If you have knee problems, this is the special sauce to start down the path of recovery. At least 5 minutes per day is what I do and recommend. We call this ROKP (reverse out knee pain).
But walking backwards ALONE, even though good for light recovery, won’t cause the pressure and adaptation that we want. At some point, we need to add some load or resistance. AND, walking backwards outside can be dangerous with obstacles, potholes, uneven terrain, etc. especially for older folks.
At that point, pulling a fitness sled on turf is the best method. Smooth, predictable surface and measurable load. The late, great Louie Simmons (RIP) popularized the sled, with some of the strongest folks in the world. I learned it from Ben Hartford and Brian Christopher. Ben is still coaching Anchor Athletics in Concord, NH. This is a great gym… with great turf for sledding!
If we don’t belong to a gym with this setup. There are many DIY sled options to make at home, but you need a good driveway, yard, or street to pull it on.
Don’t want to do that? Another fine ROKP option is the reverse deadmill. Stand on a treadmill, but turn backwards and push away with your feet. It’s good to have padding between your back and the control panel area for comfort. You can probably find a free treadmill out there. It doesn’t even need to work! Just make sure you can spin the belt and that it provides resistance. Some spin fast and gain momentum. No bueno.
Ok lastly…it’s too cold and uneven out there for backward walking, no sled, and no treadmill? You can do 5 minutes of ‘knee drops’ seen in my video, standing in place. With your hands holding something for stability, and keeping your torso vertical, let your knees go forward out and slightly over your toes. Your heels should slightly come off of the floor. While returning to starting position(straight legs) engage the tibialis and lift with the toes. Keep pulsing down and up. When knees lockout, toes should lift off of ground slightly. It’s NOT the same if you don’t lift the toes! This helps get into a slightly hyperextended position, but engaging the tibialis causes even more blood flow and good vibes. 5 minutes of this for less pain, and incredible pump around the knee.
Please try ROKP in some way, then tell me how the knees feel! It’s done wonders for mine. 5 minutes per day will help get your base back!
ACL injuries for kids have become an epidemic in the States. Adolescent girls suffer the most, in sports that include a lot of unpredictable cutting like soccer, basketball, etc.
My understanding of the literature as to why this is happening, can be distilled down to a lack of structural balance.
One thread seems to be ‘quad-dominant’ athletes, with strong muscles on the front of the thigh, but weak hammies.
Another common thread is overuse with one side of the body…think athlete that kicks a ball hundreds of times with 1 leg, and a couple times with the other.
Lastly, athletes are adding weight and getting bigger muscles, but AREN’T proportionally building up the structures that MOVE those muscles, ie feet, ankles, calves, tibialis, knees, vmo’s.
Every pound added above the waist corresponds to an exponential weight impacted at the knee. We experience 2x the impact at the knee just walking flat ground. So if a 150 pound athlete is dynamically moving, jumping, twisting, stopping…it’s just common sense that the demands that are trying to pull that knee apart are incredibly high!
What can we do though? We can build from the ground up first. We know that any force not taken by the foot and ankle…travels up to the knee. It’s a kinetic chain. So bulletproof the hell out of the foot, ankle, tib…to HELP prevent. Remember, this isn’t a guarantee…but it IS a wise investment.
We can then train to achieve closer to structural balance, relentlessly identifying and pursuing weak links…NOT just continually adding weight to the lifts we like to do.
Lastly, we can train the Nordic exercise. This movement works the tissues that hold the knee together, and fight that pulling-apart action.
This is a cheap and accessible piece of equipment that should be in every gym! I was so focused on my bench and squat numbers when I played my sport. I wish I pursued being able to do even 1 repetition of a Nordic! I can still only do the eccentric portion (downward movement) after about 6 months of trying. Please send me info of any high schooler that can do a strict Nordic! I would be so happy for this kid! I believe that making the Nordic a ‘cool’ exercise would prevent a ton of ACL surgeries.
ACL tears and knee surgeries have come up to epidemic levels for teens in the United States. We don’t have definite causes for this, but we can assume that these young athletes are NOT structurally balanced, and NOT built from the ground up.
To truly bulletproof this area, and protect the best that we can, exercises that directly focus on the knee itself (like the Nordic and the ATG Split Squat) will eventually be more crucial.
However, in the early years (think tweens) we can start that process of building from the ground up with some simple exercises. This will at the very least start building strength and protection below the knee, in the foot, ankle, tibialis, and calf, therefore collecting much of the impact before it gets to the knee.
The 80’s mix is an easy to remember, kid-friendly set of 4 exercises, 20 repetitions each…that are recommended for use before practice, before game, before the trampoline park. Really, they can be used effectively to activate those lower legs before participating in any activity. Hopefully, 80s mix will help your kid stay more protected!
I’m so excited around this time of year. It’s full of closure and renewal…ups and downs. And as long as we can navigate that emotionally, we can accept the exposure, and learn a ton!
Speaking of learning…I found a bunch of good books in 2022 that I want to share with you, and I learned a lot from them. I suppose if I distilled down what I learn when I read, I could name it Perspective (possibly humility too though). Reading presents me with another point of view, broadening my scope and reminding me that the world isn’t just seen through my own eyes. In that sense, it also humbles me. I know that each person I talk to, knows more about something than me. Reading has encouraged me to do that.
As always, I try to keep up on posting my reading list on my website here. I want to sing the praises of a select few that I read this year. Hopefully you’ll find one to enjoy:
Less — by Andrew Sean Greer Pulitzer prize winner right here! I think I read this book in a day or two, and was so pissed when it was over. It follows Arthur Less who is trying to avoid the inevitability of his own life. Sadly, I could relate. It was laugh-out-loud funny, but also seriously threaded through the challenges we all face. Arthur is a failing author, who is invited to the wedding of his ex. So he quickly attempts to set up a book tour to show that can’t possibly RSVP. It’s messy and relatable. Oh…and Pulitzer prizes aren’t just passed out lacklusterly.
City of Girls — by Elizabeth Gilbert Set in the hustle of 1940s New York, Vivian is kicked out of college and is then sent to be with her Aunt who runs Lily Playhouse — a somewhat rundown theater. Vivian tells the story as an old woman in the last years of her life…looking back. It’s full of great characters, the lively theater world, and the romanticism of New York city. It’s beautiful.
The Signature of All Things — by Elizabeth Gilbert After reading City of Girls and realizing Gilbert’s quality, I heard about this. Holy! This one feels more like her magnum opus. It’s grand, spanning, and worldly. Centered in 1800s Philadelphia where a titan, Henry Whitaker establishes his estate. The story follows his daughter Alma, who instills herself in the botanical world. It’s full of family expectations, lineage, love, and death. The full span of it. I laughed and cried with both of these Gilbert pieces.
*The Dutch House* (Audiobook!) — by Ann Patchett The actual book would be just great to pick up and read. However, the audiobook (that I listened to for free in the Hoopla app…connected to your local library) is read by Tom Hanks! His familiar and comforting voice, along with his acting/reading credentials made it so very nice to listen to. I recommend the book however you can get it…but highly recommend the Hanks version of the audiobook. This story uses a house as the focal point for a family tale about a father that achieves incredible wealth through real estate, and then the paradox within the lives of his children. I love how it relates the character of a physical thing (in this case, a house and all of it’s details) and how that can affect us as people. Being a home-body myself I can totally relate, seeing how a home can become part of our identity and how we define ourselves. This story isn’t just homey and happy though. It’s got the full span of life’s challenges too, touching on all of the human condition.
Here are some nonfiction pieces that I loved:
Clear Seeing Place — by Brian Rutenberg Brian is my favorite contemporary painter/artist. I met him at a showing in Cape Cod, and what a guy! On top of his amazing paintings, he has an informative YouTube channel in which he delivers studio visits to describe his work, and educate aspiring painters like myself. This book is a valuable collection of all of his wisdom. I loved it.
How to be an Artist — by Jerry Saltz Staying on the theme of art, Jerry is the only art critic that I’ve found so far, that I would read and listen to. Instead of the typical hoity toity look-down-your-nose-at-me type of writing and critique…Saltz is blue-collar, humble, realistic, seriously knowledgeable, encouraging, and hilarious. In this book, he very directly details the simple path to becoming the artist that you keep wondering about.
The 5am Club and The Monk Who Sold his Ferrari — by Robin Sharma Both of these books are considered ‘Self Help’, which I love. I think that genre gets a bad reputation but sheesh, call it ‘Personal Development’ if that helps you feel better. I respect the hell out of anyone that takes time to read a book that potentially motivates them, and introduces them to new ways of living. Both of Sharma’s books here do that. One of them is focused on mornings and the structure of our day, and the other reminds us of functional ways for us to live more like a monk in today’s world. The x-factor to both of these books though, is the format that Sharma used. In both works, he uses characters and a story-type narrative structure to more effectively illustrate the messages. Both of these books are awesome.