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.
We clearly hold our bodies in some interesting positions at the workplace…and consequently throw our bodies waaaay out of structural balance. It’s no wonder we have tight backs, hips, shoulders, etc.
I believe that our bodies will balance out on it’s own. But modern day desk sitting is NOT natural. Therefore, we must move in particular ways to remedy this.
Here are some movements to do while sitting at the desk. I’d do these 3 or 4 times throughout an 8 hour shift:
25 reps Seated Tibialis Raise (shoes off if possible) — By staying seated, this exercise becomes easier than standing. Start with your feet flat on the floor, then lift your toes to the sky keeping your heels down. Aim for a 45 degree angle with the foot. Hold in the top position for 1 second . This works the front of the shin, and the tibialis muscle is the ‘decelerator’ muscle of the legs. If weak here, the rest of the body takes more impact than it should.
25 reps Seated Calf Raise (shoes off for this too!) — Bring your feet back a little bit under your chair so that there’s a slight stretch on the heel. Then simply stand up on the toes while staying seated. This focuses on the soleus (one of the calf muscles), which is connected to the achilles tendon. Often overlooked, this is a great way to strengthen that tendon, which has the strongest pull of any in the body. Also huge with this movement is strengthening the feet which we neglect. By focusing on going up on that big toe, we do wonderful things for those dogs that carry us around all day.
15 reps Seated Cat Cow — Similar to the yoga movement performed on your hands and knees, but stay seated in the chair. Start by simply hunching forward slowly, curling your back and getting to that posture that looks poor. It helps to exhale while moving into this. Roll the shoulders forward when going here. Then, roll the shoulders back and slowly move that stretched and arched position. Sit up tall. Chest out, and proud as hell! Inhale during this movement. Smile and hold for a second. Repeat 14 more times!
20 reps External Rotations — Still seated at the desk and pretending to work…lift elbows out so that upper arms are parallel to the floor. Forearms are hanging directly down toward the floor with palms facing behind you. Keeping those upper arms stable and parallel to floor, roll the shoulders back so that fingers point in front of you and eventually all the way so that fingers are pointed to ceiling. Then roll shoulders and arms back to original position. Repeat 19 more times! This does incredible things for reversing out shoulder pain (ROSP), and creates that ‘opening up’ effect of the upper body. This paired with the Cat Cow can help to balance out our poor posture from the desk sitting all day.
Dear friends, Let’s talk about knee pain. For the past five years or so I’d say my knees felt uncomfortable. But last winter, I started experiencing acute pain in my right knee…in the patellar tendon directly below the knee cap. It got to the point where the first thought I would have upon waking would be worrisome… Because I knew the first squat up out of bed… And then the first step down the stairs in the morning would be excruciating. I didn’t enjoy that as my very first thought! What a way to start the day.
I figured that this is just something that happens for those of us that play a sport, and begin aging. I see many of my friends and family members dealing with joint pain so I accepted that this is just something that comes with getting older.
When I found Kneesovertoesguy and the ATG system at the beginning of 2022 I was intrigued and caught off-guard. Here was a guy proving that training with our ‘knees over our toes’ was actually beneficial, and perhaps the route to recovery. I’ve been around sports and gyms all my life… And one of the phrases I heard ad nauseam was “don’t let your knees go over your toes”…meaning don’t allow your knee to go forward in exercises like squats, lunges, etc. so the ATG system was radical, different, and against many of the accepted literature. I love that.
The mainstream caution stems from a research study done in 1978 at Duke University concluding that when the knees go over the toes it creates more pressure in the knee. And then word was exaggerated over time to just avoid that position. Ok, that movement DOES create more pressure, but the conclusion COULD have been that we should carefully and strategically strengthen that area…not fricken avoid it!
Look at how we move in life. Look at how athletes move in sport. Start the first movement down a stair, and look at how far your back knee goes over your toes. Look at how far my right knee is over my toes in the picture (also see my dad and family worried about my knees going over my toes). We are in this position all the time! Doesn’t it make sense that we should strengthen our bodies in that position? Throughout my entire basketball career, I never strengthened myself in that position. However, within my sport I consistently drove my body into that position and put the harshest of demands on it. It’s no wonder my knees suffered!
The more ancestral cultures, look at China in particular, inherently use the deep squatting position often whereas most of us in the West stop at 90 degrees after a certain age. Range of motion then suffers for us. And 1 knee surgery in China for every 19 here!
When we don’t express a joint throughout its full range, our body stops sending synovial fluid to the area. Consequently, we miss out on the nourishment and lubrication there. Then the pain sets in! After all of my knee surgeries, I used a ton of painkillers and anti-inflammatories (which actually break down cartilage!), and of course I limited the range of motion of my knee, compounding the issue. Anything at or past 90° felt too tight and too painful.
One of the great things about the ATG system is that it meets you wherever you are. Instead of trying to work through pain or avoiding an area (we see how that works!), we can be grateful for whatever pain-free ability you have now and slowly and consistently build on that. Remember though… I’ve been strengthening muscles WITHOUT full range of motion… And WITHOUT letting my knees go over my toes for about 27 years (since I was 15). I can’t expect to achieve structural balance and undo all of that within a couple of workouts. As I’ve said, I am making good progress and I feel like I’m on the right track. It’s just good for us to understand that this is going to take time.
Since making my first Facebook post on this and asking for feedback… I’ve already received so many stories that make me more passionate about wanting to help. Some of us have to move in a particular way throughout our day to avoid pain on one side… Then when that used side gets too painful, we have to find other ways to navigate. Some of us have knee replacements, hip replacements, multiple surgeries attempting to repair the same issue… Then further surgeries recommended, then replacements. It’s just not a path that looks promising. ATG at least provides another option to consider.
I want to close in saying how grateful for, and how much I respect the doctors that are doing this work. A lot of my current feelings will sound like I’m anti-surgery. But actually, doctors and surgery are what stitched me up and put me back together to get back out there and live my life. These folks are way more educated than me, and they have the courage and skill to look at pictures, then actually open up a knee and correct the issue they see. I am certainly not an expert, and by no means want to put these people down. I’ve just been introduced to another method… A different option… And I want to share that with anyone who may be interested.
Do me a favor and share your story with me! I’ve heard a bunch but I haven’t heard yours yet… And I want to connect. This is completely free for now…And simply want to learn and help as much as I can rolling into 2023 with knees a little better than 2022. ‘When spider webs unite, they can tie up a lion.’ You can start adding tiny webs and fibers to your knees tonight.