Quad Talk with Christye

Back by popular demand, it’s Body Talk with Christye! This series of posts is dedicated to the unsung heroes of your muscular system. They are the pillars of proper biomechanical movement, the behind-the-scenes champions of pain-free athletic performance – if your body were the Hunger Games, these muscles would volunteer as tribute. It’s my mission to bring these little-known muscles into the spotlight, because when strong and functioning at their full potential, they can make a HUGE difference in your athletic career (and your career as a bipedal human being).

Now that Butt Talk is behind us (har har), it’s time to move on to the muscles on the front of the thigh: the quadriceps. Quad donkeys like Coach Jace and I know just how important your quadriceps muscles are. You can’t squat, lunge, walk, run, or look awesome in jeans without them. You’ve got 4 total (stick with me here through the Latin, because I’ve got to name them all so you know I’m legit): rectus femoris (the biggie), vastus lateralis (on the outside), vastus intermedius (kind of in the middle), and the vastus medialis (on the inside of the knee - AKA the VMO). It’s the VMO that we’re interested in today. Why? Because this small quadriceps muscle single-handedly (single-leggedly?) affects whether your kneecap tracks correctly in its patellar groove. If you ever experience knee pain or injury, strengthening your VMO could relieve your pain and help your kneecap get its groove back.

 

WHERE IS IT?

The VMO is a cute, teardrop-shaped muscle of the quadriceps muscle group.

The VMO is a cute, teardrop-shaped muscle of the quadriceps muscle group.

If you’ve been regularly foam-rolling your quads (thereby helping angels get their wings and reuniting lost puppies with their owners), you may have noticed it doesn’t feel uniform throughout the front of the thigh. You may have even experienced some abrupt jerks, shifts, or lumps when rolling to the inside or outside of the quad. This is because your quadriceps is made up of 4 muscles, with differently positioned fibers and distinct functions. While the quadriceps muscle group as a whole acts to extend the knee (as in kicking a ball), each quad muscle has its own special expertise within that action – and if one muscle is weak or functioning improperly, it can throw off the whole darn thing. Your VMO refers to the obliquely (diagonally) situated fibers of the vastus medialis muscle, which is located just above and medially to your knee.

Track down your VMO with the determination of a thousand Katnisses.

Track down your VMO with the determination of a thousand Katnisses.

Here’s how to find it: sit on the floor with one leg straight in front of you. Place your fingers on the flesh of your thigh (why is the word “flesh” always so creepy-sounding?), just above your kneecap, to the side closest to your other leg. Then, try to press the back of your knee into the ground. Your foot should lift off the floor. If this doesn’t work, try rolling up a small towel (or Volt Athletics t-shirt) and placing it beneath your knee joint before engaging the quad and pressing the knee down. You will hopefully feel a teardrop-shaped muscle contracting decisively beneath your fingers – that’s your VMO! It’s very cute. It might just be the cutest muscle in your whole body. Practice firing this muscle on both sides, and try to notice if one side feels stronger than the other. Is one side firing (contracting) more strongly? Does one VMO feel bigger than the other? This is important data that will help you perform maintenance on your body, so hunt it out like Katniss hunted Peeta in The Hunger Games!


 

WHY SHOULD I CARE?

The VMO is crucial to the proper tracking of your patella (kneecap). If your patella isn’t sitting correctly in its patellar groove as you bend or straighten your knee, it can wreak all sorts of havoc on your knee joint. Think derailed train. This mal-tracking of the patella can contribute to symptoms as minor as the dull pain on the inside of your kneecap known as patellofemoral pain syndrome, or injuries as major as an ACL rupture. If you have knee pain while running or walking, or notice your knees faulting valgus (collapsing inward) while you squat or lunge – and you’ve ruled out glute med weakness – you may want to take a closer look at your VMO. The VMO helps your patella stay in its groove, so when it is either weak or inhibited throughout even part of its active range of motion, yucky stuff can happen. Thankfully, YOU CAN FIX IT!

 

HOW DO I ACTIVATE IT?

True story: one time I ran a marathon. Scratch that, one time I ran half a marathon and limped a subsequent half in the same 5-hour stretch. Ask my mom how I was feeling at mile 21, and she’ll tell you I was crying tiny VMO-shaped tears from the intense medial knee pain I was feeling. It got so bad by the end of the damn race, my knees felt like they were locked into a semi-bent position, and I was running like a sad, weird wooden puppet (and wooden puppets are pretty sad and weird to begin with, IMHO). When I saw a PT soon thereafter (“Why did you keep running if you were in so much pain, you dummy?!”), she helped my find my VMO and tested it with the same exercise as above. I pressed my kneecap into the special paper-covered table I was sitting on. Nothing. Crickets. Puzzled, I tried again, sticking my tongue out with effort. This time, the faintest whisper of muscle contraction. “Hmm,” she said, “Seems like your VMO isn’t activating. We should fix that.”

So I spent a few weeks learning how to activate my VMOs while watching season 4 of Grey’s Anatomy on DVD, and voila! Knee pain: gone. It’s amazing how great your knees feel when your kneecaps stay in their grooves! Like a thousand fairies sprinkling magic rainbow dust on your thighs!

To reteach your body to activate the fibers of your VMO muscle, perform the above isometric VMO contraction. If you are working through an injury, be gentle (and, of course, stop at any sign of pain and reach out to a real PT). Aim for 10 reps of 10-second holds on each leg. You should be feeling a toasty VMO burn by the end. And keep your fingers on the muscle – if at any point you don’t feel the VMO contracting, stop for the day. We want to help your body relearn to fire the right muscle, instead of compensating with different muscles to get the job done faster. Repeat this exercise 3-4x/week until you can maintain a strong contraction for the entire 10-second interval.

 

HOW DO I STRENGTHEN IT?

If your VMO is firing correctly, but you notice one side feels stronger than the other, you’ll want to strengthen the weaker side so that you don’t develop any imbalances in the body. Here are my 2 favorite VMO strengthening exercises, in order from most to least horrible: 

1. Dynamic Wall Sit with Inner-Thigh Squeeze

Keep the movement small and controlled, and think of pizza.

Keep the movement small and controlled, and think of pizza.

Because your VMO also contracts when your adductors (inner thighs) do, this is a great way to achieve a functional VMO contraction. It will make you sweat and cry, though, because it is nasty-hard. Place a pillow or light medicine ball (or a pizza, or a live baby – it really doesn’t matter what you use as a prop here) in between your knees. Find a wall and, keeping your low-back flat against it, lower yourself slowly until your knees reach no more than a 90-degree bend. Then, slowly straighten your legs and rise back up to standing. During the exercise, you’ll want to keep your fingers on your VMOs the whole time to make sure they are contracting throughout the entire range of motion. Repeat 3 sets of 10 slooow reps, 3-4x/week. Then eat the pizza (not the baby).     

2. Heel Drop

Maintain a solid contraction through your VMO as you drop your heel towards the floor in front of you.

Maintain a solid contraction through your VMO as you drop your heel towards the floor in front of you.

Stand on a small step (or your copy of The Hunger Games: Catching Fire), with your weight on the weak or affected leg. Placing your fingers on the VMO of your standing leg, slowing drop your opposite heel towards the floor. You don’t have to bend the knee very deeply for this exercise – your VMO is most active during the last 5-10 degrees of knee extension – so stop as soon as you feel your VMO stop firing. Slowly straighten the leg. Remember to stay focused on maintaining a nice contraction in your VMO throughout the exercise – you’re guiding your quad train back to its rails. It’s a beautiful thing. Repeat 3 sets of 10 controlled reps on each leg, 3-4x/week.

THE TAKEAWAY

Performing these PT-type exercises can be kind of a drag, since they require precise movements and Katniss-like focus, but the rewards are ENORMOUS! Reteaching your body to consciously use this overlooked, underdeveloped quad muscle will help your body use it automatically during competition. Reduced risk of ACL injury will keep you mobile no matter what life throws at you – because you never know what the Capitol’s Gamemakers have in store for you inside the Arena. May the quads be ever in your favor.              


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Christye Estes, CSCS, ACSM-CPT, is one of the regular contributors to the Volt blog. She is a CSCS-certified strength coach, a certified personal trainer through the ACSM, and a Sports Performance Specialist at Volt.
Learn more about Christye and read her other posts | @CoachChristye