Question for Gurus VMO Recruitment

I have a question for anyone who is knowledgeable in the area. Here is the situation. I am 5 days post op of a bilateral knee scope for chondromalcia. I am limited per M.D for about 6 weeks to rehab work no more than 70 degrees of knee flexion. During this period I am working on 1. hip/hamstring/gastroc/IT band flexibility,(with foam roller work),
2. hip ABD/ADD strength
3. limited ROM Leg press, step ups, step downs, retro treadmill etc…
4. McConnell taping before ex.

This has been a long standing problem and the I have laterally tracking patella bilaterally. This is a least partially if not mostly due to a lack of VMO firing or imbalance.

Now here is my question. In many of the journals is read and with most of the PTs I work with, there is general agreement that VMO cannot be emphasized and rehab is centered on exs mentioned above. I have read many of the coaches’ articles here that suggest deep squats/deeper split squats etc… emphasize VM/VMO. This is relatively contraindicated with most patella femoral problems. What would be the suggestion as a way to effectively address this and suggestions as I progress back to Full ROM exercises in several weeks.

I apologize for the length of the post and appreciate any feedback.


Hey there Kevin,

I’ve had the patello-femoral struggles for years, and I’m an Athletic Therapy student (a trainer in the States). In my practicuum I’ve seen the following in situations similar to yours:

Include piriformis stretching in your routine, its vital and commonly tight. If you’re work the rest of your hip, you’ll want to include this in any flexibility program.

For the VMO, which is active during the first 30 degrees of flexion, we employ wall squats with a 2 ball set up. You’re going to do a wall squat, which has a Swiss Ball (Stability ball, whatever you see the females sitting on doing curls in the gym) between your back and the wall.

Feet slightly forward of the torso, but not much as this increased patellar joint reaction forces which you already know about.
Now you’re going to hold a medicine ball, preferably one of the newer rubber types, between your shoulder width knees. You must maintain enough pressure on the ball to keep it from falling as you squat no more than 30 degrees.

By including the adductor muscles, you will be facilitating the VMO due to irradiation, and the VMO will be active during the squat. Might think of it as double recruitment.

Of course, you should discuss this with your medical team before trying to implement it. Best of luck, hope this helps.

Thanks very much for the feedback t-bone. I do incorporate the exercise you described into my rehab. I appreciate you taking time to respond.

Let me try to narrow this question down a little further. Can anyone give me a heads on an EMG study or any research available that corresponds to the advice of many strength coaches that deep squats, split squats increase VM/VMO activity.


I know you mentioned step ups and step downs so you might be doing this type of exercise, but I’ve read Polquin uses Patterson Step ups for VMO work and I believe Coach X and 62 use Terminal Knee Extensions (TKE’s)also for this purpose which might be the same thing as the Patterson Step Up. However, I think a theraband is used during the TKE’s. Go to the Elite Fitness site and post a question for X or 62.