Exercises for Vastus Medialis

[august1302]

Hello! I am a physio student and I have a patient who suffered from tibial plateau fracture on left leg. He has some pitting edema in his left foot but otherwise ROM of the ankle is not too bad.
However he can't fully extend his knee due to weak quads. Not pain cos I passive and also active assisted and he was able to fully extend his knee without much pain. So I suspect it's his VM which is very weak. Basic knee extension exercises would only strengthen the muscle bulk of the quads but how about some which specialise directly onto the VM? I did some I/T on the VM but right now need some home exercises for him to work on the VM. He only comes in to the dept twice a week.
Btw, he is already post-op 1 month.
Thanks fellow physios!

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[Canuck Physio]

Unilateral work should isolate the VMO,

Regards

[august1302]

Thanks for your reply. What sort of unilteral work should I give?

[makkan00]

Ask patient to sit on a high chair, slightly lateral ratation of tibia, so that max. muscle work goes on VM.
Than patient can use copntralateral leg to resist.
Best of luck

[linbin]

hi friend
some exercises which is routinely used in clinics for VMO
1-assisted short arc exercise with a pillow under the knee
2-with a pillow under the knee,slowly passively extend the knee and ask the patient to try to hold that position,while you slowly remove the support.it caused eccenric actvation and gradually patient will be able to maintain the position
3-in supine lying,external rotation at hip and slowly make patient to do active straight leg raising,initially assist to maintain knee in extension
4-in same side lying ask ,keep the upper leg in front and ask to do adduction against gravity
as you know the VMO fibers originate from the adductor area and its oblique alignment 3 & 4 th exercise helps with adductor activity
you can even try electrical stimulation to VMO with concurrent short arc exercise over a pillow.arthrogenic inhibition of VMO can occur in various conditions.
VMO is considered as the core muscle of knee and its proper functioning is essential for terminal extension activities
cheers

[jesspt]

There's not a lot of data that shows we can actually isolate the VMO.

[Canuck Physio]

There's not a lot of data that shows we can actually isolate the VMO.

You are correct, however the muscle recruitment patterns have been studied. And the VMO is recruited, rather than isolated, in 2 situations: either when unilateral work is done, or consistent training for experienced lifters allows greater VMO activation. Most people for rehab aren't experienced at the squat, so the unilaterals will have to do.

The relationship between training status and intensity on muscle activation and relative submaximal lifting capacity during the back squat. J.Strength & Cond. Res; 14 (2):175-181.

[Canuck Physio]

A study published by researchers from the U.K. has shown that foot position and stance does not alter the activation of the VL or the VM in the thighs.

Ref: Journal of Sports Sci 22: 284-285, 2004

[august1302]

A big thank you to all for the helpful suggestions. Much appreciated

[Yarok]

hi
why exactly u want to strenthen VM, simply try improve knee extension, even,isolated exercises i would support with synergists ie PNF, remember about antagonists function as well
thanks