Specifically, what are the best exercises to strengthen and build a atrophied VMO or vastus medialis?
As always, seek out the advice of an appropriate sports medicine professional first. There are a few questions that arise here:
- Is the VMO indeed atrophied or just lacking in what is perceived to be an adequate amount of mass?
- Is there an asymmetry from right to left?
- Was there an injury of some sort?
- Has the individual seen a sports medicine professional of some sort? If so, what was the prognosis?
- Has the individual gone through rehab? Are you as the trainer taking on a post-rehab responsibility?
I am unaware of any research to support the idea that one can isolate a single head of the quadriceps. Research has shown if there is a lower extremity/knee injury history, it may be possible that the VMO (vastus medialis) has weakened/atrophied for the two main reasons:
- The VMO may only attain maximal concentric contraction in the last 10 degrees of extension, a ROM rarely achieved/visited due to injury.
- The VMO has also been found to contain a large quantity of TYPE II muscle fibers. These fiber types are activated primarily during higher intensity activities, which once again may be impossible to perform due to injury.
Whether there has or has not been an injury history, two items to consider are the cereal postural distortion patterns know as lower crossed posture (LC) and pronation distortion posture (PD), which can be characterized by:
- Increased lumbar lordosis and an anterior pelvic tilt.
- Excessive foot pronation (flat feet) particularly during functional movements (walking, running, stepping, lunging, etc.).
- KNEE FLEXION (#1 ABOVE), internal rotation and valgus (knock knees) during functional movements.
These postural distortion patterns have a series of muscles prone to becoming short/neurologically facilitated that CREATE the posture as well as their reciprocal muscles prone to becoming long/neurologically inhibited that ALLOW the posture to occur.
- LC & PD MUSCLES TO BE STRETCHED:
- Rectus femoris
- TFL (Tensor fascia latae)
- Erector spinae
- ITB (Iliotibial band)
- Hamstrings (lat/med)
- LC & PD MUSCLES TO BE STRENGTHENED:
- Glute Max/Med
- Hamstring (lat/med)
- Ant/post tibialis
It is recommended to administer the proper flexibility protocal using STATIC parameters to begin with (please see the PTN Exercise & Flexibility Library), prior to initiating integrated strength training. Once having done so, here are a few beginning exercise progressions to be performed two to three sets, 12 to 20 reps, at a 4-2-2 tempo (eccentric/isometric/concentric):
- Bridging Progressions
- Floor bridge
- Ball bridge
- Single leg floor bridge (active/passive locking of the flexed hip)
- Lower Ab Progressions
- Knee to chest
- Leg slides
- Dead bug
- Reverse crunch/knee ups
- Iso Ab Progressions
- Prone (sagittal)
- Side (frontal)
- Rotation (transverse)
- Single Leg Progressions
- Multi planar reach
- Free Motion/cable knee extension
Good luck, and remember, nothing in the body occurs in isolation... the VMO did not atrophy/weaken on its own!