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WEAK VMO & KNEE PAIN: How To Improve VMO Strength & Reduce Knee Pain In 5 Simple Steps
Written by: Nick Jack
Category: 2014
Hits: 142505

Everyone wants to have strong legs, for we know that we need strength to perform even simple tasks like walking up stairs. And all of us would love to have the great athletic lean toned muscles you see with elite athletes. There are many exercises and methods used to do this but if you get it wrong you can create a multitude of problems. Lately, there seems to be an epidemic of knee related injuries. There are many reasons for why people may have developed knee pain but by far the most common cause is from tight hips, restricted ankle mobility and faulty movement patterns that in turn create weak gluteal muscles (your butt) and lastly a weak VMO muscle (one of your Quads). It is very important to understand that the VMO weakness and knee pain is often caused by the four factors I just listed. This article I will explain exactly why. And often the weak gluteal muscles can also contribute to other injuries in the lower limbs such as Achilles, plantar fasciitis, hip and groin problems, back problems and even shoulder problems! Here is 5 simple steps you can follow to ensure that you get on top of your injury or prevent it if you only have mild soreness. This program we have effectively rehabilitated over a thousand different knee injuries over the past 12 years as specialists in rehabilitation using movement retraining methods and simple process for correcting muscle imbalance.

Surgery & Medical Drugs Should Be A Last Resort

We have been taught in today’s modern world to treat symptoms. What we must recognize is that unless your injury was due to a traumatic accident it is a POSTURE and MOVEMENT problem. It is pointless to just take away your pain without addressing the original cause. I have literally worked with hundreds of clients who at some stage were told, "never to squat" or "don't ever run" or "do resistance training on your legs", as it will ruin your knees and you will need a replacement. Only for these clients to apply the principles I am going to show you in this article, and within months be able to not only do all of the things they said they will never be able to do but also go back to playing netball, football or even 7-day hikes in the mountains! We must become more educated about how to apply good principles of health using a proven formula of strength training, nutrition and lifestyle habits to prevent injury and also overcome chronic pain. To see pictures and videos of some of these incredible stories go to our Testimonials page.

In this article I will attempt to give you as many secrets to this proven formula as I can, but if you would like the detailed version with a 65-page report and 60-minute downloadable video scroll to the bottom of the page for more details or click here to learn more.

You Must Find The Cause Of Your Pain Or Injury

I mentioned in the introduction that often knee pain is often linked with 4 common factors.

  1. Tight Hips
  2. Restricted ankle mobility
  3. Weak glutes
  4. Weak VMO

And often it is in this order that it usually happened. Although the ankle is also often the original leak in the pipe. It is funny because the area that caused all the problems often has no pain! But this is also why most treatments fail people for they are addressing the effect and not the cause. It is inevitable that problems will resurface if the cause is not addressed. I want you to take a good look at the picture below as this will give you great insight into how a knee problem is so easily caused by either the ankle or the hip.

Let me explain this picture.

This picture gives you a great image in learning what is known as the "Joint by Joint" approach which was invented by Mike Boyle. The leak in the pipe often starts with the feet that leads to compensation all the way up the chain through every joint. What you will see is that every second joint will need flexibility and mobility, while the other joints require the exact opposite being stability and strength. Here is how it works. 

  1. Feet - The feet have a tendency to being lazy, and easily losing strength and motor control. From poor footwear to sitting too much, and even the lack of barefoot walking, the feet need exercises to make them stronger and more stable.
  2. Ankle - The ankle tends to develop stiffness very easily and needs more focus on mobility and flexibility.
  3. Knee - The knee like the feet becomes weak and sloppy easily, (VMO for instance completely shuts down with as little as 10ml of fluid present). This, in turn, creates severe knee injuries and if left untreated eventually chronic stiffness in an attempt to stabilize it. Stability and strength work is needed for this joint.
  4. Hip - This joint is often the cause of many problems. The hips have a tendency towards stiffness and as a result, benefit from flexibility and mobility work.
  5. Lumbar Spine - The lumbar spine needs stability to prevent unwanted flexion or extension.

The most vulnerable of these joints is the knee and the lumbar spine as both these joints need stability but when they are forced to move into positions they cannot perform due to the joint below or above being restricted is when all the problems arise. That is when you see the terrible single leg squat form in the picture below that leads to terrible career-ending knee injuries like ACL tears! The chain reaction matrix helps explain how this all started. Often from things we think nothing about such as sitting too much, previous ankle sprains, improper stretching or exercise technique. All things that don't create pain until later on. To fully get on top of your problem you MUST grasp this concept for just using isolated VMO exercises is a waste of time without addressing the cause.

To fully grasp this concept I suggest you read our articles below

Why Poor Ankle Mobility Can Cause A Chain Reaction Of Injury

When You Have Knee Pain Rarely Is The Knee The Problem

Okay so let's take a look at the 5 Important Steps.

Step 1 - Assess Flexibility & Release any Tight muscles

This must be your first step as tight muscles (Tonic) can disrupt the entire timing and firing of muscles within a movement that will produce weakness, instability and compensatory patterns that in turn, create more pain. The concept of loosening a tight muscle first is, that a tight muscle will cause a weaker nerve signal to be sent to its opposing muscle. Again your areas to look at the most are often the hips and ankle.

From a mechanical perspective, a tight muscle will limit the range of movement through which its opposite muscle can move. For instance, in the case of the gluteus maximus (your big butt muscle), a tight hip flexor muscle at the front of the hip mechanically will limit hip extension (backward leg movement) and neurologically will decrease the force of the nerve signal to the buttock. In other words, the tight muscle at the front of the hip will make the rear hip muscle less efficient and weak, which in turn will significantly affect the function of the kinetic chain, increasing strain on the lower leg. I regularly use this method in sessions when we are working on movements like lunges which typically cause pain. Foam roller release and Quad stretching are crucial here. So many people make the mistake of using strength exercises first without weakening the dominating muscles. This leads to frustration later when the corrective exercises don't work even though they are the right exercise. Never skip this step!

For more information on this flexibility read these two articles

How To Loosen Tight Hips

Everything You Need To Know About Stretching

Step 2  - Tape The Knee

This is very simple to do and research has proven that it is extremely effective at increasing the nervous system firing of the weak VMO muscle on the inside of your knee. Many people report that they instantly feel better when the tape is on, almost as if the muscle has been awoken and starts to do some work! To do it correctly make sure you put the tape on the outside of the leg and pull it inwards ensuring that you see a little skin fold crease as you do it. Having said that there is also plenty of literature proving that by just putting tape on the knee in some way will activate the Proprioception within the VMO significantly, even if it is done wrong! So the point you want to take out of this is to make sure you put tape on. Below is a quick video on how to do this.

Step 3  - Train Your Joint For Stability

Often this step is ignored, but make no mistake you WILL NOT DEVELOP STRENGTH WITHOUT IT! Stabilizers are so different to prime mover large muscles in that their job is to fire first and react within a split second to correct faulty alignments of joints and positions of the body. They are not strong enough to produce movement but they ensure the integrity of the movement is maintained so the big movers can do their job.

This does not mean you go straight to doing crazy exercises on the BOSU or with Balance Boards. I like to start with simple brain exercises such as single leg standing exercises with eyes shut. Kneeling exercises such as the horse stance (below) are excellent along with lying on your back Swissball hip extensions. This position allows you to keep pressure away from the joint but still work on the stability within the knee. Swissball Lateral Ball Rolls (pic on the right below) is also excellent for encouraging lateral movement with glutes, abdominals, and VMO all on the job at the same time. A deceptively tiring exercise that we use with almost every rehab client for knee or back pain. Only once I have progressed from single leg partial squats with perfect patella tracking and balance would I begin using the BOSU or Balance Boards for squats and lunges. This would also mean I am now in a position to being integration exercises.

Great article to read about this is Stability Training What Is It Really & How To Do It

Step 4  - Isolate & Strengthen Weak Muscles

Before you can begin to do full body strength movements like squats, lunges and step-ups you need to identify weak muscles and establish whether they are at optimal strength and can fire correctly. The 3 main muscles to isolate are the Glutes, VMO, and the calf. Great isolated exercises for the glutes are “The Clam” & “The Wall Push”. For the VMO we use a blood pressure cuff to give us feedback as to what is happening but you can use a cushion under your knee to do the same thing. Lastly, single leg calf raises are used to identify any weakness in the calf and ankle which can be a massive cause of dysfunctional movement. In some cases more so for females, the hamstring muscles may also need to be considered. Length-tension testing can tell you if there is a weak hamstring complex that may be causing the knee to hyperextend leading to tight quads and hips.

Great article to read for this is How To Strengthen The Glutes

Below is a very simple and quick video that shows you this in action using 3 simple exercises.

Step 5  - Integrate and Strengthen with Full Body Functional Movements

The last step is possibly the most important. The worst thing you can do is use machines to try and strengthen your body. Remember back in step 3 we looked at Stability, well machines basically tell your body you don't need stabilizers! Not a great idea. So don't do it. Any strength or muscle you add is giving you a false sense of strength. In many cases, it is the brain that is the problem and not the muscles. Faulty patterns of movement can only be trained by using exercises that target the nervous system and the way you move. These exercises are often complex and require great skill and teaching methods to change them. See How To Become Stronger Using Brain Exercises

Read our article Squat vs Leg Press Which Is Better to see more detail about exactly why machines are so bad for knee rehabilitation, and basically exercise in general.

Below is a video of 2 ways we use to teach the body how to begin using the glutes within stability exercises prior to strengthening.

Without learning how to complete Functional movements in a standing position you are not yet fully rehabilitated. There will be a chance that you will have to go back to rehab. This is a delicate time as there may no longer be any pain however your body is not quite ready to go back to what you want to do. Without a doubt the best exercise to use is the Single Leg Squat as this brings into play all of the weaknesses with flexibility, stability and strength all at once! It is possibly the best glute strengthening exercise you can do. It is also the same movement pattern most people hurt their knee with! Learning how to do this correctly and improving your skill and strength is critical for the prevention of further injury or getting rid of your pain.

Squats, Deadlifts, and Lunges are all great exercises to help achieve the same goal but they are nothing compared to the single leg squat or the single leg deadlift.

Read our article Why Single Leg Squats Are The Best Exercise For Knee Rehabilitation to see why.

Over the years I have come across many people who were experts at everything lying on the ground but when they stand up and try a lunge or a squat it is a different story. This is because although they have worked the muscles in isolation correctly, the sequential timing and stability has not been taught in the right order meaning the movement that is likely to hurt them is still compromised. Look at it this way, how many people do you know that have hurt themselves lying down versus how many people do you know that have hurt themselves standing up? This is common with bodybuilders as they isolate muscles to an extreme degree that their whole body is out of whack. The body thinks in terms of movements, not in terms of muscles. Isolation training will eventually lead to a dysfunctional body. Unfortunately, this is also true with many rehab programs as once again they fail to provide a method of progressing from the ground to standing. Pilates is a perfect example of this.

The most effective way to train integration for VMO weakness other than single leg squats and bridges is by applying cables or straps pulling across the knee to provide correct activation of the weak VMO and the Glutes thus assisting the knee joint in creating stability free from pain. We like to refer to these as iso-integration. Meaning you are trying to isolate a weak muscle within an integrated movement. Your program MUST include various types of lunges, squats, deadlifts, step ups and standing upper body movements to train the body for everything it encounters in life. Remember exercise technique is absolutely essential here if you want to build good movement and muscle. Read our article on Movements instead of muscle to understand more about the importance of this step.

Below is 2 videos showing you how we do this with ACL rehabilitation programs and also using a simple Box Step Up exercise using the strap.

If you play sports learning how to move is essential if you want to avoid more injury or ruin your career! The exercises shown in this video are so important if you want to stay on the field.

Be Careful Of Poor Form With Wall Squats & Single Leg Squats

The two videos below are good examples of where a good exercise turns bad. Firstly the single leg squat is too upright and causes all sorts of problems at the knee by moving like this. The wall squat exercise actually contributes to knee pain instead of helping it. It is not even close to resembling a VMO exercise. This exercise is actually likely to enhance your problem as it does 4 disastrous things to enhance your problems.

  1. Enhances faulty movement patterns with the squat. It is not even close to good form.
  2. Encourages quad and hip dominance and we already discussed this is often a big problem and the major source of pain
  3. It tightens adductors and not the VMO to squeeze the ball. The adductors work in combination with the hips to internally rotate the femur placing your knee in a terrible alignment to create pain and injury
  4. All of the above make it near impossible to strengthen your glutes which adds to further dysfunction and more internal rotation and pain

Whatever you do, get rid of this exercise from your mind and never do it ever again.

Knee Pain Download, DVD & Toolkit

As mentioned due to the overwhelming number of questions we were receiving about our Knee rehab program we decided to document ALL of our assessments, stretches, stability, strength, power exercises and programs and put it all into one big bundle so anyone could follow the path we had spent many years developing. If you want to see a quick trailer video of what is inside click here.

Below are both of our options and I highly encourage you to at least get the 60-minute video as this has over 60 exercises with instructions and detailed explanations on how we have helped hundreds of clients in the past few years.

CLICK HERE to get both the 60-minute download video and PDF report complete with 6 months of programs to get you started right now!


I hope that this report provides you with enough information and knowledge about how to go about strengthening your VMO and your legs as a whole unit of muscles. We must move away from looking at areas in isolation for this is not how we move. Important for everyone from sporting athletes to people just wanting to have toned legs and look great. But even more important to those needing knee rehabilitation to address pain and dysfunction. Using an intelligent method of program design based on the principles I have just shown will help build strength like never before and help almost every type of injury. You cannot rush the process, you must be patient and aim for perfect form and movement before progressing to the next phase. It is not more exercises that will make you better, rather better quality. The most important points to remember are:

  1. Assess don’t guess
  2. Follow the Success Formula - Flexibility first, Stability, Strength and lastly Power
  3. Stretch tight muscles first before trying to strengthen
  4. Isolate then Integrate within the Strength Phase
  5. Always aim to improve MOVEMENT PATTERNS in a standing position and not just focus on muscles
  6. Consider other factors such as Stress, Sleep, and Nutrition in your rehab program and devise a plan to improve them
    1. FREE Report That You Can Download To Help You

      Make sure you get a copy of our FREE Glute Checklist below by clicking the image to download. This will help you to implement many of the key things discussed in this article.

      If you live in the Melbourne area and have any form of Knee Pain you can request a Free Assessment and consultation by filling in the form below

      About The Author

      Nick Jack is owner of No Regrets Personal Training and has over 14 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.


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      • The ACL Solution - by Robert G Marx
      • Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine
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      • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
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