Be Flexible in Your Philosophy

By September 20, 2011 Training Philosophy

Sometimes I enjoy looking back at my training journals over the years. My workouts have always been effective, but the way I’ve trained has morphed considerably over time. The same goes for how I train clients. In my own training over the past twenty years, I’ve gone through a high-volume bodypart split phase, a high-intensity total body phase, a lower-upper split phase, and a high-frequency total body phase. I started out using mostly machines, transitioned to mostly bodyweight, barbells and dumbbells, and now like to also incorporate bands, and kettlebells. In my time I’ve toggled back and forth between unilateral and bilateral, high reps and low reps, high force and high velocity, isolation to integration, and quantity to quality.

After a while you realize that everything has a purpose. When considering training for rehabilitation, hypertrophy, strength, power, speed, agility, and endurance, many types of systems and many tools are warranted, and it all blurs together.

Two days ago I gave my first of many upcoming 21st Century Glute Training workshops. It was a huge success; 32 trainers, coaches, and therapists spent an entire day equally divided between lecture and hands-on learning. Afterward I was speaking to some of the attendees and I told them that my training methods, beliefs, and philosophy are always evolving. My systems are in a constant state of flux depending on the knowledge I gain from training more individuals, reading more research, and learning more about biomechanics.

Flow With Science

One thing that is very difficult for lifters, trainers, physios, and coaches to do is flow with science. We get a rigid belief and picture of how things work in our head only to find out down the road that we were wrong. When reading Muscle, Smoke, and Mirrors, I had to laugh at all of the things that the industry once thought was true. As resistance training became more popular, folks came out of the woodworks trying to prevent the methodology from spreading. Resistance training supposedly led to enlarged hearts and created slow, clumsy, and inflexible muscle. Squats supposedly destroyed the knees. Luckily some bold individuals ignored these naysayers and forged ahead.

Hypotheses

I suspect that over time we’ll learn a few more things, and I’ve been fairly vocal about these hypotheses. I believe that we’ll learn that crunches do not destroy the discs as most people believe, that squats are not the the best strength training exercise for increasing linear sprint speed, and that power development is maximized when methods are aligned according to force vectors.

The way my brain currently understands these items above is that some spinal motion is healthy for the discs, hip thrusts and back extensions are better for maximum speed development than squats, and max power requires training for strength, power, and elasticity in multiple planes and directions.

Being Wrong

But what if I’m wrong? What if new research comes out over time to refute my beliefs? What if research emerges showing that every repetition leads crunchers one microscopic step closer to disc herniation as the nucleus slowly works its way through the lamellae? What if upcoming research shows that squats lead to more improvements in sprint speed than hip thrusts due to increased leg spring stiffness? What if future studies show that general strength training methods involving the basics do just as good or better of a job than vector-specific training?

I will not feel embarrassed for being wrong. I’m proud of my current knowledge and my courage to state my opinion as I stick to what’s true in my mind regardless of whether it will or will not make me popular with the mainstream. What’s important to me is that I flow with science. Based on my knowledge of biomechanics, my experience training others, and my knowledge of the literature, I’m pretty confident in my beliefs.

But I will be the first to update my readers if new research emerges indicating that I’m wrong. I’ll also be the first to update my readers if new research emerges indicating that I’m right. And if any of this research has particular strengths or weaknesses, I’ll be sure to point it out to my readers. I’ll also be sure to update my own training systems and change the way I train myself and others based on my new knowledge.

Confirmation Bias

Don’t ever be too rigid in your beliefs that you quit adapting with science. I’ve realized some things about gurus that really turns me off. Most of them quit adapting. I think this has to do with the fact that many of them sell products, write articles, film videos, and teach workshops. Since they share their opinions in these mediums, it becomes difficult to say, “I was wrong.” Nobody should be faulted for being wrong, but they should be faulted for ignoring evidence, putting on blinders, and refusing to grow.

If all you have is a hammer, everything looks like a nail. Gurusim leads to confirmation bias and I try my best to avoid it. In case you don’t know, this is Wikipedia’s definition of confirmation bias:

Confirmation bias is a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true. As a result, people gather evidence and recall information from memory selectively, and interpret it in a biased way. The biases appear in particular for emotionally significant issues and for established beliefs. For example, in reading about gun control, people usually prefer sources that affirm their existing attitudes. They also tend to interpret ambiguous evidence as supporting their existing position.

It’s not that these gurus are jerks; they’re not knowingly attempting to deceive, it’s unintentional. Robert Maccoun believes that most biased evidence processing occurs unintentionally through both cognitive and motivative mechanisms.

When I speak at seminars and workshops, my attendees always seem to ask me a couple of questions. First, they ask what my opinion is regarding training the VMO, and second, they ask me what my opinion is regarding training the TVA. Let me tell you what my opinion is.

The VMO

I’ve read around twenty articles in the past two years that indicated that knee valgus and patellofemoral pain is linked to the hips, not the VMO. Before we go any further, just use some common biomechanical sense.

Do you think that this:

Is caused by weakness of this?:

Or weakness of this:

I know what makes more biomechanical sense to me, and I also know what I feel when I walk up stairs or squat while trying to keep my knees out.

Matt Fitzgerald discusses some of this in his article here, but there are literally dozens more studies, and to get an adequate grip on this topic you really need to consider the entire body of evidence. In fact, in a recent review paper titled Influence of the Hip on Patients With Patellofemoral Pain Syndrome: A Systematic Review, the researchers identified 15 worthy papers on the topic and this search was limited to September of 2010. Since then many more have emerged; a couple new ones every month on this topic. Researcher Christopher Powers does an amazing job explaining the biomechanics of knee injury mechanisms in his article titled The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective.

Having read all of these papers and trained some folks in this position with success, I can tell you some surprising things. It’s not all about strength, it’s about strength balances. It’s not all about the gluteus medius, it’s also about the gluteus maximus and hip external rotators. Finally, it’s not all about strength, it has much to do with motor control (timing, patterns, etc.). One paper showed that simply telling runners to contract their gluteus maximus and envision their leg staying in a straight line when they ran led to improvements in running mechanics. I’m sure that the same is true for jumping and landing. This is not to say that knee valgus is only motor control related, as it’s also related to strength, but the best outcomes will occur with a strengthening and kinaesthetic awareness/educational protocol.

One thing I’m pretty sure about is that it’s not the VMO! The notion that the VMO even exists is debated in the literature in a paper titled Do the Vastus Medialis Obliquus and Vastus Medialis Longus Really Exist: A Systematic Review, and a review paper by the same authors found that the VMO cannot be preferentially activated over the VL here in a paper titled Can Vastus Medialis Oblique be Preferentially Activated? A Systematic Review of Electromyographic Studies. I’ve only seen one paper showing much of a difference in VMO activation relative to VL and that was when performing a squat while squeezing a Swiss ball between the knees. Do you really want to train that pattern? And the difference was something very small such as 8% if I recall correctly, which is not something to write home about.

My guess is that some coaches have had success with their training methods in curing patellofemoral pain because they’re prescribing exercises such as Bulgarian split squats for the VMO, thereby training the hips and increasing lateromedial and torsional hip stability, all the while incorrectly attributing the methodology to the increased strength of the VMO. My take: don’t give the VMO a second-thought in training. The quads get strengthened in proper balance through knee dominant training. Focus instead on hip dominant work, accessory hip exercises, and neuromuscular awareness.

The TVA

Moving on, we don’t need to train the TVA with healthy people. It’s true that I’ve read plenty of papers showing that the TVA doesn’t function optimally when the low back is in pain. Injury and pain can cause certain inner core unit muscles to contract late in the game in regards to extremity motion, including the TVA and multifidus, and it may be important for physios to retrain these muscles early on in rehabilitation. In this case lower abdominal hollowing has been shown to be an effective route for isolating the TVA, and bird dogs can be used to train the multifidus. But this is for rehabilitation purposes, and the TVA might simply fix itself all on its own once pain subsides.

Hollowing for rehab is one thing, but hollowing for increased stability during heavy lifting is monumentally different. In 2007, Grenier and McGill found that abdominal hollowing was far inferior to abdominal bracing for stability purposes due to a reduction in the leverage in core muscles (rectus abdominis). I can’t figure out why anyone would want to suck in their abs when performing heavy strength work – you want long levers for stability, not short levers. The researchers found that the TVA contributed a paltry .14% to the stability of a brace pattern, which is also nothing to write home about.

A recent paper by Stokes titled Abdominal Muscle Activation Increases Lumbar Spinal Stability: Analysis of Contributions of Different Muscle Groupsshowed that further increases in TVA activation above normal levels of activation did not improve spinal stability. Furthermore, Cholewicki and VanVliet found in a study titled Relative Contribution of Trunk Muscles to the Stability of the Lumbar Spine During Isometric Contractions that all muscles are important for spinal stability; no muscle moreso than any others when considering different loading variables. My take: ignore the TVA if you train healthy individuals. The TVA gets trained in proper balance with every single action you perform that recruits the inner core.

Barking Down the Wrong Tree

One reason why all of this is so important to me is that if we continue to believe that we’ve got the criminal but we’re wrong, then the true killer is a free man while we’re oblivious. For example, if we attribute back pain to crunching then we may fail to examine potentially more important factors such as weak glutes. If we attribute knee pain to the VMO we may fail to examine potentially more important factors such as weak glutes as well. It seems that some experts would rather go down defending their original stances than educate their readers about new findings in the literature.

Mel Siff’s Legacy Lives On

There are a bunch of trainers including myself who were highly influenced by Mel Siff. For those of you who don’t know of him, he was the Elvis Presley of Sports Science. He could silence the cockiest of gurus. He didn’t give a damn about popularity, he cared about advancing sport science. Many of my colleagues such as Keats Snideman, Joe Dowdell, Joel Jamieson, and Brad Schoenfeld, to name a few, were heavily inspired by Mel. Though Mel passed away long ago, there are a bunch of us who try our best to carry his torch.

I’m certainly not anti-guru as I’ll be the first to admit that I’ve learned a ton from dozens of top trainers and coaches. I value the knowledge I’ve gained from these folks dearly. I would say that I am anti-arrogance, anti-bro science, anti-bullying, and anti-bull headedness.

The way I see it, if you’re a guru and new research comes out suggesting that you might be wrong, you should be thankful for the researchers’ efforts as it challenges you to become better. This is the way it should be: no egos, just the pursuit of excellence.

Hitch Your Trailer to Science, not People, and You Won’t be Led Astray

My professor John Cronin always says to me and his other students:

This is what I know to be true today. It is subject to change next week as I continue to learn.

This is how a true scientist thinks, and we’re all scientists whether we know it or not. The simple fact that you’re reading this blogpost means that you’re searching for answers, seeking knowledge, experimenting, and learning. What you believe to be true today will indeed be different from what you believe to be true five years from now. Be flexible in your philosophy. Be open-minded. Be skeptical.

30 Comments

  • Good stuff, Bret! I should have an article published rather soon about the VMO stuff you presented here. Always a huge influence.

  • Jon Goodman says:

    I had the same conversation with a client of mine last week. We just hit our 4 year anniversary together and I took out some of her old workouts to show her how far she had come (frozen shoulder fixed, torn ACL rehabbed, arthritis in hands and feet no bother anymore, 45lbs lost).

    What threw me was how bad my programming was back then. Maybe not bad as it worked. How many of the programs I would never do now though knowing what I know.

    They worked though and you can’t knock the results. I guess that’s the beauty of what we do. There are so many paths to positive results and, to be the best, we have to continually search for stronger and stronger links to science to find the best paths.

  • Patrick says:

    Excellent post here Bret, and yes flexibility and adaptability makes for the best trainers out there.

  • Ted says:

    Maybe I am being an idiot here, but I don’t get why the existence of the VMO is questioned.
    Isn’t it obvious that front squats build a different kind of leg compared to back squats due to a swift in leverages and a greater recruitment of the VMO?
    From experience, those that only back squat have different looking legs than those that mostly front squat.

    Thanks. Good stuff as always, Bret! Good job.

    All the best,
    Ted

  • Bret,

    Good usage of the word paltry! 😉

  • Oh yeah, very good post too!

  • Eric Helms says:

    Absolutely fantastic piece Bret, having a few NASM certs I learned a good bit from this post on the VMO, TVA, Multifidus, stabilization front, and the overall philosophy is spot on. That is how learning is done, the ego is only a barrier!
    -Eric

  • Great article Brett! Research is the key to everything and you really nailed it on this one. We love your articles, keep them coming!

  • Darren says:

    Great article Bret,

    Really nice to hear this when so many in the exercise science field are completing unwilling to be swayed from their beliefs and hypotheses. It’s what led me away from a career in academia.
    By the way, a client of mine attended your recent workshop and had great words to say about it.

    All the best,

    Darren

  • Darren says:

    COMPLETELY unwilling……. 🙂 Maybe it should have been my poor mastery of grammar and spelling that kept me out of academia…….

  • Great post Bret.

    I like to take a moment every 6-12 months and remind myself of all the things I have been certain of – that proved to be wrong and identify paper/experience/whatever that made me change my mind. Keeps me down on earth. We can never be certain that what we believe will always be “true” in all environments – but we can allays be open minded and treat people with respect, even if we don’t agree.

    In strength,

    Bojan

  • Matias says:

    I’m going to ignorantly disagree in hopes of picking your brain. I hurt my MCL in a soccer game during a routine tackle with the inside of my right foot, pushing my tibia laterally towards the outside of my body. At the time I had given up squats and was focusing on deadlifts(sumo)to bring my hammies up. Growing up, I had felt pain on the inside of my right knee when shooting the ball with the inside of my foot. I blame this on my weak VMO. After my injury I couldn’t walk. I rehabbed with knee pull backs to strengthen the VMO. I discovered that the stationary bike with the pedals in front gave me a pump on the VMO like I have never felt before. It even made me walk different. Why is it that sumo deadlifts still make my knee feel weird?!?

  • Bret says:

    Thank you very much for all the good feedback everybody, which means a lot to me coming from such intelligent folks.

    Matias, you could be right, but two things to consider:

    1) I believe that with most people it’s the hips, not the VMO (your situation could have been unique), but I appreciate the anecdotal evidence and unique observations with the TKE’s, bicycle, and walking kinematic alterations.

    2) I’m trying to wrap my brain around the different biomechanics involved in a kick with the inside foot. It’s different than a squat, jump, or land. In this case the VMO is likely more important. However, the possibility exists that you “rehabbed” your knee by removing the insults (stopped the actions that were hurting it) and it wasn’t in fact the terminal knee extensions (TKE’s) but the removal of pain-generators. Sumo deads might make you feel weird because you’re not forcing your hips out…you really need to get them out wide. I’d have to see your form.

    Thanks for the comment and please don’t ever refrain from comfronting me about something you disagree with. I appreciate you doing it in such a polite manner. Cheers!

  • Matias says:

    Being a soccer player with real strength goals puts me in a very lonely training category. I’ve had questions and challenges arise with no researched solutions or suggestions. My injury was acute instead of chronic so I believe that my rehab warrants the absence of quotations…lol I’ve combined my experience with lessons from Mr. Contreras, Gentilcore, and Cressey and have learned things about the soccer athlete that I question if even the professionals know. I’m a complete believer that the glute strength is crucial to knee health and I think I’m the only player in the world doing weighted glute bridges. If I make it, I owe you a check 😉

    God bless.

  • Good stuff Brett.

    Hope all is well

    RB

  • Rob Panariello says:

    Matias,

    An injury to your MCL will cause pain. We know that if the injury occurred at the site of the femoral attachment you will have a greater amount of pain than if you injured your MCL at the tibial attachment. Since the MCL is “stressed” with knee extension (especially full/terminal knee extension), it is at these terminal ranges of knee extension that you will feel the most discomfort. That said,it is very important for you to achieve full knee extension, as this is imperative for you to return to “normal function” and optimal athletic performance.

    With regard to the VMO, specific positions or ranges of motion of the knee/lower extremity (i.e. straight leg with external rotation, terminal knee extension, etc…) do not have a greater affect on VMO firing. What is most important for the restoration and stimulation of the VMO is intensity. You must lift appropriate, safe, yet optimal intensities to enhance VMO strength.

    The pain that you feel when shooting with the inside of your foot was most likely came from your MCL as when you used this method to shoot the ball you were also applying a valgus stress to your knee thus also stressing the MCL. This is certainly not to say that your VMO was working optimally as well as with such a trauma that you describe multiple anatomical structures may have been affected.

    Just my opinion.

  • Matias says:

    Rob,

    Thanks for your input. I agree with you as these steps helped me out tremendous in my rehab, so the proof is in the pudding. I’ve sinced progressed to reverse weighted lunges from a defecit. These, along with glute work, have brought my knees and confidence back up to competition level.
    I still focus on my knee, because sometimes it feels stiff and a couple of “air” leg extensions makes it pop and feel better. This pop also occurs within the first reps of my lunges or couple seconds on the bike.
    I agree that the kicking causes valgus stress and strains the MCL. My question is: Can a dominant vastus lat pull the knee away from a weak VMO and cause stress to the MCL before the kick even takes place?

  • Rob Panariello says:

    Matias,

    The “popping” that you are feeling is most likely coming from your patella. The reverse lunges that you are performing are enhancing your quad strength while decreasing patella-femoral compression forces (a good thing based on your injury). The posterior lunge exercise performance i.e. stepping backward will maintain more of a vertical tibia posture, thus reducing patella femoral compressive forces when compared to a forward stepping lunge where during the exercise performance, the knee is often “driven” forward thus increasing these patella-femoral compressive forces. Maintaining an erect torso/posture will maintain a long moment arm (of the weights) to the knee thus enhancing the work of the quads during posterior lunge exercise performance.

    The reason that the VMO may not be isolated during exercise performance is because the Femoral Nerve innervates all of the quad muscles. The vastus lateralis is stronger than your VMO, so the concern is the “proportionate contribution” of all of the quad muscles to result in “optimal” function/performance when working together. If your VMO is weak you will affect this quadriceps “homeostasis” so to speak, and this probably will have an affect on knee biomechanics. In my opinion a weak VMO would have more of an affect on your patella-femoral joint (perhaps why you “pop”) vs. the MCL (tibial-femoral joint)of the knee.

    I do not know if you had any imaging studies (i.e. MRI) after your knee injury but if you did damage your MCL and VMO, I would not ignore the possibility of damage (not definite but possible damage) to your medial retinaculum, as well as the medial patello-femoral ligament of your knee. This would be especially true if you subluxated or dislocated your patella while making your violent tackle. To be clear, I am not saying that you have these additional injuries, I am just making a suggestion for your follow-up if you (a) have not had any imaging studies besides x-ray, and (b) if you are not satisfied with the way you are progressing since the injury.

    Just my opinion

    Rob

    • Bret says:

      Thanks for your expertise Rob! Has anybody ever told you that you know a lot about the knee joint? 🙂

      Would it be wise for folks with prior knee ligament injuries to attempt to alter their movement patterns during high force and high velocity movements in sports to be more knee friendly?

      For example, slightly increasing trunk lean upon landing, staying more upright during cutting, performing counterbalance single leg squats, etc.? I know you need to strengthen the quads but you also need to teach the athlete to utilize their hips more which would spare the knee, correct?

  • Lynne says:

    Hi there, I found out about you through Valerie Waters’ blog, and was really impressed. I purchased your guide, and am looking forward to your newest edition. Question: a majority of your glute/hip exercises involve arching your back at some point. Unfortunately, I have several back issues (arthritis, missing cartilage between two discs, etc.) that causes me pain when I twist and arch my back. I am 47 years old, and while my “glute” work with my trainer has done wonders for my hamstrings and quads, it has done little for my actual glutes. Any suggestions, please??!!!!

    • Bret says:

      Lynne, you don’t have to arch your back with these movements. In fact, if you overarch then you’re doing them incorrectly. Follow my advice in this Youtube video: http://www.youtube.com/watch?v=hCm-70-9_XE
      Master bodyweight first and progress gradually over time. That should help! -BC

      • Lynne says:

        Thank you Bret, I watched the video and gave it a try. I did feel some tightness in my quads and hip flexors, and will have to stretch before I do your exercises “officially.” Which of your exercises would help a woman’s outer glute/saddlebag area? Or do yours cover everything? It seems women’s lower body/glutes/etc. are so much more complicated to effectively sculpt than men. (Sorry for all the questions, but you really have been the most knowledgeable person I’ve come across. And, believe me, I’ve been looking!!) Thank you again.

  • Matias says:

    If you’re still listening. I’ve bet you’ve never encountered THIS…lol. Remember how I said my knees heart during SUMO? Well, apparently something happened on my quest for strength and my knees hurt during regular deadlifts too. I checked my form and my knees are “caving” OUT during my descent. What’s up with that?

  • Rob Panariello says:

    Matias,

    As you know the descent (eccentric) or lowering of the bar to the starting position is not as critical for the exercise (concentric) performance success in the deadlift when compared to the squat or the bench press. When attempting a single rep deadlift PR, after pulling the bar from the floor and succeeding in the deadlift, unlike the squat or bench press, the bar could just be dropped to the floor if so desired as the lift has been completed. When performing multiple reps in a deadlift set, I am of the opinion that a lifter can “get away” with less control of returning the bar to the floor (starting position) in the deadlift when compared to the crucial performance of the bar descent (eccentric) necessary to ensure squat or bench press (concentric) success. I believe that you may have 2 different scenarios, not just one, and yes, the second it is more common than you may think.

    1. Your knee pain is probably due to your knee injury and I am of the belief (keep in mind I have never examined your knee nor seen you lift weights) that there is a patello-femoral component to you pain. As you lower the bar you may be applying increased compressive forces to your patello-femoral joint and you may be “caving out” as you state, in an attempt to assume a knee position that will decrease the pain.

    2. In a conversation I had a while ago with one of my partners, a former successful powerlifter and Physical Therapist named Tim Stump, our discussion was based on if we possibly wanted to return some patients/athletes (i.e. post-op hip labral repairs) to deadlifting after their rehab was complete (i.e. return to athletic performance training). During the conversation it was discussed, that SUMO style is probably a more comfortable and efficient style of deadlifting with those athletes that may present with hip issues. Whether the athlete has tight hips (capsule and/or other soft tissue structures), osseous changes (i.e. CAM/Pincer lesions, FAI), etc… OR due to the performance of the SUMO technique performed over time the lifter may develop a tight hip (i.e. loss of hip internal rotation) as the exercise is consistently performed with the hips externally rotated. Since you previously performed the SUMO technique, your “caving out” may be due to the comfortable patterning (i.e. your present anatomy, soft tissue, osseous structure, etc…) of the body to externally rotate the hips at certain positions during your deadlift performance. This also occurs with lifters that do not present with knee pain for the reasons stated.

    I also believe that you would still have knee pain if you didn’t “cave out” as you describe, and were able to maintain a “traditional” deadlift type stance (form). Check your hip flexibility, especially your internal rotation. I do not know if I am correct (regarding #1 and #2 above), but that is my opinion based on the limitations of the Internet.

    Good luck.

    Rob

  • Rich Tolman says:

    Rob,

    As always, thanks for coming to this blog and posting your thoughts. I had a couple of questions regarding the VMO. Some coaches advocate “targeting” ( perhaps a better choice than “isolating?” ) the VMO through terminal knee extensions and Peterson Step Ups. They view it as the place to begin with regards to structural balance or restoring the homeostasis you spoke of. What are your thoughts on this? Also, what type of progressions might you employ if you suspect one has a weak VMO? Thanks!

  • Rob Panariello says:

    Rich,

    As always, thank you for your kind words.

    My brief response is that you cannot “isolate” or “target” the VMO because the quadriceps muscle group is innervated by the same nerve, the femoral nerve. Therefore stimulation of the femoral nerve will fire all of the quadriceps muscles simultaneously. Try it yourself. Fire your quads as hard as you can and see if you can “fire” the VMO harder than the other quad muscles or vice versa (assuming you have no pathology).

    When I think of the VMO I think of (a) patella and (b) knee extension, both are the responsibility of the VMO/quads. An example of a very “general” progression (without knowing the knee pathology or why the VMO is weak) would be the initiation of simple exercises such as (supine/long sitting) quad sets (with Russian stim if appropriate) to planks (prone) to straight leg raises (supine). Knee ROM is not necessary with the performance of these exercises as in some pathologies knee ROM may induce pain. However, one thing is certain, the exercising individual must achieve full knee extension.

    Progress to the standing position and perform Tegney exercises progressing to Tegney exercises with a half foam roller under the heel of the exercising extremity (eliminates the contribution of the gastroc), step-ups, to step down (eventually stepping down off of an 8 inch step/block).

    SUPINE leg press with increased knee exercise ROM but less than body weight, progressing to full body weight. At this time you may get the individual on their feet as they can now exercise supporting their full body weight.

    Now the question is what is the condition of the VMO/patella/patello-femoral joint? Do you need vertical tibia i.e. squats, reverse lunges, or can you allow the tibia to translate anteriorly which will require more work from the quads/VMO which brings us full circle because patella is effected by VMO/Quads so don’t we want enhanced quad strength? i.e. squats and lunges but performed differently than vertical tibia.

    If you want to stimulate the VMO you need intensity, period. Apply heavier weights or higher velocities, as long as they are appropriate. That is why I am an advocate of (safe and appropriate) intensity during training, because it’s all about a stimulus application and an adaptation to the applied stimulus.

    How does one decide upon the exercise prescription and exercise progression? That is the “talent/eye of” the coach isn’t it? That’s why I’ve always stated; make an educated decision, not a decision based on the fact that someone else is doing “X”. Know the difference between fact and opinion.

    My explanation is limited to the “VMO/quads” due to the nature of your question. Obviously the hips and other anatomical structures will affect the patella as well.

    Just my opinion and hopefully I’ve answered your question, to at least some extent. Be well

    Rob

  • Matias says:

    Rob,

    You are absolutely right about me lacking internal rotation in my hip joints. I think it comes from a life of soccer and logically my non-dominant leg is has even more externally rotatated because I use it for support as I handle the ball. I’ve noticed that when I go to sit or stand up from sitting my heels are close together and me toes point out, allowing me knees to track towards me toes and my hips to externally rotate. As I focus on improving my internal rotation, I feel my glutes firing a lot better. I’ve lowered the pounds on the deadlift while focusing on pushing my knees in. As my legs shake in the effort I feel my adductors working like never before.

  • Rob Panariello says:

    Matias,

    I would appreciate if you would keep us informed (as I am curious) if a progressive improvement in your hip internal rotation has a positive effect, i.e. a reduction in your knee pain, when you resume deadlifting with higher intensities.

    Rob

  • Joe Miller says:

    VMO question:

    So I’ve got a leg length discrepancy of 1/2″. My shorter leg’s knee suffers from PFS the longer leg knee is fine. I’m told by a orthopedist that my patella tracks to the side. I was also told to do straight leg lifts (alot of them, like 150 reps with 10lbs).

    What you’re saying is to focus instead on strengthening the gluteals? Am I understanding this correctly?

    Any and all feedback is welcomed.

    –Joe

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