This is the story of my client Phil who managed to overcome some serious injuries and return to his once active outdoor lifestyle. Though only in his mid-20s years of high level volleyball and other sports left him with a damaged knee. Three ACL tears and five knee surgeries later the doctors put him on the bench and told him to wait until medical technology improved enough to offer him a solution. No more hiking, surfing or rock climbing. Simply stepping off a curb presented a challenge. Fast forward less than a year later and, after consistent and strategic hard work in the gym, Phil has safely and confidently summited Half Dome, Mauna Loa and can hike over the most rugged terrain. If you'd like to learn the strategy and some specific exercises for how we strengthened his knee, and his VMO muscle specifically, to accomplish this, read on below. And you can read his story in his own words here and below.
[Note: if you suffer from a past or current knee injury consult your physical therapist, surgeon, physician or other medical professional before attempting the movements below. I am a personal trainer, not a doctor. In developing programs for my injured clients I work with medical professionals to ensure safety and efficacy of fitness programs so please do the same.]
Based on input from his doctors we focused on two key strategies:
- Gluteus medius ("glute med") activation and strengthening
- Vastus medialis oblique ("VMO") strengthening
Weakened or "sleepy" glute muscles are very common in today's technologically advanced world. Sleepy glutes stem, basically, from chronic sitting and poor standing postures. When the glute med is weak it can cause the knee to collapse inward, compromise its stability and lead to nasty injuries (like torn ligaments). The VMO is one of the four muscles that make up the quadriceps. It is the innermost (or "medial") of the quads and, among other things, is key in keeping the patella ("kneecap") tracking correctly. Obviously both are important muscles if you want to overcome or prevent a knee injury (not to mention if you just want strong, stable legs).
Lateral Band Walking
One of the best ways to get those sleepy glute meds firing again is through lateral band walking. Pick up a package of bands that offer increasing levels of resistance and integrate various versions of band walking (like the three below) into your warm up and strength program. Start with moderate resistance and increase as your glutes strengthen. Move slowly, with control and lead with your heal. Don't arch your back and don't let your returning foot drag on the ground. When done correctly the glute med (side of your butt) should be very warm/burn and you should notice it becomes easier to keep your knee tracking inline with your ankle versus collapsing in. Start with 1-2 sets of 10-20 reps in each direction. More advanced gym goers can also integrate the bands into their lifts for extra glute med work (for instance, keep the band in Var 1 below during a goblet squat, back squat or HEX bar deadlift).
Bulgarian Split Squats
The Bulgarian Split Squat is great for ironing out lower body strength discrepancies and for targeting the VMO muscle specifically. Body weight is shown in the video below but you can load front, back or side (unilateral and offset) with any form of load (barbell, dumb bell, kettle bell) or add an upper body press or pull for added challenge (see image below video for a few ideas). Put pressure through your forward foot/leg and only use your back leg for balance. Resist pushing off that back foot.
Transverse Step Up
The transverse step up is a great way to target the glutes and quads (especially the VMO) for knee stability and hip mobility. Body weight is shown in the video below but you can load front, back or side (unilateral and offset) with any form of load (barbell, dumb bell, kettle bell) or add an upper body press or pull for added challenge (see image below video for a few ideas). Press through the heel of your forward foot and try and step as quickly but softly on the back foot as possible (think "Ninja Feet").
Note, the exercises in this article are just a fraction of the effective activation and strengthening drills and movements that can strengthen your knees and that should be part of a balanced program. The ones here are ones I've found 1) especially useful 2) typically lacking in folks' programs 3) have the added bonus of working your hips in different planes of motion. So if appropriate and safe, give them a shot and I hope they help you move well and move often!