Filed Under (Corrective Exercise, Exercise Rehabilitation, Fitness Education, Knee Injury, Knee Pain) by Rick Kaselj on 06-07-2010
What Exercise is Ideal for Clients with Patellofemoral Pain Syndrome due to Muscle Imbalances
Approximately 60% of athletes have patellofemoral pain syndrome (PFPS) sometime in their life, and a long line of research has shown that PFPS is primarily caused by muscle imbalances in the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles.
Activation, endurance and strengthening of these muscles is key to PFPS prevention and rehabilitation, but the best exercises for these muscles have not been conclusively determined.
In an effort to help clarify contradictory findings in the exercise science literature on this topic, researchers in the United Kingdom conducted a study designed to test the effect of two closed kinetic chain exercises and one open kinetic chain exercise on VMO and VL muscle activity in healthy individuals.
Highlights of the Study
The study’s participants were 11 men and 11 women between the ages of 18 and 40 who were not experiencing any symptoms of PFPS at the time of the study.
Researchers used electromyography (EMG) to measure VMO and VL activity and calculate a VMO:VL ratio while the participants performed three quadriceps-strengthening exercises after a 5-minute indoor cycling warm-up.
Other Amazing Stats about Patellofemoral Pain Syndrome
- incident rates in the general population of 25%
- one of the most common injuries in the lower body
- the ratio of VMO:VL should be 1:1 but in people with PFPS it is estimated to be 0.54:1.
- muscle imbalance of VMO:VL leads to a decrease in medial pull leading to patella maltracking
Exercises They Tested
The three exercises were:
− double leg squat with isometric hip adduction (pillow between knees)
− open kinetic chain knee extension exercise (sitting on the edge of a table and alternating bodyweight leg extensions)
− lunge exercise (static)
Take Home Message
Summing It Up – EMG results showed that the double leg squat and the lunge exercise showed a significantly greater VMO:VL ratio than open-chain knee extension exercise, and the double leg squat produced the largest VMO:VL ratio (1.18:1).
Leg Extension – In contrast, the open-chain knee extension exercise preferentially activated the VL muscle, giving a VMO:VL ratio of 0.72:1.
Men and Women- No significant gender differences were seen on any measurements.
The Lunge – The lunge exercise gave a VMO:VL ratio closest to the theoretical ideal of 1:1 (1.14:1). The study’s investigators recommend the lunge exercise as the ideal exercise for treating PFPS when correcting VMO/VL imbalances is necessary.
Double Leg Squat with Hip Adduction – The double leg squat with isometric hip adduction is ideal for targeted VMO strengthening.
Last Word from Rick Kaselj <== THE PART TO READ
Want to Focus on VMO – Do the double leg squat with isometric hip adduction.
Want to Focus on VL – Do the leg extension exercise.
Key Point to Remember about Leg Extension – Performing open-chain knee extension exercises may not be a good idea for clients with PFPS because it may induce excessive lateral tracking of the patella due to focus on VL.
Want to Balance out VMO & VL – Do the lunge exercise.
Where to Get More Information
Irish SE, Millward AJ, Wride J, Haas BM, Shum GL. (2010). The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis. J Strength Cond Res. 2010 May;24(5):1256-62.
If you are interest in fitness education course where I go into more detail when it comes to Patellofemoral Pain Syndrome, check out the course, Exercise Rehabilitation of the Knee.
If you would like more information on how much imbalances can lead to Patellofemoral Pain Syndrome, check out Muscle Imbalances Revealed.
Rick Kaselj, MS
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I think one important exercise was missed regarding building VMO strength: Knee extension as you described but focussing on contracting the VMO at the top of the extension (focus on the last 5 degrees of the exercise and isometrically contract the VMO for 5 seconds). Done for 10 reps three times a day as a corrective exercise can be very successful for PF pain.
Mind, some people have a terrible time learning to activate the VMO in this way and require a fair amount of coaching.
Wish this had been included in the study.
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Rick Kaselj Reply:
July 14th, 2010 at 12:54 pm
Thanks Barry, I wonder if some research has been done on that.
Rick
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[...] to say and what is new in the research. Last week, I reviewed a research article on exercise and patellofemoral pain syndrome, check it out [...]
For exercises tested in the study, what exactly is meant by a “static” lunge? Sounds a bit like an oxymoron. It would be helpful to know as I’m wondering if walking lunges are as effective as split squats, or furthurmore, maintaining the lowest phase of the split squat position for a given period of time (which is what I imagine the ‘static lunge’ could be?) Or is it lunging and then pushing off with the front foot to return to the original position, and repeat?
Thanks in advance.
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Rick Kaselj Reply:
July 16th, 2010 at 7:58 pm
Carla,
With the static lunge, foot position did not change.
They didn’t look at dynamic lunge in the study.
it would be a good one to look into.
Rick Kaselj
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So this was a study of people without PFPS? How can you possibly make the leap that these exercised will help someone with PFPS, since the cause of PFPS is not established?
[Reply]
Rick Kaselj Reply:
July 19th, 2010 at 3:10 pm
Thanks Frank.
I would order the article and read it in detail if you would like more of the specifics.
Rick Kaselj
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