T Nation

Working the Vastus Medialis


Hey guys,

I am having problems building my vastus medialis, I partially tore my patella tendon on my left knee and its gotten much better but I still don't really want to do heavy squats just yet. Just wondering if there are any exercises you guys can help me out with that focus on the vastus medialis without putting too much pressure on the knees.

Also its not so much that I need size on all of my quads, my vastus lateralis is disproportionately large to my medialis.


Are you just waiting for your patella to heal or did you get it fixed? Sorry to hear about the injury.


Thanks elusive, Well its been a while and I’ve been doing some rehab and its like say 90% at the moment, I’ve started doing deadlifts again and lunges but I’m trying not to go past parallel on lunges. The reason I got the partial tear in the first place was because I was doing Olympic weightlifting and I’m pretty sure it’s because of all the deep squats especially because I’m very flexible I went very low.

I can still do lunges, deadlifts, glute ham raises, power cleans, bulgarian split squats with no problems so far but i just havn’t been going too heavy on lunges or split squats for fear of tearing my tendon again.

And something I found a bit weird is that my knee didn’t hurt while doing deadlifts, so I slowly went heavy and my knee didn’t hurt at all…I weigh 73kg=161pounds and I ended up getting 200kg=441pounds and my knee was fine doing this, it just seems to be going low in squats.


I personally wouldn’t prioritize anything knee related in the weight room right now until your knee is 100%. I wish I had better advice. I’ve had 4 knee surgeries in the past and I know how much a knee injury can suck. Get better and good luck with the recovery.


Here’s a good article from Thibs describing his favorite exercises for targeting different parts of your quads. http://www.tmuscle.com/free_online_article/sports_body_training_performance_bodybuilding/bulk_up_cut_up_quads_and_tris


Yeah, I’m certainly no therapist, but might it be better, if you were to train legs (if at all!) as a bodypart, and not stressing one particular area? I know that after my experience a couple of years ago in a strongman contest, I’m very wary of creating imbalances through my BBing training.



Like everyone else said, none of us are PT’s and in order to push really hard you gotta get your knee to a 100%. Here are a couple of possible ideas though.

*Step downs
*1-leg box squats
*Sled pulling


Assuming your knee is feeling ok and you have no pain, I would work first on regaining some flexibilty rather than really pushing the weights hard. Sled pulling could be good for getting strength back, but I would not do anything heavy at this point.

I had a knee surgery 3 months ago and I have been focusing a lot on single leg stuff and trying to increase the ROM over time. My personal favorites have been 1 leg box squats (add weight once it gets too easy) and bulgarian split squats with the front foot elevated, which helps a lot with flexibilty. Start with no weight at all, and maybe not even elevating the front leg, and work up. Again, if there is pain though, back off the weights.



I’m sorry to hear about your knee trouble, man. I think most people on this site can attest to what you’re going through (myself included) and we all wish you the best in getting back to full strength.

Concerning work for the Vastus Medialis, there are three modalities that are normally used in succession to “bring up” a lagging VMO: soft tissue work, motor control, and strength training.

When a knee undergoes any sort of acute trauma - like a torn tendon - the VMO has a tendency to just shut off and fire erratically, which leads to faulty motor patterns in the surrounding musculature. For this reason, your first two courses of action should be to lengthen the tissue (via foam roller, stretching, massage) and then reclaim the motor control with an exercise called the close-chained terminal knee extension (TKE).

Check this video out, which does a pretty good job of explaining the TKE ==> http://www.youtube.com/watch?v=ZscBVtoX62U

So maybe say a good 1-2 minutes of soft tissue work on that quad followed by 3 sets of 12-15 of the TKEs is how you should start your lower body sessions for the next little bit. After that, feel free to transition into strength training that you feel comfortable with. If you’re not sure what your knee can tolerate, follow this single-leg progression and stop at the appropriate level:

  1. Isometric Hold
  2. Step-downs
  3. Step-ups
  4. Split Squat
  5. Reverse Lunge
  6. Dynamic Lunge
  7. Bulgarian Split Squat
  8. Single-Leg Squat

Hope that helps, man. If you have anymore issues, I highly recommend you pick up Mike Robertson’s “Bulletproff Knee” manual, which is about as comprehensive a resource of post-PT knee rehabilitation that I’ve come across.