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Sam Pitcairn
Your Knees Aren't "Bad"—They Are Just Weak. (The VMO Solution)
Training
By Sam Pitcairn
If I had a dollar for every time a client in Pittsburgh told me, "I can't squat because I have bad knees," I would own the Steelers.
Let me tell you the truth about your "bad knees." Unless you were hit by a bus or played 10 years in the NFL, your knees aren't "bad." They are weak.
Specifically, you are suffering from VMO insufficiency.
Most doctors and physical therapists will tell you to avoid deep knee bending. They will tell you to "never let your knees go past your toes."
This is the worst advice in the history of exercise science. It is the equivalent of telling someone with a weak grip to never hold anything heavy. You are babying the problem, ensuring that the joint remains fragile forever.
The knee is a dumb joint. It just does what the hip and ankle tell it to do. But it has one primary bodyguard: The Vastus Medialis Oblique (VMO).
This is the "teardrop" muscle on the inside of your quad, right above the knee. Its job is to track the kneecap (patella) correctly.
The VMO is the first muscle to atrophy (shrink) when you have pain, and the last one to wake up.
Here is the variable almost everyone misses: You cannot fix the knee if the ankle is frozen.
I don't say this lightly. I literally wrote research papers on this subject.
In my published work regarding ankle biomechanics and knee function, we demonstrated a definitive link between Dorsiflexion (the ability of the knee to travel over the toe) and VMO activation.
Here is the mechanics:
If you don't fix the ankle, you can't fully use the VMO. You can do step-ups until you are blue in the face, but if the foundation is locked, the house will not stand.
For decades, uneducated trainers screamed, "Don't let your knees pass your toes!"
Think about this logically. When you walk down the stairs in Mount Washington, does your knee go past your toe? Yes. When you kneel down to pick up a child? Yes.
If you never train this position in the gym, you will be weak in this position in real life.
My mentor, Charles Poliquin, championed the concept of full-range knee training decades before it became a "trend" on Instagram. He taught us—and my research confirmed—that to bulletproof the knee, you must strengthen the VMO in its fully shortened position.
We don't fix knees with painkillers. We fix them with mechanics.
To target the VMO, we need an exercise that creates knee flexion without engaging the hamstrings or glutes too much.
Perform this twice a week as your "A1" exercise.
A1. The Poliquin Step-Up (Heel Elevated)
A2. Hamstring Curl (Lying or Seated)
You do not have to live with knee pain. You do not have to avoid stairs for the rest of your life.
But you do have to stop listening to people who tell you to rest. Rest causes atrophy. Atrophy causes pain.
If you want to hike Frick Park without pain, or squat heavy without fear, you need to fix your ankles and build your VMO.
If you are in East Liberty, Shadyside, or the South Hills, book an assessment. We will measure your VMO function and build the roadmap to pain-free knees.
After you submit this form we will be in contact within 24 hrs to set up an appointment to come into our East Liberty location for a performance assessment.
