Debunking the Myth of the Vastus Medialis

The quadriceps complex is comprised of four main muscles: the rectus femoris, the vastus intermedius, the vastus lateralis, and the vastus medialis (which seems to have become the most buzzworthy muscle of the four). The vastus medialis obliquus (commonly referred to as the VMO) is the middle “tear drop” shaped muscle of the quadriceps complex. Both personal trainers and physical therapists often blame generic knee pain on this guy being weak, but the literature just does not seem to substantiate that concept. If a doctor or physiotherapist has ever told you that you need to strengthen your vastus medialis, then he or she is spouting off outdated and false information.

I have seen many an article claiming that one can “isolate” the vastus medialis, or emphasize its activation, by raising the heels in a squat, by narrowing one’s squat stance, or by doing some wild exercises. These exercises are frequently prescribed to individuals with patellar tendinopathy, patellar tracking, or post-op ACL tear patients. While these concepts sound excellent in theory, the data has shown that those ideas are effectively no more than broscience. The vastus medialis and lateralis muscles contract together, and no amount of heel raise, hip external rotation, or close-stance squats will change that.

Do decline squats increase VMO activation?

The first exercise myth about the VMO is that raising the heels will increase its activation in the squat. While using Olympic lifting shoes or standing on a board will undoubtedly increase total quadriceps recruitment, as your torso will be more upright, the vastus medialis receives no preferential treatment. Rather, the vastus lateralis and medialis simultaneously work harder to squat when the heels are elevated. Similarly, the high bar squat is more quad-dominant than a powerlifting low-bar squat, and a front squat is the most quad-dominant of the three.

Does squat depth influence VMO activation?

When analyzing the angles at which the vastus medialis and lateralis are most active, Lee et. al. found that 90° or less of knee flexion was optimal. Essentially, deeper squats allow for greater vastus medialis and vastus lateralis contraction. Again, both muscles are being targeted in this instance, so the VMO is working harder, but so too is the vastus lateralis.

The other take home here is that if you want quads of the Gods, you can’t skimp on your depth. If you have to ask someone if you’re going low enough, you’re probably not! If mobility is an issue for you, then you should seek the advice of a qualified professional and dedicate time at the end of your sessions to improving your bottom position.

What about narrow-stance squats?

None of the research to date indicates that squatting with a narrow stance impacts the vastus medialis to a higher degree. In fact, it doesn’t appear that it changes the activation in any of the quadriceps muscles at all. I’m not quite sure where this myth arose, but it seems to be contradicted by the literature.

Squatting with your feet close together won't increase VMO activation,
but it may result in faulty mechanics and potential for hip impingement.

One study with Paoli et. al. looked at the EMG in 8 different thigh muscles, measuring activity in three different squatting widths and three different intensities (no load, 30% of 1 RM, and 70% of 1 RM). They tested both quadriceps and hamstrings muscles, and there was effectively no statistical difference in any of the muscles except for the gluteus maximus. No matter how close the lifters stances, their quadriceps muscles (vastus medialis included) were no more or less active at any intensity.

Surely foot position matters?

This is one that I have heard for years, and even believed myself for a while: trainers boast that externally rotating the feet will preferentially recruit the VMO, whereas a parallel foot position would lead to more evenly divided muscular recruitment. Unfortunately, no studies to date have confirmed this concept.

Murray et. al. tested twenty physically active adults in 4 different foot positions during a partial squat on the Power Tower machine. They found no real differences in EMG amplitude in differing levels of external/internal rotation. Similarly, Ninos and colleagues tested two varying foot positions (externally rotated and neutral) in the Olympic squat, and there was no noteworthy difference in vastus medialis activation.

The take home? If you have strong quads, you have a strong VMO.

Trainers have managed to come up with many creative circus-trick exercises for targeting the vastus medialis muscle, but while they might look exciting to try in videos, the basic foundational leg movements are all you need; squats, lunges, step-ups, and split squats will help you build strong quadriceps muscles, and, in turn, strong vastus medialis muscles. You can perform your leg extensions with your feet externally rotated all day, and you still won’t be able to isolate your medial quadriceps. Instead, just stick to those previously mentioned core movements and reap the benefits of your tree trunk legs!

A Case Against Box Squats

The box squat is ubiquitous in both high level strength and conditioning facilities and Globo gyms. While a lot of coaches and trainers tout the box squat as being beneficial for "explosiveness" and overall strength, I am here to dispute its efficacy, and highlight some of their potential drawbacks.

I am guessing that some of you are already prepared to jump on me for questioning a movement that is so widely utilized, but before you do so, give this article a read. If you still vehemently disagree with my claims, then I'm always happy to hear other opinions.

One of the biggest underlying detriments to using the box squat, in my opinion, is the lack of "biomechanical transferability" to a traditional back squat (specifically high bar); by this, I mean that the movement is quite different in terms of joint angles. One cue you will often hear in the box squat is something to the effect of "push your butt back." Now, this may also be applicable to a powerlifting low bar squatting style, but it is contraindicated on a high bar, Olympic style squat. You'll notice that in this diagram, that the low bar back squatter (on the left) sits his hips back farther, and his shins are closer to vertical, whereas the high bar squatter on the right sits more upright, and the knees track in front of the toes.

The cue "sit back" leads to the athlete maintaining a shin that is almost completely vertical and ends up in a position that would not otherwise be sustainable. Try to do a high bar or low bar squat by pushing your hips back to an extreme degree like some coaches advocate on the box squat–you will likely fall over, because that is not the natural way to descend the hips. Take a look at this guy in the photo. Squatting this way sans box would be very difficult.

Aside from the altered mechanics of the box squat, this movement often decreases the standard range of motion. The only time I would ever prescribe box squats for a client is if he or she were having difficulty achieving or gaging depth on the movement. In this case, a box or a medicine ball can give the client a target or a standardization for depth. Over time, one should progress to a lower box, and eventually eliminate it altogether. If you're comfortable with the movement, then you should always aim to maximize your range of motion with great technique, rather than decrease it.

Similarly, a lot of people tend to get lazy on the box. By this, I mean that the lifter will fully relax and disengage in the middle of the movement. This is not only disadvantageous (as it would never happen in a normal back squat), but it is also dangerous. Now, the lifter has to recreate tension as they stand. There is a tremendous risk of back injury for this reason. If you do choose to use box squats in your training, you should simply tap the box and then quickly rebound, rather than sitting completely.

While some strength coaches praise the box squat for its ability to develop explosiveness out of the hole, I prefer two other squatting variants: paused squats and jumping barbell squats. Both of these movements are, in my experience, far superior. The paused back squat allows the lifter to achieve full depth and build concentric speed, and the jumping barbell squat teaches that rebounding, plyometric power that is desirable in most sports. I prefer to keep repetitions per set lower (<6-8) for both movements, because the lifter can focus on perfect technique. For the paused squats, it is ideal to use a weight that will be challenging, but will not slow down your ascent. For example, if you're grinding to stand up with the weight, you've gone too heavy. Speed trumps weight here. Weight should be between 20-30% of back squat 1 repetition maximum for the jumping barbell squats. Heavier weights won't allow for a quick rebound.

Overall, while some prefer to program the box squat, I think it is limited in its practical application for most people. Not only does it reinforce improper mechanics, but it also could result in injury. Try different squatting variations to stimulate the same effect.

Getting Rid of the "Butt Wink"

The "butt wink" is a term that has puzzled personal trainers and other movement practitioners. Some people attribute it to tight hamstrings, others have mentioned ankle mobility, some say it's hip flexor strength, or even hip/femur anatomy. My two cents? Motor control. Everyone I've met who had a "butt wink" was able to eliminate it with some proper cuing and movement sequencing.

If you're not sure what a butt wink is, and if you have one, let me enlighten you: this is a term used to describe lumbar flexion in the bottom of a squat (pictured below).

Oof.

Now, let's first touch upon some other theories contributing to this fault...

Dr. Quinn Henoch mentions that the hamstrings cannot be responsible for the butt wink: "The hamstrings are a two joint muscle.  When you descend into a squat, the hamstrings are being lengthened at the pelvis, but shortened at the knee. So it would seem to me that the net length change is negligible." The hamstrings are not a likely culprit.

Hip anatomy makes the most sense out of all theories. Some individuals are just going to be better at squatting, out of sheer, genetic fortune. If you have the right anthropometry (limb length), you're gonna be a better squatter, plain and simple. 

Anatomical factors aside, though, it is possible to eliminate the dreaded butt wink with a little bit of practice and tweaking.

I'm not going to get too much into the hip and femur anatomy here, because I think Dr. Ryan DeBell covers that nicely. If you want to read his article on it, check out the works cited below. What I will say, though is that factors like your acetabulum (hip socket) alignment, femur length, and tibia/fibula length will all influence your squat stance. Some people have to squat wider than others, so playing around with your stance will greatly help your bottom position.

You want to work through a range of motion where you can maximize the integrity of the movement. If, initially, that means that you're squatting just to parallel, then so be it. Over time, the goal is to get progressively lower.

I usually start out my clients with a quadruped rocking drill. This will teach them how to hinge at the hips without load and minimize any lumbar flexion. If you find yourself reverting to the butt wink on this drill, move slower and focus on keeping the core engaged.

Once they grasp this concept, I would then progress them to the assisted squat drill. The goal here is the same as that of the previous drill, but now we're upright and preparing for a load-bearing squat.

Congratulations! Now you're ready to try an air squat without assistance! A couple of things to keep in mind: if my core isn't engaged, and I shift into an anterior pelvic tilt (hyperextension), then it's impossible for me to avoid lumbar flexion. If, however, I maintain a nicely braced position and descend straight down, I should be just fine. You want to imagine "pulling through your hip flexors" as you lower yourself.  If you're squatting high bar or front squatting, you will descend straight down, and if you're squatting low bar, then the hips need to come back more.

With a little bit of reverse engineering, even the most troubled squats can minimize the "butt wink." Sometimes you need to regress in order to progress. When you lay a solid foundation for quality movement, you can get a squat PR without looking like Quasimodo.

Nate's FREE Beta Squat Program!

When you have more plates on the bar than you have fingers, you know you're strong.

My friend Nate is back for another guest post. You may remember his last post for me about proper breathing for the squat. Now that you know how to breathe on the lift, this program will help you get stupid strong squats. Nate is a competitive 198/220 Powerlifter and trainer under the NSCA who is currently pursuing his CSCS. Nate has been lifting for a little over 2 years and boasts an impressive 535 pounds recently in the gym. He is currently chasing 600+ pounds, weighing 198 himself.


FOREWORD: One of the things I want to accomplish as a trainer/coach is to give back and to help people improve themselves–that’s really it. I’ve tried to commit myself to the processes involved in learning and applying the things that I’ve learned to allow others to push their limits and achieve their goals: that’s the reasoning behind this program.

Over the past year-and-a-half I’ve done a lot of my own programming as well as writing things up for friends to get practice with writing programming for different people. I sat down with some of the things that did and did not work and tried to design a 9 to 11 week Squat Program for beginners or intermediate lifters. I call it a “Beta” program because, let's face it, it’s a first attempt at writing something more serious and distributing it out to a lot of people to see how it works. With a large enough sample size, it gives me an idea of what things will generally work and what things generally won’t.

The added benefit is, I’m hoping, to help lifters hit PRs.

It should be noted that this is a very abridged cycle. I have not included accessories or recommended frequency for the bench press and deadlift. This is 100% squat focused.

THE PROGRAM

PREFACE: As you’ll see, I have days listed as Day 1/2/3 and later as Day 1 and 2. This is because not everyone can run a Mon/Weds/Fri split even though, in my opinion, that’s ideal. I know some people are in school, have work, have lives.

You’ll want at least one day of recovery in between squat sessions, especially for those who add accessories or who have other lifts or training to do other than purely squatting. For Phase 3, the ideal would be Monday and Thursday or Tuesday and Friday as long as 3 days of rest are taken between the days.

PHASE 1: Conditioning Phase 
The reasoning for the conditioning phase is simple: Conditioning. At percentages under 80%, the goal is to condition, practice, and build confidence as stepping stones for later cycles. If your goal is maximum weight, then spending some time to bring up your work capacity is not a bad idea. This will also be beneficial for people who have run extremely long, demanding programs or just need a good starting point instead of jumping into weight over 80%. As with the other phases, I’ve given you ranges on some days (example: 63-65%) because some lifters recover faster than others. You’ll see it in later cycles too. Always err on the side of training hard. However, the goal is to avoid missed reps and to aim for weight that you’ll be able to squat with the best technique.

This is the only phase with variations.

Week 4 in this phase is for lifters who feel they need a sort of break, usually the ones who are not used to conditioning and volume work or those who are just deconditioned to begin with. It is recommended to not take the taper for more experienced lifters.

**FOR LOW BAR SQUATTERS, DAY 2 IS A PAUSED HIGH BAR DAY. FOR HIGH BAR SQUATTERS DAY 2 IS A PAUSED FRONT SQUAT DAY.

PHASE 2: Accumulation/Volume
The point of this phase is to accumulate volume between about 70-85% of a persons 1RM. This will be the meat and potatoes. The goal of this phase is to build, build, build. Build strength, fearlessness under increasing load, and for the lifter to practice their competition (or stronger) squat. Day 2 in this cycle is built in to work on technique, power, and to have a day that is less demanding as the cycle increases without going into ridiculously low intensities that won’t benefit the lifter.

PHASE 3: Intensity
Plain and simple this phase is about putting some weight on your back with the confidence to push your comfort zone and create the confidence to break old PRs! For most lifters, they’ll likely be hitting weight/rep PRs weekly before the big max out. I recommend that the lifter have at least 3 days of rest on their squat between either day, and minimize deadlifting, to maximize recovery. Week 4 can be the taper from Week 4 of the Conditioning phase or for more experienced lifters, can max on the next week.

I hope those of you running this enjoy the program and see some gain from it! Thanks for reading and putting confidence in both myself and Arianna. I’d like to thank her too for allowing me to share on her page and for putting out all the information she does.

Now go crush some heavy squats!