# Strengthening the VMO muscles



## Wolf616 (22 Oct 2015)

I've had a go at self-diagnosing my knee pain and I have come to the conclusion that it is due to my knees not tracking properly and therefore weak VMO muscles (not glutes as my bum is rock hard dear reader, rock hard).

Theoretically it could be a poor bike fit, and I know at least seventeen of you will tell me to go get a proper bike fitting but I cannae afford it so let's just pretend it's all fine. I realise the stupidity of that, but needs must.

To be fair, I'm getting (very mild pain) in the areas suggested by a weak VMO muscle, and only AFTER I've cycled, not during. Additionally my knees click when I straighten them which is another sign that they are not tracking properly. Part of the pain is probably overuse - i.e. I increased my distances far too much, far too quickly, but as this appears to be an issue I might as well sort it out now.

ANYWAY: does anyone know good, no equipment needed, VMO strengthening exercises? I'm also going to start stretching my ITB a lot more regularly as that should also help.


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## ColinJ (22 Oct 2015)

[QUOTE 3966322, member: 9609"]
And of course don't believe anything you ever read on the internet.[/QUOTE]
I'm not sure I believe that ...


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## Crackle (22 Oct 2015)

My knees click, it's when they don't that things aren't tracking right! I wouldn't pay too much attention to a bit of crepitus.

Check out this website It helped me enormously, whereas two physios didn't.

http://www.knee-pain-explained.com/


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## vickster (22 Oct 2015)

For vmo from memory, both wall slides and front/side leg lifts with foot or feet pointed out. And squats and lunges if there's no issue with your knees

Otherwise just google vmo exercises and get a foam roller

You can't really stretch your itb but you can roll it

Use oft linked guides to bike set up and diy. Also check cleat angle and position


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## Wolf616 (22 Oct 2015)

Yeah I am in the process of setting my bike up a little more scientifically using calculators and such. It's odd, the pain only came relatively recently but perhaps that's cause I've been overdoing it a bit, I've managed fine for the past few months


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## Crackle (22 Oct 2015)

I don't know what you need to do for VMO's but I can definitely recommend rolling, it pretty much got me back on the bike after a knee injury, which was essentially patella tracking caused by some major muscle groups needing releasing, hence the rolling.


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## Wolf616 (24 Oct 2015)

Well I've tried rolling the ITB band. Christ this is painful - clearly doing some good then!


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## vickster (24 Oct 2015)

It should get less painful the more you do it


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## Wolf616 (24 Oct 2015)

Yeah I have been doing it religiously to my calves for a long time now, and they barely even register it anymore.


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## vickster (24 Oct 2015)

Do your quads too. All in addition to steetching


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## fossyant (24 Oct 2015)

I thinks something's not right in setup.

I've always run on Bernhard Hinault's setup advice, get out that tape measure.


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## Wolf616 (26 Oct 2015)

fossyant said:


> I thinks something's not right in setup.
> 
> I've always run on Bernhard Hinault's setup advice, get out that tape measure.



You are probably right, so I will get out the tape measure. Thought I'd conquered it with some stretching but today after sitting down at work for a few hours my left knee and calf feels stiff again (if not actually painful). I appreciate it will take longer than that to 'fix', but early indications aren't great! Having said that, I did cycle quite a lot this weekend...

Going to put my seat back a little bit and see if that helps. Failing that I guess I should probably seek professional help, which means no cycling for about 3 months while I scrape and save to do so...


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## vickster (26 Oct 2015)

Wolf616 said:


> You are probably right, so I will get out the tape measure. Thought I'd conquered it with some stretching but today after sitting down at work for a few hours my left knee and calf feels stiff again (if not actually painful). I appreciate it will take longer than that to 'fix', but early indications aren't great! Having said that, I did cycle quite a lot this weekend...
> 
> Going to put my seat back a little bit and see if that helps. Failing that I guess I should probably seek professional help, which means no cycling for about 3 months while I scrape and save to do so...


Why? Cycling should save you money on transport?

Depending on where you are in the country, an initial physio assessment should cost £40-50

Are you icing the knee after cycling to reduce inflammation? Which might be causing the pain and stiffness. Bag of peas in teatowel works well, 15-20 minutes max

If you are suffering from PFS, expect to need months of stretching the problem muscles to see a difference


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## Wolf616 (27 Oct 2015)

vickster said:


> Why? Cycling should save you money on transport?
> 
> Depending on where you are in the country, an initial physio assessment should cost £40-50
> 
> ...



Well that's the thing - as far as I can tell there is no inflammation. There's no soreness if I poke my knee, either, just an occasional feeling of tightness and not pain, as such, but maybe at worst mild discomfort? Theoretically it's just from overuse, but I'm a little terrified about what it _could_ become considering I cycle everywhere now and to be without bike would probably kill me.

Having said that I did not realise how affordable a physio assessment is, so that's good news. Cheers!


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## Crackle (27 Oct 2015)

Their might also be a muscular skeletal service in your area which you can access through your GP. It will take longer but not cost you anything. I took a twin approach of seeing one privately but also going through the GP. Turns out the physio I saw in the unit also did some work in the private practise I went to initially. Also, do not discount sports therapists, they are pretty skilled in muscular stuff, probably better than many physios, who often specialise in individual areas and in more traumatic injuries. My sons use one who works with the British climbing team and he's good. Get an initial assessment first.


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## vickster (27 Oct 2015)

It's a sports physiotherapist that I was referring to. Preferably one into cycling if there's anyone local

My cycling physio also did an on bike assessment after a few session once she had assessed my myriad knee / leg issues. Cost £80. Much better than the £150 I'd spent previously on Retul as she actually considered my history unlike Retul guy who wasn't v interested. Although to be fair, the physio didn't change the Retul set up

If you really only have minor knee issues and only cycling, the bike set up should be the starting point. If there are broader anatomical issues, then physio would be the way to go imo. I have leg pain at least rest, which is neither better not worse when cycling


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## Wolf616 (2 Nov 2015)

vickster said:


> It's a sports physiotherapist that I was referring to. Preferably one into cycling if there's anyone local
> 
> My cycling physio also did an on bike assessment after a few session once she had assessed my myriad knee / leg issues. Cost £80. Much better than the £150 I'd spent previously on Retul as she actually considered my history unlike Retul guy who wasn't v interested. Although to be fair, the physio didn't change the Retul set up
> 
> If you really only have minor knee issues and only cycling, the bike set up should be the starting point. If there are broader anatomical issues, then physio would be the way to go imo. I have leg pain at least rest, which is neither better not worse when cycling



How much did you end up spending on initial assessment and then some physio? Also did you do it in London and, if so, where?

My main problem is I don't have very much money. And I know prevention is cheaper than cure, but I really can't afford to be spending £100s on physiotherapy


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## vickster (2 Nov 2015)

Wolf616 said:


> How much did you end up spending on initial assessment and then some physio? Also did you do it in London and, if so, where?
> 
> My main problem is I don't have very much money. And I know prevention is cheaper than cure, but I really can't afford to be spending £100s on physiotherapy


Physio charges £45-65 a session from memory (bupa kindly paid). The on bike assessment was £80. Which was done after a few physio sessions, I was recovering from knee surgery
In Putney

http://www.pelotonphysiotherapy.co.uk/prices/

I had the original retul fit done at Cadence in Crystal Palace, think it was £150

Take some time off the bike, see if it improves?


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## Wolf616 (3 Nov 2015)

Yeah rest is looking like the only option now


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## vickster (3 Nov 2015)

Do you actually have a diagnosis? Seen a Dr or preferably physio

Worked on bike fit?


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## Wolf616 (3 Nov 2015)

vickster said:


> Do you actually have a diagnosis? Seen a Dr or preferably physio
> 
> Worked on bike fit?



Not seen a doctor or physio yet due to lack of money (physio)/complete lack of faith (GP). If it's still irking me after a week of rest then I might consider biting the bullet and going for an assessment.

As for bike fit, I know KOPS isn't that great but is better than nowt and I've sorted that out by moving my seat back slightly. Weirdly the pain (mainly lateral/anterior, although it's hard to tell which sometimes) only started, I think, after I raised my seat. So I've now put it down a bit (and worked out inseam * 0.883, which also told me to lower it), even though most internet advice suggests too low seat = anterior pain and too high seat = back of knee pain.

I guess the only other fit problem could be foot positioning, but as I can't yet afford cleats I'm using the cages that came with my bike and normal walking shoes so I can't actually change the foot positioning in any way at the moment.


Ironically I've been fine up until the point I started messing around with it, I even did a ridiculously hilly week long tour in Wales without any problems whatsoever. So either I've finally knackered my cartilage or I've somehow managed to mess up the admittedly half-arsed fit Decathlon did for me when I bought the bike (that I changed anyway).


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## vickster (3 Nov 2015)

Sounds like patellofemoral syndrome if anterior and lateral

Are you stretching and foam rolling daily? And icing


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## Crackle (3 Nov 2015)

I can't stress this enough: Don't ignore it won't go away. Well, it might but not by the sounds of things. Also don't get frustrated, this might take time and experimentation but you need to be proactive and with no money, I'd be bothering your GP for an onward referral. Multiple approaches required. It took me over 6 months to sort my knee out.


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## Wolf616 (3 Nov 2015)

vickster said:


> Sounds like patellofemoral syndrome if anterior and lateral
> 
> Are you stretching and foam rolling daily? And icing



Yep I am stretching and foam rolling. Not icing yet though, and now I'm going to stop cycling for a bit probably no need as there's no swelling anyway.



Crackle said:


> I can't stress this enough: Don't ignore it won't go away. Well, it might but not by the sounds of things. Also don't get frustrated, this might take time and experimentation but you need to be proactive and with no money, I'd be bothering your GP for an onward referral. Multiple approaches required. It took me over 6 months to sort my knee out.



Thanks for the advice (both of you). Hard not to be frustrated, particularly as I am moving house at the end of the month and my whole commuting plan is entirely farked up by this injury. I'm going to be destitute, fat and depressed by the end of this!


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## vickster (3 Nov 2015)

Don't know where you are in London, but in sutton, there's an 8-12 week wait for NHS physio if not post op etc

Can you really not cycle at all? I've been riding with sore knees for 6+ years. Just take it easy, find flatter routes etc


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## Wolf616 (3 Nov 2015)

vickster said:


> Don't know where you are in London, but in sutton, there's an 8-12 week wait for NHS physio if not post op etc
> 
> Can you really not cycle at all? I've been riding with sore knees for 6+ years. Just take it easy, find flatter routes etc



I can cycle, it's not even that painful. Nor is it that painful off the bicycle. There's definitely a pain though, and I've always been taught that pain (not the good pain you get from cycling up a hill or something, obviously) is a sign to stop what you are doing.

Plus, if it really is patellfemoral syndrome then that means continued cycling will destroy my cartilage which will take ages to heal due to a lack of blood supply. My new commute is going to be 22 miles round trip, which is definitely not suitable for my newly knackered knees!


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## vickster (3 Nov 2015)

How does your kneecap track?

If that concerned and if it doesn't improve, it certainly is worth investing in physio IMO

I assume you don't get private healthcare through work?

Certainly no physio nor orthopaedic surgeon I have seen has ever told me to stop cycling, just consider how. No standing on the pedals for starters. A mildly inflamed patella tendon or fat pad, also part of PFS won't wreck articular nor meniscus cartilage (depending on which you refer to) 

Running on the other hand a no no


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## Wolf616 (3 Nov 2015)

vickster said:


> How does your kneecap track?
> 
> If that concerned and if it doesn't improve, it certainly is worth investing in physio IMO
> 
> ...



Not a clue how it tracks, to be honest, as I've never paid any attention to my knees before so I don't know what's normal and what's not! I didn't realise, for instance, that you can wobble your knee caps when your leg is almost straight - that scared the hell out of me for a minute or two. My knees do click when they didn't used to (and my hips for that matter)

No private healthcare through work, unfortunately, one of the joys of working in the charity sector!

I might get an initial assessment somewhere, at the very least I'll know what I'm dealing with then and I assume physios aren't out to rip you off...

I also know it's an investment, but the money freed up by not taking the tube would no longer be there and that's the only wiggle room in my budget, to be honest.


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## vickster (3 Nov 2015)

If it's PFS, the kneecap almost always tracks laterally towards the outside, bend your knee with your feet up and you should be able to see. You should be able to see how the kneecap tracks. Also, with PFS you get pain at St and also going down stairs or slopes

http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/patellofemoral-syndrome-pfs

Physios won't rip you off, but if money is so tight, ask the GP for an NHS referral, you may get seen more quickly, depends on the area. You do seem pretty concerned about this so get it looked at


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## Wolf616 (3 Nov 2015)

vickster said:


> If it's PFS, the kneecap almost always tracks laterally towards the outside, bend your knee with your feet up and you should be able to see. You should be able to see how the kneecap tracks. Also, with PFS you get pain at St and also going down stairs or slopes
> 
> http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/patellofemoral-syndrome-pfs
> 
> Physios won't rip you off, but if money is so tight, ask the GP for an NHS referral, you may get seen more quickly, depends on the area. You do seem pretty concerned about this so get it looked at



Thanks again for the information. I will go and see my GP but the reason I am sceptical is last year I went about RSI in my wrist (from playing piano, the last hobby I had to quit due to injury, something I do not want to repeat here) and they were absolutely useless. Just told me to splint it and rest, with no strategy for overcoming it and no option to see a physio.

Looking at my knees they don't seem to track obviously one way or the other, so maybe it's just overuse. I do tend to be overzealous with how far and regularly I cycle as it's my main (read: only) form of transport these days. Plus I do get an occasional twinge on stairs so it does sound like PFS, regardless of what my untrained observations suggest


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## Crackle (3 Nov 2015)

Also don't assume the source of the pain is the cause. I had patella pain but it was caused by, well just about everything else, tight hamstrings, tight adductors, tight sartorial and a few others. Mrs C has knee pain but it's caused by weak glutes.


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## Wolf616 (3 Nov 2015)

I must admit I have the tightest calves and hamstrings in the world. I've never been close to being able to touch my toes! I essentially need new legs


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## vickster (3 Nov 2015)

Lots of stuff a physio can help you with there

My calves are ridiculously tight too, however thanks to a bone spur on my fibula I can't stretch or massage them


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## Wolf616 (3 Nov 2015)

Well I guess I just need to take it easy on the bike wherever possible and hope that seeing a physio won't take too long via my GP (unfortunately I need to wait until I move, so won't get chance until December - will be a nice Christmas present to myself though... Let's hope Lambeth have a short waiting time)


Thanks both once again for reading, help and advice - it's much appreciated.


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## vickster (3 Nov 2015)

I very much doubt Lambeth will unfortunately, but fingers crossed

In the meantime, keep stretching and rolling


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## Wolf616 (3 Nov 2015)

Yeah Lambeth will have a long waiting time, much like the rest of London. Will be far shorter than Newham where I currently live though!


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## vickster (3 Nov 2015)

You'll find private physios that close to London costly, maybe consider looking in the burbs. Some of the poncy places around Clapham charge £100+

If cycling is the goal, I'd see Nicole at peloton in Putney


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## Wolf616 (3 Nov 2015)

vickster said:


> You'll find private physios that close to London costly, maybe consider looking in the burbs. Some of the poncy places around Clapham charge £100+
> 
> If cycling is the goal, I'd see Nicole at peloton in Putney



Yeah that was the physio I was tempted to go to for an initial assessment and then possibly, following selling one of my kidneys, the bike fit thing too. Could probably just about afford 150 quid I reckon


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## vickster (3 Nov 2015)

See what she says first. She is very thorough


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## Wolf616 (3 Nov 2015)

I'm just worried it'll end up being 'you need 6 sessions' which I definitely cannot afford. But you don't know until you ask I guess!


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## vickster (3 Nov 2015)

Wolf616 said:


> I'm just worried it'll end up being 'you need 6 sessions' which I definitely cannot afford. But you don't know until you ask I guess!


Just tell her what you want to know, the initial hour might be enough for a diagnosis and exercise programme. If you are self paying, she'll get you on the right track ASAP


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## Crackle (4 Nov 2015)

vickster said:


> Just tell her what you want to know, the initial hour might be enough for a diagnosis and exercise programme. If you are self paying, she'll get you on the right track ASAP


This. 

I was pretty clueless when my knee went, totally lost in fact. The first physio relieved the pain short term and the second instilled into me that i had reached the age where I needed to be proactive. Neither of them directly solved the problem but each of them contributed to me solving the problem.

I also bought a good book on stretching which shows you all the muscle groups. This helped enormously to visualize what was going on, where muscles attached and which muscles might be responsible for the pain and stiffness, which naturally led on to rolling those areas and youtube was invaluable for rolling technique.

This may not be applicable to you but I say it for example. It's normal I think, to feel a bit lost and frustrated but slowly you'll find a path.


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## vickster (4 Nov 2015)

I was recommended this book on stretching, it's clear and comprehensive
http://www.amazon.co.uk/Prescriptive-Stretching-Kristian-Berg/dp/0736099360


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## Wolf616 (4 Nov 2015)

Cheers - I'll definitely take a look at that. I've booked myself in for an appointment, so let's see what happens!


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## vickster (4 Nov 2015)

Cool stuff


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## Sailorsi (11 Nov 2015)

Crackle said:


> My knees click, it's when they don't that things aren't tracking right! I wouldn't pay too much attention to a bit of crepitus.
> 
> Check out this website It helped me enormously, whereas two physios didn't.
> 
> http://www.knee-pain-explained.com/


A great resource, thanks for the link - Looks like a period of rest, stretching and strengthening is in order before I get back on the bike. Don't you just hate being unwell!


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## Wolf616 (11 Nov 2015)

Well I went to the physio and it turns out, contrary to my OP, that my gluteus medius is a bit shoot and pretty much every other muscle in my leg far too tight. I've got some stretches and exercises and my knees feel a bit better already, even though I have cycled every day since Sunday (don't worry, I'm going to take a rest tomorrow).

Only time will tell whether this will solve it, but feeling much more positive about it all now. Might even dig a bit deeper into my pocket and go back for another appointment as Nicole at Peleton Physio was great - highly recommended (let's just hope she doesn't frequent this site and read this)!


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