Knee pain is something virtually all of us hard-training folks encounter at some point in our life. The cause of the pain can be attributed to many possible problems such as a fallen arch or weak outer hip muscles. However, your vastus medialis muscle is often a major factor because when it’s weak it can’t hold the patella (knee cap) in its proper alignment. Faulty alignment of the patella can irritate the patellar tendon and cause pain below the knee cap.
I prescribe strength exercises for the vastus medialis whenever a client comes to me with knee pain 
and it always helps. It might not completely rid the person of knee pain because, as mentioned, there can be other factors at work. But sometimes it’s all that’s needed.
Whenever you have joint pain, start with the simplest solution first. Strengthening the vastus medialis muscle should be your first line of attack.
The lowest portion of the vastus medialis, closest to the inside of the patella, is thought to contain fibers that run in a more oblique direction than other parts of the muscle. These vastus medialis obliquus (VMO) fibers are often mentioned in clinical settings as being the ones that are typically weakest and most difficult to recruit. The jury’s still out with regard to the possibility that those VMO fibers even exist because anatomists have had a tough time finding them on cadavers. 
In the past, trainers and physical therapists often used the leg extension exercise to strengthen the vastus medialis. On paper, this approach seemed valid. However, in practice it rarely helps and sometimes exacerbates the problem due to the large shear forces that accompany the leg extension movement.
The best exercise I’ve found to increase the strength of the vastus medialis, and maybe the VMO (if those fibers exist), is the step-down. It effectively strengthens the vastus medialis without putting excessive strain forces on the patellar tendon. When you perform the step-down correctly, you’ll feel tension directly on the inside of the knee, in the vastus medialis.
The video below shows the proper technique for the step-down. But before you watch it keep these three points in mind.
1. Perform the exercise slowly: it’s not easy to target the vastus medialis so you must move slowly to develop the mind-muscle link you need to activate the correct fibers. Push through the ball of the foot on your working (elevated) leg throughout the contraction.
2. Hold weights if necessary: if you can easily perform 15 reps without feeling much tension in your vastus medialis, you’ll need some external load. Start light, maybe a pair of 20-pound dumbbells if you’re a strong guy, and work up from there.
3. Stop if the exercise causes more pain: prescribing rehab exercises is rarely simple since your problem might be more complex than one exercise can fix. With the step-down, or any other rehab exercise, if you experience more knee pain after the exercise you should not continue. You should feel less pain and more strength around your knee after each set is finished.
Step-Down: perform 3 sets of 15 reps with each leg, every other day, until the knee pain goes away.
Finally, I’ll be covering all of my best joint rehab exercises in my seminar in Phoenix, AZ on February 2-4. To find out more seminar details, click this link.
Stay Focused,
CW
