VMO Exercises

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I have only found one VMO exercise that consistently activates the VMO. Oh, and it does a number of the gluteus as well.

Diagonal Sit Backs








    1. Start with the patient on one knee and heel directly under opposite buttocks. (right knee on the ground with right heel in line with left buttocks)
    2. Now the leg should be at a 45 degree angle, slight hip external rotation.
    3. Instruct the patient to perform a brace & breathe and slow start to sit back onto their heel. Do not have them go into lumbar flexion.
    4. They may not be able to touch their heel.
    5. Return to the starting position and repeat.



  • No flexion or posterior pelvic tilting should be noted.
  • The arms can be raised for balance.
  • This should be felt in the VMO and gluts.



Trigger Finger and Thumb Pain

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Finger and Thmub Pain

Check out this great info on trigger finger and thumb pain.

Hallux Limitis

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Hallux Limitis literally means limited big to motion. Hallux Limitis is a degenerative or arthritic condition in which the big toe becomes progressively stiffer ad more painful. While motion still exist in the  big toe with Halux Limitis, Hallux Rigidus is an extreme version of  Limitis where little to no motion is present.

Many people have Hallux Limitis and do not realize it. Pain generally does not occur until toe range of motion is less an 35-40 degrees. Hallux Limitis occurs more commonly in runners, especially those whose big toe is longer than their second toe. With this condition a bone spur begins to grow directly on top of the big toe “knuckle.”

Hallux Limitis can cause many biomechanical problems and needs to treated correctly. Techniques like Active Release and Graston can restore motion by 30 degrees and home exercises can help prevent the recurrence of ROM loss. General ankle mobility should be addressed and over-the-counter orthotics can help lessen pain. Click here for ankle mobility exercises.


Yours in health,


Dr. Justin Hildebrand

IT Band Syndrome

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IT-BandIliotibial (IT) Band syndrome or Runner’s Knee frequently occurs in runners, especially those upping their mileage. ITB is described as a burning pain in the outside of the knee and the pain is increased with activity. If left untreated and activity continues pain can begin to move upward from the knee, into the IT Band.

The IT Band is a fibrous, extremely strong structure that begins in the hip as the gluteus medius, maximus and tensor fasciae latae. It travels down the outside of the leg and attaches just below the knee. The pain associated with ITB is due to tension in the band due to the muscle pull in the hip.

Studies have shown that individuals with ITB Syndrome have greater inward rotation at the knee and an increase in hip drop on the side of pain. Lack of hip muscle flexibility can increase the risk for ITB Syndrome by increasing the strain placed on the band. The foot, although commonly ignored, plays a significant role in IT Band pain. Having a high arched or rigid foot has shown to cause ITB Syndrome. This means that the foot and the hip need to be treated for resolution and preventative treatment for IT Band Syndrome.

Click here to see exercises for IT Band Pain.


Yours in health,


Dr. Justin Hildebrand

Patella Tendinopathy

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indexPatella tendinitis or jumper’s knee is more accurately called patella tendinopathy. Tendinitis mean inflammation of the tendon but patella tendinopathy is a degenerative condition of the patella tendon. This condition is described as local tenderness of the patella tendon at the attachment on the patella.

Patella tendon injuries occur more commonly in distance runners, sprinters, and athletes that freqently jump. The increase is knee flexion or bending predispose these individuals to the injury because knee flexion increases the force and stress on the tendon. Excessive quad tightness or dominance may increase the risk for injury as well.

Treatment for patella tendinopathy consist of Active Release and Graston on the quad muscles as well as the tendon to decrease tightness and built up adhesions. These myofascial release techniques also start the rebuilding of the tendon by starting a controlled inflammatory response. Rehab exercises to strengthen and lengthen the  quad muscles help decrease longevity and recurrence of the injury.Interestingly, research has shown that resistance quad strengthening such as knee extension exercises has a negative effect on recovery.


Yours in health


Dr. Justin Hildebrand

Knee Cap Pain

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imagesPatellofermoral Pain Syndrome, also called retropatella pain,  is successfully treated in more than 2/3 of cases with conservative treatments including rehabilitation. The goal of these programs should be to reduce pain and restore function of the foot, knee, and hip. A classic sign of PFPS is pain in the knees while sitting for long periods of time and reduction of pain when standing.

The exact cause of patellafemormal pain syndrome is debated by many different specialists. Many believe that weakness in the VMO or medial/inside quad muscle causes abnormal movement of the knee cap and leads to pain and dysfunction. Exercises to strengthen the VMO are commonly preformed but these exercises only make the underlying dysfunction worse.

Current research shows that the true cause of PFPS is not the abnormal movement of the knee cap but the abnormal movement of the femur under the knee cap. This abnormal movement is caused by weakness in the hip muscles, which allow increased inward movement of the leg. Not only the hip but the foot can increase one’s risk of developing PFPS. Loss of motion of the ankle joint or major excessive pronation or supination of the foot can increase the stress on the knee and lead to pain under the knee cap.
Braces and straps can help decrease symptoms.

For PFPS exercises click here.


Yours in health,


Dr. Justin Hildebrand

Meniscus Injury

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meniscusA meniscus is a crescent shaped fibrocartilage that divides a joint. In the knee the menisci are C shaped and  provide structural integrity to the knee when it undergoes stress. The knee menisci are commonly injured during twisting activities and during collisions involving inward or outward movements of the knee.

The lateral meniscus is less commonly injured than the medial meniscus. Small tear in the meniscus can and should be treated conservatively. A lateral meniscus tear presents as pain in the outside of the knee that is worse with twisting and especially going down stairs.  Due to its connection to the lateral meniscus the popliteus muscle, located behind the knee, commonly causes posterior knee pain when the lateral meniscus is injured. A medial meniscus tear presents as pain in the inside of the knee that is worse with twisting and especially going up and down stairs.

Swelling and/or stiffness will appear in the knee when a tear is present. If the knee locks in extension or flexion and popping and clicking are present a more serious tear maybe present. An MRI with contrast maybe necessary to determine the extend of the tear.

Non-contact meniscus injuries occur due to lack of hip and ankle stability. When the foot and ankle can not control knee motion correctly increased stress is placed on the menisci. Eventually the stress overtakes the strength the joint and injury occurs.

Conservative treatment for meniscus injury starts with restoring proper joint motion loss whether flexion, extension or both. This can be accomplished with joint mobilization exercises and Active Release Technique. Once joint motion is restored and pain is under control, focus should begin on correcting the hip and/or ankle imbalances that predisposed the individual to the meniscus injury.


Yours in health,


Dr. Justin Hildebrand