Detailed guides to painful problems, treatments & more

Wrong again, sort of, this time about vastus medialis isolation 

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Anatomical illustration of the lower half of a man, dissection revealing the muscles only, highilighting the vastus medialis parts of the quadriceps muscle group, on the inside of the thigh.
Yet again, for the third time this year so far, I have reversed a position on the basis of new evidence (or having old evidence pointed out to me). I no longer believe it is impossible to isolate contraction of the vastus medialis (which is an allegedly desirable thing to do if you have patellofemoral syndrome).

Debunkers like myself have said no, often and loudly, for many years. I’ve called VM isolation a “pernicious myth,” based on evidence like Mirzabeigi et al — one of many studies over the years that strongly suggested VM isolation was either impossible (or only possible in the sense that what you see at Cirque du Soleil is possible, but out of the reach of the average person). In 2002, Malone, Davies, and Walsh wrote, “The concept of VM isolation through specific exercise should no longer be part of our lexicon.” Such professional opinions have been common for a decade and they are still out there.

We were wrong-ish.

My position is not truly reversed, because I still have strong evidence-based doubts that the isolation is clinically significant. The sting of this particular mea culpa is also blunted by the fact that all the evidence that changed my mind is really quite fresh. It’s not like I ignored it for years or anything. Like I did with sitting and back pain. 😜 Read all the details in my updated vastus medialis article: Patellofemoral Pain & the Vastus Medialis Myth. (All the new stuff is in the final section of the article, Is it possible to ‘isolate’ vastus medialis contraction?)

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