Dear Dr. Bell,

I have an issue with vastus lateralis development. My medialis is overactive in almost all lower body movements (squats, leg press, extensions, etc) and as such has grown much larger over the past years. I have a slight Anterior pelvic tilt, very limited internal rotation in my femurs (approximately 10 degrees movement if knee and hip at 90 degree angles) and excellent external rotation (can reach 90 degree rotation with same parameters set). I have a feeling that the default, externally rotated/bow legged position I’m in is restricting lateralis activation, but I am not sure. There are so many different variables that confuse my thought. Would love to hear what you have to say about this issue especially considering lateralis development is usually easy for most.

Thank you for the, Albeit: complex question! The complexity is due to the correction for all you describe will require programming in virtually ALL of the 12 IFPA Components of Fitness. Let’s take each of the components in order:

1) Strength: Obviously you describe an imbalance in strength between your Vastus Medialis (the V.M.: Tear-drop shaped muscle above the knee on your quadriceps) and your your Vasutus Lateralis (the V.L. muscle of your quadriceps located on the outside of your thigh). If you are doing most of your leg work with your feet in wide stance, you have been targeting your V.M.

To switch emphasis to your V.L., you will need to do all your leg work in narrow stance or even better: Single Leg. The Single Leg-Leg Press is highly recommended for you.

2) Speed: While you may not be interested in Speed Development, Sprinting is a GREAT quad exercise and will work your V.L. better than most any other exercise.

3) Power: Once again, pure Power may not be your goal, but even relatively low intensity, beginner level hops, skips and jumps will assist your V.L. development (especially when done single leg).

4) Anaerobic endurance: you have to take your V.L. muscle fibers beyond their normal muscular endurance limits to effect faster improvement. Begin with 1-2 minutes of relatively high intensity and build to 3 minutes of sustained activity. This can be accomplished by using the plyometric exercises mentioned above at lower intensity and longer duration. I combine both by starting high and finishing low intensity as fatigue builds.

5) Aerobic endurance: For most people walking is 3-4 mph, the longer your legs, the faster you can walk. Jogging is between 4-6.5 mph and Running begins for most people at 7 mph. You need to use ALL the IFPA Exercise Training Principles described in the IFPA Book of Personal Training, especially the GPO: Gradual Progressive Over Load Principle to start with a level of intensity that will encourage the body to adapt and improve without over doing it to cause injury and over training. Personal Training is both Art and Science, but in your case…if it hurts…YOU ARE DOING IT WRONG! Build slow for great long term results.

6) Agility: most agility exercises will also work your V.L. and provide some fun and variety to your workouts.

7) Balance: most balance exercises also require a balance in your muscle development. Keep in mind that even performing the strictest Single Leg exercise can never negate the V.M, only move the emphasis on to the V.L.. Single leg work of all kinds is highly recommend for you. Many IFPA Certified Personal Trainers will perform Single Leg exercises as a Warm-Up to their more intense exercises for themselves, as well as their Personal Training clients. You can Warm-up your Strength Training exercises by performing them on one leg (typically switching legs after each Rep). Many Strength Training exercises can be done Single Leg: Bicep Curls, Shoulder Presses, Side Lateral Dumbbell Raises, Bent over-Reverse Flyes(for rear Delt), Bent over rows, etc.

8) Coordination: exercises are also a fun way to add variety to your program. Most IFPA Certified Trainers have found very lucrative opportunities having older, more mature Personal Training clients and find Agility, Balance and Coordination exercise highly effective and rewarding at returning their clients to full functionality.

9) Flexibility: is essential for you to correct your imbalance. I could list the specific exercises for your low back, hips and legs to correct your lack of flexibility, but that would hardly correct every issue in a body lacking a full, functional range of motion(FROM). I suggest instead you either refer back to the IFPA Book of Personal Training or pick one or more of the advanced Flexibility Specialist Certification Courses we have available for you to become an expert in Flexibility Training, not only for yourself, but for all your future Personal Training clients. Then do what all IFPA Certified Personal Trainers are taught to do, prepare a complete flexibility program for every joint and muscle group throughout your body. You can also consider sessions with a PhysioTherapist to add your progress. We also have the IFPA Yoga Instructor and Pilates Instructor Certification Courses that could also aid you in this goal to increase your FROM.

10) Body Composition: you did not specifically mention it, but keep in mind that any excess weight you are carrying can place undue stress on nearly every bone and joint in your body. You are describing pain from the low back on down. If you are carrying any “Loosely Packed Muscle”….sometimes referred to by mean Personal Trainers as “fat” on your body, that can also cause you pain. If this applies to you, lose weight.

11) Symmetry: To correct the asymmetry of any muscle or group will require your focus on the weak side. I recommend 3 exercises for the weak side for every exercise you do on the strong side, but based on what you describe, I would stop all exercises that target the V.M. until you get your V.L. in balance. Please take the time to review all the muscle balance tests and ratios I provided for you in the IFPA Book on Personal Training. You may have other imbalances that you may not be aware of. I have also written many other FitBits and Blogs on related topics you should review.

12) Biochemical Balance: if you are out of balance, it could be a cause or contributing factor to your problem. Examples of what to look out for are: Nutritional Deficiency, Abnormal Bone Development, Fractures, Vitamin D Deficiency, Overweight/obesity, Blount’s Disease and Flouride Poisoning can be just a few of the things that can be a factor in what you describe. I highly recommend you consult a doctor just to rule out these factors and others. There is no harm in you taking up to 3,000 I.U. of Vitamin D/day (I recommend D-3) and many benefits beyond your issues. Likewise, you may benefit from a Body Detox program.

Good Luck with your training and your Personal Training career.

Best regards,

Dr. Jim Bell


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