J. Phys. Ther. Sci.

25: 257–258, 2013

Activation of VMO and VL in Squat Exercises for

Women with Different Hip Adduction Loads

Eun-Mi Jang1), Hyo-Jin Heo1), Mi-Hyun K im2), Won-Gyu Yoo2)

1) Departmentof Rehabilitation Science, The Graduate School, Inje University
2) Departmentof Physical Therapy, College of Biomedical Science and Engineering, Inje University:
607 Obangdong, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea. TEL:+82 55-320-3994,
FAX:+82 55-320-1678, E-mail: won7y@inje.ac.kr

Abstract. [Purpose] The purpose of this study was to investigate the activation of the vastus medialis oblique
muscle (VMO) and vastus lateralis muscle (VL) during squat exercise with various hip adduction loads using a
pressure-biofeedback unit, and to suggest the most effective exercise method. [Subjects] We recruited 15 healthy
adult females with no pain in the knee joint and no other orthopedic problems of the lower limbs. [Methods] The
enrolled individuals performed four exercises (conventional squat exercise, maximal load hip adduction squat ex-
ercise, 80% hip adduction squat load exercise, 40% hip adduction load squat exercise). [Result] VMO was more
active at 80% and 40% hip adduction loads than in the conventional squat and maximal loading hip adduction squat
exercises. [Conclusion] We suggest using a 40%~80% hip adduction load in squat exercises for VMO strengthening
in the clinical setting.
Key words: Squat exercise, Hip adduction, VMO
(This article was submitted Sep. 27, 2012, and was accepted Oct. 26, 2012)

INTRODUCTION loskeletal, or neurological history of any pathological

Patellofemoral pain syndrome (PFPS) is an overuse
injury characterized by an aching pain in the peripatellar
area1–3). In general, women have wider pelvises, greater
hip varus, larger hip width to femoral length ratio, and
increases in lateral patellar contact forces. One of the main
mechanisms of abnormal patellar tracking in PFPS is an
imbalance in the activity of the vastus medialis oblique
muscle (VMO) muscle relative to the vastus lateralis muscle
(VL)4, 5). Many exercises emphasize the importance of
the VMO6–8). Anatomic cadaver studies have shown that
fibers of VMO originate from the distal part of the adductor
magnus; thus VMO is provided with a stable origin from
which to contract in hip adduction9). Hip adduction also
stretches the VMO fibers, adjusting the length and tension
properties of the muscle and increasing the contraction
force. Previous research has useed maximum hip adductor
contraction during squat exercises. Much effort is required
to maintain maximum contraction during an examination
period, and subjects actually have difficulty in confirming
the maximum muscle contraction. Therefore, the aim of the
present study was to assess the effect of different relative hip
adduction loadings on VMO and VL EMG activity, with the
goal of establishing the most efficient way to perform squat
exercises for promoting a higher activation of VMO.
SUBJECTS AND METHODS
Fifteen female subjects with no known surgical, muscu-
condition in the lower extremities participated in this study.
The mean age of the participants was 23.67 ± 3.48 years,
their mean height was 162.33 ± 4.85 cm, and their mean
weight was 52.93 ± 5.20 kg. The electrical activity of the
VMO and VL was recorded using surface EMG electrodes
(Biopac System Inc. Santa Barbara, CA. USA). Prior to
data analysis, all results were normalized by calculating
them as a percentage of their maximal voluntary contraction
(%MVC). Subjects were instructed to bend their knees to
45° and hip adduct their knees together. Subjects performed
conventional squats and squat with various hip adduction
loads (maximum, 80% load, and 40% load). Squat exercises
were executed in the following sequence. The conven-
tional squat exercise was performed by descending to 45°
knee flexion, holding for 6 s, and ascending to the initial
position. Squat exercises with various hip adduction loads
were performed by compressing a biofeedback air cushion
placed between the medial joint lines of the knees. Subjects
inserted the air cushion between their knees and squeezed
it at maximum effort for 6 seconds, and this sustainable
status was defined as the maximal hip adduction. Maximal,
80%, and 40% hip adduction load squat exercises were
performed by descending to 45° knee flexion and holding for
6 seconds. The data were analyzed using SPSS version 18.0
(Chicago, IL, USA) to examine the significance of differ-
ences in activation of the VMO and VL muscles among the
squat exercises. A one-way repeated measures ANOVA was
initially performed to determine significant differences in the
activity of each muscle during the exercises. Bonferroni’s
258 J. Phys. Ther. Sci. Vol. 25, No. 3, 2013
correction was performed post hoc to assess differences
among various hip adductions loads. A value of p <0.05 was
considered statistically significant.
RESULTS
The EMG activity of VMO was more active at the 80%
and 40% hip adduction loads than in the conventional squat
and maximal load hip adduction squat exercises (p<0.05).
The EMG activity of VMO was higher at 80% than at 40%
hip adduction load. The normalized EMG values of VMO
during 80%, 40%, maximal, and conventional squats were
44.73 ± 14.58%, 42.38 ± 17.62%, 42.03 ± 13.79%, and 35.45
± 14.70%, respectively. No statistically significant differ-
ences were noted among the activities of the VL muscle
(p>0.05). The normalized EMG values of the VL muscle
during the 80%, maximal, 40%, and conventional squats
were 39.36 ± 18.24%, 38.86 ± 18.67%, 36.42 ± 18.28%, and
33.13 ± 16.15%, respectively.
DISCUSSION
Rehabilitation of patients with PFPS requires strength-
ening of the knee muscles7, 9). Accordingly, many researchers
have recommended VMO and VL muscle activation in squat
exercises5, 8, 10). This study investigated the activation of the
VMO and VL muscles, to enable more precise treatment.
We analyzed and compared the magnitude of the VMO and
VL muscle activities in squat exercises with four different
hip adduction loads. We found that the VMO muscle
activity increased in squat exercises with hip adduction
compared to the conventional squat exercise. This result
agrees with the findings of previous studies, in which the
VMO muscle showed significantly greater electrical activity
during a double leg semisquat exercise associated with hip
adduction5, 11). Some researchers also reported that squat
exercises with maximal adduction of the hip showed an
increase in the myoelectrical activity of VMO7, 11). These
previous studies used squat exercises with hip adduction
to establish higher EMG activity levels in VMO and VL.
However, in all of these studies, maximal voluntary hip
adduction was used. The present study used squat exercise
with for different hip adduction loads, and found significantly
higher activities at 80% and 40% hip adduction loads than
in the conventional squat exercise. Much effort is required
to maintain maximum loading, and it is actually difficult to
maintain it using biofeedback. Consequently, compensatory
movement or irregular activation of muscles might occur.
Therefore, we suggest using 40%–80% hip adduction load
during squat exercises for VMO strengthening in the clinical
setting. Further EMG investigation is necessary to determine
the most appropriate hip adduction load, as well as to clarify
the differences between PFPS and healthy persons, in order
to compare the effects of muscle training programs utilizing
various hip adduction loads in squat exercises.
ACKNOWLEDGEMENT
This research was supported by Basic Science Research
Program through the National Research Foundation of
Korea (NRF) funded by the Ministry of Education, Science
and Technology (No. 2012001058).
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