Knee pain is one of the most common complaints in training… and in many cases, the root cause isn’t the knee itself. It’s a weak VMO.
The VMO, or vastus medialis oblique, is the teardrop-shaped muscle on the inner quad just above the knee. It plays a critical role in controlling how the kneecap tracks during movement, and when it’s underdeveloped relative to the rest of the quad, the patella gets pulled out of alignment. That’s when knee pain starts.
The Poliquin step-up is one of the most effective exercises available for targeting this specific muscle directly, and it’s become a staple in both knee rehabilitation programmes and Knees Over Toes training for good reason.
This guide covers everything you need to know, including how to perform it, the muscles worked, benefits, and how it fits into a broader knee-strengthening progression.
What is the Poliquin Step Up
The Poliquin step up is a single leg step up variation that involves stepping down and up from a raised surface with a raised heel. This can be achieved by either using a slant board, or placing your heels on an object (e.g. barbell plate) that is on top of a low step box.
The optimum height will depend on your own height and the desired knee range of motion. This isn’t a deficit single leg squat though, so the aim isn’t to fully bend at the knee from a great height. Instead, try and target a 30 degree knee bend (as a rough estimate, we find if the heel of your non-working leg is about 2-3 inches off the floor in the starting position, this feels about right). Over time, you may want to increase/decrease this to better suit your specific training.
3 “Step” Progression
The Poliquin step-up sits within a well-established three-exercise progression that moves from accessible to advanced: the Patrick step-up, the Poliquin step-up, and the Petersen step-up. Each builds on the last in terms of the demand placed on the knee joint, ankle stability, and VMO strength.
To being with, start with a smaller step and work your way up.
Due to the raised heel, the Poliquin Step Up focuses on the VMO (Vastus Medialis Oblique), which is the “teardrop” looking part of the quadriceps.
Strengthening the VMO is associated with better knee health and movement… and is used frequently in exercise programs like Knees Over Toes training that prioritize exercises that are beneficial for the lower body joints.
The Poliquin Step Up is a regression from the Peterson Step Up, which involves raising the heel without support from a slant board or weight plate.
“Step ” Biomechanics
Although it’s often referred to as the Poliquin “Step Up”… the movement is really a “step down” in terms of how the exercise starts and the subsequent biomechanics.
How to Perform a Poliquin Step Up
To perform a Poliquin Step Up:
- Place a slant board or weight plate on top of a raised surface, such as a low step box.
- Place your left foot on the slant board or weight plate so your heel is raised and that your right foot hangs off the raised surface unsupported.
- With a straight torso, flex the toe of your right leg up.
- Bend your left knee so you lower your right foot to the floor. The heel of your right foot should be aligned with the toes of your left foot.
- As you bend your left knee, it should go over your left toes slightly.
- Pause for a moment before contracting the quads to straighten your left leg and return to the starting position.
- You may want to do the exercise near a wall for support if you are struggling with balance.
Coach’s Tip – This isn’t a single leg squat… so keep your glutes tucked in and avoid any hinging at the hips. The movement wants to focus on the knee and VMO activation.
Slow and Controlled Movement
Poliquin Step Ups involve a relatively small range of motion, especially compared to something like squats. This means you’ll probably find you can do repetitions faster… and more of them… but try and keep things nice and slow and avoid trying to do this exercise at speed.
Muscles Worked
The Poliquin Step Up primarily works the VMO muscle on the inner quad. It also activates the tibialis anterior, core and the other muscles in the quad.
The glutes, hamstrings and calves will also be engaged.
VMO (Vastus Medialis Oblique)
The VMO is the primary target and the reason most people include this exercise in their programme. It’s responsible for the final degrees of knee extension and plays a critical role in keeping the kneecap tracking correctly during movement.
When the VMO is weak relative to the vastus lateralis on the outer quad, the patella gets pulled laterally out of its natural groove – which is one of the most common causes of runner’s knee, patellofemoral pain syndrome, and general knee discomfort during squatting and lunging movements.
Quadriceps
The other three muscles of the quad, the rectus femoris, vastus lateralis, and vastus intermedius, all contribute to the knee extension movement, though the raised heel position and short range of motion bias the VMO more significantly than standard step-up or squat variations.
Gluteus Medius
The gluteus medius acts as a stabiliser throughout the exercise, working to keep the hips square and prevent the pelvis from dropping as the non-working leg steps down.
A weak gluteus medius is commonly linked to both knee and lower back pain, making this secondary activation a useful bonus – particularly for those using the exercise in a rehabilitation context.
Tibialis Anterior
The non-working leg holds the toes dorsiflexed throughout the movement, which keeps the tibialis anterior actively engaged. Though this isn’t the primary purpose of the exercise, it contributes to the broader lower leg and knee resilience that makes the Poliquin step-up such a well-rounded addition to any programme.
Core
As with any single leg exercise, the core works continuously to maintain an upright torso and prevent any lateral shift or rotation during the movement.
Poliquin Step Up Benefits
VMO Strength and Patellar Tracking
A strong VMO is the foundation of healthy knee mechanics. Research found that individuals who performed Poliquin step-ups experienced greater knee stability and reduced discomfort compared to those who did traditional step-ups.
The primary reason is that the raised heel position creates a longer moment arm at the knee, placing greater demand on the VMO specifically at the terminal range of knee extension – the exact position where the VMO is most responsible for kneecap tracking.
For anyone dealing with knee pain linked to quad imbalances, for example, a weaker VMO compared to a Vastus Lateralis (outer quads), this targeting makes the Poliquin step-up one of the most direct tools available.
Core Stability and Balance
Being a single leg exercise, the Poliquin step-up demands active core engagement throughout to maintain a level pelvis and upright torso. Over time, this builds the kind of functional stability that carries over to running, sport, and everyday movement – not just gym-based strength.
Ultimately, this is incredibly important, and is why Poliquin Step Ups are so effective to include in any sort of strength training program for over 50’s, due to the practical benefits in everyday living.
Gluteus Medius Activation
Most people think of the Poliquin step-up purely as a quad exercise, but the gluteus medius is working throughout every rep as a stabiliser. Given that gluteus medius weakness is one of the most commonly overlooked contributors to both knee and lower back pain, this secondary benefit makes the exercise more valuable than its simple appearance suggests.
High Volume Exercise
Muscle development thrives on diversity and most of us are guilty of sticking with the same number of reps/sets for each exercise.
Poliquin Step Ups include quite a small range of motion and as a result, once you feel confident with the movement, you may find you can do 20 reps per set quite happily.
Not all exercises lend themselves to high volume sets, so exercises that do, are great to have in your arsenal to keep your workouts diverse and varied.
Replicates Walking Downhill
The actual biomechanics of the Poliquin Step Up replicates walking downhill, which helps to strengthen the muscles required to do such an activity.
If you find your knees hurt after a long hike, or walk, it may be due to a weak VMO… in which case, doing Poliquin Step Ups can help strengthen this, resulting in the ability to hike/walk for longer, with less pain.
Tibialis Anterior Activation on Non-Working Leg
The non-working leg requires your toes to be pointed upwards. This dorsiflexion of the ankle engages the tibialis anterior, and although this isn’t the primary focus on the exercise, it still provides benefits.
Frequently activating and strengthening the tibialis anterior (shin muscle), helps your shins absorb more impact during physical activity, which helps to protect your knees, hips and ankles.
This is another fundamental pillar of Knees Over Toes workouts.
Serious About Strengthening the Tibialis Anterior?
Check out our Tib Bar review, which explains how to take your tibialis anterior strengthening to the next level.
Great for Knee Rehabilitation
If you’ve been seeing a Physical Therapist due to knee pain, the Poliquin Step Up or something similar may feature in your home exercise program. This is because it can be a great way to get the knee working and VMO activated, without putting the joint under unwanted pressure (like with squats and other compound movements).
Alternatives
Our guide on cyclist squats is worth reading if you like the idea of adding more load to VMO-centric exercises. Cyclist squats are a type of squat variation focused on the quads and involve squatting using a slant board.
The Petersen Step Up is a very similar exercise to the Poliquin Step Up and we highlight the differences between these two movements further down this article.
We also recently highlighted the benefits of Spanish squats, as an effective rehabilitation exercise for Jumper’s Knee. Interestingly, this exercise requires the knee to be positioned as back as possible, as opposed to over the toes.
Weighted Poliquin Step Up
Once you can comfortably complete 15 to 20 reps per side with good control, there are several ways to progress the exercise. Holding a pair of dumbbells is the most straightforward option and works well for most people.
From there, progression options include increasing the angle of the slant board to increase VMO demand, attaching a resistance band to create downward pull throughout the movement, or elevating the slant board on a bumper plate to slightly increase the range of motion.
Avoid going too high with the elevation – once the step becomes very deep, the exercise starts to resemble a pistol squat and the targeted VMO activation begins to diminish.
A useful rep target throughout all variations: because the range of motion is deliberately short, 15 to 20 reps per side is generally the sweet spot for achieving adequate time under tension in the VMO. Chasing heavier weights at lower reps tends to miss the point of the exercise.
The Patrick, Poliquin and Petersen Progression
The Poliquin step-up is part of a three-exercise progression that works from beginner to advanced for VMO and knee joint strength.
The Patrick step-up is the most accessible entry point – a reverse step-up performed flat-footed without any heel elevation. It introduces the movement pattern and builds initial VMO and tibialis anterior strength without the added challenge of the raised heel.
The Poliquin step-up is the intermediate progression, adding heel elevation via a slant board or weight plate. This increases VMO demand at the terminal range of knee extension while keeping the foot connected to a stable surface throughout.
The Petersen step-up is the most advanced variation. Rather than the heel being supported on a slant board, you balance on the ball of the foot as you step down – a significantly greater challenge for calf strength, ankle stability, and VMO control.
It’s also spelt Peterson step-up in some sources, named after Carl Petersen. Both spellings refer to the same exercise.
Working through this progression methodically is one of the most effective approaches to building bulletproof knees from the ground up.
Bottom Line
The Poliquin step-up is a deceptively simple exercise with a specific and well-supported purpose: strengthening the VMO to improve knee stability, correct patellar tracking, and reduce the risk of the quad imbalances that drive a large proportion of knee pain in active people.
It works best as an accessory movement – included in warm-ups to activate the VMO before heavier lower body work, or as a dedicated knee rehabilitation exercise alongside other single leg and hip stability movements.
Aim for 15 to 20 reps per side, keep the range of motion controlled and deliberate, and progress through the Patrick to Poliquin to Petersen sequence over time as your VMO strength and ankle stability develop.
If you’re currently dealing with knee pain, speak to a physiotherapist before starting – but if you’re training preventatively, this is exactly the kind of targeted work that keeps knees healthy over the long term.
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Featured image and video demonstration credit – Engineered Bodies Strength & Conditioning