Peterson Step Up

The Peterson step up (also known as VMO step up) is a modified step up exercise where you stand backwards on an elevation and lower one leg down until the heel touches the ground, then push back up. The difference with a regular step down is that here you lower your leg slowly with emphasis on eccentric control and VMO (vastus medialis obliquus) activation. The exercise is named after Dr Mark Peterson and is very effective for knee rehabilitation, especially for patellofemoral complaints and patellar tendon problems.

Making an appointment

Table of contents

Peterson Step Up

Purpose of the exercise

Strength exercise for the quadriceps (especially vastus medialis obliquus/VMO), glutes and knee stabilisers. Improves eccentric knee control, VMO activation and ankle stability. Also effective for restoring knee extension strength after injuries, improving patellofemoral tracking and preventing knee injuries. Helps develop single-leg control during descents.

Supplies

Step, box or stairs (10-20 cm high, start low)
Stable wall or handrail for balance (optional)
Sufficient space around the scooter
Flat, stable surface

Starting position

Stand backwards on a step or box
Place one foot fully on the step (working leg)
Let your other leg hang freely next to/behind the scooter
Stand about 5 cm from the edge for safety
Keep your torso upright and stable
Arms in front of your chest or on hips
Tighten your core
Weight entirely on the leg that is on the scooter

Implementation

Slowly lower your free leg down
Bend your standing leg knee in a controlled way (eccentric)
Keep your standing leg knee in line with your foot
Lower until your free heel touches the ground
Keep your torso upright (don't lean too far forward)
Lightly touch the ground with your heel (tap the ground)
Push yourself explosively back up via your supporting leg
Fully extend your supporting leg
Tighten your quadriceps (especially VMO) to the max at the top
Repeat the movement

Points of interest

✓ Focus on slow, controlled lowering (3-5 seconds)
✓ Keep your knee in line with your foot (not inwards)
✓ Keep your torso upright and stable
✓ Touch the ground only lightly (do not step over)
✓ Push back up explosively
✓ Feel the quadriceps (especially VMO) working intensively
✓ Breathe in on lowering, out on rising
✗ Avoid your knee falling inwards (valgus)
✗ Don't let your hips sag to one side
✗ Don't lean too far forward with your upper body
✗ Don't fall down hard (controlled lowering is crucial)
✗ Don't put your free foot fully on the ground
✗ Don't use your free leg to push up

When this exercise?

This exercise is suitable in knee rehabilitation for patellofemoral pain syndrome, patellar tendinopathy, after cruciate ligament reconstruction or for quadriceps weakness (in consultation with physiotherapist). Ideal as a progression of Spanish squats or leg extensions. Very effective for VMO strengthening and eccentric knee control. Perfect for athletes returning to sport after knee injuries. Also valuable for knee injury prevention in runners and jumper athletes. Suitable as an accessory leg exercise for knee health. Start with low step (10-15 cm) and gradually build up height - higher step = heavier. In case of acute knee pain, swelling or instability, have it assessed by a physiotherapist first. Focus on the slow downward phase - this is where the therapeutic value is. The explosive upward phase develops strength, but the controlled downward phase is essential for knee stability and VMO activation.

Table of contents

Ruben Luijkx

Ruben Luijkx, Master of Science and co-owner of Fysio Fitaal, specialises in sports-related complaints, ultrasound diagnostics and manual therapy. Writing on physiofitaal.nl, he introduces you to the expertise and professionalism of Fysio Fitaal in Tilburg.