Pain During Leg Press
 I'm
having trouble finding good leg exercises to vary my routine..reason
being, my knees hinder me to some degree.... normally I use a
leg press for 5 sets (12 reps, 10 reps, 8 reps, 6 reps, ....gradually
increasing weight then 12 reps with a weight that will only allow
me to do 12...and I think that my legs are strong for a 53 year
old woman. I'm pressing about 360 for 12 reps on this particular
leg press...) finishing with the leg extension for 12 reps....that
covers the quads. My problem is my knees....mainly the right
one....under the knee cap...I can't do lunges, quads, sissy squats,
or any of that stuff....even the leg extension isn't my favorite
and can bother my knee as the weight gets higher...I have been
told that I COULD do those exercises if I didn't allow the knee
to go past a 90% angle, but I haven't been able to do them without
some degree of pain....I need ideas....
I must first say I am not qualified to give diagnosis and
rehabilitation prescription for injury. These cases require the
expertise of a licensed physician. I would advise setting an
appointment with a sports medicine doctor or an orthopedic physician.
If the issue is not too serious they will likely refer you to
a physical therapist. Keep in mind many insurance plans requires
you to be referred by a general practitioner who sometimes are
not well educated in sports medicine.
I can give you general information which should not be misconstrued
as a personal prescription for you. Individuals that have minor
knee irritation may find relief when performing a leg press,
smith squat, lever squat, or sled squat by one or more methods.
1) placing the feet slightly higher (or forward when upright)
2) decreasing the depth, or range of motion of the exercise as
you mentioned 3) using less weight.
Consequently, with the feet placed higher during a leg press,
the quadriceps are exercised less. If this technique is used,
find the minimum height that you feel no pain. Likewise, find
the greatest range of motion and the greatest weight that does
not irritate your injury. Obviously there will be interaction
between your foot placement, range of motion, and the resistance
used.
I can suggest to educate yourself about your injury. One starting
place on the internet is the Merck Manual (see medical
links). Realizing I am not an expert on diagnosing injuries,
my best guess is you are suffering from Patellofemoral Pain.
Therapy may include specific stretches and exercises, antiinflammatory
medication, and later as your injury begins to heal, the introduction
of weight training exercises with light weight, progressing slowly
in resistance. Take care of even minor injuries as they can sometimes
get worse if you ignore them. Also see Sports
Injury First Aid.
Author's Knee Injury
Experiences
 When
I was young I was not aware of certain
adaptation principles as outline on the ExRx. At 15 years
of age I had read you should shock the muscles to make them grow.
I commenced in performing 10 sets of 1/4 squats with 405lbs and
10 sets of leg presses on a Universal machine with the entire
stack. Shortly after my workout, after my endorphines and enkephalins
subsided, my knees gave out and I collapsed to the floor in pain.
I was unable to squat
with my own body weight without severe pain. This injury persisted
for 5 years since I continued to reinjure it when attempting
to exercise through the pain. I probably could have completely
recovered from this injury within months if I hadn't continued
to irritate it by continued weight training and intermittent
running. Throughout the next few years I sought the advice of
many doctors of various specialties with little success. I had
limited success with deadlifts (limited knee flexion) and isometrics
(no knee movement).
Finally after years of pain and several doctors later, I took
a long lay off from quadriceps
exercises. I later resumed my own physical therapy devised
from elementary exercise
principles. Hanging on a fixed bar about shoulder height,
I slowly lowered myself to a squatting position. From there,
I pulled my self up, just enough I did not feel pain. I performed
50 to 100 reps this way. Initially this required me to perform
nearly a full pullup with my upper body so no pain was experienced.
Only months later I was able to push a bit more with my legs
without pain, still pulling myself up. If I inadvertently irritated
my injury, I took several days off and started back with less
resistance (more assistance from my upper body). The key with
my rehab process was progressive resistance and backing off if
I sensed I was reinjuring my knee.
After about 1 year I was finally able to use just my body weight
with no pain. For the next year I continued the same progressive
resistance protocol, starting with a broom stick on my back.
I tried to add only 5 pounds periodically. Again I took several
days off if I experienced pain and resumed with a lighter weight
progressing slowly all over again. Through out these two years
of diligent rehabilitation, I continued aggressive hamstrings
exercises and stretched regularly.
After those two years of rehabilitation to this date, I regularly
performed full
squats. I slowly worked up to 405 lbs for several reps with
absolutely no pain. My knees have adapted to this stress; I can
now jump, sprint, run, perform aggressive plyometrics.
I was unable to do this for years! Some time ago the head physical
therapist at Grant Medical Center in Columbus, Ohio had tested
my knee stability and quadriceps/hamstring
ratio and reported it was one of the best test results she
had seen. This rehabilitation experience profoundly affected
the development of my understanding of exercise adaptation throughout
my later undergraduate and graduate studies.
If I was to do it again today with the available equipment,
I would choose the lying
leg press instead of assisted squats. I now warm up with
a very light weight before every new exercise. I also perform
fewer sets (with greater intensity) which I advocate for less
risk of chronic joint pain, or overuse injury. Scientific studies
demonstrate fewer sets have similar effects on strength and muscular
size. Also see Dangerous Exercises,
Squat and Smith
Squat articles
Glute Exercises with Bum Knee
I am a 48 year old female, 5'10" and 135 lbs. I get
my aerobic exercise on a treadmill 4 times a week for 30 minutes
at training level for my heart. In July, I started weight training
and have seen wonderful gains in my upper body and my quadriceps
and inner thighs. I am frustrated with my glutes and have been
going slowly on the hamstrings due to injury. I trained 20 years
ago with Nautilus and believe I had good results on my gluteous
max with the Nautilus hip back machine. Now, they have a hip
extension machine, but only one place in San Diego has this.
I am really having trouble getting a good workout on the glut
max because my knees hurt. I don't see that joint getting strong
enough to max out my gluts. My trainer tried to teach me some
exercises and said that I had a poor neural muscle connection
there. I find that the butt blaster involves my knees too much
and the weight I need on the multihip machine (in order to get
a burn in the muscle) pushes me forward too much. The leg press
also hurts my knees. I have a roman chair at home, that I use
with some low weights while I'm building up slowly, but I don't
feel safe putting weights on my back at home alone. I believe
that I could benefit from the Nautilus hip extension machine,
and would like to petition 24 hour Fitness (my fitness club)
to buy one. I am concerned though because no weight training
books seem to cover it. Is it dangerous or ineffective or not
popular for some other reason? I think it would be very effective
in taking my gluteous to muscle failure with minimal impact on
my knees and minimal need for stabilizing from my other muscles.
I am working on my lower back on another machine to build up
strength. What is your opinion of the Nautilus hip extension
machine?
You probably have guessed you should see an orthopedic surgeon
or sports medicine physician about your knee. Until your knee
problem can be remedied you could certainly try performing an
isolated exercises such as the one you described. Keep in mind,
however, close chain compound movements involving simultaneous
hip and knee involvment will be the most effective. I would suggest
to do whatever it takes to find a sports medicine or orthopeadic
physician that can properly diagnos your injury and prescribe
the best coarse of action.
You'll need to assess if your objective is to add a slightly
greater curve to your glutes (increase muscle mass) or simply
to reduce fat in this area. If you are attempting to reduce body
fat around your glutes, understand spot
reduction is not possible. In this case certain dietary
stratigies will need to be implemented to see meaningful
reductions in bodyfat.
If you objective is indeed to restore muscle mass to your
glutes, the basic exercises such as squats, leg presses, and
deadlifts will be the most effective, but only if you can manage
to get proper treatment and your knees return to normal. This
could take sometime so in the mean time, you can try the isolated
exercises you have mentioned although they generally will not
be as effective. Keep in mind that it is not necessary to feel
a burning sensation
to assess the exercise's effectiveness, particularly with compond
(multi-joint exercises such as the mentioned ideal exercises).
 The
Nautilus (Duo) Hip and Back machine was in the Nautilus line
some time ago. I haven't seen one in a number of years so I can
only imagine it has been replaced by another machine, possibly
the Multi-hip machine. You can try the Nautilus web site to confirm
this.
Instead of trying back extensions at home, you could try a
slight variation call the hip
extension on an hyper-extension apparatus at your gym, starting
out with your hand behind your hips and gradually adding resistance
later. Once you can do 12 reps with the hands above your head,
then consider holding weight as seen when you follow the links.
Another option is the Reverse Hyper-extension.
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