Knee Injury

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....

You likely have Patellofemoral Pain Syndrome. However, you might want to consider setting an appointment with a sports medicine doctor or an orthopedic physician to get a proper diagnosis and to explore your treatment options to restore the full use of your knee. If your issue is not too serious, they will likely refer you to a physical therapist for treatment with specialized exercises, typically specific strengthening and flexibility exercises depending on your particular case. Keep in mind, many insurance plans require you to be referred by a general practitioner who sometimes is not well versed in these sorts of orthopedic issues.

The general information which I provide here should not be misconstrued as a personal prescription for you (or any of our site visitors). Generally, once you get a proper diagnosis and a treatment plan, typically rehab requires you to take a few steps forward and a step back depending on the feedback you get from the injury you are rehabilitating. Initially, exercises may need to be modified and resistances will be much lighter. For example, when performing a leg press, your therapist may suggest you 1) place the feet slightly higher on the platform, or 2) decreasing the depth, or range of motion as you mentioned.

Consequently, with the feet placed higher during a leg press, the quadriceps are exercised less. If this technique is used, either find the minimum height that you feel no pain or find the greatest range of motion with a reasonable resistance that does not irritate your injury. The goal then will be to progressively increase the resistance in very small increments every week or so, as long as there is no sign of pain. There will be an interaction between your foot placement, range of motion, and the resistance used. Some individuals who experience knee pain during full range squats and leg presses do fine with Deadlifts since the knees do not bend as sharply.

I can suggest educating yourself about your injury. One starting place on the internet is the Merck Manual (see medical links). Take care of even minor injuries as they can sometimes get worse if you ignore them. Also, see Dealing with Injuries and Sports Injury First Aid.

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 the 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 gluteus 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 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 multi hip machine (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 gluteus 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?

I would suggest you do whatever it takes to find a sports medicine or orthopedic physician that can properly diagnose your injury and prescribe the best course of action. They may be able to refer you to a good physical therapist who could potentially help you rehabilitate your knee.

First, let's examine your goals behind these glute exercises. If you are attempting to reduce body fat around your glutes, understand spot reduction is not possible. In that case, certain dietary strategies will need to be implemented to see meaningful reductions in body fat. However, weight training can accentuate your curve in your glutes (increase muscle mass) and increase your metabolism for hours after your workout (thereby assisting in overall fat loss), particularly if you engage large muscles like the Glutes and Quads during your workouts. Also keep in mind, unless your goal is local muscular endurance for that particular muscle, it is not necessary to feel a burning sensation to be assured of the exercise's effectiveness, particularly for a compound, multi-joint exercise.

Generally speaking, the basic compound exercises (AKA close chain movements) involving simultaneous hip and knee involvement will be the most effective for most fitness goals (Eg: functional strength, increased resting metabolism, maintaining muscle mass, etc). Since you cannot yet perform squats, one of the most effective exercises, you might want to consider some of the techniques I suggested above (see Pain During Leg Press).

If compound movements in any form are out of the question due to your knee issue, you could certainly try performing isolated exercises such as the one you described. Although isolated exercises instead of compound exercise will not be as effective, they will certainly be better than performing no exercises at all for the glutes.

Nautilus (Duo) Hip and Back machine

The Nautilus (Duo) Hip and Back machine were in the Nautilus line some time ago. It's quite a relic and I haven't seen one in several years, although other manufactures like Hammer Strength have somewhat similar versions. Nautilus had since replaced it with their version of the Multi-hip machine (the one that pushes you forward). There is nothing wrong with these movements, other than what I have explained.

You will still want to have at least a few other movements in your repertoire so you can switch up your exercises every month or so (See Restimulating Progress by Changing Exercises). You could also work your low back, hamstrings, and glutes together with either Bent-knee Goodmorning or hyperextensions, either the horizontal variety or on a 45 degrees apparatus, but with the knees bent to place more emphasis on the glutes instead of the hamstrings. Also, consider the Reverse Hyper-extensions.

On any of these exercises, take care to perform a warm-up set with approximately 50% of your total resistance before you heavier workout set(s). If you're not accustomed to these movements, start very light and work up in small increments (once you can correctly perform 12 reps, for example) particularly since you recently suffered a hamstring injury.

Author's Knee Injury Experiences

Full Squat

When I was young I was not aware of certain adaptation principles as an outline on the ExRx. At 15 years of age, I have read that you should shock the muscles to make them grow. I commenced in performing 10 sets of 1/4 squats with 405 lbs and 10 sets of leg presses on a Universal machine with the entire stack. Shortly after my workout, after my endorphins and enkephalins subsided, my knees gave out and I collapsed to the floor in pain.

I was unable to squat with my 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 isometric squat holds (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 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 myself up, just assisting enough so I did not evoke pain. I performed 50 to 100 reps this way. Initially, this required me to perform nearly a full pull-up 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 to my rehab process was progressive resistance and backing off to recover if I sensed I was reinjuring my knee.

After about 1 year of progressively applying for less and less assistance onto the bar, 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 broomstick 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. Throughout those 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, and 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 lightweight 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 (see Single versus Multiple Sets). Also see Dangerous Exercises, Squat, and Smith Squat articles.

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