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starting out easy after a knee injury

Posted: Sun Apr 11, 2010 6:37 pm
by sks24
Is there a way to strengthen my thighs and quads without stressing my knees?

I'm only just now getting over some patellofemoral pain that began last summer. 14 days ago my pain was at maybe .25 on a scale of 1-10.

The pain didn't clear up until I stopped running and doing squats. After stopping those two activities, the pain cleared up in about a month.

I tried doing squats 8 days ago with the parallel bars on my power cage set as high as they would go (legs bent to @150 degrees, bar + weights equaled 115lbs) and the pain came back, and still persists a bit. Four days earlier I did squats with no weight and I had no problems. So I added too much too fast.

Having read "Author's Knee Injury Experiences" (here:, it looks like what I'll have to do is:
1) wait until the pain once again subsides completely, and,
2) add stress more gradually.

I've got an elliptical and I water run, so there's no need to run this summer.

But it certainly would be nice if there was a way I could strengthen my legs without risking re-injuring my knees.

I also have a Body-Solid weight station with a leg press on it. I could move the pin on the stack so that I wouldn't have to start with my knees bent very much.

It also has provision for leg curls and leg extensions.

But both of those still involve bending the knee.

Would isometrics help? I could weight my bar in the cage in such a way that all I would be able to do would be to push against it without lifting it off the parallel bars.

I also have a hyper-extension chair. I may be able to adjust it so that the fulcrum is below my hips.

Thanks in advance,

Posted: Sun Apr 11, 2010 7:42 pm
by ApolytonGP
1. I think doing double leg exercises is advisable because one leg can help the other.

2. Try the leg extension machine and emphasize the finishing point (leg straight), because you can still work the quad, but without the patella mechanically engaged (it engages around 90). I find a little bit of a swing to get started at the beginning is helpful (not a jerk, but not a slow rep especially at the beginning). And then be deliberately slow about advancing the weight. Maybe go about half as fast as you could if you were just advancing as fast as possible.

3. Biking on flat terrain with minimal pedal pressure might be a good activity to replace the running.

Posted: Mon Apr 12, 2010 3:48 am
by KPj
I would stay away from knee extensions.

Use exercises with a vertical shin - DL variations, mostly. Start light and perfect form before loading up gradually. Single leg variations like single leg deadlifts and reverse lunges will adhere to this aswell and help the cause. However, you may not be ready to go single leg in which case you need to build some basic strength on 2 legs first.

Really, you want to work on the glutes. Anything that puts emphasise on the quads will put stress on the knees. With healthy knees/hips this is a good thing but when you're in pain it can be a bad thing until you get things sorted out.


Posted: Fri Apr 16, 2010 11:35 am
by sks24
Thank you ApolytonGP and KPj:

I've found a way to stress my quads without bending my knees at all using a lever leg extension: On my Body Solid weight station I grab hold of the lat pull-down bar while standing with my lower legs trained through the, uh, padded leg things. Then I just lower my body to the seat while keeping my legs ramrod straight. (The bar is directly over the seat.)

I think I'll gradually add both weight and coming off the 180 degree on that one.

I did Sumo deadlifts and straight-leg/arm/back deadlifts in the cage with the parallel bar positioned such that I could keep good form. (I'm 48, and not very flexible, especially my hamstrings.)

Since I did these things while still having a tiny bit of residual pain, it's hard to tell if these exercises will prevent healing. I don't think they made the knee pain noticeably worse.

My gut tells me that the de facto isometric leg extension exercise is all but innocuous?

I think the Sumo deadlift may of bothered my knee a bit.

So, for control purposes, I'll eliminate the SD for now and stick with other two.

Again, thanks.


Posted: Fri Apr 16, 2010 12:44 pm
by sks24
Thinking out loud here . . .

I have an attachment for my bench which allows me to do lever lying leg curls and leg extensions.

I could do standing (cable) hip extensions.

So that would be gluts and hamstrings.

Add my "straight-leg" leg extensions and that covers everything a barbell squat ( ... Squat.html) and deadlift would do, no?

Except for my back. Probably better to do this:

1) Straight- leg/back/arm deadlift ( ... dlift.html)

2) Bent Row.
3) Bench press
4) lat pull down
5) shoulder press
6) "straight leg" leg extensions.
7) Abs swiss ball "stir the pot" (demonstrated in the video halfway down this page:

Normally I begin my lifts with squats and deadlifts.

I also cycle through two additional exercises over three lifts:
wrist curl/reverse wrist curl
wrist supination/pronation

Posted: Fri Apr 16, 2010 3:17 pm
by Jungledoc
Naah. What KPj said.

Posted: Fri Apr 16, 2010 4:06 pm
by sks24
OK. So, any DL which keeps my tibia perpendicular to the floor is a go?

Posted: Fri Apr 16, 2010 6:31 pm
by stuward
sks24 wrote:OK. So, any DL which keeps my tibia perpendicular to the floor is a go?
The DL you suggested is a good one. I wouldn't say "any" DL. Keep a straight back and don't lock the knees. This is one I wouldn't do with any significant weight even if the shins are vertical. ... dlift.html

Posted: Fri Apr 16, 2010 6:43 pm
by sks24
Gotcha. Thanks Jungledoc and Stuward.

Posted: Mon Apr 19, 2010 3:41 am
by KPj
Just to note - Sumo's can be tricky if you don't know how to do them properly.

The big difference with Sumo style DL's is that you need to actively 'break the floor apart' with your feet. You grip the floor with your feet and push the feet and knees out to the side. I would bet that when you do it your knees 'cave in' - you want to avoid this as it shifts stress from the muscles and tendons on to ligaments and cartilage and that's where you'll feel discomfort.

DL's with a closer stance don't really require the cue to push the knees/feet out so if in doubt, just do one of those variations. However, in my personal view, sumo DL's are a very valuable tool in your situation. Not only do they teach you how to DL but they teach you how to squat. In the squat you need to push the feet/knees out, too. Not only that but there's a little more emphasis on the glutes, which is probably just what you need.

If it helps, for the most delicate of knees, I start then on Sumo's but holding one DB. I sit the DB between their feet - not out in front, but, right between mid foot. This tricks your sub conscience into pushing the hips back to get down and pick it up. In other words, it's a lot more natural to lift with good form. You really just need to think about pushing the knees out and keeping the chest up.

Also, I really wouldn't worry about hitting the quads right now. They do get a little work with DL variations but, other than that, I just wouldn't worry about it. I would just stick with a vertical shin, pain free movements, hitting the muscles you need to hit the most. When you get your glutes strong and your form nice and solid, you'll be able to slowly add in some more direct quad work. The golden rule is "if it hurts, don't do it", so you can let pain be your guide, too.


Posted: Mon Apr 19, 2010 2:54 pm
by sks24
Thanks KPj:

I lifted yesterday and only did the straight back/straight leg DL. It's supposed to target your gluts, but it seems to hit my lower erector spinae pretty hard. I wonder if my flexibility is so bad that I can't bend over enough to bring the gluts into play?

The reason I bring this up is because my lack of flexibility could make it difficult for me to do many exercises effectively, and the sumo DL could be in that category.

Take the SB/SL DL: I had the parallel bar on my cage at one inch above my patella. The guy in the video [ ... dlift.html] picks his barbell up fro the ground where, arms outstretched, his back is about parallel to the floor. I can't get anywhere near that. I don't know what angle his back is at when he gets to bar to an inch above his knees, but that's as far as I can go.

So I think we might have to think out of the box with me.

As to the sumo DL: I do all my deadlifts in my cage. If I lower the parallel bars to as low as they will go the barbell is suspended with the 45 lb plates about an inch off the ground. That's the position from which I did the sumo DL, and it didn't cause any immediate pain. But, since I know that the SL/SB DL doesn't hurt me at all, I'll be able to work the sumo in and know whether it will forestall my knee healing.

Bottom line is that I do have to bend my knees a bit with that one, so there has to be some stress.

Just to make sure I learn the correct form, I'll train my body with your dumbbell technique and thereby learn how it's supposed to feel.

I am very careful, BTW, to keep my back ramrod straight.

Thanks for taking the time to consider and advise. You guys are invaluable.


Posted: Mon Apr 19, 2010 3:05 pm
by stuward
Your Erectors are used isometrically in the DL. Even though it's not "used" in the lift, it's worked very hard. Don't assume you're not using your glutes just because they don't hurt.

Your flexibility will determine how low you can go. Don't be concerned if it's not as low as the model. Just don't go so low you have to compromise form, i.e. round your back.

You should be bending your knees some.

Posted: Mon Apr 19, 2010 8:12 pm
by sks24

On the sumo DL: would it make sense to weight just one end of the olympic barbell, place the weighted end's tip at midfoot, and then lift as you instruct?

I was just thinking that that might make more certain the correct form.

Thanks in advance,

Posted: Mon Apr 19, 2010 8:15 pm
by sks24
I was just thinking that that might make more certain the correct form.
. . . and that with weight sufficient to actually train the muscles. (I don't have heavy dumbbells.)

Posted: Tue Apr 20, 2010 3:32 am
by KPj
sks24 wrote:KPj:

On the sumo DL: would it make sense to weight just one end of the olympic barbell, place the weighted end's tip at midfoot, and then lift as you instruct?

I was just thinking that that might make more certain the correct form.

Thanks in advance,
That would work. I'm not sure if it would better or worse, but it would do the job. The purpose of the DB Sumo DL is really just to get form right. My only doubt with what you mentioned is where you'll pick up the bar from. What I like about the DB method is that I instruct clients to place the DB between their feet and put it back down from where they picked it up. This stops the weight drifting out front which can mess with your form and it makes you get the hips back without thinking about getting the hips back... Using one end of the bar, technically you should pick it up and put it back down in the same place all the time but, it may be more beneficial in the long run to do it with a DB with you being in complete control of where you sit it back down.

I don't think I mentioned this but, you sit the DB on it's end and kind of 'scoop it' up with both hands. Basically, it would be better done with a kettlebell but I don't have any in my gym so I use DB's.

Another tip - The people I do this with almost always lose form as the set goes on. Even when the weight is very light for them, for whatever reason, they can't maintain good form throughout the whole set. However the first rep is always perfect. What i've started doing is making them pick the DB up, put it back down, stand back up to the starting position (without the weight), and that's one rep. So, a set of 10 is really a set of 10 single reps, if that makes sense.