Thread: Leg Workout for Severely Injured Knee?

Originally Posted by ThicknCurvy

Need some suggestions for leg workouts to accommodate severely injured knee. Goal is to rebuild strength not bulk as legs are still pretty muscular from years of dance & gymnastics. I'm working with a trainer & former fitness competitor but we're running out of ideas to vary my leg workout.

Ortho won't let me do any open chained exercises, climb stairs, use elliptical, hike on incline, do squats or lunges, and can't do any weight bearing position with the weight on the front of the patella.

ThicknCurvy,

Open Chain Exercises

None of the exercises you lised are Open Chain Exercises, they are Closed Chain Exercises.

Open Chain are basically non weight bearing, where you are not in contact with the ground. Open Chain are usually isolation exercises. Example: Leg Exetensions, Leg Curl, etc.

Close Chain are weight bearing, where you are in contact with the ground. Close Chain are compound/multi-joint exercises. Example: Squats

So, my understanding is that your doctor has limited you to Open Chain exercises, correct?

Open Chain Leg Exercises

If these are the only type of leg exercises that you are allowed to perform, you are a bit limited on Open Chain Exercises.

Options For Open Chain Exercises

While you may be limited on the number of Open Chain Exercise, you can impliment some variances in the training method applied to these exercise to elicit an increase in strength.

However, the information in your post indicates that you can perform Close Chain exercises, if performed properly...more on that to come.

More Information

Provide more information on your training would be helpful. (Exercises, reps and sets per exercise, rest period between exercises, what exercise you perform on what days, etc). More information is better than less.

Originally Posted by ThicknCurvy

Currently no functional exercises beyond what we do in zumba classes.

Contracitory Information

These exercises are closed chain"climb stairs, use elliptical, hike on incline, do squats or lunges, and can't do any weight bearing position with the weight on the front of the patella"

Reading Between The Lines

What your ortho appears to be telling you is not to perform any exercises in which "Shear Force" occurs.

Shear Force On The Knee

Any movement in which the knee is drive forward toward the toes places shear force on the knees. In other word, the knee is placed in a vurnerable postion.

Not only that but the weight/load is magnified due angle of your knee.

Knee Postion In Lower Body Movements

The key to minimizing Shear Force on the knee is to make sure you maintain a 90 degree angle of the shin to the floor.

That insuress that you knee is NOT driven forward, placing Shear Force on you knees.

Shear Force Lung Examples

In performing a Lung, most individuals step forward. In doing so, they automatically allow their shin to track forward toward the toe and beyond it.

Doing so places an enormous amount of Shear Force on the knees.

Proper Lunges

In performing a Lungs, stepping back insures that you shin remains perpendicular/90 Degrees to the floor. That means it minimizes the Shear Force on you knees.

Squats

It the same with squats. You want to Sit Back as you squat. Doing so, insures your shins are perpedicular to the floor.

Stair Climbers = Knee Wreckers

The performance of this exercise is notorious for drving the knees forward and magnifing the Shear Force on you knees.

Ellipticalls and Incline Hiking...

Not much Shear Force on the knees is involved in either of these exercises. So, I find it perplexing for these exercises to be considered bad.

Down Hill Hiking

It not going up that kills you knees, it going down that will kill them.

The knee is driven forward in "braking" as you descend. Also, the eccentric force magnifies your body weight. Thus, placeing an even greater load on you knees.

Squat and Lunges

How you perform them determines the Shear Force on the knees. So, it not the exercise but you technique.

Partial Range Squats and Lunges

Also limiting the depth of your squat and/or lung will minimize the Shear Force on your knees.

Effective Leg Exercises

From the small amount of information you have presented, it appears to me that some partial range squats, lunges...even the elliptical would strengthen you legs and the muscles around you knees.

Originally Posted by ThicknCurvy

My leg workout includes 100 reps on almost every machine. Usually start on on incline press (up to 200 reps at weights maxed at 270 lbs,

Incline Press

Might I assume this is a Leg Press. If so, it no different than squats or lunges.

100 Reps

I am assuming that your 100 reps is the accumulated total for each machine.

Killing A Fly With A Sledgehammer

Performing that many reps to work the muscle/muscles is like killing a fly with a sledgehammer rather than using a fly swatter. It is overkill.

It is also not very productive.

Sets and Reps

You're better off performing 6-15 reps per exercise for 3-5 sets.

There is a indirect corolation, see-saw relationship, between Reps and Sets. That means when one goes up, the other goes down.

Thus, if your performing a high number of reps, you do a smaller number of sets.

High Rep/Low Set Example

15 Reps X 3 Sets

When using a low number of reps, you perform a higher number of sets.

Low Rep/High Set Example

6 Reps X 6 Sets

Originally Posted by ThicknCurvy

Six knee surgeries.

Sorry to hear you had to go through that.

Kenny Croxdale

Wow Kenny... very helpful. Thanks so much for taking the time for such a detailed response.

And yes, you're reading between the lines was right on point; my descriptions were not! LOL.

The prohibition against hiking, elipticals etc is because of the sheer force. And you're right, when I'm on the incline press, as long as I keep my knee at 90 degrees, it's tolerable. Oddly, we've tried lunges, squats and plies in 2nd position where I'm at 90 degrees and these have caused swelling & pain in the knee. But perhaps it's time to try them again now that my strength has increased exponentially over the last nine months????

Note: the ACL reconstruction is stable & doesn't cause the problems... the pain is across the anterior side of the patella. I do need a knee replacement but doc wants to forestall that if possible until I'm at least 55.

Here's my leg workout we do twice a week for about 90 minutes:
Because I'm limited on amount of weight because of my knee, the PT suggested we train the muscles to the point of exhaustion with more sets & more reps. The incline press is the only one that varies much from workout to workout.

1. Incline leg press. We rotate each workout... one day is downset, one interval, one downset, one consistent weight. Then we repeat the cycle. I always work with feet near the top of the platform but sometimes I'm wide parallel, other time narrow parallel. Can't do turnout because of stress on the knee. Don't get knee angle beyond 90 degrees.

Leg Day #1 - Down sets.
270 x 20, 220x20, 200x20, 180x20, 160x20, 140x20, 120x20, 100x20, 100x20, 100x20. We do this with no break in between except for her to take the weight off the bar. At the last few reps, I can barely push the 100lbs up... legs are shaking in fatigue.

Leg Day #2 - Intervals.
I start at 140x20, 190x20, 240x20, 190x20, 240x20 x 190x20, 140x20. There's sometimes a few minute break in the midst of these sets so I can get the blood flowing back to my legs again. If I can handle it, sometimes I'll add two more sets... seems to depend upon how much protein & glutamine I've had before the workout.

Leg Day #3 - Downsets again.

Leg Day #4 - Consistent weight -- either 140 lbs or 180 lbs and we vary between one set of 20 working the full ROM at slow pace,, then the 2nd set is pulsing & only about 1/3 of the full ROM. We repeat this to 200 reps total... 100 full & 100 pulsing. Rest of 30 seconds after 2 sets; longer 2-3 minute rest & get off machine in the middle of sets.

2. Seated Hamstring Curls
60x20 -- five sets. No more than 30 second rest between sets. Laying Hamstring curls bother the knee but seated don't????

3. Seated Leg Extensions
35x15 slow, 35 x 15 holding in extension for 8-10 seconds, 35x15 slow, 35x 15 holding in extension for 8-10 seconds. Can't increase weight much more because of stress on patella. Extensions done in turnout to minimize stress on patella. Legs are trembling in fatigue about half way thru each set of holds. Usually about 2-3 minute rest/walk around after first 2 sets.

4. Calves
Rotate between Donkey(90#), Incline Press in turnout (90#) & Standing Calves (160#). Always sets of 12-15. Slow flexion & point, rapid flexion & point, then holds for 5 seconds. Between 5 & 8 sets.

5. Resistance Bands
Various activities but none with extenstion thru the knee. 10 sets of 10-12.

6. Seated Abduction Machine
200 reps total. 60x20 - five sets slow, 60x20 - five wide pulsing sets.
2-3 min rest after each 2 sets.

7. Seated Adduction Machine
100-200 reps. 70x25 - five set slow. Sometimes will add pulsing sets. These are always the last things in the workout.

We're open to any new ideas you have. Beside the leg days, I ride bike for 30-60 mins a day (depending if it's a leg day or zumba day) and do zumba appx 3-4 times a week. Leg days are Tuesday & Friday; upper body on Saturday. Monday is usually a complete rest day.

Only supplements are L-glutamine, bromelain, L carnitine & CLA... although I'm not convinced the latter two help with fat burning. The glutamine is a lifesaver. On leg days, 2000 mg at breakfast, 3000 before workout, 3000 after workout, 2000 before bed. Eating at least 100 grams protein with a breakdown of 35-50/35-50/10-15 Proteins Carbs Fat.

Thanks again for the tips!
Michelle

Originally Posted by ThicknCurvy

Wow Kenny... very helpful. Thanks so much for taking the time for such a detailed response.

Hi Michelle,

Nice to have a name.

As you can tell, I am a bit anal about this stuff. It relates to what I do/work.

Originally Posted by ThicknCurvy

And yes, you're reading between the lines was right on point; my descriptions were not! LOL.

I understand. This stuff gets confusing at times.

Originally Posted by ThicknCurvy

The prohibition against hiking, elipticals etc is because of the sheer force.

Ellipticals

Michelle, there isn't much shear force placed on the knees on quality ellipticals. That because the shin is pretty perpendicular to the foot plate.

Hiking Uphill

There isn't much shear force in hiking uphill either. In stepping forward while going up, again the is for the most part perpendicular to the ground.

So, I don't see much of a problem with either of those.

Hiking Downhill

Hiking downhill places an enormous amout of shear force on the knees. So, this type of movement is usually determinal to the knees...even good knees.

"If It Hurts, Don't Do It."

That the bottom line.

Originally Posted by ThicknCurvy

And you're right, when I'm on the incline press, as long as I keep my knee at 90 degrees, it's tolerable. Oddly, we've tried lunges, squats and plies in 2nd position where I'm at 90 degrees and these have caused swelling & pain in the knee. But perhaps it's time to try them again now that my strength has increased exponentially over the last nine months????

Tyring Them Again

I commend you for trying them again. However, if they give you problems...don't do them.

Push Your Butt Back

Pushing your butt back is one of the a majory key in keeping your shins perpendicular to the floor.

Limited Range Of Motion

Also, instead of performing a deep squat or lung, perform only a quater squat or lung. This will place less stress on you knees.

I realize your Range of Motion is already somewhat limited.

Originally Posted by ThicknCurvy

Note: the ACL reconstruction is stable & doesn't cause the problems... the pain is across the anterior side of the patella. I do need a knee replacement but doc wants to forestall that if possible until I'm at least 55.

Here's my leg workout we do twice a week for about 90 minutes:
Because I'm limited on amount of weight because of my knee, the PT suggested we train the muscles to the point of exhaustion with more sets & more reps. The incline press is the only one that varies much from workout to workout.

1. Incline leg press. We rotate each workout... one day is downset, one interval, one downset, one consistent weight. Then we repeat the cycle. I always work with feet near the top of the platform but sometimes I'm wide parallel, other time narrow parallel. Can't do turnout because of stress on the knee. Don't get knee angle beyond 90 degrees.

Leg Day #1 - Down sets.
270 x 20, 220x20, 200x20, 180x20, 160x20, 140x20, 120x20, 100x20, 100x20, 100x20. We do this with no break in between except for her to take the weight off the bar. At the last few reps, I can barely push the 100lbs up... legs are shaking in fatigue.

PT

Does PT mean Physical Therapist or Personal Trainer.

Down Sets

Your down set program of of 200 reps, doesn't make much sense.

The down set method is one bodybuilders have employed forever. The method is effective for building muscle mass.

However, 200 reps is like my analogy of killing a fly with a sledgehammer instead of a fly swatter.

Originally Posted by ThicknCurvy

Leg Day #2 - Intervals.
I start at 140x20, 190x20, 240x20, 190x20, 240x20 x 190x20, 140x20. There's sometimes a few minute break in the midst of these sets so I can get the blood flowing back to my legs again. If I can handle it, sometimes I'll add two more sets... seems to depend upon how much protein & glutamine I've had before the workout.

Interval Sets

Interval sets are another effective method of training.

Too Many Reps

However, one again 140 reps are overkill.

Distance Runners

This weight training program is a "strength endurance program", as you know. While it will increase some strength, the emphasis of a program like this is more on endurace than strength.

Strength and Size

The use of mega reps is akin to distance runners. They don't have very little strength.

Sprinters

Sprinters limit the number of "reps" they perform in a set compared to distance runners.

Sprinters possess a great deal of strength, as well as strength and power.

Interval Sprints

Sprinters perform short intervals sprints during their training.

Growth Hormone

Growth hormore production is a by product of these short interval sprints. This increases muscle mass.

Limit Strength

Limit strength is that amount of force you can produce for one all out effort. Thus, the most weight you could push up in the leg press one time would be a measure of your limit strength.

Training To Increase Limit Strengh

Training to increase strength is completely different than for strength endurance. Reps are low while sets are high.

Thus, some type of Limit Strength Training need to be employed in every program.

Energy

I don't see the addition of protein really helping increase you stamina.

Caffeine

Caffeine has been shown to increase you abiltiy to work, stamina. Usually, a cup of coffee (about 200 mg of caffeine) will give you a boost...minus sugar and/or cream.

I see coffee as a legal way to "main line" caffeine.

However...

Creatine, Caffeine, Whey Protein

This coctail appears to enhance stamina. The 2010 issue of the journal Nutrition Research showed a 10% increase in stamina.

Originally Posted by ThicknCurvy

Leg Day #3 - Downsets again.

Leg Day #4 - Consistent weight -- either 140 lbs or 180 lbs and we vary between one set of 20 working the full ROM at slow pace,, then the 2nd set is pulsing & only about 1/3 of the full ROM. We repeat this to 200 reps total... 100 full & 100 pulsing. Rest of 30 seconds after 2 sets; longer 2-3 minute rest & get off machine in the middle of sets.

Slow Pace

This is an effective tool. Placing the muscles under a longer "Time Under Tension" increases muscle mass and strength to some degree.

Pulsing???

What does that mean?

Mega Reps

Again, the mega reps just don't make sense.

Originally Posted by ThicknCurvy

2. Seated Hamstring Curls
60x20 -- five sets. No more than 30 second rest between sets. Laying Hamstring curls bother the knee but seated don't????

Hamstring Muscle Fiber

The hamstrings are composed of fast twich muscle fiber.

Fast twitch muscle fiber respond best to low to moderate repetitions...not higher reps.

So, what you want to do is provide them with the right stimulus (reps). That is best accomplished with repetitions that are no more than 10 per set.

The Right Tool For The Right Job

You can use a crescent wrench to drive a nail in but a hammer works much better. The take home message is that, you will get better results if you use the right tool for the right job.

The most effetive stimulus (right tool) for training fast twitch muscle fiber is low to moderate repeitions.

Training fast twich muscle fiber with high reps is like using a crescent wrench to drive nails. It works but not as well as the hammer.

Originally Posted by ThicknCurvy

3. Seated Leg Extensions
35x15 slow, 35 x 15 holding in extension for 8-10 seconds, 35x15 slow, 35x 15 holding in extension for 8-10 seconds. Can't increase weight much more because of stress on patella. Extensions done in turnout to minimize stress on patella. Legs are trembling in fatigue about half way thru each set of holds. Usually about 2-3 minute rest/walk around after first 2 sets.

Holding = Isometrics

Isometrics are another effective training method.

Leg Extensions

However, I don't see much value in leg extensions...with the exceptions of Quad Sets that are presecribed by Physical Therapist.

Originally Posted by ThicknCurvy

[4. Calves
Rotate between Donkey(90#), Incline Press in turnout (90#) & Standing Calves (160#). Always sets of 12-15. Slow flexion & point, rapid flexion & point, then holds for 5 seconds. Between 5 & 8 sets.

Gastrocnemius

This muscle in the calf is a fast twitch muscle fiber. Standing movement work this muscle. It responds best to 12 reps per set or less.

Soleus

This calf muscle is worked with steated calf raises. It is a slow twitch muscle fiber. It responds best to mega reps, 20 reps plus.

Originally Posted by ThicknCurvy

[5. Resistance Bands
Various activities but none with extenstion thru the knee. 10 sets of 10-12.

Resistance Bands

They are a great training tool and also one of the most misunderstood...especially with men.

Originally Posted by ThicknCurvy

6. Seated Abduction Machine
200 reps total. 60x20 - five sets slow, 60x20 - five wide pulsing sets.
2-3 min rest after each 2 sets.

7. Seated Adduction Machine
100-200 reps. 70x25 - five set slow. Sometimes will add pulsing sets. These are always the last things in the workout.

Abduction/Adduction Machines

I am not a fan of these machines. The Leg Press, Squat, Lung, and similar exercise work it well.

However, if it makes you feel good...do it. I am all about doing thing that make me feel good.

Again, the rep range for the number of sets doen't make sense.

Originally Posted by ThicknCurvy

[[We're open to any new ideas you have. Beside the leg days, I ride bike for 30-60 mins a day (depending if it's a leg day or zumba day) and do zumba appx 3-4 times a week. Leg days are Tuesday & Friday; upper body on Saturday. Monday is usually a complete rest day.

Cafateria Training Ideas

I will provide you with some ideas in another post. You can pick and choose what you like might like to try...like going through a cafeteria line.

Overtraining

I suspect you may be overtraining you legs. The point is to stiumlate them, not annihilate them.

"Wound Healing"

Training is somewhat like making yourself sick. You then need to rest so you can heal.

Rest allows your body to grow and become stonger.

Originally Posted by ThicknCurvy

[Only supplements are L-glutamine, bromelain, L carnitine & CLA... although I'm not convinced the latter two help with fat burning. The glutamine is a lifesaver. On leg days, 2000 mg at breakfast, 3000 before workout, 3000 after workout, 2000 before bed. Eating at least 100 grams protein with a breakdown of 35-50/35-50/10-15 Proteins Carbs Fat.

There is some good evidence on glutamine. However, I like you, I dont see any value in the others.

Originally Posted by ThicknCurvy

[Thanks again for the tips!
Michelle

Michelle, you are welcome.

"Research is what I am doing when I don't know what I am doing." Einstein

One of my areas of expertise from all my experimentation is, "Here's what NOT to do."... It part of my research.

Investigate

The main thing is don't take my word nor anyone elses word on this.

Investigate information for yourself.

Kenny Croxdale

Hi Kenny:

Thanks so much for the tips. I've given them to my trainer so we can incorporate your ideas into my workouts. She's also working on her Physical Therapy degree right now so I know she's intrigued by your comments.

A couple of follow-up questions...
I liked you analogy re distance runners vs sprinters. While I definitely have seen a huge increase in my strength & endurance over the 9 months, I can't up my weight much more on many of the machines, especially the Leg Extension & Incline Leg Press because of the pressure on my knee. On the Incline, I've maxed out at 270 lbs. Given that I can't seem to increase the weight much more, it seems I don't have an alternative but to do different workout or do more reps. Given this, would you suggest less reps but at a higher weight like 220 lb? What is the max sets/reps you'd recommend?

Re closed vs open chained. Ortho has prohibited open chained but also some closed chain if it puts too much pressure on the anterior of the patella... I think that's why squats, lunges & plies' have been forbidden. Hoping as my strength increases, I can incorporate these back into my workout. Eventually would love to be able to take a ballet class again as it's been over 20 years.

Re cardio, the rotation of the elliptical -- while weightbearing -- seems to cause the problem. Ortho cautioned me that every pound of weight puts 7 lbs of pressure on the knee. Recumbent biking & rowers seem to be much less painful on the knee. Even with daily celebrex, the knee couldn't tolerate the elliptical.

Re supplements, for what it's worth, bromelain has made a huge difference in my inflammation & recovery post-workout. Just had some plastic surgery done and my surgeons advised me to take it post surgery too. Said there was a recent article in one of their medical journals speaking to the beneficial effects of glutamine & bromelain in post surgery recovery. You seem to be a man who researches a lot... thought you might want to know their thoughts.

Thanks again,
Michelle