T Nation

Knee Surgery, Trade Squats for Legpress?


#1

so, not that long ago i tore some knee cartilidge, had it all "fixed" up was told in 6 months i would be back to normal, although i might have to strengthen the leg again due to being on crutches and not working it out and all that jazz,

now im faced with a problem, i obviously need surgery again because i didn't ever use the crutches, my knee is as strong as it ever was but it feels very unstable and its painful at times, im wondering if it would be forgivable to trade squats for leg press until i build more stability in the left knee, will it hinder my gains that much? i know that squatting is like the ultimate lift (that or dead-lift) but im just not sure how long i can get away with squatting for before my knee decides to fuck me over and send me to the deck, any help will be appreciated :slightly_smiling:


#2

You shouldn't be performing any exercises that stress your knee until you have rehabbed it and it is stable.


#3

I find leg presses harder on my knees than squats.

Really though, what Blue said. You need to rehab your knee before you even think about training it


#4

Give your knee time to heal; any stress on the joint right now could risk damaging the cartilage all over again.


#5

I work with both pre- and post-operative knee surgery patients. First rule is if a movement is causing you considerable pain then avoid it unless specifically told to by your surgeon.

Beyond that, if a movement is asymtomatic then you can do it, but i'd be sticking to strength-endurance rep ranges (15 - 30 reps per set) and controlling the movement heavily. Partial ROM lunges can be very useful if nothing else is possible.

Obviously hip dominant movements are going to be another good choice for you because there's less knee ROM, but you will get less quad development out of them. Hamstring curls, DL's, Stiffies all for higher reps.

End of the day you need to get your knee fixed properly, all of this is only going to be a stop-gap if you've got torn cartilage.
Follow your post-op rehab protocol next time.


#6

yeah thank you mate, tbh, its just the outer side of my knee i tore my lateral meniscus not all the way through though, i was supposed to make a full recovery in 6 months, but i still get pain, the pain varies each day, like on some days im sure i could bust out a good few heavy squats, but other days im stuck on the leg press, rotational exercises or anything that turns my knee out too much can be painful,
to be honest i think i need to go back to the hospital and have it looked again, thanks for all your comments though and good advice crushkilldestroy i appreciate it :slight_smile:


#7

I had the same injury twice.

My advice: give it time! Sorry to tell you, but in my case the first time it took me more then a year to fully recover. That's partly because I couldn't hold myself from starting too soon with my quad training. The second time I managed better and full recovery came in sooner.

Be patient. Train your hams and calves like crazy. Start with some leg extensions (bilateral and unilateral) and some partial presses (leg press, smith machine squat) but don't overdo it. Then go to full range leg presses.

Bike sprints can also help to maintain size and recover.

Forget about squat and hack squat for a while.

Of course I don't know wether you're a bodybuilder or a powerlifter or what your strenght and development level is.


#8

Who made the determination that you "obviously need surgery again"? The only obvious course of action is to have it examined to determine what state it is currently in.

If your knee "feels very unstable and its painful at times" then it is NOT "as strong as it ever was." You may be able to rehab/train it to be as strong as it was prior to the trauma. This depends on the severity of the injury, your dedication to rehab, how intelligently you train/prehab/avoid contraindicated modalities, and your ability to avoid unintelligent behavior. Of course, a little bit of luck plays a role.

So, if you actually have your knee examined (don't be shy about second or third or more opinions) and go through the rehab process, you can then worry about squats vs leg presses.

Get this straight. If you refuse to go through the first two steps described, your chance of re-injury is a near certainty.

Let's say that you've tempered your youthful impatience and actually did those two things. And now you're ready to move to the next step. Here are my thoughts.

One of the fundamental differences between a squatting pattern and a leg press pattern is the former allows the pelvis to move more freely. This allows the quadriceps to act as knee extensors IN CONJUNCTION with movement at the hips.

A typical leg press, because it inhibits this, places greater loading at the knees. You can minimize the load on the knees by placing the feet higher on the platform (think of the typical 45 degree leg press machines). This will shift the load towards the glutes and hamstring complex. Easier on the knees with less work done by the quadriceps.

Does this mean no more leg presses in your future? Not necessarily. There is a continuum in which it's beneficial to have the stability that a machine provides. All machines are not evil. Some have their time and place.

As a part of your rehab and into your training life, you must be constantly aware of growing stronger in all three planes: frontal; sagittal, transverse. This means take a macro look and understand how the hamstring complex, the adductors/abductors, glutes, the core, as well as the rest of your body contribute to a clean beneficial squat. There are many exercises which address this and to describe them all is beyond the scope of this post.

In fact, my stance is that most people need to EARN THE RIGHT to perform the traditional squat. Those who have compensatory movement patterns, overactive/underactive issues, lifestyle choices, postural limitations, the reasons go on and on, etc. have no right to perform the traditional squat in an aggressive manner.

Until they earn this right, they must explore other options in a squatting pattern. And even after they've earned this right, they should still incorporate it into their training (just how much and how often is individual dependent).

What's interesting (as well as maddening to see everywhere) are those on the other end of the spectrum who completely blow off the need to strengthen the less glamorous muscles or learn the more challenging exercises and go straight to the machines. Why bother learning the RFESS when that pretty and shiny leg press machine is right there...? Who gives a shit about the popliteus when it's those VMOs that gets attention?

To recap:

1) Get that knee examined.

2) Go through the rehab.

3) Even after rehab, integrate into your training getting stronger on all three planes I discussed. You (along with a large segment of the population) have some imbalance that needs to be addressed. It's a never-ending quest, really. A classic mistake I see often is a lifter who continues to do rotator cuff work with 5 pound dbs even though his main lifts are getting stronger. Big mistake. If the rotator cuff is the weak link (as they usually are with most people), it's absurd to not strengthen them as the prime movers grow stronger.

4) As the less glamorous muscles grow stronger, know the point at which too much stability work within a workout or a cycle can actually stifle your hypertrophy goals. One example would be lifter who does work requiring more stability and then follows up with work in which stability is not an issue (i.e. machine-based ). This also hints at the importance of pre-exhaust as well as the continuum between stability-intensive movements and those in which stability is less of a factor. Keep in mind that you must be healthy in the first place to even contemplate this and knowledgeable enough to know just where on that continuum you should focus on.


#9

Agree that leg press should be done with high foot stance. This still gives enough stimulation for quads.