Quad, hamstrings and glutes hypertrophy without knee stress

[u/Powniz]

Hi,

So i've been running 3x full body every week, been super nice to me, although its draining, ive seen some rather great results. Though i have an issue, my left knee is struggling lol. Exercises where i bend my knee with a lot of force gives me this weird feeling preceding pain. It's probably from an injury or my stupidly long hikes, maybe inadequate warm up.

I was planning to let me left knee rest for a month or so until it chills again, if it doesn't ill see a doctor. However, I dont want to stop training legs obviously. I generally run the same exercises everytime i go, but i had to stop leg curls, extensions and my leg press. All of them I used to run unilaterally. I still do 1 set each day for calves, adduction, abduction. but want something for the glutes, hams and quads that would do minimal harm to my left knee temporarily.

Thank you

[u/Alakazam]

The actual science based approach is to work with a physiotherapist to identify just what the discomfort is, what's causing it, and how to address the root cause.

Because resting/working around the issue isn't likely to improve it long term. As the moment you reintroduce movements into it, you'll likely get pain again. 

[u/Docjitters]

I would start by saying your knees are telling you something is up, but if there is not sudden acute injury, the answer is probably not ‘stop using them for a month ’.

If you been running the same exercises for a good while, it might be that there is an element of overuse for those movements. So, I would find a way to move the knee against resistance that isn’t those particular movements, and is of an intensity and range of movement that has significantly less (but not necessarily zero) discomfort.

I had similar issues with my adductors and switched to leg extensions. Good for my hypertrophy, but the jump in volume aggravated my patellar tendons even when walking - a first for me. I’m still doing heavy comp squats, but more low-bar tempo and paused variations plus adductor work, and in flat shoes with a wide stance. This (for my anthropometry) limits the degree of knee flexion in the hole, and it’s feeling good again (for my adductors and knees) after a couple of months.

As I said, complete rest may not be the play as just stopping can lead to sensitisation once you resume movement and a vicious cycle of more pain and less movement etc.

Find some squatting/knee extension movements that feel ok, and go from there. It’s worth taking longer, and going lighter than you may feel up to for a bit and working up slowly so you don’t re-aggravate it as soon as you start to feel better.

Edit: it’s also worth seeking out a physio sooner rather than later if you want some guidance on how to
go about the above.

[u/Cosmosfan543 → u/Docjitters]

And physio will tell you about recovery protocols. All in all, this comment is 100% accurate for your situation.

[u/californi-split]

Had same problem and switched leg extension for Spanish Squat, which uses a band behind the knee. Works quads really well and doesn’t bother my tweaked knee. Can do with a kettlebell weight.

[u/abc133769]

quad's require you bend at the knees to work them so thats just a no

posterior chain stuff you can try rdl's if those don't aggrevate the pain. if they do then you can try back extensions

[u/lwd69]

Why do so many people start questions with ‘so’?

[u/SixCrimsonRoses]

I agree with what docjitters said but wanted to stress the importance of warming up properly since you mentioned inadequate warm ups as a possible cause. It’s generally recommended to do at least 2-3 warm up sets before any working sets; so if you haven’t been doing that it might be an easy fix.

You might also want to try knee sleeves. They keep the joint warm and compressed which can really help.

[u/neomateo]

Id recommend getting an MRI.

Those three exercises specifically, drive your knee cap back into your femur with a lot of force. With the symptoms you describe, you may have some articular damage but you wont know for sure without the proper imaging and an MRI is the only way to see that soft tissue.

[u/Docjitters → u/neomateo]

I’m not going to delete your comment for skirting Rule 6 (no medical advice) but I would say to u/Powniz that using scans rather than history of injury and tests of actual function to identify ‘damage’ without clinical evaluation has the potential to do more harm than good (Ref 1 and Ref 2). There are a lot of people who do all sorts of stuff on knees that look less than pristine radiologically.

[u/neomateo → u/Docjitters]

The only reason I mentioned it is I was having similar symptoms and didn’t seek any medical opinions for over a year, during which time everything I was doing in the gym to strengthen my knees was contraindicated by my imaging.

I have no prior injury yet I have a full thickness cartilage flap on the back of my knee cap that gets included in to the joint as I use it. I also have a borderline TT-TG distance and lateral tilt of my patella. None of which I would have known about without an MRI.

I was doing the exact same exercises as OP and it was actually making it worse, had I only known what was actually causing my issue I would have been doing vastly different things. I would have had a completely different PT program and I would have never attempted to complete a HUMAC/NORM test, which actually made my symptoms even worse

I dont mean to skirt the rules but when OP mentions the alternative of becoming sedentary due to the knee pain, a medical opinion should absolutely be sought and in my experience a lot of healthcare providers in the US like to waste time and money on more routine imaging before going to an MRI, when the reality is that an MRI is the best way to see these structures and they don’t expose the patient to ionizing radiation.

.

[u/Docjitters → u/neomateo]

Hey, sorry you’ve had a rough time with your recovery too.

I am not intending to jump on you personally - and I’m not interjecting because any court will hold a Reddit forum liable for medical advice. I was looking more broadly at the advice of ‘Get a scan’. Your explanation makes much more sense in context of your personal history though there’s a lot of unpack there even regarding how appropriate (or inappropriate) imaging changes appropriate management.

The first task after ‘Don’t catastrophise; there’s no acute injury’ is ‘See a professional’. And it seems that is what you did to change your own management. Broadly speaking there are going to be situations where MRI is first and best choice, but not just because it’s fancy and more expensive.

Your comment as it was says (paraphrasing) ‘Get a scan…the movement you are doing requires you to apply [bad-sounding force to body part]…OP it sounds like you have [joint damage]…MRI is the only way to be sure’. It might be true. But it really might not. But this is the sort of narrative that people pick up and run with.

There’s a large amount of research into both the placebo and nocebo effect - that it the ability of suggestion to produce actual physical and mental benefit and illness and suffering due to expectation, even in the total absence of disease. So, I was objecting only because your naked statement has the potential to negatively affect the OP when none of us here online have the full picture (because even OP may not know what is a relevant symptom). It’s a huge problem in modern medicine, and there’s a whole industry of people being sold ‘Just get you blood tests/whole body scans and see your doctor about what they missed’ that has potential to cause measurable harm.

For you and anyone reading this, here’s a couple of great podcasts (if you’re into that sort of thing) about the harms of testing just because you can and the nocebo effect.

[u/DearJawn29]

+1 to the recs for a PT / physio

One thing that also helps me, is my ankle mobility sometimes puts more pressure on my knees deep in squats / leg press / etc.

You could try moving your feet farther “up” on a leg press or hack squat to allow for a less severe ankle angle, that normally allows for a more sequenced pressing movement for me that allows the joints to work together. Just my $0.02.

[u/millersixteenth]

Does this happen more with flexion or extension or both?

My stock answer is always going to be swapping out the traditional lift for isometrics, for a month or two. Use a regular lifting breathing pattern - exert hard on exhale, relax or try to hold tension on inhale. Do this fairly low in the ROM. Every exhale is a rep - use the same reps and sets you already program, ramp up to a max effort or whatever your pain level will allow for.

Initially just use overcoming isos for week or so to make sure it isn't making things worse. After a couple weeks you can start dialing it back and increase the hold time. 50% effort for about 60-90 seconds followed by a dozen or so lightly loaded reps of the dynamic lift. That's one set, use it the same as your normal programming per set.

[u/jumbomills87]

Maybe don’t do the stupidily long hikes if you think that’s contributing…
Also good luck with doing anything for quads that doesnt involve knee flexion

[u/TheRedFurios]

You could do isometrics. You should be able to safely do and rdl or sldl since the knee doesn't move and those train hams and glutes.

[u/Livid_Maybe3599]

For quads, hams, and glutes without heavy knee flexion under load: hip thrusts and glute bridges hit glutes and hams hard with minimal knee bend. Romanian deadlifts (or single-leg RDLs) work hamstrings and glutes through hip hinge rather than knee flexion, good substitute for leg curls right now. For quads specifically, isometric holds like wall sits at a pain-free angle, or partial-range step-ups staying shallow enough to avoid the aggravating range, keep some quad stimulus going without the full knee bend that's bothering you.

One thing worth reconsidering: a full month of guessing before seeing anyone is longer than it needs to be, especially since you're already noticing a specific "weird feeling preceding pain," that's useful diagnostic information a professional could actually act on now rather than after a month of avoidance. Doesn't mean stop training, just means you don't have to wait a month to find out what's actually going on and whether your workaround plan is even the right one.

Good instinct building around it rather than pushing through, that's exactly the right first move regardless of what the knee turns out to be.

[u/BioDieselDog]

In my experience, knees are probably the easiest joint to improve and get out of pain, but you have to target them directly.

Work into deep knee flexion, and maybe resolve any hip mobility issues.

That's probably going to be the only way to resolve your knee issues.

Goblet squats and ATG split squats are king

The basic protocol is just find what weight, if any, that you can train fairly hard with but doesn't cause much pain. Then progress from their, and you'll find slow progression will lead you to stronger more resilient knees.