Leg Day with Bad Knees



by Devin Sarno, NSCA-CPT

A common occurrence amongst many people are knee pain and back pain. It can happen to individuals just getting into fitness, or starting back up after a long period, or even some of those that have been active for quite some time and just sustained too much impact over time. What we are going to focus on is knee pain, and how to train with it. A common instinct might be to avoid doing leg exercises, fearing it may exacerbate the issues you currently have, but this is not necessarily the case. There are many ways to safely and effectively train with knee pain, and in many cases you probably should be proactively training your legs.

Knee pain can be caused by a wide variety of factors, such as: excess weight, lack of muscle flexibility or strength, poor posture, poor technique during exercise, high impact sports or exercise, or previous injury. One of these factors in particular make it evident that training your legs should not be avoided just because you have knee pain: lack of muscle flexibility or strength. The reason that this can lead to knee pain is because muscles that are tight or weak don’t provide enough support for the knee joint, causing the joint itself to have to absorb almost all of the stress that is paced on it.

With that being said, there are a number of exercises that are able to be performed very safely and effectively that will help strengthen those leg muscles, and at the same time not compromise the knee in any way. First, one of the simplest and most underutilized exercises that is great for (most) individuals that experience knee pain is the Step-Up.  The great part about this movement is that it is excellent for building leg strength, but also forces you to keep very neutral shin angle and keep that knee over your ankle. Ideally, you are going to want to pick a step height that sets your top leg at approximately a 90 degree angle when you place it flat on the step.

For some of the same reasons that the step-up is a great move for those with bad knees, so are REVERSE lunges and the single leg squat. The reason I say reverse lunges as opposed to a forward lunge is that as you stride forward on the forward lunge and all your momentum and weight are carrying you in that direction, it makes it very easy for that forward movement to cause for the knee to make its way out over the toe during the movement. During the reverse lunge, it is much easier to control that shin angle and weight distribution; just make sure you stride far enough back and stay heavy in your front heel. For the single leg squat, the principle is very similar. With your rear foot elevated on a step, box, or bench of some sort, you should try to get that front foot out to a point that is comfortably far from the unit you are using to elevate that foot. If you are far enough out, your shin angle should change very little, if at all when you drop down to squat on that front foot. Again, your weight should stay pretty heavy on your front heel.

One very popular exercise for those with bad knees is the box squat. While I am not the biggest fan of the box squat because I believe that if a squat is performed properly, a deeper squat should not necessarily put any additional pressure on your knee joint. However, along with a box allowing somebody to control their depth, it also gives them a better platform to really work on the proper hip hinge pattern at the top of the movement and get that butt back without the fear of falling backward. So although it is not my favorite movement, it can certainly help somebody get their squat right so that they are not causing any further damage to their knees. To perform this movement, you should start the same as a regular barbell squat but have a box set behind you right around the point where your thighs are parallel to the floor when your backside makes contact with the box.

With the quads arguably being the toughest part of your legs to work when you have bad knees, it should also be open season on those glutes, hamstrings, calves, abductors and adductors. Incorporating moves like sled drags, glute bridges, hip thrusts, Romanian deadlifts, calf raise variations, side leg lifts with resistance, and band walks/shuffles should be a regular thing for you as well. Really build up those posterior chain leg muscles, as well as the medial and lateral leg muscles with movements that all should be able to be performed in a pain free fashion. This should be the easy part of working your legs even if you have bad knees!

Beyond just being able to work your legs with bad knees, it is IMPORTANT to work your legs even if you have bad knees. As you can see, there is still a lot of exercises you should be able to do; but beyond that, doing exercises like these regularly are ultimately going to help build stability in the knee as you build up the surrounding muscles, as well as relieving some impact from the joint itself. As discussed earlier, a lack of strength and flexibility is often a big reason for knee problems, so building strength and being sure to stretch and foam roll should be big priorities for those with knee problems. You have more control over your situation than you probably believe, and here is a blueprint of exercises that can help you out if your knees are holding you back!


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