How leg extensions saved my knees (quick, knock all the wood!)
Every time I post my progress with getting to pain-free squats in the gym again, someone always comes in with knee advice. It’s a whole thing. I rant on Twitter about random things all the time, but this particular topic never fails to elicit some kind of “Have you tried this?” “You should do this!” “Check out this person” “What about this?” “How do you feel about lunges?” - even when I didn’t ask (and I’m pretty sure I’ve never asked, at least on Twitter).
I totally get it. I talk to really nice folks on Twitter who always try to be helpful, and it always comes from a good place. And with knee issues being so prevalent, it only makes sense that people have dealt with this and want to share their knowledge. Heck, I’m pretty sure I’ve done it before, too.
Each time, I patiently say “Yes, I’ve seen this.” “Yes, I’ve tried this.” “No, it’s not an injury, I have chronically bad knees and have tried almost everything under the sun.”
Here it is, the full history of my knees and how leg extensions (I think, for now), saved them.
- Pandemic atrophy
- The sad history of my knees
- Back to the present-ish
I barely worked out, and not at all at the gym, during the pandemic. I used to lift 2-4 times a week. Suddenly, all that stopped. I got a kettlebell and did swings for a while. I got a pole and did all sorts of cool pole tricks in my house. I worked out at the outdoor gym a couple of times, trying to do some squats there. But in the end, none of it stuck.
Nothing changed too much in an overly visible way. I generally maintain muscle pretty well and then build it back up pretty easily. And at that point I’d been lifting for almost a decade, so I had quite a bit of “old” muscle that always feels like it sticks around longer (I have no scientific backing for this, it’s just something I think I’ve noticed).
But by the end of that 1.5-ish years, it did become obvious that my legs especially had atrophied. And what made it obvious were my knees.
The sad history of my knees
(If you want to skip my knee history ramble and just go straight to the leg extension thing, here you go)
Not the bee’s knees
My knees cracked ever since I was a child. In my late teens to early twenties, they got really bad. It would hurt to go down stairs. I couldn’t bend down to tie my shoes without pain. The regression seemed so gradual and natural that for me it just seemed “normal”. Like “Yeah, I have bad knees and I’m just living with it”
It did eventually get bad enough for me to go see a doctor, back in Australia. They did X-Rays. They said my knees were just structured like that, and gave me some exercises and orthotics.
The exercises didn’t really seem to help, and to be honest I’m not sure if I wore the orthotics consistently enough to know for sure - but my knees kept hurting. I had resigned myself to living with bad knees.
Running - first “Aha!” moment
It was only when I started running that they got legitimately better. I realized (or at least suspected) that strengthening my legs helped my knee pain. It seemed counter-intuitive, since I’d read so much about running hurting people’s knees especially if they already had knee issues. But for me, running never resulted in any knee pain whatsoever and only seemed to help long-term.
After moving to Sweden, I stopped running consistently and my knees got worse. They would especially get bad over the winter, to the point where I just thought the colder Swedish climate exposed existing issues and didn’t really link it too much to the exercise (like a fool). The issue was, I’d grown to not really like running… and especially not in the freezing cold.
But I’m vain and I wanted to stay in shape, so after a year or so of being pretty lazy I joined the small neighborhood gym. It was almost always empty and did not have a proper squat rack, but was enough to start getting me into weights and some machines. I quickly decided my favorite thing to do was deadlifts. I looked up technique videos online for both deadlift and squat, and other free-weight exercises. I’d nerd out over this for hours and then go try it at the gym. I started taking grainy progress pictures.
I liked lifting much more than running.
And over time, my knees improved again, even in winter!
At one point I stopped going to the gym for about a year. My knees got worse again, and by this time I definitely got the message.
At some point, I started lifting heavy enough to warrant (for me) knee sleeves in winter (when my knees get cold very easily and then need extra help to warm up for heavy lifting).
Other things I’ve tried
Over the years, on and off, I’d tried different techniques for helping my knee pain during periods between running or lifting. In the end, they did not work for me either because they just weren’t effective for my issue or, in some cases, maybe I hadn’t tried them for long enough. Other times, they would hurt my knees during the movement in a way that just felt very wrong.
I’d also had physiotherapists and sports massage therapists try sports massages and techniques of various kinds. Sometimes a massage releasing some tenion in my back or hip would help my knees feel better for a while, but the effect was always short lived.
I by no means claim that I tried every single one of these techniques and ideas perfectly consistently or in ideal conditions. All I can say is that through trial and error I got what I believe is a good sense of what’s worked and not for my knees. At this point, if the recovery attempt I describe down below stops working, the next step is a doctor; not a new “online knee guy” technique attempt.
Back to the present-ish
And like a fool, I stopped doing proper exercise over the pandemic. By this point I knew this was likely to impact my knees. I’d been aware of my knees my whole life and experienced various weak and strong points. I had an idea of what would happen.
And well yeah… it did.
Slowly but surely, my knees got worse. By the time I got vaccinated, my knee issues were back with a vengeance. Couldn’t tie my shoes without pain. Couldn’t bend over to pick something up off the floor without pain, resulting in using my back to compensate, putting myself at risk of injuing my back, too! And the worst part is for a long time it just felt “normal”. Like “Oh yeah my knees a crap, I’m living with it.” Again.
But then I went back to the gym again. And could not squat. And that was the last straw (I do not know what I expected). Not being able to squat is finally what got me to try and fix my knees -.-
Sure, my knees hurt before, but not being able to squat a barbell without my knees feeling like they were going to explode was what really drove it home that this was going to be a huge issue for the rest of my life unless I handled it. Heck, I couldn’t even comfortably do a body weight squat at that point.
I had a theory, based on nothing scientific, only on personal observations over the years.
My kneecaps naturally tend to shift inwards, and I think this gets worse when my legs are weak. Specifically, I thought the “Vastus medialis” muscle was the culprit. Ie, this sucker:
I think of it as the little teardrop muscle on the inside of your leg, just above and next to the kneecap. My theory was that strengthening this muscle would help to push the kneecap out and stabilize it (my kneecaps tend to shift in by nature).
Because I suspected that muscle atrophy caused this degradation, and that would take time to fix, I decided to give myself 3 months. If I saw no improvement in my knee pain after 3 months, I’d go get checked by a proper doctor and drop my little amateur theory. I mean, as much as I’m convinced that stronger muscles are usually better for pain prevention, there is also a chance that this is some other structural/medical condition that cannot be self-medicated with the gym (my mind was jumping to some form of arthritis…)
My plan was cable leg extensions - both single and dual-leg extensions.
For many years I thought leg extensions would just hurt my already crappy knees and never did them, until a few years ago when a PT showed me how to do them and I realized they didn’t hurt.
I realized that I could currently do leg extensions mostly without pain, unlike squats. So that’s what I’d do. It would be my starting point.
I did a few sets of extensions in nearly every gym session. I was also still getting back into the habit of going to the gym again in general, so this ended up being 1-2 visits per week for most of the time, and gradually going up to 3 times per week.
I saw my quads getting stronger over time. I did not see as much growth as I hoped in the Vastus medialis, though. Mostly it was growth in the center to outer muscles of the quadriceps. This made me skeptical - if that little teardrop muscle did not grow at the same rate, would this result in my kneecaps only being pushed in more? Was I doing more harm than good?
Only time would tell. I kept going.
My leg extension workout volumes began to creep up:
Trying to squat again
When my quads got considerably stronger to my eye/feel, I started trying to squat again. It did not go well at first. I would sometimes need an hour of warmup before squatting. Eventually, I realized kettlebell swings and snatches served as good warmup. They simulated part of that squat movement, and I could adjust the depth of the swing as I warmed up.
Then, progress seemed to happen quicker and quicker. Warmups are still there (as opposed to what I was doing before, which was warming up with the bar), but are getting considerably shorter. I now always bring a kettlebell with me to the squat rack and do a few swings (sometimes even between sets). The last two times, I only needed a few sets of swings before starting to squat.
I am keeping my weights low and taking it slowly. But it seems like each squat session is building up my strength at a considerable pace. I have a feeling this is not just leg strength. My body is “remembering” how to squat again. Squats are slowly taking over my leg extension time since now I can keep building leg strength through that.
I only hope that one day I can get back to my previous weights.
I did read that leg extensions are actually better at creating quad muscle growth than squats, so I definitely still do them as well and don’t plan on stopping.
For now, I am optimistic. I can tie my shoes again! And squat! I just hope I can get back to my previous strength with this momentum, and that this isn’t just a temporary positive blip. Fingers crossed.