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Leg Extensions, the Knee, and Pain Reduction - the TRUTH

My experience rehabbing my knees over the decades with this unjustly criticized but extremely beneficial exercise

by Eric Augspurger -- Copyright 2013

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Bigfoot is real, 911 Coverup, Area 51, Flying Saucers, Chemtrails, the Moon Landings were faked, etc., etc., etc.....I do get so tired of reading so much misinformation that has been posted on the internet. Especially when it comes to exercise and weight training, I hate to see so much drivel posted as undisputed fact.  Lately I have been seeing a lot of articles about the evils of the Leg Extension exercise, supposedly written by people who are calling themselves every kind of "expert" there is including exercise physiologists, personal trainers, and even orthopedic surgeons.  They all seem to be saying that the sheering forces involved while using the leg extension machine is inherently dangerous and will injure your knees (as if there aren't any sheering forces on the knees while doing heavy squats or leg presses!).  Oh, how does this sort of nonsense ever originate?  It really makes me wonder if these people have any actual experience training with weights or have ever even walked into a gym at anytime in their life.  Sure one can stack on weights that are too heavy, use sloppy form, and hurt themselves doing almost any exercise but that hardly faults the exercise itself - only the person who is doing it wrong.  Performed correctly, the Leg Extension is the safest exercise there is for strengthening the knee area.  Here are some thoughts from my 40+ years of experience with this valuable exercise....

"LEG EXTENSIONS"....just thinking about them makes my arthritic knees feel BETTER - seriously!  At 57 years old, a recent knee injury from carrying some heavy objects up a hillside (did my own landscaping) has me again thinking back 41 years ago to when I first started feeling serious knee pain while I was back in high school.

 I was an extremely energetic teenager back in the early 1970s - highly motivated for sports and driven to push myself well past the pain barrier in any sport that I tried.  My choice of self-torture finally became track and cross-country as I reveled in the individuality of those sports. I was free to run whenever I wanted to, as often as I wanted, and as long as I wanted to since I didn't have to get with a team of guys to practice as I would with basketball or baseball. Little did I know that during this period of my life I would absolutely ruin my knees and pay the price for the rest of my life.

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The problem with being a highly motivated teenager for athletics back in the early seventies was that there was very little information available in the form of good books on how to train properly for sports without injuring oneself.  I trained far too often, did running sessions too long in length, and too intensely for the long periods that I trained.  After running several miles I would often spend a couple of hours in the gym playing basketball.  One can only imagine the serious damage done to my knees with all the pounding on the hardwood floors after totally exhausting my legs out on the track. I was convinced that the harder I worked, the more successful I would become and I had little regard for recovery time, limiting duration of training intensity, and almost a disdain for getting an adequate amount of sleep.  As far as my diet went - other than drinking gallons of milk I ate little else outside of hamburgers and junk food to keep me going.  Today we have the internet and basically all the world's best (and worst) training advice is here, instantly available, if one only taps on a keyboard a few times with their fingers - truly incredible to an old school guy like me.  However one still needs to sift through the pile of rubbish that is often posted on the internet and I wish to set the record straight about Leg Extensions.

Back to my knees - I tore up everything as a young kid and it's easiest to summarize it by simply saying that it was pretty much all the soft tissue that comprises one's knees besides bone.  Knee pain became my constant companion, a deep burning feeling inside my knees 24 hours a day became an accepted part of my life - maybe commonplace for an 85-year-old but hardly normal for a 16-year-old!  I came to dread long car rides more than anything because I was forced to sit with my knees in a bent position for a long period of time and the pain would become almost unbearable.  But hey, I KNEW I was an athlete because my #%#&*@ knees were killing me; I looked at it as a badge of honor....what a stupid kid!  Later on in life I would compound the damage done to my knees by getting into a couple of motorcycle accidents - damaging both my right and left knees in separate accidents.  Some of us learn more slowly than others...

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Around 1972, about a year into my serious knee pain, I found an old book on athletic training in my high school library.  The book mainly focused on dealing with athletic injuries - pulled hamstrings, sprained ankles, etc.; but what mostly interested me was the section on rehabbing injured KNEES - my preferred injury.

 The book recommended using heat on one's knees before activity and ice afterwards and an exercise to both relieve pain and rehabilitate knee injuries.  NO, the exercise mentioned was not squats or leg presses but LEG EXTENSIONS done on a machine.  If a Leg Extension machine was not available then the old-fashioned iron boot with attached weight plates was to be used.  The book recommended doing 3 sets of 15 reps, one leg at a time if coming back from a knee injury.  Each repetition was to be performed with absolutely strict form and holding each rep at the top of the movement for a full 3 second count, and then slowly lowering the weight.  The cadence of each rep should be 2 seconds up, a 3 second hold at the top, and 4 seconds to lower the weight.  The amount of weight to be used was to be light to moderate, certainly not enough to compromise perfect form.  I started on the program immediately.

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During my first workout with these leg extensions I performed 3 sets of 15 on each leg with a very light weight which was  probably about 20 lbs. back then.  I made sure that I followed the strict form that the book recommended which was taking 2 seconds to lift the weight, tensing my quadriceps hard at the top for 3 FULL seconds, and then taking a full 4 seconds to lower the weight.  I remember at the end of the first set I could feel a tremendous pump in my quads, which looking back, was new to me considering I had limited weight room experience then and really didn't know what a 'pump' even was.  By the end of the third set my thighs were absolutely on fire with what I now recognize as a huge pump in my quadriceps.  But most importantly, my knees felt great with no pain whatever.  The constant nonstop burning I had felt from the tendonitis was gone for the first time in a year.  Sure my quads were on fire from the exercise but I could recognize that as a good type of discomfort and not agonizing joint pain which I had gotten so used to.  The pain did not come back in my knees until sometime later that evening, long after the pump had subsided in my quads. 

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I kept up with the leg extensions at that point doing them the old school recommended 3 times per week and sometimes even more often.  The temporary relief I got from the increased blood flow in my knees was enough to drive me to perform leg extensions everyday of the week at times (but with just light weight - 20 lbs.).  I never believed in taking any kind of pills as a painkiller but I doubt they would have been as effective as this exercise.  Eventually, both my knees got much better and the pain disappeared after a couple of months.  Unfortunately, once my knees were better I didn't stay with the exercise and a few months after discontinuing Leg Extensions, the pain returned in both knees.  And so it has gone over the last 40+ years, an on again and off again affair with the exercise - always adding them back into my routine when the pain returned or when I needed to rehab a knee after a new injury such as a motorcycle accident.

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You see, I am a slow learner who doesn't want to admit that I have permanent injuries that require constant maintenance.  I wish I could just perform power movements all the time such as squats, deadlifts, and bench presses and eliminate what old school free-weight advocates would refer to as 'fluff' - but I can't as my body doesn't hold up long under a routine like that with just the basic powerlifts.  The truth is that simple and basic weightlifting routines work great for young healthy guys.  Once we get a little holder or develop an injury our routines have to change or we have to quit working out altogether and it's as simple as that.

Sure, the basic power-lifts along with bent-over rowing and behind neck presses will build the maximum amount of size and strength when used in a brief, intense, and heavy routine.  The only problem is that you need to be healthy with pain free joints to continue to perform a routine like that - and being younger than 30 also helps.  The reality is that we age and the body eventually breaks down and there are NO exceptions; it's just a matter of when not if with each individual.  But most weight trainees, especially the younger ones don't like to live in reality.  I probably never met an enthusiastic teenager who was just getting started in bodybuilding and hadn't already convinced himself that he was going to be Mr. Olympia one day and do it naturally.  If you're one of those guys I can't help you right now so come back and re-read this article in ten years or so when you have decided to quit living in a fantasy world of being a drug-free professional bodybuilder as they don't even exist.  For the rest of you who understand what I am saying I will summarize the best way to use the Leg Extension machine for best results without injury....

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For Rehab Work

When I was a bit younger I got into the habit of riding motorcycles a lot which in and of itself does not damage the knees.  The only problem is when one is forced to unexpectedly get off a motorcycle while it is still traveling forward but not necessarily on the wheels anymore.  Yes, I have been involved in a couple of accidents and further trashed my knees.  After a couple of months of recovery I was able to start working my legs out again, but still not able to perform any kind of squats or leg presses so it was back to my old friend the Leg Extension.

Usually you'll only have one injured knee at a time, whether it be from a football injury or an accident, although tendonitis from sports like basketball often injures both knees at the same time.  Either way, whether one or both knees are ailing, it is best to work one leg at a time for rehabilitation purposes.

I have experimented with many different set and rep combinations over the years but nothing was ever any better than the first leg extension routine I read about 4 decades ago in that old book so here it is AGAIN if you didn't absorb it earlier:..

Perform leg extensions with just one leg at a time for 3 sets of 15 reps, alternating sets(that's actually 6x15 total if you are counting both legs together), starting out with an extremely light weight.  You never will end up working very heavy in the rehab phase - this is mostly about getting the blood to circulate in the knees while using a cadence of 2 seconds to lift the weight, 3 second hold at the top, and 4 seconds to lower the weight.  Stating off with just 10 Lbs. or even less depending on how severely injured your knee was (post surgery?) and gradually progressing with small weight increases over a few months time should get you back to pre-injury status.  Since you won't be working heavy at this time you can probably benefit from doing leg extensions every other day.  When your knee(s) is pain free again you can start adding in bodyweight only freestanding squats or very light leg presses after you complete the leg extension routine.

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For Bodybuilding

This is where many bodybuilders make a huge mistake and can injure themselves - Leg Extensions are not meant to be a standalone HEAVY exercise for bodybuilding but have great value as a warm-up and pre-exhaust exercise.  As your knees get stronger and the pain subsides, you can start using traditional two-legged extensions as a pre-exhaust exercise that is supersetted with squats or leg presses to build some serious muscle in the quadriceps.  After a couple of warm-up sets with progressively heavier weights, do a set of leg extensions with a moderate to heavy weight in the strictest form possible - select a weight that will take you to absolute failure in 15-20 reps using the 2-3-4 second cadence as described earlier; just keep the form STRICT.  After finishing the set of leg extensions go immediately to your leg presses or barbell full squats with NO REST in between and go to near failure or absolute failure in the 15-20 rep range.  ONE superset only which has been properly performed to failure in this manner is all that any drug-free human can handle in one workout so don't try to do more for your quads.  At the end of this single superset you should be breathing like a locomotive, sweating profusely, and your quadriceps will feel as if someone ran a blowtorch over them - you'll even have trouble walking afterwards if you have worked hard enough. If you're lucky you'll maybe have just enough energy left in you for one set of leg curls and one set of calf raises and then you're done for the day - no other leg work should be performed that day if you are after maximum gains in size and strength.  Anyone who can even perform a second set of this leg extension / barbell squat routine didn't work hard enough on the first set.  Squats to failure should of course be performed INSIDE of a sturdy power rack with the safety bars set one-inch below the barbell at the bottom of your full squat.  If no power rack is available at your gym then do leg presses or the hack squat machine instead for your own safety unless you don't mind getting crushed under a heavy barbell.

Following the above advice on how to properly use leg extensions in your routine will only strengthen your knees and prolong the number of years that you will be able to train your legs with heavy squats or leg presses. And isn't that really what training is all about - being able to do it all your life rather than just for a short time in your youth?

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