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Leg Presses With Torn ACL

post #1 of 16
Thread Starter 
Trying to figure out if the leg presses are irritating my bad knee causing swelling and stiffness. If you would be so kind as to read the below data to see if this makes sense and should I replace leg presses with just squats? I don't have free weights but I could probably come up with something. I did do some squats without weights trying to simulate skiing; heel stays on the ground and upper body is upright.

Here's more data than you want:

April 18, 2008 - Tore ACL grade 3. Also sprained MCL grade 1 or 2. OS said ACL needs to be replaced, MCL will heal on its own.

I'm 48, 5'& 180# and could stand loosing 25 pounds but I'm in good shape otherwise.

Lots of PT, home and at clinic (2~3x/wk). Focus on ROM

Knee was always swollen and would only straighten under pressure. Had knee drained a couple of time (42 CC then 22 CC of fluid). Scheduled surgery because it was believed a stump of the ACL was caught in knee preventing straightening and causing swelling

July '08 - In for surgery, couldn't complete because I had arthrofibrosis. Found that the acl still had continuity so no stump to worry about. OS drained and injected steriod and delayed acl reconstruction until arthrofibrosis is cleared.

Next couple of months did PT 2x/wk at clininc and other days at home. Drained a few more times and more steriod injections. PT focus ROM, Strength and then agility. Started running and could hop side to side on bad leg.

No improvement with regards to full extention and swelling so OS prescribes NO PT and to use leg little as possible for one month. Only stretching. OS says leg is strong and very stable. Probably needs a break since it been through so much.

After 3 weeks I go to the Chiropractor. To this point the leg doesn't feel much different; swells easy and stiffens preventing full extention. Chiropractor uses accupuncture and some sort of hamstring muscle massage. Leg feels GREAT! Best since accident.

Follow up with OS and he prescribes PT on my own and to continue with Chiro. Also prescribes a brace for skiing and recommends follow up in spring to see if surgery is needed/desired.

Since then to current. PT on my own is fairly consistent but could be better. Use the stationary cycle most. Now doing 60 + minutes daily at a fairly good cadence. Also do lunges and the like and use a bowflex.

After a good cycle ride, leg feels great and ROM is great. Next day too. I've been noticing that when I do the bowflex and the lunges too (not daily), my leg seems swollen.

Still go to Chiro monthly.

I used to do lots of leg presses at PT; 3 sets of 225~250 #12~15 reps and then 3 sets of single leg 125~150# 12~15 reps.

On Bowflex I max out at 210# but it is probably closer to 170# (not at max arch). I also do leg curls on bowflex at 45#.

Leg is better than it has been but now I'm thinking that the weight bearing exercises (leg presses) are causing the swelling.

Thanks,
Ken
post #2 of 16
When I tore my ACL 1 1/2 years ago, my ortho and PT suggested that leg presses were fine, leg extensions were not. My motto is "if it hurts stop doing what you're doing". There are so many exercises that you can do for your legs I am sure you can find something that doesn't irritate the knee.

Good luck!

Mike
post #3 of 16
Thread Starter 
Thanks. I was told the same thing, "No leg extentions!" She even went on to say that even if I wasn't nursing an injury, I shouldn't do them. Something about the way the knee (patella) tracks.

My issue is that I'm trying to figure out which exercise(s) irritate it. I'm guessing on the leg presses. I'll leave them out for a while and see what comes of it.

Right now it is a bit sore so I've declared today a day of rest. I probably haven't been doing that enough lately anyway.
post #4 of 16
Quote:
Thanks. I was told the same thing, "No leg extentions!" She even went on to say that even if I wasn't nursing an injury, I shouldn't do them. Something about the way the knee (patella) tracks.
Finally, the voice of reason speaks!



Here's why

post #5 of 16
Quote:
Originally Posted by Lisamarie View Post
Finally, the voice of reason speaks!

Here's why



Here's a funny thought: other than climbing/pullups and pushups is there a closed chain exercise for the arms?

Do we have good reason to abstain from the open chain ones?
post #6 of 16
The leg curls might also be the problem. My PT said the usual leg curl/extension machine (where you sit down) is not good for knees. The ones where you lie on your stomach are much better. I actually felt this as I was doing my exercises.

Just my 2 cents. Might be worth thinking about.
post #7 of 16
Thread Starter 
Are you saying doing leg curls in the sitting is not as good as leg curls while lying on your belly?

I was doing the curls using the bowflex attachment. I was on my belly. I'm 5'7" so it would always feel awkquard to me.

When I took the attachment off, I did them on the bowflex by hooking my heels over the legs of the bench. Felt much better and fits everyone (wife is 5'3", son is 5'10" daughter is 5'). The only thing you have to worry about fitting is your butt in that little seat.

Is it possible your PT was saying doing the sitting extentions are bad but the laying curls are good?

I'm curious because one of the things I really need to work is my hamstring and leg curls are perfect for it.

Thanks,
Ken
post #8 of 16
Quote:
Originally Posted by L&AirC View Post
Are you saying doing leg curls in the sitting is not as good as leg curls while lying on your belly?

Is it possible your PT was saying doing the sitting extentions are bad but the laying curls are good?

I'm curious because one of the things I really need to work is my hamstring and leg curls are perfect for it.

Thanks,
Ken
Either leg curl (hamstring curl) is OK whether you are sitting or prone (lying on your stomach). I would suggest doing both in order to maximally work your hamstrings. The reason for this is a pretty long explanation.

Leg Extensions are a pointless exercise even for those that are totally healthy. There are so many better ways to work your quad with out destroying the back of your knee cap. IMHO, the leg extension is the most useless piece of equipment in the gym.
post #9 of 16
Quote:
Originally Posted by Bucki78 View Post
Either leg curl (hamstring curl) is OK whether you are sitting or prone (lying on your stomach). I would suggest doing both in order to maximally work your hamstrings.
I agree here. The point is your ACL is already shot, but you need your leg as strong as possible before surgery 'cause you are really going to notice a major decline in leg strength following surgery.

I found doing curls on my stomach to be better overall than sitting though.
post #10 of 16

I'm almost 11 weeks post ACL replacement and am also trying to figure out what is causing swelling.  At the recommendation of the Docs assistant (& my PT) swelling is much less after taking most of the last week off other than a few of the exercises they give you the first few weeks like heal slids and leg raises.  Also reduced my walking (on snow) although they said I could continue normal daily activities and the stationary bike (which I haven't bothered making a trip to the gym for this week).

 

Will be interested to see what exercises my PT adds back and which he steers me away from at my next appointment.  FWIW, Leg presses were one of the exercises I was doing, but my PT did not think this was one of the causes of the swelling, so I imagine that he will have me start up with them again. 

 

My PT recommended seated leg curls when I started doing them at a gym with both types of machines last month, but I didn't get an explanation as to why. 


Edited by MEfree30 - Mon, 02 Feb 09 23:09:29 GMT
post #11 of 16
Thread Starter 

I think one of the key things I've gotten out of this is doing "closed chain" exercises Vs. open chain.  At least I think that's the term.  As long as I exrcise without my foot coming off the ground (or platform) I'm fine. Cycling, squats, leg presses etc. Open chain, like running, lunges, jumping jacks, cause swelling.

 

Fortunately, skiing is closed chain

 

Bumps and jumps would be open chain.

 

The only time I've had swelling after skiing is when there was a lot of crud or powder (for NH)  Both lead to too much bouncing.

post #12 of 16
Thread Starter 

I think one of the key things I've gotten out of this is doing "closed chain" exercises Vs. open chain.  At least I think that's the term.  As long as I exrcise without my foot coming off the ground (or platform) I'm fine. Cycling, squats, leg presses etc. Open chain, like running, lunges, jumping jacks, cause swelling.

 

Fortunately, skiing is closed chain

 

Bumps and jumps would be open chain.

 

The only time I've had swelling after skiing is when there was a lot of crud or powder (for NH)  Both lead to too much bouncing.

post #13 of 16
Thread Starter 

I think one of the key things I've gotten out of this is doing "closed chain" exercises Vs. open chain.  At least I think that's the term.  As long as I exrcise without my foot coming off the ground (or platform) I'm fine. Cycling, squats, leg presses etc. Open chain, like running, lunges, jumping jacks, cause swelling.

 

Fortunately, skiing is closed chain

 

Bumps and jumps would be open chain.

 

The only time I've had swelling after skiing is when there was a lot of crud or powder (for NH)  Both lead to too much bouncing.

post #14 of 16
Quote:
Originally Posted by L&AirC View Post

I think one of the key things I've gotten out of this is doing "closed chain" exercises Vs. open chain.  At least I think that's the term.  As long as I exrcise without my foot coming off the ground (or platform) I'm fine. Cycling, squats, leg presses etc. Open chain, like running, lunges, jumping jacks, cause swelling.

 

Fortunately, skiing is closed chain

 

Bumps and jumps would be open chain.

 

The only time I've had swelling after skiing is when there was a lot of crud or powder (for NH)  Both lead to too much bouncing.

 

Just because your foot leaves the ground/platform does make it totally an open chain exercise.  Take a forward lunge for example:  the majority of the muscle activity is performed by the forward leg absorbing/controlling the forward momentum of the body and then pushing off to propel the body back to the upright standing position.  All of this muscle activity is performed within a closed kinetic chain while your foot on the ground.  Yes there is an open chain component of a forward lunge while your foot is in the air but is lifting your leg to advance it forward and/or back a bad thing just because it is open chain?  If so we all better stop walking.  I consider lunges to be a closed chain exercise because the emphasis of the exercise is the part in which the foot is on the ground.  If done quickly enough, lunges can be a plyometric exercise but that is a whole different discussion.

 

Just because an exercise is closed chain does not make it good.  When performing a closed chain exercise it is important to prevent the knee cap from moving out past the toes.  When the knee cap moves past the toes it greatly increases the pressure between the back of the knee cap and the thigh bone.  If you do this enough times you can increase the pain and/or swelling in your knee in a hurry even though you are performing a closed chain exercise.  If you want an easy example, try going up and down a flight of stairs and see which is more stressful on the knee.  Both are closed chain activities but one is more irritating to the knee than the other because of the position of the leg.

 

Just because an exercise is open chain does not make it bad.  Hamstring curls (seated or prone) are open chain exercises but yet they are a crucial part of an ACL rehab.

 

The best exercises are the ones that most accurately replicate the functions you ask your body to perform.  Many of these functions have both closed and open chain components.  Example, walking.  There are 2 phases of walking, stance (foot on the ground) and swing (foot in the air).  You need to perfrom both in order to walk so I would argue that you need to exercise in both open and closed kinetic chain to return to normal walking following an injury.

post #15 of 16
Thread Starter 

Great info.  Thanks. I would have thought that leg curls would be closed chain since your feet (ankles) are in constant contact with the machine (platform).  

post #16 of 16
Quote:
Originally Posted by L&AirC View Post

Great info.  Thanks. I would have thought that leg curls would be closed chain since your feet (ankles) are in constant contact with the machine (platform).  

 

I can see how you would get to that conclusion, but the important thing to consider is what is going on at the end of the kinetic chain, in this case the foot.  If the foot is moving while the rest of the body remains still (as is the case with a HS curl) it is an open chain exercise.  If the foot is fixed while the body is moving (squats, lunges, etc.) it is a closed chain exercise.  If you want to try a good closed chain hamstring exercise, try sitting in a chair/stool that is on wheels and pull yourself across the floor with your legs.  It will be easy on tile, but on carpet it can be pretty tough.

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