Strengthening thigh muscles

jhansman

Platinum Member
Feb 5, 2004
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Hey all-
I'm an avid hiker who has lost about 40 lbs. in the last few months (type II diabetes, on metformin). Seems like I've lost muscle mass in my upper legs, and now when I go for a fairly strenuous hike, I'm getting knee pain for days afterward. I've suffered from IT band pain in the past, and now I'm getting the same pain on the other side of the knee. Assuming all this is a result of the connective tissue not being properly supported by too-weak muscles, can anyone suggest exercises that would help me strengthen those muscles without putting to great a strain on the knee. I have access to a full gym, but no trainer, so I don't want to end up doing something that could make things worse. Any help is much appreciated.
 

Whisper

Diamond Member
Feb 25, 2000
5,394
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My default answer is going to be squats, but I'll defer to others who might be able to respond in more depth.
 

Blackjack200

Lifer
May 28, 2007
15,995
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Squats are a great excercise, but if the pain is bad enough to last for days, I'd see a doctor and get a referral to an orthopedist. Maybe some physical therapy could really help here.
 

jhansman

Platinum Member
Feb 5, 2004
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Yeah, I've tried squats in the past, but they put a pretty good strain on knee ligaments. I have a doc's appt. on Monday and probably will end up back in PT (been there for back & shoulder); I expect to learn what can be done with machinery, and from there hope to be able to get to a gym a few times a week to keep things in tune. I'm 64 and in pretty good shape, but recovering from minor injuries takes a lot longer than it used to. The body hates to be ignored, and makes no bones about letting you know it. ;)
 

classy

Lifer
Oct 12, 1999
15,219
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Usually a good alternative to squats with less knee pressure is leg presses. Also I have mentioned this before, guys need to wrap their knees. Something a lot people avoid nowadays because people believe proper form can prevent most injuries. While there is some truth to that, sadly nobody ever keeps perfect form.
 
Mar 22, 2002
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Usually a good alternative to squats with less knee pressure is leg presses. Also I have mentioned this before, guys need to wrap their knees. Something a lot people avoid nowadays because people believe proper form can prevent most injuries. While there is some truth to that, sadly nobody ever keeps perfect form.

As I said previously and as someone who is 4 months from being a doctor of physical therapy, wraps are unnecessary and be detrimental to proprioception, motor learning, and psychological drive. Squats are very frequently done as a therapeutic activity, but only after pain has been reduced, impairments have been addressed, and the individual has been re-trained on how to move. Knee wraps aren't around in real life, but we all need to squat - some more than others. Doesn't mean you should rely on an external tool to attempt to remedy this.
 

jhansman

Platinum Member
Feb 5, 2004
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As I said previously and as someone who is 4 months from being a doctor of physical therapy, wraps are unnecessary and be detrimental to proprioception, motor learning, and psychological drive. Squats are very frequently done as a therapeutic activity, but only after pain has been reduced, impairments have been addressed, and the individual has been re-trained on how to move. Knee wraps aren't around in real life, but we all need to squat - some more than others. Doesn't mean you should rely on an external tool to attempt to remedy this.

Understood, but it's worth noting that in my case, when I used a simple knee brace, I always came back from a 3-5 mi. hike painless. That extra support was no substitute for stronger, more limber muscles, I know, but it helped. I always do the requisite stretching beforehand, all learned from months in PT. BTW, I watched a 1.5 hr. video of a knee replacement (on a cadaver) on Youtube the other day, and holy shit, I had no idea what was involved. So, my goal here is to rehabilitate the knee through PT, and in the process, learn to do whatever it takes to keep the musculature in tone so the knee gets the support it needs. I do appreciate the feedback here from those of you more knowledgeable than I.
 
Mar 22, 2002
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Understood, but it's worth noting that in my case, when I used a simple knee brace, I always came back from a 3-5 mi. hike painless. That extra support was no substitute for stronger, more limber muscles, I know, but it helped. I always do the requisite stretching beforehand, all learned from months in PT. BTW, I watched a 1.5 hr. video of a knee replacement (on a cadaver) on Youtube the other day, and holy shit, I had no idea what was involved. So, my goal here is to rehabilitate the knee through PT, and in the process, learn to do whatever it takes to keep the musculature in tone so the knee gets the support it needs. I do appreciate the feedback here from those of you more knowledgeable than I.

I'd definitely suggest seeing a PT before trying to implement your own exercise program. Braces can be good, but keep in mind if you have structural knee damage, the brace is only a bandaid. You may not feel a lot of pain, but your current presentation may be a hint that you're doing more than your knee is capable of. That may be a temporary status or it may be permanent. Some people don't have the knees to do what they want to do so they 1) run their knee into the ground or 2) reduce the activity a bit by finding a happy medium.

Total knee replacements are severe, but the recovery is quite good. I'd definitely say put it off as long as you can by completing PT and modifying your activity levels. That could be as simple as reducing your hikes to 2-3mi until you're stronger, and then slowly working your way back up. The brace is fine if there's no other way around it, but I find that people who HAVE to use braces don't last as long until knee surgery.
 

jhansman

Platinum Member
Feb 5, 2004
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I'd definitely suggest seeing a PT before trying to implement your own exercise program. Braces can be good, but keep in mind if you have structural knee damage, the brace is only a bandaid. You may not feel a lot of pain, but your current presentation may be a hint that you're doing more than your knee is capable of. That may be a temporary status or it may be permanent. Some people don't have the knees to do what they want to do so they 1) run their knee into the ground or 2) reduce the activity a bit by finding a happy medium.

Total knee replacements are severe, but the recovery is quite good. I'd definitely say put it off as long as you can by completing PT and modifying your activity levels. That could be as simple as reducing your hikes to 2-3mi until you're stronger, and then slowly working your way back up. The brace is fine if there's no other way around it, but I find that people who HAVE to use braces don't last as long until knee surgery.


Good advice all around, and likely what I what I will learn once I'm back at the therapist's. I aim to keep my own knees as long as possible. One of my problems is I live in an area surrounded by excellent hiking, and the temptation often overrides good judgement, both in terms of distance and difficulty.
 
Mar 22, 2002
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Good advice all around, and likely what I what I will learn once I'm back at the therapist's. I aim to keep my own knees as long as possible. One of my problems is I live in an area surrounded by excellent hiking, and the temptation often overrides good judgement, both in terms of distance and difficulty.

Having worked as a PT student and having been a patient, I totally get it. If I wanna mountain bike or run, it's gonna happen whether my knee or back is up for i. You just have to learn the ability to decipher when it's ok and when it's too much. It's a fine line and sometimes we get stubborn, but it's easier to do if you think about the longevity of your knees. If you are a bit more selective, maybe you put off knee surgery for three years. That's a pretty big deal, considering most knee replacements only last 10-15 years and you don't want to have to get the replacement replaced :p Try selecting some of the shorter trails and see how that goes. Reducing the activity a little bit can be a nice middle ground for both satisfaction AND comfort.
 

jhansman

Platinum Member
Feb 5, 2004
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The last time I had really bad IT band pain, I went for an MRI, thinking the surgeon would say, "Yep, your a candidate for replacement." He looked the images and radiologist's report over and said, "Nope, you need better conditioning." Apparently, all my parts were sound, just under-supported. That was two years ago, and I doubt much has changed, except (as I mentioned earlier) my recent weight loss that apparently took muscle mass with it. So this time around, I plan on doing it right, with the long term in mind.
 
Mar 22, 2002
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The last time I had really bad IT band pain, I went for an MRI, thinking the surgeon would say, "Yep, your a candidate for replacement." He looked the images and radiologist's report over and said, "Nope, you need better conditioning." Apparently, all my parts were sound, just under-supported. That was two years ago, and I doubt much has changed, except (as I mentioned earlier) my recent weight loss that apparently took muscle mass with it. So this time around, I plan on doing it right, with the long term in mind.

Yeah, the human body can hurt A LOT without visible changes on diagnostic imaging (x-ray, MRI, CT, etc). PTs work with that quite a bit. Strengthening, improving muscle length, range of motion, re-training movement patterns, etc can many times be enough to get people back to what they're doing and stave off structural damage. Recently, I actually read a paper that showed PT was just as effective as surgery for meniscus tears.

Your weight loss may or may not have anything to do with it as losing weight will help with a lot of problems (particularly those related to the joint and meniscus). Unless you did a crash diet or were completely inactive when losing weight, it's not that common to lose a lot of muscle mass. It could have just flared up - sometimes that's a bit confusing to people, but the body does that sometimes when you're hovering between healthy and injured.
 

classy

Lifer
Oct 12, 1999
15,219
1
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As I said previously and as someone who is 4 months from being a doctor of physical therapy, wraps are unnecessary and be detrimental to proprioception, motor learning, and psychological drive. Squats are very frequently done as a therapeutic activity, but only after pain has been reduced, impairments have been addressed, and the individual has been re-trained on how to move. Knee wraps aren't around in real life, but we all need to squat - some more than others. Doesn't mean you should rely on an external tool to attempt to remedy this.

Weightlifting in general is not natural to the body. Everyone is different and the problem with your advice is you won't have the first clue as to what is considered therapeutic for one and stress for another. In over 30 years of athletics, some people are just born with weaker joints and some have no joint problems, but just weaker muscle strength. You can take two people of exact same physical makeup and take the same weight in any exercise. For one it may not be any challenge and for another it could be a daunting task.

The human body varies from person to person like snowflakes. The use of these aids will help him develop a level of strength that could be beneficial, that without them he may not be able to achieve. His desire is not to be some great weightlifter, his desire is to be a better hiker and lessen his pain. Getting stronger will help that, using aids such as wraps can help him get stronger, but at the same time help prevent further injury. That's from 30 years of experience.
 
Mar 22, 2002
10,483
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Weightlifting in general is not natural to the body. Everyone is different and the problem with your advice is you won't have the first clue as to what is considered therapeutic for one and stress for another. In over 30 years of athletics, some people are just born with weaker joints and some have no joint problems, but just weaker muscle strength. You can take two people of exact same physical makeup and take the same weight in any exercise. For one it may not be any challenge and for another it could be a daunting task.

The human body varies from person to person like snowflakes. The use of these aids will help him develop a level of strength that could be beneficial, that without them he may not be able to achieve. His desire is not to be some great weightlifter, his desire is to be a better hiker and lessen his pain. Getting stronger will help that, using aids such as wraps can help him get stronger, but at the same time help prevent further injury. That's from 30 years of experience.

I'm sorry - what? Lifting weights and strength training - something to body responds readily and easily to; something that has been required for establishment of trade and by artisans since the beginning of time - is not natural to the body? Your vision of the body as a frail, easily breakable apparatus is flawed. There are very specific physiologic processes (enzymes, inflammatory response, etc) to resist injury when dosed in an appropriate manner. Some people do have weaker connective tissue strength - yes. That means they need to dose their increases more gradually, not that they need to rely on the use of assistive equipment. That's why strength training programs need to be geared toward the individual and changes must be made over time.

The use of these aids is a crutch, which actually allows for improper motor programs, reduced proprioceptive awareness, and weakness in key muscle groups. Knee wraps, for example, create stability in the frontal plane. This reduces the muscle demand on the abductors, which are rarely stressed beyond their ability in a weighted back squat. It also reduces demand on the quads and hamstrings, but that's less significant because they're still heavily loaded. Assistive equipment with strength training and weight lifting has not shown to reduce injury in research. I can find the articles, but it will take some time as I don't have the same research access as I used to. The things I'm saying are based on evidence based practice for physical therapy, athletic training, and sports medicine. Anecdotal experience is the lowest evidence in the research world with randomized controlled trials (the research I'm talking about) is at toward the top (2nd best). I'm saying that you are talking based on experience, but research shows that your experience is not the case (to 95% certainty).

I have worked with hundreds of patients and we will always move away from bracing, wraps, and aids as soon as we can to make the body self sufficient. If someone is a powerlifter and wants to squat with a suit, knee wraps, and a weight belt - we will train that eventually, but they will train an unassisted squat for the majority of the time.
 

classy

Lifer
Oct 12, 1999
15,219
1
81
I'm sorry - what? Lifting weights and strength training - something to body responds readily and easily to; something that has been required for establishment of trade and by artisans since the beginning of time - is not natural to the body? Your vision of the body as a frail, easily breakable apparatus is flawed. There are very specific physiologic processes (enzymes, inflammatory response, etc) to resist injury when dosed in an appropriate manner. Some people do have weaker connective tissue strength - yes. That means they need to dose their increases more gradually, not that they need to rely on the use of assistive equipment. That's why strength training programs need to be geared toward the individual and changes must be made over time.

The use of these aids is a crutch, which actually allows for improper motor programs, reduced proprioceptive awareness, and weakness in key muscle groups. Knee wraps, for example, create stability in the frontal plane. This reduces the muscle demand on the abductors, which are rarely stressed beyond their ability in a weighted back squat. It also reduces demand on the quads and hamstrings, but that's less significant because they're still heavily loaded. Assistive equipment with strength training and weight lifting has not shown to reduce injury in research. I can find the articles, but it will take some time as I don't have the same research access as I used to. The things I'm saying are based on evidence based practice for physical therapy, athletic training, and sports medicine. Anecdotal experience is the lowest evidence in the research world with randomized controlled trials (the research I'm talking about) is at toward the top (2nd best). I'm saying that you are talking based on experience, but research shows that your experience is not the case (to 95% certainty).

I have worked with hundreds of patients and we will always move away from bracing, wraps, and aids as soon as we can to make the body self sufficient. If someone is a powerlifter and wants to squat with a suit, knee wraps, and a weight belt - we will train that eventually, but they will train an unassisted squat for the majority of the time.

Let me make this plain and simple. I normally agree with you, but if I understand the OP, he is asking for help to strengthen him as a hiker. He already has discomfort, that he now has in both knees. For one he needs to not worsen the condition and until he learns how to lift, including different exercises, he should use aids such as wraps and belts as well. And that 95% is complete nonsense, because with your mode of thinking, we would NEVER EVER see the type of physical barriers broken today.
 
Mar 22, 2002
10,483
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Let me make this plain and simple. I normally agree with you, but if I understand the OP, he is asking for help to strengthen him as a hiker. He already has discomfort, that he now has in both knees. For one he needs to not worsen the condition and until he learns how to lift, including different exercises, he should use aids such as wraps and belts as well. And that 95% is complete nonsense, because with your mode of thinking, we would NEVER EVER see the type of physical barriers broken today.

The problem is he shouldn't be using assistive devices to complete squats if he hasn't had a thorough evaluation by a professional. He honestly doesn't need to be lifting PERIOD at this stage until he gets his knee checked out. Other interventions are likely indicated in this case - weighted squats will be a long way out.

I'm saying do DIFFERENT exercises in addition to other physical therapy interventions (joint mobilizations, massage, neuromuscular re-training, stretching, postural education, etc). When you get to weighted squats, you should not be using assistive devices. If you HAVE to use them to complete squats, you shouldn't be doing squats until you have the original problem addressed. You seem to think that doing squats with wraps are a good option for him. If it's meniscus or joint related, that's actually going to worsen his condition even with knee wraps. I'm saying he needs to start at lower level exercises that don't require assistance, improve his tissue quality and strength (not just muscle, but bone, tendon, ligament, and cartilage) and then move on to squats without anything.

I regularly see people push their barriers when it comes to injury. However, to get there, it's a much more gradual and thoughtful process than "Ok, now do some barbell squats, but wear these knee wraps and this belt."

OP: Sorry for letting this get off topic. I've been trying to address classy's points in other threads as well, but the response simply culminated here.
 
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pauldun170

Diamond Member
Sep 26, 2011
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Weightlifting in general is not natural to the body.

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jhansman

Platinum Member
Feb 5, 2004
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Before this thread turns into yet another urinating contest (as happens so often here), I'll chime in with an update. I'm in PT, with a therapist that has worked with me on my back and shoulder, both with excellent results. I am unable, at this point, to make a step up on my right leg higher than, say, a few inches without significant pain to the knee. I have home exercises to do along with the machine work at PT, and am confident that together we will get the knee pain free and develop strengthening for the thigh muscles. I suffer from tight hamstrings, in particular, so daily stretching is now also part of my regimen. If I learn anything I think is worth sharing, I'll post it here. Until then, you all can argue the merits of your various methods.
 

jhansman

Platinum Member
Feb 5, 2004
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Pretty much just hamstring stretches with some stepping and isometrics that flex the quads without putting too much on the knee. Once the knee is pain free, I'll probably do more machine work for strengthening, but I need to build muscle mass a well, so I expect diet will come into it as well. I have about a month and half before I go to the mountains, so by then I'm planning on being where I should be to do 8-10 mi. a day with a light (20 lbs) load.