Bad knees don't need to stop you from getting big quads. While you may be limited to certain exercises, there are effective ways to structure your workouts so you can relieve knee pain as you make your way through your workout.
Getting big quads and legs with bad knees is about modifying exercises so your knees don’t go past your toes and using isometrics to enhance tendon creep and collagen synthesis which also creates a numbing effect.
A quick disclaimer. The knee pain I’m talking about in this article refers to general patella tendon pain. While some of the exercises will help you work around some structural problems (e.g. cartilage damage), the overall premise is that we can relieve general tendon pain with these exercises.
However, these exercises will not fix structural damage and you need to see a professional to find the best course of action.
Table of Contents
What Causes Knee Pain
As mentioned, this will be focused on general knee pain of the patella tendon. As a quick primer, tendons attach muscle to bone. The patella tendon (the main tendon that runs down the front of your knee and behind your knee cap) attaches the rectus femoris muscle to the top of the shin bone.
This pain above, below, or behind the knee cap is the patella tendon. Tendons can get this way when they become too stiff. Essentially, the collagen fibers form crosslinks instead of being in a nice straight line.
Pain can also come from a short and tight rectus femoris muscle. Those that sit often may have this problem since the rectus femoris crosses both the hips and the knee. When the muscle cannot stretch through the full range of motion, the tendon starts to stretch too which is not nice on a stiff tendon.
We will go over specific exercises and protocols later in this article that can be used to produce new collagen fibers in the tendon and break down these crosslinks so we can get a healthy, pain-free tendon.
If you would like to learn more on this topic, check out the video below showcasing leading tendon researcher Dr. Keith Barr.
Will Building Leg Muscle Help With Knee Pain?
Building leg muscle will help with knee pain depending on the pain you are experiencing. For example, having weaker quads increases your risk of cartilage loss in the knees threefold [1]. Regarding general patella tendon pain, it is often not a muscle size problem. As mentioned above, it's often a tendon structure problem.
There are exercises and training protocols we can use to rebuild the tendon structure so we can move pain-free. But first, here are the exercises to avoid while you're in pain and the best exercises you can do to build massive quads while avoiding pain.
Exercises Not To Do With Bad Knees
Avoid these exercises at all costs so you don’t aggravate any knee pain.
Exercises That Push The Knee Forward
Having the knee travel forward during exercises places greater stress on the quadriceps. This is great for those with healthy knees to build big quads. But greater stress on the quads means greater stress on the knees. Here is a short list of exercises that push the knee forward during the exercise:
As you can see, pretty much every major quad exercise is listed here. But don’t worry, I’ve got you covered in the next section.
Exercises With A Heavy Eccentric Phase
While this is exercise-dependent, sore knees often don't enjoy the lowering phase of an exercise especially when it's an exercise listed above. We can add the leg extension to the list for aggravating knee pain.
Best Exercises With Bad Knees For Big Quads
With the above guidelines in place, I have some of the best exercises you can do to build big legs when you have bad knees. All of these places the shin in a vertical position instead of pushing the knee forward making them perfect for those with bad knees.
Low Box Step Up
The low box step up is like walking up small stairs. Stairs may cause you pain but if use a low enough platform for your step up, you can mitigate a lot of this pain. Using a 25 or 35 lb bumper plate can be a good place to start.
Add load by holding dumbbells. This will allow you to lean forward as you step up if your knee still hurts which will place more load on the glutes and hamstrings. Keep your shin as vertical as possible and push through your heel with the front foot.
Recommended sets and reps: 2-4 x 5-20/leg
Box Squat
The box squat is different from a squat to a box or bench. Many will use a box or bench to gauge depth when squatting. However, the box squat is about loading your glutes and hamstrings. Your shin will be near vertical which will reduce the stress on your knees.
When performing the box squat, instead of squatting straight down, you will sit back as far as you can to maintain that vertical shin position. Once you get to the box, don’t relax. Just pause and then stand back up.
You can also use a wider stance which can also help with relieving knee pain.
Recommended sets and reps: 2-5 x 5-10
Reverse Sled Drag
The go-to quad exercise for those with knee pain. It pumps your quads full of blood and the tendon where blood flow is limited which delivers essential nutrients for healing. Many lifters find performing a few rounds of reverse sled drags takes their knee pain away temporarily making it the perfect warm-up exercise.
Simply hold the straps in your hand and slowly walk backward. You can also use a belt around your waist attached to the straps and sled but this becomes more difficult as the loads get heavier.
Recommended sets and reps: 2-5 x 20-50m
Quad Exercises To Fix Knee Pain
Tendons love load. In fact, the worst thing you can do when you suffer from knee tendon pain is to rest and do nothing. The tendon remains in the same painful state. You need load to remodel the tendon.
Based on Dr. Keith Barr’s research, to enhance the healing process of your tendon during these exercises, take 15 g of collagen before exercise. This is the best quality collagen you can get by Paleo Pro which has collagen from beef, marine, chicken, and eggshell.
Paleo Pro Multi-Collagen
Take a ¾ scoop 30-60 minutes before exercise with a vitamin C tablet.
Long Duration Isometric Split Squat
The number one exercise to start your rehabilitation is the long-duration isometric split squat. You will have some pain when doing this. That is fine. As long as it is bearable, you need to deal with it to see progress.
Why this exercise? Dr. Keith Barr states you need to re-orientate the collagen fibers. The crosslinks need to be broken down and the new collagen fibers need to be made to run in the direction of the pull.
Slow movements are what allows this to happen. Specifically, isometric exercise which is the slowest of them all. Holding the split squat position allows for what is known as tendon creep. As the muscle is not changing in length (i.e. isometric), the tendon does slowly lengthen while you hold this position.
This lengthening slowly under load is what signals the direction for the new collagen fibers. These are relatively low stress so you can perform these every single day and build your volume each week. Further, research has shown that isometric exercise has a numbing effect so using them as part of your warm-up can set you up for a great workout [2].
Holding this position for 1 minute is brutal to start with. You can perform one set of one minute or you can perform multiple sets of one minute to build volume.
Recommended sets and reps: 1-3 x 1-5 minutes
Reverse Nordic
The reverse Nordic, while it doesn’t provide the same level of tendon creep as the isometric split squat, it lengthens the rectus femoris. How? Eccentric exercise lengthens muscle fibers by adding more small blocks of muscle fibers to the end known as sarcomeres.
The idea behind this is by lengthening the rectus femoris, you increase the length in which you produce the most force. If you can produce more force at longer lengths, you are less susceptible to injury. Further, the more sarcomeres you have in a line, the faster the muscle contracts.
While these performance benefits are great, the benefit to your knee health is that you don’t have a weak and tight muscle pulling on your tendon. When performing the reverse Nordic, I like to have my toes dug into the ground. It lets you apply more tension when falling back.
As you lower yourself slowly backward, squeeze your bum to push your hips forward. A common mistake is lifters will bend at the hips because they have such tight rectus femoris muscles. Once you get to the break point (i.e. the point in which you can’t control the speed), break at the hips and return to the starting position.
Recommended sets and reps: 2-3 x 3-6 reps
Eccentric Lunge Push
This exercise also targets the rectus femoris. But through the mid and upper range. The reverse Nordic targets the rectus femoris through the mid and bottom range. So, it’s a good idea to do both of these exercises.
I’ve used this exercise with older rugby players and seen their knee pain vanish. It is brutal so you must be thoroughly warmed up to do these. Place your hand against a wall at around lower chest height. Any higher and it will be difficult to keep applying pressure when you lower yourself.
Place your front foot a few inches away from the wall. To start the movement, push with your legs and arms in to the wall as hard as possible while squeezing your back leg glute. As you do this, slowly lower your back knee to the floor. It should take you 3-4 seconds to get to the bottom.
Once your knee touches the floor, relax and return to the starting position to start the next rep. You will feel an intense stretching sensation in your back quadricep. This is your rectus femoris going under stretch under extreme tension.
Recommended sets and reps: 1-3 x 3-6 reps
Quad Workout With Bad Knees
Exercise | Set/Rep | Load |
|---|---|---|
A1) Long Duration Isometric Split Squat | 1 x 1-2 minutes/leg | Bodyweight |
B1) Reverse Sled Drag | 4 x 20-40 m | Increasing load each set |
C1) Box Squat | 4 x 8 | 7 RPE |
D1) Low Box Step Up | 3 x 15/leg | 8 RPE |
E1) Eccentric Lunge Push | 3 x 3/leg | Bodyweight |
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References
1. Chin, C., Sayre, E. C., Guermazi, A., Nicolaou, S., Esdaile, J. M., Kopec, J., ... & Cibere, J. (2019). Quadriceps weakness and risk of knee cartilage loss seen on magnetic resonance imaging in a population-based cohort with knee pain. The Journal of rheumatology, 46(2), 198-203.
2. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British journal of sports medicine, 49(19), 1277-1283.