Adjustments for Knee Pain on the Leg Press

Scenario: your knee hurts when using the leg press.  Should you stop using it?

No, at least not right away.  I never advocate working through joint pain (not to be confused with muscle "burn"), but there are several confounding factors.  A simple adjustment or two can eliminate all of the joint discomfort. 

As for why you should exhaust your options to make the leg press work, it's the cornerstone of a strength training program.  The leg press utilizes the gluteus maximus, hamstrings, and quadriceps: the three largest muscles/muscle groups in the body.  As recently discussed on Health-Actualization, using the leg press can lead to increases in lower back bone density, in addition to strengthening the bones of the knee and thigh.  The strength gained from a leg press directly ties to performance of important activities such as sprinting and vertical jumping for athletes, or standing from a chair and walking up stairs for the elderly.  If you want your butt and thighs to look good, the leg press can do that, too.  To state it simply, the leg press is extremely important. 

Improper Use and Knee Pain

1. When a trainee is feeling knee pain on the leg press, the first factor I look at is use of the feet.  Is he pushing through the heels or toes?  Knee pain during the exercises often occurs when people start pushing through their toes, which is the opposite of how the leg press should be performed.  Pushing through the toes overemphasizes the calf muscles, decreases the use of the glutes, and puts a lot of force (and stress) on the joints of the feet as well as the knees.  If a simple reminder doesn't correct this problem, keep moving your feet up on the footplate, one inch at a time, until it's easy for you to push through your heels.  
2. The seat may be too close to the footplate.  The greater the bend is in your knee, the weaker the quadriceps are.  If your leg press seat is too close, not only is your knee stressed, but your lower back may be as well.  I prefer to move the seat in as close as possible before your hips slide down in the seat (if you have a large gut or a current hip pain/injury, you probably have to move the seat further back).  
3. Going back to the feet, a source of knee pain on the leg press is often inward rotation of the feet.  Inward rotation is when your toes are closer to each other than your heels are.  If your feet are turned in, your hips are improperly positioned and may hurt in addition to your knees.  Ideally, your feet should be parallel to each other (although this may not work for some people, but I'll get to that soon).  

  Your Setup is Perfect but You're Still Feeling Pain

Are you out of luck?  No.  Here are a few effective tricks for eliminating knee pain on the leg press:

• You might have your feet high enough to easily through your heels, but you still feel pain.  Try moving your feet up anyway.  As you see in the picture above, the woman has her feet so high that the toes are off the footplate.  This strategy is also effective for people with past ankle injuries as it limits ankle flexion in either direction.
• Some people are accustomed to walking with their toes pointing away from each other.  For these people, having parallel feet on the leg press might cause knee discomfort.  Pointing the toes outward may help relieve the discomfort. 
• I'm sorry that I have to include this one in (you'll see why), but your footwear could be the source of your knee pain as well.  If you wear shoes that have an elevated heel, such as high-heeled shoes, it will naturally force you to push through the toes. (Side note: you might think I'm being ridiculous for putting this in, but sadly, some clients show up to work out in high heels...I'm much, much clearer on my dress code now).  Also, shoes with rounded bottoms, such as the Sketchers Shape-ups, also naturally promote pushing through the toes (and no, they don't have magic powers for burning calories or "toning" your butt).  Avoid using any shoes that have rounded bottoms or elevated heels.  

If you have any additional tricks that have worked for you or your clients, please share via the comment section.  The leg press is too important to drop from your routine when pain could be relieved with a simple adjustment.