To Leg Press or Squat if You have an ACL Injury?

To Leg Press or Squat if You have an ACL Injury?

Squat and leg presses exercises improve one’s overall lower body strength. In resent research, they had experienced male lifters performed squats, high foot placement leg presses and low foot placement leg presses with technique variations in order to measure the amount force at the knee joints and the muscle activity while performing these activities. This was a way to determine which among these exercises is more effective in muscle development. The results revealed that the squat appeared to be more successful in achieving this goal. However, because muscle activity and knee forces are greater with squats, those diagnosed with posterior cruciate ligament and patellofemoral disorders must be especially cautious on knee bending at great angles (>50-degrees).  ACL patients on rehabilitation may effectively do the squats and the leg presses.

Highlights of Leg Press and Squat Forces and Muscle Activity

1. No difference in muscle activity or knee force in squat or leg press when feet were straight ahead or turned out 30 degrees.
2. Squat had greater quadriceps and hamstring activity than the high and low foot placement leg press.
3. The wide stance foot placement leg press generated greater hamstring activity than the narrow stance foot placement leg press.
4. Wide stance foot placement created greater posterior cruciate ligament tensile force than narrow foot position.
5. The narrow stance foot placement generated greater tibiofemoral joint and patellofemoral joint compressive force than wide stance foot position during the low and high foot placement leg press
6. The wide stance foot placement generated greater tibiofemoral and patellofemoral joint compressive force than the narrow stance during the squat.

Take Home Message about Squat and Leg Press for ACL

PATELOFEMORAL DISORDERS
– Avoid wide stance squats
– Avoid narrow stance leg press
– Patelofemoral  joint force increased with depth of the squat or leg press

ANTERIOR CRUCIATE LIGAMENT DISORDERS
– All exercises are good for ACL rehabilitation due to low force on ACL

POSTERIOR CRUCIATE LIGAMENT DISORDERS
– Avoid wide stance leg press
– Greater force place on posterior cruciate ligament with deeper squat and leg press

TIBIOFEMORAL JOINT DISORDERS (Meniscus or Osteoarthrtis)
– Avoid wide stance squats
– Avoid narrow stance leg press
– Tibiofemoral joint force increased with deep squat or leg press

FOOT POSITION
– Changing the foot position in the squat or leg press has no effect on the muscle activity or knee forces.

FOCUSING ON QUADRICEPS
– The squat is better

FOCUSING ON HAMSTRINGS
– The squat is better
– Wide stance is better

The Last Word from Rick Kaselj

What does all this mean?

The above points are important to consider if you have a client that is in the early rehabilitaiton process with the above conditions.

The above are some good guidelines for exercise modification for clients that may come to you with the above conditions.

When a client fully recovers from their injury, the above may not have much influence on their goals and training.

Where to Get More Information

Escamilla RF, Fleisig GS, Zheng N, Lander JE, Barrentine SW, Andrews JR, Bergemann BW, Moorman CT 3rd. (2001). Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc. 2001 Sep;33(9):1552-66.

If you are looking for effective exercises for knee injuries, I would recommend checking out Exercises for Prevention, Rehabilitation and Overcoming Knee Injuries webinar .

If you would like to attend one of Exercise Rehabilitation of the Knee live course, CLICK HERE.

Rick Kaselj, MS

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