View Full Version : Hiking with chronic knee pain tips/tricks/advice
Has anyone spent extended time on the trail with a chronic knee injury? I'm 34 and hiking is my favorite hobby but my left knee sometimes inflames due to a five year old injury. I have a Baker's cyst from said injury but my MRI shows no other obvious problem. An x-ray doesn't really show arthritis either. My wife and I had plans to start travelling and hiking extensively in July, including the 100 mile wilderness (maybe more). My latest set back has me frustrated. It's likely I'll pursue an exploratory arthroscopy this winter to be sure there isn't something the MRI isn't seeing causing my problem.
I'm wondering if anyone has any tips or tricks beyond the obvious for making the most of hiking while dealing with a chronic knee injury. A knee brace helps stabilize the knee a bit. I've always hated hiking poles but I understand now that they're probably not optional for me any longer. I'll be picking some up at REI this weekend. I know downhill is the worst part as far as impact on the knees goes and I've been working to retrain how I hike to actively engage the hamstrings when going downhill so that the movement is more smooth and deliberate instead of the jarring incurred by simply allowing the earth to stop your foot against the force of gravity.
Thanks in advance for any input!
MuddyWaters
05-10-2018, 13:55
What kind of conditioning do you do for it?
Does it only hurt when you go hike or does it hurt all the time?
I would not let a doctor do anything until I exhausted physical therapist route. And not even then if it was something I could live with. Doctors do not always make things better.
I posted this same question on the Facebook 2018 SOBO group, in case anyone is a part of that and wonders.
What kind of conditioning do you do for it?Does it only hurt when you go hike or does it hurt all the time?
I would not let a doctor do anything until I exhausted physical therapist route. And not even then if it was something I could live with. Doctors do not always make things better.
I do understand that doctors don't always make things better, which is the main reason why I haven't done anything significant before now. It only hurts during physical activity and even then only under certain conditions. I was a stock clerk at a grocery store for two months this winter and when I wrapped that up my knee was the best it's felt since the original injury in January 2013. It felt good enough that I thought I'd try racquetball once a week to see how it felt (I haven't really been able to jump since the injury). The knee felt great initially but after about the 5th week it was a little sore. I've become pretty good at judging how sore is too sore over the years so I thought I was still okay. I went for a 6 mile walk several days later (felt great during the walk) and the next morning my knee was inflamed like it hasn't been in a year or more. I was legitimately hobbled for about two weeks.
Subsequently, I've begun a physical therapy regimen on my own focusing on strengthening the patellofemoral muscles and I just noticed last night that my left quadriceps is significantly smaller than my right one. It was shocking. However, I can't straighten my left knee those last 5 degrees from 0 to -5 so that could be having an effect on my ability to completely contract that quad. As soon as my legs get strained under load I start to favor the left leg as that knee fatigues faster so I suppose it's not surprising that that muscle group is smaller but damn, it was kinda scary to see the difference. I'm seeing a PT center that has a great reputation for sports medicine next Wednesday to put together a plan for my specific symptoms.
The orthopedist I saw told me right up front that exploratory arthroscopy has probably a 50/50 chance of doing anything for me. He said sometimes they'll find something that an MRI doesn't pick up but other times not. It's clearly not anything significant like a meniscus or ligament tear or it would show up in the images.
Fortunately I'm not working right now so I intend to approach this like a professional athlete. I will make it my full time job if need be to run this to ground. I'm cognizant of over-use as well though. I'm just fed up after feeling the best I have since injury just a couple months ago and having a bad set back.
stephanD
05-10-2018, 14:25
A. Hiking poles are a MUST. Get the best you can afford.
B. Get a knee brace, but not the cheap ones from the over the counter pharmacies. mine cost me about $60.00 plus from a specialty store, and i would pay as 10 times as much for it.
C. use NSAIDs sporadically. They interfere with the body's natural healing process, and they have some bad side effects.
D. Take zeros whenever your body/knee tells you. Know your limits. Don't listen to those who tell you to walk "through the pain".
E. When going on steps/rocks down hill, take one step at a time, regardless of how long it takes you.
That's what i can think of right now. I'm sure there are more good tips, advises out there.
Uncle Joe
05-10-2018, 14:32
If possible, add pedaling to your regimen. Cycling or even a stationary bike puts your body in a fixed position and allows good working of your knees. Stretching would probably help too.
MuddyWaters
05-10-2018, 14:50
Sometimes things hurt and you can't figure out why.
If your knee swells they ought to be able to figure out why that means something is wrong. If it just hurts, things hurt sometimes.
I fought an elbow injury for years that happened to my senior year in high school, ( a damaged ligament in my elbow). kept me from throwing and made me quit playing baseball. After 10 minutes of throwing or batting practice my elbow would throb until I needed to roll around on the ground screaming. Once's the pain came on took it about 30 min to go away Doctor couldn't figure out what it was so I quit playing ball. Bothered me on and off for about 15 years after, even when swimming, and and I finally noticed it wasn't there anymore when my kids started playing ball and I was throwing with them.
I think it was Scar Tissue pushing on a nerve somehow. But the moral of the story is eventually it went away.
Sometimes things hurt and you can't figure out why.
If your knee swells they ought to be able to figure out why that means something is wrong. If it just hurts, things hurt sometimes.
I fought an elbow injury for years that happened to my senior year in high school, ( a damaged ligament in my elbow). kept me from throwing and made me quit playing baseball. After 10 minutes of throwing or batting practice my elbow would throb until I needed to roll around on the ground screaming. Once's the pain came on took it about 30 min to go away Doctor couldn't figure out what it was so I quit playing ball. Bothered me on and off for about 15 years after, even when swimming, and and I finally noticed it wasn't there anymore when my kids started playing ball and I was throwing with them.
I think it was Scar Tissue pushing on a nerve somehow. But the moral of the story is eventually it went away.
There's definitely an acute injury at the root of this. The initial injury back in 2013 was on a jump to spike a volleyball. Landed, heard a pop, and the knee gave out. MRI results not conclusive but might show partial ACL tear. For a good two years I couldn't jump. Just the effort of taking off, that explosive movement, was excruciating. PT helped some but I admittedly didn't give it the attention it really deserved back then.
Second orthopedist visit in 2017 was precipitated by an attempt to return to the gym, only to bail after 2 months due to the new patellofemoral pain in the front of the knee accompanying the original symptom of swelling of the synovial fluid and pressure in the back of the knee. That doctor, who was considered one of the best in the area, thought I was headed for ACL replacement surgery after the physical exam only to be surprised by the new MRI showing an intact ACL.
The symptoms of the initial injury match an ACL tear almost verbatim, so I was a bit disappointed to see an MRI refute that without showing any other reason for the issues I was having.
Based on this latest setback coming on the heels of feeling the best since injury, it seems highly likely that even with a successful, intensive rehab regimen I'll probably never jump again. The setbacks have always been when I felt like the knee was improved enough to try jumping. Trampoline, racquetball, etc. I'm willing to accept that but I can't give up hiking. That's a deal breaker for me.
Don't attempt to do any knee exercises. Physical conditioning of your knee will do more harm than good. Try to control swelling and pain with medication. On the steep downhill sections go slow and stop frequently. Embrace the suck.
Fear: Can I hike the AT again??
Yesterday, I had knee surgery.. something long in coming.
Several months ago, I went in for left knee pain. I was told it was probably arthritis. After several months of increasing pain, I went back, had an XRAY, and was told it showed up as arthritis since I didn't have any popping or clicking. Two months after that, I called my doctor back and LIED! I said it was popping... so he sent me for an MRI. . The MRI showed TWO meniscus tears! One was to the Medial Horn and the other to the Medial area - a flap tear.
Ok... so now things get moving! I was scheduled for surgery and told that it should be able to be cleaned up enough that I can train to hike the AT for 200 miles in August and run a 1/2 Trail Marathon (did one last year but have been completely sedentary for the past 6 months due to knee pain).
Yesterday: Surgery... While I was unconscious and recovering, my son was told the surgery took longer than expected because I had more than two tears... I also had cartilage damage - apparently, my cartilage looks like it was struck by a cinder block." (I did have a fall on the AT on rocks last year... limped for a couple days - but then kept going. Not sure it that was when this happened).
I will not find out more until the 22nd. What I am getting at is... push to find out what is wrong... then, research it (in Medical Journals - not online - or seek the opinion of other doctors who are conservative about surgery , but acknowledge problems.)
After yesterday, I am willing to give up running if necessary. I am only hoping that I can continue to hike the AT. I am 950 down (sectioning a portion each year - live too far to go more than once a year to the trail). I hoped to do another 200 this year and be half-way done. This is a major bucket list item for me... I understand where you are at... don't give up... but push ahead and find answers!
~Shelb
Trailname: Einstein
fiddlehead
05-10-2018, 20:22
I've had a bum knee since the 70s.
Done 6 thru-hikes since the plus lots of overseas hiking.
Here's how I attack a downhill:
Lean back slightly.
Never straighten the knees (bent a little bit always)
Widen my stance a bit. (sort of imitate one of those Chinamen who pull a rickshaw with their wide stance, short choppy steps if that makes sense to you)
Take short steps and approach each steps as if it were icy or slippery rocks that you are going to step on.
That way, you never put all your weight on any step, just quick little steps with a wide stance.
It works for me and I go down hills fairly fast.
I also take glucosamine a few months before a hike and during (sometimes, depends on the length of the hike, on my last 2 I stopped when the hike started as I hate taking pills)
I also wear a cheap knee brace. (last year on my 800 mile Via Dinarica hike, I lost it half way through and a week later, I could feel the knee pain coming back. So I bought another one although all I could find was size large and I really take a medium. It still helped a lot and the knee pain was minimal.)
Good luck with your problem
BuckeyeBill
05-10-2018, 20:51
I also suffer from knee pain. My pre-hike training includes trips to the local Y and walking on the treadmills. I usually do 20 minutes with a slight elevation. I then raise to a full elevation and do another 20 minutes. I then slow things down a little bit and turn around and do a downhill simulation for another 20 minutes. I ask another person to lower the treadmill a little and finish with a downhill for 10 minutes. I do this for a few weeks 3 times a week. After that I up the training by wearing my pack with a little more weight than I would be carrying on my hike. I get some strange looks from some members, but the staff knows that when I walk in with my pack I am going somewhere to hike.
Traveler
05-11-2018, 07:34
To the OP, and for what its worth, I respect anyone who stays on trails having chronic joint pain. Having had knee issues for a very long time, I have tried a number of remedies and combinations. What I have found works for me is:
I have been using knee compression sleeves (Tommycopper.com) for the past several years and found them to be very helpful in providing support. I went through a variety of knee braces and support products before stumbling into the compression sleeves, which is probably the path you are on now, or if not soon will be. The braces and bands did not work as well as these do.
Trekking poles take 20% to 30% of impact off the hips, knees, and ankles, provide stability and in some instances as I have gotten older, agility (never mind being handy for a variety of uses from picking up dropped items to fending off errant dogs. I have used these devices for a number of years and credit them for getting me this far.
Evolving hiking strategies are necessary as well to accommodate or manage pain. Steep grades can really aggravate knees, even using poles, so adopting a short switchback style of downhill walking helps lessen the impact of these grades just moving from side to side instead of straight down. Slowing down also helped, perhaps more than most anything else. Slowing my pace from 3.5 - 4 mph or so downhill to 2.5 mph had startling impact reduction results.
I also am careful to use Ibuprofen (or other pain meds) sparingly when hiking, as it has a tendency to mask changes in pain level. I monitor knee pain and have found it reaches a point where it does not worsen unless conditions do. Increasing pain gets my attention and causes me to change how I am walking that eases the pain back to where it normally resides. Ibuprofen masks that, which has resulted in some swelling or tenderness that could have been avoided. If when I am done for the day there is post hike pain, then I will reach for the Ibuprofen.
There is merit in stretching and conditioning exercises of course, which can strengthen muscles that support joints. But at the end of the day the pain is likely to be with you and I found the list above to have worked well in combination.
I wish you well in your pursuit!
Runner2017
05-11-2018, 08:32
Has anyone spent extended time on the trail with a chronic knee injury? I'm 34 and hiking is my favorite hobby but my left knee sometimes inflames due to a five year old injury. I have a Baker's cyst from said injury but my MRI shows no other obvious problem. An x-ray doesn't really show arthritis either. My wife and I had plans to start travelling and hiking extensively in July, including the 100 mile wilderness (maybe more). My latest set back has me frustrated. It's likely I'll pursue an exploratory arthroscopy this winter to be sure there isn't something the MRI isn't seeing causing my problem.
I'm wondering if anyone has any tips or tricks beyond the obvious for making the most of hiking while dealing with a chronic knee injury. A knee brace helps stabilize the knee a bit. I've always hated hiking poles but I understand now that they're probably not optional for me any longer. I'll be picking some up at REI this weekend. I know downhill is the worst part as far as impact on the knees goes and I've been working to retrain how I hike to actively engage the hamstrings when going downhill so that the movement is more smooth and deliberate instead of the jarring incurred by simply allowing the earth to stop your foot against the force of gravity.
Thanks in advance for any input!
It seems like your body has inflammation which could largely come from intake of animal proteins. Cutting down or eliminating meat, cheese and diary from your diet can significantly reverse and even make your pains disappear entirely. Just watch YouTube channels of Dr. McDougall, and Dr. Michael Greger for guidelines.
If you don't want to change your diet/lifestyle choice, you can take Mega Red Joint Care supplement, which is made of Omega 3 rich krill oil. It's scientifically proven Omega 3 oil can numb nerve feedback system so you won't feel as much knee pain as a result. But be aware that you are playing fire with your nerve system in this way.
I've hiked with knee pains over the years and I appear to have survived them. I've have been prepared to drag one leg after the the other after a weekend or week of hiking as a standard ritual until one day it quit hurting me. Not sure what I did but I've have a few suggestions.
1. Hiking poles, yes they became a part of my hiking and I've haven't considered hiking without the poles (and straps) since .
2. Hiking shoes, I wonder why I ever got into boots but it's pretty standard for thru-hikers for many years.
3. Lots weight, I dropped from a high of 260 to 175 and it has been wonderful.
I'm not saying anyone of these is mandatory, just saying that all three have been important to my life and I'd strongly recommend anyone hiking to strongly consider them. During my 2011 AT thru-hike I've hiked without any knee pains and it's been a wonderful experience.
greenmtnboy
05-12-2018, 10:05
I'd go the natural approach; essential oils like Tiger Balm, etc..; avoid all junk foods, instead follow a nutrient dense diet full of minerals, protein and other quality products. Only use pain killers as a necessity which just turn off nature's signals that there is something wrong. Don't overdue it!
When I have knee pain after a hike, I apply curd. Helps better than most drugs. In lack of curd, you can use plain yoghurt or similar diary product too.
I would be very hesistant to undergo an exploratoty arthroscopy. A knee can get worse if something goes wrong.
fiddlehead
05-12-2018, 22:26
Have a good friend who has had knee problems from torn cartilage for a long time.
He's been researching and putting off surgery.
Now he's decided to try stem cell treatment.
Heading to Vegas as he says they seem to be on the cutting edge out there.
Not sure which company but I'll ask.
Sure sounds like an attractive solution (if it works)
He said it's around $4k.
I'll guess it will take a year to really know.
I'll try to keep all informed here on whiteblaze.
The funny thing is that a long distance hike could possibly be the best thing for me. Absent major trauma, which I don't have, the most likely source of my problem is muscle weakness. That's why people are referred to PT. For the first four years after the injury I never had patellofemoral pain. But it's possible, perhaps likely, that my continually weakening quads have allowed my patella to not track properly, starting the wear of cartilage, which also causes inflammation, which leads to more synovial fluid, which leads to an enlarged popliteal cyst, which limits range of motion, which leads to even less activity. The whole thing could be one big downward spiral.
When I was stocking groceries for two months over the winter I was squatting hundreds of times per day. It hurt at first but I lived on Ibuprofen for a few weeks and kept going because I had a job to show up to. Interestingly, by the end of that two months, my knee felt the strongest it's been since injury. Which led to my latest attempt at thinking I could occasionally play sports and this setback.
Perhaps a long distance hike, keeping close control on mileage and extra focus on slow downhill (the impact part), would be another form of intensive, but controlled PT. That's basically what my grocery stocking experience was.
And you get the two-for of weight loss, which I'm working on anyway. I'm already down 20 pounds since my thru-hike attempt in 2016 and I intend to lose another 30-40 pounds by the end of the year. That would put me at a good weight (185-195) for my height (6').
I won't spring this on my physical therapist first thing but it's something kicking around in the back of my mind. We could start in MD, only 30 from our parents' houses, in an area with plenty of towns and civilization. That would make for an easy start at a light weight. I guess I'll just have to see how the next 7 weeks progress until my wife is finished working.
It would surely be ironic if my injury is was spurred me to complete the thru-hike I've wanted to do, after a failure just two years ago, and finishing the hike made my quads the strongest they've been since initial injury.
The big down side of a long distance hike is that it's impossible to eat a solid low-inflammation diet. There is that, which could end up being a key part of minimizing the inflammation in my knee and allowing it to get stronger without reinflamming.
I've had knee issues for years (torn menisci and arthritis)due most likely to sports injuries. I strongly recommend PT as opposed to surgery-I've had both. In 2013 an MRI showed a big meniscus tear in my rt. knee, but I decided against surgery as I had already lost the other meniscus in that knee and didn't want to lose any more cartilage. I did the excercises religiously and in one month things had turned around to the extent that I was able to finish NH without too much issue a couple months later. The beauty of PT is that when I start to have problems again I start the excercises and so far it has kept straightening things out. I also wear a knee brace when hiking, usually just a neoprene sleeve, but take a heavy duty hinged one with me just in case. I never had ACL issues, but hopefully this info is helpful.
Bottom line-my knee issues have never stopped my AT hiking-I've had to get off and heal on occasion, but only temporarily.
The big down side of a long distance hike is that it's impossible to eat a solid low-inflammation diet. There is that, which could end up being a key part of minimizing the inflammation in my knee and allowing it to get stronger without reinflamming.Look into getting some turmeric, natural anti-inflammatory and it can be added to all kinds of food.
The big down side of a long distance hike is that it's impossible to eat a solid low-inflammation diet. There is that, which could end up being a key part of minimizing the inflammation in my knee and allowing it to get stronger without reinflamming.
This is true, but being aware of low inflammatory foods and supplements and following as well as possible can only help. Also, if your inflammatory load is minimal at the start of hike (through diet, supplements, medications) you will probably have less pain.
Not sure if mentioned already but... hiking poles plus little bitty steps (sometimes sideways cha cha steps) on downhills helps my knees tremendously.
Consider rice when possible. Rest, ice, compression (or cold spring water compress), and elevation with rest stops and in evening.
best of luck to you!