Help with knee pain

[Squirrel29]

Whats the best way to get rid of and prevent hikers knee?

[Turtle-2013]

I'll be interested in the responses you get... I actually have one knee that had a total ACL reconstruction years ago and when I started section hiking I had one trip that I had to come off the trail early. Since then I have always carried ibuprofen (which works well for me), but I use it less than I did for a while. I think the primarily "cure" has been strengthening the knee so that it is more prepared for the miles. These days I generally do 16-20 mile days and might take something once or twice during a week-long trip, generally to calm the knee so that I can sleep at night. BUT, I will be interested if you get some useful suggestions.

[MuddyWaters]

Whats the cause?

Not all pain is same

And normal people, have none

[MtDoraDave]

Go easy for a while, go even easier on the down-hills. This is hard when you are cardiovascularly fit...at least for me.
If I get in a hurry, I find that I stomp my feet somewhat. When I notice this, I have to remind myself to "place" my footsteps.
.
Overall, my knees hurt far less than before I started hiking back in 2014.
.
Other tips:
Use trekking poles.
Spend the time (research) and money to get lightweight gear.
.
And, yeah, ibuprofen does wonders for me when I overdo it.

[GoldenBear]

Having torn my knee's MCL to the point of requiring surgery, I have personal knowledge on this issue.
How to handle the problem?
1) If you ignore this suggestion, all other steps that follow will be meaningless. So I list first
DON'T OVERDO IT!
Next to your feet, your knees are probably the most vulnerable part of your body, to the stress of back-country hiking. So be gentle with them. Don't hike too far, or too fast, or too quickly up/down hills. And if you start to feel pain in your knees, change SOMETHING -- your speed, your route, your amount of rest.
2) Exercise your legs in the weeks prior to hiking by going up & down steps, repeatedly. Yes, it's terribly boring to walk up & down, up & down, up & down, etc. But it's the best way to get your muscles in shape for The Trail. Just don't forget #1 at this point!
3) The efficacy of stretching either before, during, or after exercise, as a means of avoiding injury, is a contentious issue. I'm not qualified to make a judgement on this.
4) Periodic rests -- 55 minutes hiking, five minutes sitting -- have helped me maintain overall strength through an entire day of walking.
5) If knee pain starts while hiking, locking the knees -- ie, not bending them at all -- is a good way to slow down the pain.
6) If pain continues; rest, elevation, heat, and massage have helped. I personally do NOT like pain-killers, as I consider pain to be a vital message telling me, "You're doing something wrong!" Others will probably recommend taking daily pain killers.
7) If pain still continues, consult your doctor. My surgery kept me away from backpacking for thirty days, but I have since done over 1000 miles on the A.T., and have no plans to stop. If I had tried to hike through the pain, I might have been permanently on crutches within a few months.

[RockDoc]

Reduce body weight, pack weight
Strengthen muscles around knee
Find a quality brace or compression sleeve
Be gentle descending hills

[nsherry61]

1) Build up slowly and consistently. Strength is you most powerful tool and building up slowly and consistently is key to limiting injury and maximizing strength. Consistency is key to staying strong so you are ready physically when opportunity knocks.

2) Use trekking poles. Poles may only increase your overall performance by 10 to 30%, but they can reduce the peak knee stress for any given step by huge amounts. 90% of your damage comes from the 10% (actually probably more like 1%) of your knee use that is peak stress. Use those poles.

3) To my knowledge, there is inconsistent data to support the use of the joint supplements chondroitin and glucosamine. But, in my case and my orthopedic doctors case, we both see significantly reduced knee pain in association with taking chondroitin and glucosamine. So, it's probably worth a try. My personal knee pain improvement has been pretty dramatic after taking it for a while.

4) Tendon massage can be quite helpful for knees as well as other places (like the achilles). For IT band issues, those painful foam rollers have an excellent reputation. My patellar tendon is to strong to effectively massage by hand, so I massage it using a rolling pin, a broom stick, or my folded up trekking pole working back and forth (not up and down) and massaging to the point of pain and not into pain. The object is to break down the tendon material bit by bit so that it can rebuild under controlled consistent training load and not damage it. I can generally get pretty good results from achilles massage by use of my thumbs or more gentil use of my trekking pole/broom stick, or whatever.

5) NSAIDS (naproxen, ibuprofen and the like) can be super helpful, especially when used short term (days to weeks, not months) to reduce inflammation and the associated irritation causing inflammation, causing irritation causing inflammation, etc. I will often use NSAIDS to allow me to hike a particular hard day or to recover from one without causing damage from sustained inflamation. I am not a fan of regular or extended use of them as, at least for me, I start getting some significant internal pain and bleeding in my bowels. Your mileage may vary.

6) Finally, the last thing I've found to be truly significant in managing knee paid is body weight. I am not particularly fat at 6'4" and 220 lbs, but one of the most dramatic changes I've experienced in reducing knee pain was when I dropped my body weight down to 195 lbs (not especially lean, but lighter). Suddenly, for the first time in years, I could run up stairs daily and not experience pain in my knees. It was awesome . . . time to get more disciplined and get down there in weight again!!

[Traveler]

I am not sure what "hiker knee" entails. There can be a number of reasons for knee pain while hiking, some of which may have nothing to do with hiking itself. Just reaching one's late 30's the development of pain due to aging, joint wear, or disease can start to be noticed.

With a vast overarching description of "hikers knee" there is not enough information to make more than generalized exercise suggestions or offer some hiking techniques that may reduce the symptoms but may do little to address the underlying cause. Some questions that a medical professional may ask:

Physiological questions would likely include: Do you experience pain in one specific knee or both? Do you experience this pain during any other activity like yard work, going up and down stairs, or other common activities during day? When hiking, is this chronic pain in one or both knees all day? Is it pain that occurs when climbing or descending steep places? Is it pain that does not go away after a nights rest? Is there swelling? Does the pain continue to intensify or does it reach a certain level and remain at that level for the duration of the activity? Are you pushing for faster trail speed and stretch your gait to accommodate speed? Is there pain from the first step, pain that comes and goes during the walk, or mostly after completion of the day's walk?

Gear and conditioning related question may include: Do you use trekking poles or other walking aids? Do you wear a pack? Does the pain come and go with a pack on or off? What is your pack weight? What is the foot gear you use? What kind of terrain do you typically hike? What is your body weight? What is your level of physical health/condition? Do you have a regular exercise program or is it sporadic? Do you have any knee pain when jogging or during weight workout (squats, Nautilus equipment)? Are you in an occupation that involves using knees as tools like carpet installation? Have you had injury to your knee(s) early in life from sports or other activities?

There are some good suggestions already from this forum to try, however development of recurring pain should be checked out by a real medical professional to get to the root cause. It could be something as simple as trying to stretch your stride too far for speed, hauling too much weight, footwear issues, or it could be a different part of the body like hips, back, or ankles that you have subtly compensated for under normal conditions that now manifests in knee pain when hiking.

Knee pain and other maladies as we age can be vexing problems to solve. Good luck!

[Time Zone]

1. Consult a medical doctor qualified in orthopedics
2. Try hiking poles. I find them especially helpful in reducing knee pain while descending.

[Venchka]

I’m older than dirt.
I have had good results for hip and shoulder pain after a thorough consult with my GP Doc and an 18 day tapering course of Prednisone.
A seven day infant dose of Prednisone from an Urgent Care Shop in Colorado was useless.
I now carry the directions for the Prednisone with me. If my doc agrees, I’ll carry the 40 pill prescription in my first aid kit.
YMMV.
Wayne

[Nanatuk]

I've been using an inversion bench to stretch my back. I've discovered that my knee pain is not my knees, its coming from my spine. I've found that all my hip and knee pain is easily managed via decompression of my spine.

YMMV

[Venchka]

I’m older than dirt.
I have had good results for hip and shoulder pain after a thorough consult with my GP Doc and an 18 day tapering course of Prednisone.
A seven day infant dose of Prednisone from an Urgent Care Shop in Colorado was useless.
I now carry the directions for the Prednisone with me. If my doc agrees, I’ll carry the 40 pill prescription in my first aid kit.
YMMV.
Wayne
PS:
All of the great conditioning and strengthening advice above is important for long term pain free hiking.
However, if you’re hobbled and virtually crippled by joint pain there’s little you can do to start the prevention training.
When I returned from Colorado in August I could barely walk due to persistent hip pain. Thanks to the Prednisone I’m now pain free, walking daily and getting stronger every day.
A comprehensive plan is needed.
Cheers!
Wayne

[ldsailor]

I eliminated knee problems (and ankle problems) by exercising and strengthening the muscles around the knees and ankles. The first LASH I did of 532 miles I wore a knee brace on one knee and then the other. There was a lot of pain. I also had a sprained ankle, and I wore an ankle brace. When I got home, I went to a physical therapist who had me do exercises to strengthen the knees and ankles. My next AT LASH of 750 miles there was no pain at all, but I still wore a brace on my left knee. This year I eliminated the brace altogether on my 595 mile LASH and again had no pain.

There is no substitute for exercising and any exercising you do must be ongoing. I guess you can start a few months before your hike, but the best way to do it is exercise year round.
I'm told a brace actually serves to weaken the knee muscles; although I don't know how true that is. Do a Google search for exercises. You'll get a lot of hits.

[Captain Panda]

Great advice from everybody. Most of the induced knee pain while hiking is associated with the physics of going downhill with weight on your back. That creates quite a load on the knees with each step, and the repetition eventually causes pain and inflammation; or worse. When descending (even mild descents); I keep my palms down on top of the pole grips, and try to cushion each step by absorbing a significant amount of the load into my arms and upper body. I have a wonky knee, and this technique really reduces the discomfort.

[MuddyWaters]

Theres joint pain......more serious
Theres strain of muscles and tendons around the knee area...less serious.

You can alleviate muscle/tendon issues with conditioning.
The best conditioning for overuse injury....is repetitions....running.

Soft braces correct /aid mechanical problems.

[Five Tango]

Can't speak to anyone else's issues but things that have helped me since turning 40 about 26 years ago include the following: orthodic inserts in all shoes(keeps everything lined up).If you have unusual wear on heels of dress shoes or work boots that have heels that could be what it means.Also,an inversion table and a Total Gym for lower back and leg exercises,Tommy Copper compression sleeves,(always in my pack because they are light weight and very helpful), and supplements like Tumeric have helped.Not everyone can take NSAIDS like ibuprofen but I can take regular or baby asprin and I do take both twice per day.And hiking sticks because they shift pressure away from the knees as others have stated.

[Squirrel29]

Thanks for all the info, sounds like to much to fast. I have always day hiked and have wanted to start backpacking. So on the rare chances I get to go I carry about a 33# load for about 6 miles with only normal aches that are gone by morning without taking anything. This day I went about 12 1/2 miles with only about 30 min. total rest in around 6 hours. No problems until the last 2 miles which some of it was a very steep decent. Still did not stop thinking I will rest on the way home. The pain fells like it is under one side of my left knee cap, the rest of my body is fine no pain at all. I will take yalls advise and work on strengthening my knees. Thanks again

[Venchka]

Sneak up on the distance and the load. Distance first for awhile. Then gradually increase the load.
Variety is the key. Give your body time to adjust.
Wayne

[jimmyjam]

Talk to an orthopedic doctor and have him develop an exercise plan for you to strengthen your knees.

[Alligator]

Seeing a knowledgeable doctor would help a lot to determine your specific issue. I had knee pain for a number of years while backpacking and it really helped to know my specific problem (ITB). Lots of good advice here though but not all will be applicable. For instance, for me, I already have strong legs but when my IT Band gets tight and causes knee pain I make sure to stretch it out with a foam roller. A physical therapist may also be helpful to prescribe appropriate treatment for your condition.

[Deserthikes]

Have you tried trekking poles?

[shelb]

Have you tried trekking poles?

DEFINITELY, helpful!

Last year, I added Walgreens/CVS knee braces.

This spring, I had knee surgery and was told that I have extreme arthritis in both knees - looking at knee replacement in the next few years. I researched and found numerous positive reviews for the "Cho-Ban" knee braces off Amazon. I bought two. Strangest thing occurred: my knees felt better on the AT than they do going up and down the stairs at home!

[Dogwood]

I was having some knee pain. Found out through a chiropractor I was misaligned. Turned out when I took my fat arse wallet of my right back pant's pocket where I had always stored my wallet the knee pain stopped. Coincidence? I dont think so. Seemed I was propped up on one side leading to the issue. Posture improved at the same time.

Some hiker knee pain is caused by going too rough ergonomically inefficiently or too strenuous on ascents and especially descents. I see many backpackers pound down hills taking deep riser step downs. Always shorten the riser heights. Dont engage in deep knee bends with heavy loads all day day after day. Keep feet undernbeath you. Dont haul too heavy a pack going too far beyond your comfort zone for awhile. Make sure your pack fits and is adjusted correctly. I gained a valuable lesson when I learned I was over tightening one shoulder strap. It caused spinal mis-alignment from which I was favoring one side of my body making one knee do more work than the other. I've learned to not do that and alternate which foot and sided I lead with while hiking. See what happens. Employ trekking poles RIGHTLY taking wt off your gait. SHORTEN your gait. Take smaller steps. Avoid the role polly rocks and debris. See your doc. Stretch correctly.

I take 23 -32 different supplements. About 1/3 are for joints, ligaments, and muscle recovery. Unequivocally they work. No one supplement has been a lone silver magic bullet though. I would know after yrs of semi pro tennis, HS/college/rec basketball, engaging in high impact aerobics 4x weekly for 1.5 hrs per session when it was the fad, being an asphalt and trail runner, and LD hiker. I'm a firm believer in and dedicated to a non inflammatory lifestyle. It used to be when I bent down or rolled my wrist, ankles, or neck it was like gravel in my body with all manner of grisly sounds. No more. AND, that's when I was younger. SO, I GOT BETTER as I aged in this regard.

[Astro]

I was having some knee pain. Found out through a chiropractor I was misaligned. Turned out when I took my fat arse wallet of my right back pant's pocket where I had always stored my wallet the knee pain stopped. Coincidence? I dont think so. Seemed I was propped up on one side leading to the issue. Posture improved at the same time.

Some hiker knee pain is caused by going too rough ergonomically inefficiently or too strenuous on ascents and especially descents. I see many backpackers pound down hills taking deep riser step downs. Always shorten the riser heights. Dont engage in deep knee bends with heavy loads all day day after day. Keep feet undernbeath you. Dont haul too heavy a pack going too far beyond your comfort zone for awhile. Make sure your pack fits and is adjusted correctly. I gained a valuable lesson when I learned I was over tightening one shoulder strap. It caused spinal mis-alignment from which I was favoring one side of my body making one knee do more work than the other. I've learned to not do that and alternate which foot and sided I lead with while hiking. See what happens. Employ trekking poles RIGHTLY taking wt off your gait. SHORTEN your gait. Take smaller steps. Avoid the role polly rocks and debris. See your doc. Stretch correctly.

I take 23 -32 different supplements. About 1/3 are for joints, ligaments, and muscle recovery. Unequivocally they work. No one supplement has been a lone silver magic bullet though. I would know after yrs of semi pro tennis, HS/college/rec basketball, engaging in high impact aerobics 4x weekly for 1.5 hrs per session when it was the fad, being an asphalt and trail runner, and LD hiker. I'm a firm believer in and dedicated to a non inflammatory lifestyle. It used to be when I bent down or rolled my wrist, ankles, or neck it was like gravel in my body with all manner of grisly sounds. No more. AND, that's when I was younger. SO, I GOT BETTER as I aged in this regard.

I assume you are ultra-lite with you gear, because carrying 23-32 supplements has got to add up to some weight on a LD hike. ;)

[Slugg]

Trekking poles for me. I had never had knee pain in my life, and after 2 days of hard hiking I'd have pretty bad pain in both knees. I got trekking poles, and now I hike even harder and have 0 knee pain.

[Dogwood]

I assume you are ultra-lite with you gear, because carrying 23-32 supplements has got to add up to some weight on a LD hike. ;)

LOL. They do add up in bulk which is why I like to mail resupply often. Some add calories that add not only to total daily energy but also nutritional needs. Even with them daily food consumable wt is between 1.25- 1.6 lbs/day. It all balances out to be UL. Every single piece of gear or food itcals/oz) or what's carried doesn't have to be the most UL. BTW I used to compare wt and bulk of the same supplements from different companies. Same with rubber bands, baggies, batteries...

[Dogwood]

Whats the best way to get rid of and prevent hikers knee?
You'll often hear lower your kit wt. Use trekking poles. Do what I've previously stated. That helps. What helps more? Address causes. DO NOT BE OVER WT. DEFINITELY DON'T BE OBESE!!!! GET away from the SAD...Standard American Diet...and Standard American Lifestyle!!!! Dont be sedentary!!! Dont sit around. Move...Moderate exercise. Dont smoke. Dont expose yourself to toxins...chemical, emotional, in food like substances, pharmaceutical,...Go largely plant based. DETOX. Fat cells are the most pro inflammatory cells in the body. What causes pain? Inflammation. Lose the toxic lifestyle habits. LOSE the toxicity in the body...AND MIND..AND EMOTIONS. DO NOT STRESS over everything. BE happy. Take care of your shirt. Live CLEAN. LAUGH. APPRECIATE. BE THANKFUL. Walk in Nature. Meditate in Nature, Shinrin-yoku. “Climb the mountains and get their good tidings. Nature’s peace will flow into you as the sunshine into trees. The winds will blow their freshness into you, and the storms their energy, while cares will drop off you as autumn leaves.“ Everybody needs beauty...places to play in and pray in where nature may heal and cheer and give strength to the body and soul alike.“Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wildness is a necessity; and that mountain parks and reservations are useful not only as fountains of timber and irrigating rivers, but as fountains of life.”

[BuckeyeBill]

You'll often hear lower your kit wt. Use trekking poles. Do what I've previously stated. That helps. What helps more? Address causes. DO NOT BE OVER WT. DEFINITELY DON'T BE OBESE!!!! GET away from the SAD...Standard American Diet...and Standard American Lifestyle!!!! Dont be sedentary!!! Dont sit around. Move...Moderate exercise. Dont smoke. Dont expose yourself to toxins...chemical, emotional, in food like substances, pharmaceutical,...Go largely plant based. DETOX. Fat cells are the most pro inflammatory cells in the body. What causes pain? Inflammation. Lose the toxic lifestyle habits. LOSE the toxicity in the body...AND MIND..AND EMOTIONS. DO NOT STRESS over everything. BE happy. Take care of your shirt. Live CLEAN. LAUGH. APPRECIATE. BE THANKFUL. Walk in Nature. Meditate in Nature, Shinrin-yoku. “Climb the mountains and get their good tidings. Nature’s peace will flow into you as the sunshine into trees. The winds will blow their freshness into you, and the storms their energy, while cares will drop off you as autumn leaves.“ Everybody needs beauty...places to play in and pray in where nature may heal and cheer and give strength to the body and soul alike.“Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wildness is a necessity; and that mountain parks and reservations are useful not only as fountains of timber and irrigating rivers, but as fountains of life.”

Right now I am at a rehab center for some major surgery I had last December so my diet is rather shall we say balanced but limited. I have pick up some weight that was needed as I was classified severely underweight. The dietician and nutritionist agree that my current weight is good for my height, 6' and 185. I would like to drop about 10 lbs. I have quit drinking (2007), quit smoking (January 2, 2016) and never felt better. I suffer from Crohn's Disease and when at home do eat lot6s of vegetables but have a problem with getting enough proteins to keep the doctors happy. I am also in need of various drugs to keep the Crohn's in check. I would like to do all you suggested, but it is not possible to fully follow your thinking even though I think it is excellent advise.