God! My knees!!!

[The Scribe]

Happy Thanksgiving to all

Any advice for sore knees?

Ever since Attroll and I did the Caratunk to Monson stretch over Labor Day weekend, I have been plagued with sore knees. Up and down stairs, turning on my knees, lifting my legs to get to the gas or clutch. Those are the worst of times.

On our trip, I was in agony coming down Pleasant Pond Mountain yet had no trouble with Washington about a month earlier. It took a lot of Vitamin I and a walking stick to get to Monson. Along with several talks with my knee to "cut the @#$%."

I go to the gym regularly, 4-5 times a week. I have no trouble there (4 miles on the treadmill at 4.1-4.2 mph and up to 15% elevation, and 15 min on a bike if there's time). I can do that 4-5 days in a row without issue, but when I have to climb the stairs from the locker room to go home, OUCH!

I know I have some issues with my left knee (the one that bothered me on Pleasant Pond Mountain). It clicks when I go up stairs (or boulders) and there is a numb area on the outside. My right knee, however, can hurt just as bad but has no other symptons.

I really enjoyed getting back into hiking this year and getting into the AT community. I am already reading and dreaming about hikes for next year. So if I need a PT routine, or a strengthening routine, or even if I need some work done on my left one, I want to get going on it so I can be ready when this Maine wintah is done.

Can anyone offer advice? Exercises? Vitamins? Natural supplements?

And thank you.

pcm

[Moose2001]

Knee problems suck!! I totally understand where you’re coming from. My knee problems took me off the trail in 2001.

My first suggestion would be talk to a good doctor that specializes in either orthopedics or sports medicine. Make sure there are no structural problems with your knees. If that checks out, talk to them about getting a referral to physical therapy to learn what exercises can strengthen your quads. Typically PT will work on your quads to help stabilize your knees.

You can also try glucosamin to help “lubricate” your knees. It does help some people with knee problems.

You can also talk to the Doc about something like Celebrex. I went on VIOXX in 2003 and it made a world of difference. This class of meds works to control the swelling and inflammation in your joints. It’s amazing just how well VIOXX worked for me in controlling the swelling and joint pain in my knee. I wouldn’t suggest this course for everyone but only as a last resort.

Also, if you’re not using hiking poles, I strongly recommend them. They do make a difference in how much pressure gets placed on your knees.

Good Luck!!

[Footslogger]

Hard to tell exactly what you did to yourself and whether this is a progression of a pre-existing knee condition. But, based on your symptoms you need to be taking a non-steroidal anti-inflamatory drug and would probably benefit from some physical therapist who is knowledgeable in sports medicine. Long term, you ought to consider starting a regimen of Glucosamine. A lot of the formulations contain Chondroitin. The benefits of Chondroitin have never been proven but the Glucosamine has been proven to rebuild and regenerate cartilage. The pain and clicking you feel/hear is most likely cartilagenous in nature. Cartilage has a notoriously bad blood supply and therfore heals rather slowly.

If the pain persists and you get no relief from Motrin or Rx non-steroidals then you might need to consult an orthopedist/sports medicine physician and consider having an MRI to evaluate the knee joints.

Hope that helps ...

'Slogger
AT 2003

[TDale]

Hie thee to thy doktor! Then stop off at wallyworld for some glucosimine. It won't cure all ills but it does help.

[Mr. Clean]

I agree with everything Moose said.

[The Scribe]

Did some research on Glucosamine last night. I'd heard about it before.

No, I don't have poles but that will change I imagine. Uncle Ben passed along a hiking stick to me at Bald Mountain Brook lean-to and it helped greatly. It has gone everywhere with me since.

Issues with my left knee go back a ways. Over 10 years. I didn't mention that at times if I kneel on it the right (wrong) way, it feels like I'm on a 220 volt line. Right up my leg.

Being in education, I always looked for summer work back then and for 5-6 summers I delivered 15,000 pounds of ice a day, 6 days a week.

Anyways, thanks for the tips. I will be stopping by the Dr's today to make an appt. What is so weird is that I can walk forever it seems like, but I sigh when I get home and look at the five stairs up to the deck.

Cheers all.

PCM

[MOWGLI]

Did some research on Glucosamine last night. I'd heard about it before.


PCM

If you choose to start taking this product, make you start doing so 3-4 weeks BEFORE you start hiking. It will not provide immediate relief.

[The Scribe]

LOL
Mowgli

While my mind is out in the woods, my reality is all the stairs I have to climb every day. I think I will start it today when I head out for a Turkey Day supply run.

Thanks for the tip.

PCM

[steve hiker]

I've used glucosamine and am still using it, and can swear it's made a big difference. Not as much as using hiking poles, but allows me to hike basically without knee problems.

However, I'm wondering if there are any hard scientific/medical studies that prove glucosamine's benefits. A few months ago, Airferret who is a med student cited studies in which one control group was given glucosamine and the other a placebo, and they both reported the same results. Which to me, sounds like no real benefit. Which contradicts my own experience.

Overall, the best thing I've found for combatting knee problems is two hiking poles. Tremendous benefit. Get the strain off them knees.

[tarbubble]

when i jacked up my knees several years ago, poles made hiking possible again. of course, mine were so swollen and sore that i hobbled around on crutches for a while. my knees are much better now (it's been about 6 years), but it took about 3 years for them to stop getting sore every time i went for a long walk. be pushy with your doctor, mine flat out didn't care (and my insurance sucked) so i just did what i could for myself. good luck!

[Mr. Clean]

I started taking glucosamine/condroitin for my knees, and noticed a big difference after 3-4 weeks. Then I started using poles and noticed another big difference. I've done back-to-back day hikes here in the Whites of about 1500' elevation with absolutely no knee pain recently, and hope to start increasing my elevations soon.
Lots of good snowshoeing this winter coming up. It's actually easier on snow since there are no boulders to step up onto, just slopes of snow.
Also, try doing leg excersises. While sitting in a chair (at work :D ), lift your legs out straight in front of you and hold for ten seconds. Repeat all day. This will build up the muscles around your knees and help stabilize them.

[Jaybird]

Any advice for sore knees?

Ever since Attroll and I did the Caratunk to Monson stretch over Labor Day weekend, I have been plagued with sore knees. Up and down stairs, turning on my knees, lifting my legs to get to the gas or clutch. Those are the worst of times.......etcetcetc........Can anyone offer advice? Exercises? Vitamins? Natural supplements? ................


Yo pcm25

Happy Holidays....yep, GLUCOSIMINE tabs are a good thing....start the regiment about a month before your hike. My bud, TeePee, had knee surgery & takes the glucosomine now as a daily dose. He swears by it.

I've gone the excercise route...i'm 50 now & the knees arent getting any younger...so, i ride the bicycle for an hour or so each day @ least a month before a serious hike. I walk too...on the treadmill & around the neighborhood when weather permits.

ALSO, a knee brace might be in order....are you using 2 trekking poles??????????????????....that is also highly recommended.

good luck with your future hikes! :D

[Ridge]

Eat lots of Jello. Made from animal cartilage.

[Tractor]

pcm. I notice you took a lot of the vitamin I when you had that knee trouble. I used to do the same but realized, a couple of years back, that I did more harm than good. I would take a couple in the morning, for instance, and mask the pain a bit. When the pain would come back I would take a couple more and so on and so on. The more vitamin I, the greater the pain had to be before it was unbearable, simple enough but I was tearing the heck out of my LCL's. I should have slowed down or bailed out early on that trip.

In the extreme, about 3 years back, I had taken 18 in one day. Now maybe 2 or 3 in a week.

I now pace myself better, use insoles, pack lighter and am considering a pair of hiking poles instead of the stick. Have tried glucosamine and agree it should start at least a couple of weeks before a hike...

[flyfisher]

Everyone has different experiences. However, for this 50 year old, after a near disasterous first section hike with knee pain, I did four things:

- Two poles - especially coming down hills
- Glucosamine - 1 gram in the morning and one in the evening year-round -- while I am hiking I take 4 grams a day.
- Small steps coming down hills - almost dancing my way down
- Going up "steps" on hills and coming down them, I always alternate one knee and then the other - I used to come down endless steps and climb long climbs using a single knee for the hard work - usually the one that felt the best. It sometimes starts to hurt the good knee when stressed like this.

[c.coyle]

I noticed a big improvement when I dropped 25# last winter.

Pain when you lift your leg to use the gas or clutch? I might want to get that checked.

[Bandana Man]

I learned the hard way that stretching is very important. My 2003 section hike ended a week early because of a bad left knee. I went to an orthopedic (sp?) surgeon, who referred me to a physical therapist specializing in sports injuries. The PT said I had "iliotibial band friction syndrome" and showed me several stretching exercises that cured the knee pain after about 6 weeks of treatment. The PT said I should add stretching to my work-outs and when hiking to prevent re-injury.

Here's a website that shows three of the stretching exercises I learned from the PT. The first exercise was the best for my condition! I also learned the second and third exercises, but none of the others on this website.
http://www.nismat.org/ptcor/itb_stretch

A knee problem can be any number of things. You probably should get checked out by an orthopedic surgeon and/or PT who specializes in sports medicine, especially knee injuries. Luckily, my HMO referred me to an orthopedic surgeon and PT who are familiar with treating knee injuries because they have treated some of the Orlando Magic NBA players.

The stretching worked for me and I take no drugs (glucosomine, etc.) Hope you find relief!

[Newb]

ah, ye ole knee pain. I've been having pain on the front outside of my knees for years and only after a CAT scan did the doctor determine my problem. It seems my patellas don't stay inside that nice little groove that God made for them. When I flex my kne the patella moves to the outside. The result is wearing down of underside of the patella and the bone it's moving over. Apparently this is a common congenital disorder.

Aside from major reconstruction to move the tendons on the front of my shin over a bit, I have to suffer. Glocosamine has made a big difference for me, as well as wearing braces on both knees (available at the local CVS or Walgreens) to keep the patellas stabilized. Also, hiking poles are miraculous.

[ToeJam]

Thanks for the glucosamine tip, and also the stretching advice. I admit to being slack about stretchng which in hindsight is pretty dumb! I got some GNC glucosamine with chondroiten last week at drugstore.com and it was B1-G1 free and free shipping as well. I decided to go for the lil more expensive stuff since others had expressed that name brand CAN make a diference in these types of things.

MAN those things are BIG to take tho! We shall see how they work, figure they can't HURT anyway....

[Moose2001]

Newb - I have the exact same problem you have with the knees. I'm surprised your doc didn't talk to you about doing PT. The mistrack of the knee can sometimes be caused or aggravated by weak quads. One of the "standard" courses of action is to be referred to a PT for work on the quads. By strengthing your quads, it helps to pull the knee back into track and hold it in place. I'd suggest talking to your doc about a referral to a PT. Might not cure your problem but it may improve it somewhat.

[burger]

On knee problems - what newb and Moose2001 and pcm are talking about is "runner's knee" (or patellar femoralis or chondramalacia). If you google runner's knee, you will find a lot of good references and advice, since many many runners (myself included) have had this problem. Also, just about every worthwhile book on running will include a section on runner's knee and a list of exercises that can help cure/prevent it.

Different people swear by different exercise routines, but the good news is that this is usually easily treatible without surgery (and probably without a trip to the PT if you read up). For me, what worked was reducing my running/hiking (you can still do cycling while you're recovering) for about 8 weeks and doing exercises to strengthen my inner quads. Specifically, I do leg lifts with my toes pointed out to the side to isolate the inner quads. I usually do 5 sets of 60 lifts on each leg 3-4 times a week. Since I've started this routine, I've had no pain while running and very little pain while hiking.

The bad news: if you don't get it treated and allow the condition to persist, eventually you'll destroy the cartilage under your kneecap, and that's not treatable except with surgery. I've also read that runner's knee can lead to arthritis down the road.

[Fiddleback]

I agree with everything Burger wrote. I had the problem in 1980 and an exercise program fixed it permanently. My doctor told me that 85% of the cases were curable through such exercise regimens. Specific activities recommended were swimming, cycling, and brisk walking. I also did/do squats and toe lifts very carefully. Best of luck.

FB

[atraildreamer]

Pain when you lift your leg to use the gas or clutch? I might want to get that checked.

I had this pain when driving. Realized that my wallet (in my right rear pocket) was causing me to turn my leg and causing stress to the knee. :-?
I cleaned out some of the junk that accumulates in a typical wallet, and I take the wallet out of my pocket when driving. It made a big difference. :sun

[swift]

I totally trashed knees my knees attempting the AT in 2003 and have been dealing with chronic knee pain ever since. Just before heading out for the trail in 2005 I had a series of Synvisc injections in both knees that were just amazing, it made all the difference in the world in allowing me to hike. This stuff replaces the sinovial fluid in your joints and can be redone about once a year. It sounds really spooky having a needle inserted into the center of your knee but the shots really arent bad at all. Ask your orthopaedic doctor about them.... my insurance covered the cost of the shots.

[Frolicking Dinosaurs]

I had severe pain in my right knee due to muscle weakness in the quads above (they aren't strong enough to keep the bones properly aligned). I've had extensive physical therapy in an attempt to develop all of the muscles that support the knees' function. Since my quads are damaged (auto accident), I cannot develop them further, but you shouldn't have this limitation. Developing them made a huge difference for me so I'm passing the info along in hopes it will help some here.

The exercises I was given to develop the muscle structure to lessen knee pain for hiking / backpacking:

Short-arc extensions are done sitting up or lying down. Use a rolled-up towel to support your mid-thigh while you keep your leg and foot in the air for 5 seconds. Lower your foot as you bend your knee slowly. Repeat 15 times for each leg, twice a day. Add ankle weights up to 5 lbs or 2 kilos

Quadriceps isometric exercises are done sitting up, with your legs extended in front of you. Tighten your quadriceps muscles by putting a rolled up towel under your knee and trying to push the knees down onto the floor. Hold for 5 seconds. Repeat 15 times for each leg, twice a day.

Straight-leg raises are done lying down. Bend one knee and put foot on floor. Lift the whole straight leg from the hip and keep it up in the air for 5 seconds. Then lower slowly (count to 5 slowly). Repeat 15 times for each leg, twice a day. Add ankle weights up to 8 lbs (3.5 kilos) to keep this challenging.

Hip abductor strengthening exercise - lying on the floor on your side with your lower leg bent and upper leg straight. Raise the upper leg slowly and lower slowly. 15 reps twice a day. Add ankle weights up to 8 lbs

Strengthening exercises for the posterior tibialis - lying on your side, straighten the lower leg and bend the top leg. Place toes from top leg behind the lower leg. Angle toes of lower leg about 45 degrees and attempt to point to toes to ceiling while keeping the rest of your leg on the floor.

Front step up / step down - use an exercise step, small step stool or any stable platform about 6" high. facing step - step up, hold for 3 seconds and step down using only the leg being exercised. If you are too weak to do this unassisted, use a mantle, door frame or other very sturdy structure to assist with balance and weight bearing. Start with 8 reps and gradually increase to three sets of 15 reps twice a day. I have advanced to doing this with the pack described in the squats description.

Side step up / step down - same as front step up except your side is to the step instead of you facing it. I strongly recommend you have a sturdy support handy as this is a lot hearder than it sounds and losing your balance will likely occur.

Squats - do these while facing your kitchen sink. Place your toes straight ahead about 4 - 6" from the cabinet and shoulder width apart. This keeps you from allowing your knees to protude out beyond the ends of the toes - a move which puts the strain on the knees instead of the quads. You may use the edge of the sink / cabinet to assist you with balance or weight bearing if needed.

Firms hips, buttocks & inner thighs and tuck your your tailbone down. Pull navel in and up. Lift chest and relax your shoulders down and back. Lengthen neck and look straight ahead. Slowly start to sit down, as if you were aiming for a chair. Pause when thighs are approximately parallel to floor. Return to the start position. Do three sets of 8 repetitions twice a day. Take 2 to 4 seconds to 'sit', hold for 2 to 4 seconds when 'sitting' and raise slowly (again 2 to 4 seconds). When doing this gets easy: Gradually increase the number of reps per set to 15, then put ankle wieghts on each shoulder. When that gets easy, start using a day pack and gradually get the weight up to about 20 lbs. (Water bottles make varying the weight easy - a liter is 2.2 lbs / 1 kilo, a gallon is 8.33 lbs)

Tip toes - Do these while facing your kitchen sink. Place your toes straight ahead and shoulder width apart. You may use the edge of the sink / cabinet to assist you with balance or weight bearing if needed. Slow rise to your tip-toes, hold for a count of 10 and slowly return to flat feet. Do three sets of 15. When this gets easy, do it on one foot at a time. I am now adding weights when I do the set with the good leg. My weak leg can't handle extra weight.

Beginning Lunges: Put one foot on a stable platform (exercise step, hearth, lower porch or deck step). The lower the platform, the harder this will be. Do the lunge as described below except only go as far as it takes to get your raised leg parallel to the floor. Start with 4 reps for each leg and gradually work up to three sets of 15 reps. Then add weight as described above in sqats section. Gradually find smaller platforms until you don't need the platform anymore.
Advanced lunges (once you've mastered the beginning lunge completely) - Again in front of the kitchen sink - Firms hips, buttocks and inner thighs. Stand with feet hip-width apart and hands on edge of sink. Contract abdominals throughout entire set. Place left foot 4 - 6 " from cabinet and right foot about 18* behind the left foot. Squat down bending both knees. (Left knee should be directly above toes.) Keep your back straight. Sink down so left thigh is parallel to floor. Return to the start position. Repeat with other leg. Start with 4 reps for each leg and gradually work up to three sets of 15 reps. Then add weight as described above in sqats section.

Stationary bicycling on low tension setting improves your exercise tolerance without stressing your knee if you have access to a bike. Adjust your seat high enough so that your leg is straight on the down stroke. Start with 15 minutes a day and work up to 30 minutes a day. You can also do this by biking on fairly level ground and it is a lot more enjoyable than a stationary bike.

All exercises should be mostly pain free. The expression "NO PAIN, NO GAIN" does not apply to rehabilitation. While the exercises may make you sore later, they should not be causing serious pain while doing them. If they do - see your doc as something is amiss and doing these exercises may cause further injury.

[Just Jeff]

I had this pain when driving. Realized that my wallet (in my right rear pocket) was causing me to turn my leg and causing stress to the knee.

HAHAHA!!! That's hilarious. Your new trail name is Castanza.

(I guess it's your new driving name instead.)

[Spiritual Pillgrim]

A few weeks B4 departing, I started using glucosamine. Also talked with my pharmacist who recommended taking it 3 times a day for better absorption instead of one huge dose in the a.m. He also recommened Aleve (or naproxem sodium) over Vitamin I. Not as harsh on the bodys organs, I guess. I also use trekking poles.
My left knee is the primary culprit but they both felt so good I sent my knee support home in VA. It was dead weight. Now that I am beating them to death in the Whites, I have to say they are a bit sore, but I'm not cripple yet. The glucosamine and/or it plus the Aleve and poles, has been the biggest aid to lessening the pain. That is the only thing different I did for the thru hike. Some past trips thru the Whites left me in agony because of my left knee using just poles and Vit I.

I've been warned about fat wallets aggravating my psiatica problem even though I don't have a Costanza wallet.

[atraildreamer]

HAHAHA!!! That's hilarious. Your new trail name is Castanza.

(I guess it's your new driving name instead.)

Actually, that's where I got the idea that the wallet may be causing problems. :-? That was a good episode! :p

[Spock]

Something no one has mentioned (that I noticed): cold
My doc and physical therapist both insisted that I cool my knees as often as possible. Stop at a creek, wet a bandanna and keep the knees as cool as possible for 10 minutes or so. This works out once or twice a day on the AT. It really helps, maybe as much as Vitamin I, especially at the end of the day if done before I stiffen up.

[bfitz]

http://www.orthoplex.com/cho.htm

[ASUGrad]

It took several months for Glusomine to take effect with me. When it did, it really helped. I also take fish oil pills. I have no idea if it helps but I was told it would help and my knees feel a lot better. I have a torn MCL and I don't feel it now.

Taking longer strides when you are training will stretch out the thighs. The most important thing is exercise. Walk up and down lots of hill if you can. If you can't, do steps instead.

[Time To Fly 97]

I never work out two days in a row...but rather always give my body a chance to heal muscles for a day. Take small rapid steps as opposed to monster strides. Take a good look at your posture when you are hiking - try to keep from leaning way forward.

Take advil to offset swelling in legs and knees.

Drink more water.

Hope this helps!

TTF

[Frosty]

Good luck, Scribe. You have my heartfelt (and kneefelt) sympathies.

[FatMan]

I've been taking those Glucosomine cocktails (Glucosomine, Chondroitin, MSM) for about six months now and it seems to be paying off. I have been pretty much pain free for the last couple of months. And when I started with the Glucosomine six months ago I was thinking the hiking career was pretty much over. Oh, don't forget the hiking poles. Those are essential for us old guys with bad knees.

[bfitz]

Check out DMSO. Stuff is amazing. (same MS as in MSM, but way different...)

[Frolicking Dinosaurs]

Bfitz, isn't DMSO a solvent? How do you us it?

[bfitz]

Rub it on. Antioxidant, reduces inflammation, NSAID, all sorts of supposed beneficial "side effects". Only negative side...Garlic breath!

[Frolicking Dinosaurs]

If it will also give me garlic sweat, I'm there. Buy don't like Italian food IME :D

[Farr Away]

Frolicking Dinosaurs,

Thanks so much for the exercises! I'm a newbie backpacker, and our last overnight was 11 miles almost completely downhill!! (I also just bought hiking poles, and I may start glucosamine again.)

Great thread.

[Blissful]

Frolicking Dinosaurs,

Thanks so much for the exercises! I'm a newbie backpacker, and our last overnight was 11 miles almost completely downhill!! (I also just bought hiking poles, and I may start glucosamine again.)

Great thread.

Ditto. I just saved it to a folder so I can do the exercises.

I am also a firm believer in Glucosomine.

[FLHiker]

Any advice for sore knees?

I really enjoyed getting back into hiking this year and getting into the AT community. I am already reading and dreaming about hikes for next year. So if I need a PT routine, or a strengthening routine, or even if I need some work done on my left one, I want to get going on it so I can be ready when this Maine wintah is done.

Can anyone offer advice? Exercises? Vitamins? Natural supplements?

And thank you.

pcm

Have you tried hiking fully upright - instead of on your knees?
:D

[saimyoji]

Have you tried hiking fully upright - instead of on your knees?
:D

Hahaha!

FD: Thanks for sharing this. I had serious damage to my legs and through poor medical attention and personal ignorance didn't get proper PT (or proper surgical reparation). I had no real problems until recently. I'll definately be trying out what you've suggested.

Also, would you consider making this into and 'article'? It would be helpful to most people here whether they realize it now or not. ;)

[Swass]

I've read this thread pretty carefully, but I didn't see anything from anyone who'd had knee surgery and then thru-hiked. I am a marathoner and triathlete and I just had arthroscopic surgery on my knee in July. My recovery was extremely quick and I'm expecting my surgeon will give me the okay to start a training program when I see him next week. But a lot of people have told me that I shouldn't expect my knees to be the same.

So my question is this: is it realistic to think about a 2007 thru-hike? I'd like to hear from someone who's had the surgery and done it.

And to give some advice: I thought running was enough to strengthen my legs... They sure looked strong! But I didn't do a weight training routine simultaneously. What I've learned after a couple years of knee problems, a surgery, then 2 months of PT is that I probably could have avoided it all if I had hit the weights and spent a lot more time stretching.

(and ladies, screw being lady-like! For jumping, running, squatting, etc - point your knees in opposite directions. Women who turn their knees inward during physical activity are a lot more prone to injury, according to my PT)

[TIDE-HSV]

has had two 'scopes for meniscus tears and the ACL replaced with a hamstring graft (ten years ago this month). I don't even think about it when hiking...

[Swass]

Tide, that's great to hear. I'm still at the point where walking down stairs gives me a little *twinge*, and I feel lots of pressure when I am in a full squat. But other than that, I feel like I can start running again. There are about as many reasons for me not to plan a 2007 hike than there are to do it, and I'd feel a lot more confindent if my knee wasn't a concern.

[TIDE-HSV]

health issues that would concern me with a thru hike, which I'll probably not get to make. However, my knees wouldn't be the reason. I've had bad knees for so long, that I've been able to test them under just about every situation. I know what gives me trouble and I can plan and stay away from it. But, at one time, I had the same kinds of concerns you are voicing. BTW, never, never do a full squat. With any kind of knee problems, that's asking for trouble. A half squat is fine - it doesn't place the compression load on the knee that a full squat does. How many times, in mountain hiking, do you come to the full squat position (well, with weight on your back)? Think about it.