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Jeremy hess
05-16-2012, 13:54
Was wondering if anyone had any suggestions for preventing knee issues while on the trail. I had to leave the trail on April 24th and return home do to issues with both knees it got to the point where I couldnt walk. After being home for 3 weeks my knees are finally getting to the point where I can walk down a flight of steps without pain, finally off the Vitamin I. I cant wait to get back out on the trail will be going out next week for 5 days to see how things work out, I cant wait even though I know my thru hike dream is prolly unreasonable this year but i'll spend the summer hiking locally. Any help would be greatly appreciated

Thanks

J

Snowleopard
05-16-2012, 14:09
See a doctor (orthopedist or sports medicine) and get a diagnosis. At this point you are injured. There are knee issues that respond well to exercises, but you need to know what the problem is first. The most likely treatment would be physical therapy, but without a diagnosis you might be causing serious further damage following my exercises.

To prevent knee problems before they arise, strengthening the quadriceps and hamstring muscles so they are balanced in strength will prevent many knee problems.

Jeremy hess
05-16-2012, 14:13
thanks I was thinking bout going to see an ortho doc but without insurance it is rather expensive and with my knees feeling 98% better I may hold off . I know thats what I should do but I am hoping the issue will resolve itself.

Odd Man Out
05-16-2012, 14:14
Do you use trekking poles. These help many of us with old knees.

Jeremy hess
05-16-2012, 14:16
Yes they became my best friend! :) Best money I had ever spent

MkBibble
05-16-2012, 14:35
Cho-pat straps, poles, and frequent stops saved me.

The Old Boot
05-16-2012, 14:36
The 'issue' may have to do with how you walk, how much you were carrying, how far you were pushing yourself each day, whether or not you used hiking poles, the footwear you use, etc, etc.

Any problem is likely to reappear if you keep doing what you were doing!

The bigger question is 'what are you going to do differently next time out?'

Nitrojoe
05-16-2012, 14:38
Knee problems can be very complex. See a specialist who works in that area of the anotomy, sports doctors are the best to see. I had my right knee replaced after doing PCT thru hike. The replacement was done March of 2011. My problem was arthritus. The operation made all the difference in my hiking. I was even able to do the AT this year with no pain in my knee. I had to stop because I fell and fractured my femur bone. Will continue the AT in 2013. Good luck on your prognosis.

Winds
05-16-2012, 15:28
Excellent thread, I was just contemplating this issue this morning. I wonder what those who acquired bad knees on the trail would say to someone like me who doesn’t have a knee issue with wearing some form of light brace to prevent knee problems?

I have read many folks who say that a thru-hike can make much of you feel like you’re 20 again, but can also age your joints 20 years. This is what concerns me.

Feral Bill
05-16-2012, 15:40
My daughter is a runner. Many of her friends have ended their careers by not backing off when overuse injuries appeared. If you are hurting, don't push yourself so much.

burger
05-16-2012, 15:41
I agree with the previous commenters who suggested you see a doctor (orthopedist or sports medicine would be best). You could have any of several knee problems, and the treatments will differ depending on what you have. It would be silly to suggest anything without knowing your specific issues.

Also, just because you're not having pain now does not mean that it won't come back. If you have an underlying problem (arthritis, mis-aligned patella, weakness or tightness in particular muscles, etc.), rest may not cure those issues, and you might end up with more knee pain down the trail.

You might be able to get your problem dealt with with one trip to the doctor and/or one trip to a physical therapist. Either could be well worth the cost!

LDog
05-16-2012, 15:42
I echo the sports doctor/orthopod recommendation, and would add that you ask the doc for a referral to a physical therapist. My PT found the underlying cause of my injury, and we're in the process of correcting that. If I hadn't taken that step, I'd have done the whole RICE/anti-inflammatory regimin till I felt better, gotten back out on the trail, and have the same problem crop back up.

http://www.laughingdog.com/2012/04/underlying-cause.html

Snowleopard
05-16-2012, 15:43
Jeremy, Philadelphia is large enough that there are many free care options. Call one of the local hospitals and ask. Some knee problems are pretty easy to diagnose and treatment is excersizes that are easy to learn. Also, the first item on a search for 'free clinics Philadelphia' is this: http://voices.yahoo.com/free-healthcare-clinics-philadelphia-2415651.html

Winds, if you don't have knee problems what's better than a brace is exercises that strengthen the muscles that support the knees and using poles. The older you are the more important specific exercises to protect joints and back become.

O'TOPA
05-16-2012, 15:52
I have problems with my knees when I'm walking downhill. Fortunately I don't have any underlying problems. My legs just aren't strong enough and therefore my knees take the abuse. I've been told by my PT that strengthening my quads are especially important.

Praha4
05-16-2012, 16:50
"After being home for 3 weeks my knees are finally getting to the point where I can walk down a flight of steps without pain..."

just a guess, but this could be Illotibial Band Syndrome, (ITBS) a common injury with hikers and distance runners.

http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

First remedy is RICE. (rest, ice, compression, elevation), and Vitamin I helps with the inflammation and pain.
Pain and stiffness felt on the outside of the knee, particularly on downhills, is due to ITBS. The remedy is STRETCHING, STRETCHING, STRETCHING. Learn proper stretches for the achilles tendon, quads, hamstrings, and the Illotibial band on the side of your legs. Most guys have tight hamstrings, and this is one of the leading causes of low back pain and injuries from hiking and other physical activities. Your problem could be due to other causes too, but the brief symptoms you described sound like ITBS.

if you can't afford a doctor, maybe you can see a Physical Therapist. Most ortopedic doctors will just want to do Xrays and give you drugs. One vist to a good PT and he could set you up with some home exercises and stretches. I do all the stretches while I'm on the trail, it makes a huge difference.

good luck

kidchill
05-16-2012, 16:59
Yah, I third the motion to have your knees checked out pre-hike. I work in healthcare, but I do anesthesia, NOT ortho...so, I'm in NO way offering medical advice here, but here's my recent experience. Last year I was doing a lot of 1-legged squats and biking to strengthen my legs. I was starting to get some unilateral knee pain and just backed down on my training. Eventually, I quit the squats altogether 'cause my knee was in pain regardless of training. After I quit, it got better. I'm planning a SOBO hike this year, so I've been training with a 30lb pack and kicking up the mileage quickly. Well, I ended up getting bilateral knee pain to the point it was crippling my hike (was doing 20+ mile hikes on consecutive days). So, I sat down and googled away and worked through some differential diagnoses and figured out what I thought it was. I hit up one of the ortho docs in the OR the other day and he confirmed my diagnosis and told me what the treatment plan is. I'm basically PTing myself at this point. The point of this too long story is you can't plan a treatment without an appropriate diagnosis. If you're feeling better after resting for a few weeks, it's most likely some sort of overuse syndrome; however, once you're back hiking you may quickly find the pain returning. I think it would be to your benefit to either see a doc, or spend some serious time researching common knee pain pathologies. PT is very specific and takes time to work. If you do return, slowly build up your mileage over time. Here's a link for ITBS (this seems to plague new hikers/runners) and I already clicked the differential Dx tab, so I'd work through those first... http://emedicine.medscape.com/article/307850-differential Again, I'm NOT offering medical advice, and actually seeing an ortho doc is probably your best bet...

Cookerhiker
05-16-2012, 17:21
I had more trouble with sore knees in my 20s and 30s than I do now at 64. I've been using trekking poles for 8 years which took much of the pressure off on the steep descents. But I also suspect that improved nutrition has helped. You know the usual - eat fresh fruits & vegetables and whole grains, cut down sodium, saturated fat, processed foods, soda & other sweetened drinks. I really think over the years it made a difference.

Jeremy hess
05-16-2012, 17:42
thank you all for your advice and comments thus far

Shutterbug
05-16-2012, 18:11
thank you all for your advice and comments thus far

Jeremy, when I was your age, I had frequent knee pain. I think it was from two causes, not keeping them in shape between hikes and attempting to carry too much weight in my back pack.

Now, at age 68, I have no knee pain. Last week, I hiked to the bottom of the Grand Canyon and back without any knee problems.

My recommendations:
1) Keep your weight down (both your body weight and your pack weight.)
2) Get a pedometer and walk 10,000 steps a day every day. Include some hills in your daily walk.

Shutterbug

Leanthree
05-16-2012, 19:19
Once you are healthy:
1)Hiking Poles, but know how to use them. Plant poll with every step Right poll with right foot, left poll with left foot. Feels weird
2)Lightweight pack
3)Shorter miles
4)Don't over-stride. take smaller steps, especially going downhill.

mateozzz
05-16-2012, 19:37
I highly recommend the simple nylon knee braces at Walmart or Target. They hold everything together and keep your kneecap from bouncing around, especially going downhill.

Del Q
05-16-2012, 21:36
Lots of good input.............hiking poles for sure

Instaflex is a good product, took it after my knee surgery, friend in Philly who is an "Ironman" swears by it.

I have suffered 36 years of almost daily orthopedic related pain, what I have learned, where the pain is .....is often not where the issue is.

Knee?

Calves, ankles, feet, hips, overall alignment....................fixing or keeping the other areas in check and focusing there helps everything.

Example: Have been having knee and leg pain, last hike stupid calf pain, bought "The Stick", rolling my legs daily, almost all pain is gone!!!

DaFireMedic
05-16-2012, 21:43
I have bad knees. Two things that have helped me tremendously:

1. Trekking poles

2. Walk the downhill sections backwards to take stress off of the knees, especially the steep sections. This is a biggie, one I learned 15 years ago on the cables hike on Half Dome. I came down forward because that was the "cool" way to do it, then had an 8 mile hike out with painful knees. Since then, I hike anything more than a few degrees of downhill slope backward. You want to be careful of course, plant your trekking poles and always watch where you are going, but in 15 years of doing this I have never fallen while walking backward (maybe it's because I'm more careful when doing this) but it has made a huge difference in my knees. I am planning a John Muir Trail hike in late July. I would not be able to complete this hike without walking the downhill parts backward, it would be too painful.


Ok, Ill add one more thing. When I'm doing a hike that I know is going to be hard on my knees, I take a couple of Ibuprofen before I start out. Really helps.

Old Boots
05-16-2012, 22:02
I find that hiking downhill puts,the greatest pressure on my knees. Trekking poles help a great deal, but walking toe first rather than heel first contact puts your hips in the right place and takes some of the load off the knees and puts it on the glutes.

doheir
05-16-2012, 23:47
Lots of great advice here. I would counsel an overall strengthening program - strong quadriceps to be sure, but also strong core muscles, shoulders, etc. that will allow proper use of trekking poles to remove strain from your knees. I'd also focus on bringing down body weight to a fairly lean state, since every extra pound, either on your frame or in your pack makes a difference.

I favor naproxen sodium over ibuprofen as an anti inflammatory because it has a 12 hour half life (vs. 1.9 hours for ibuprofen).

Lastly,if pain persists, don't push through it. You could be dealing with a cartilage, ligament, or meniscus defect that won't go away with conservative treatment. Hence, the recommendation for a medical evaluation is sound if you've tried many of the remedies without relief.

fiddlehead
05-16-2012, 23:54
I totally agree with the last 2 posts: Lighweight pack and practice (with short steps)
I watch the porters in Nepal go down a hill and learn from them. Short steps, knees bent, keep moving. Not seeming to put all their weight on any one foot at any given time.

I've learned to do this and it's almost like running, (but not necessarily fast).
Lightpack is so important also.

One other thing: I was having knee problems running and I switched to more minimalist shoes (No support inside), my knee pain went away.
I wore two pair of those shoes out and went back to some high-tech, shoes: knee problem came back.
So, perhaps the particular shoe you are using is causing part of the problem also.

Good luck sorting it out.
I imagine you can if you keep trying different techniques, equipment, speeds and packweights.

leaftye
05-17-2012, 00:04
I'll pile on to the idea of figuring out what's wrong with your knees, but I think you can do a lot without seeing a doctor or physical therapist. Either way, you definitely need to figure out what's wrong with your knees if you're actually going to fix them and make them better than before. Most knee problems are due to muscle imbalances. The area of pain and its triggers do a lot to help you figure out what you need to strengthen.

With that in mind, I've been working to eliminate some of my own pain. It took me a while before I could describe my pain well enough to figure out how to find the problem. The problem is a very strong posterior chain, and not so strong quads. That problem matches up with the type of exercise I had been doing this year. Now I'm working more on the front of my legs, along with doing stretches for different parts of my posterior chain to loosen that up while improving my form during squats, and my knees have been feeling better. The pain isn't gone, but I feel like I'm going in the right direction.

WIAPilot
05-17-2012, 01:18
I totally agree with the last 2 posts: Lighweight pack and practice (with short steps)
I watch the porters in Nepal go down a hill and learn from them. Short steps, knees bent, keep moving. Not seeming to put all their weight on any one foot at any given time.

:rolleyes:Ya think one of them would like to come work for me on the AT?? Tell them: Equal pay; warmer weather!

garlic08
05-17-2012, 09:15
Ditto on lightening the load. I stopped backpacking in my late 30s when it would take me months of limping to recover from a 100 mile hike. Ten years later I started my thru hiking career, hiking 2000 miles a year pain-free. The difference was about 30 pounds of pack. And about four pounds of footwear. The last time I wore my heavy leather mountaineering boots on a day hike, I limped for weeks afterward. Something about my knees will not accept hiking in heavy footwear.

Snowleopard
05-17-2012, 10:08
Jeremy's symptoms are also consistent with patellar chondromalacia, caused by a misalignment of the tendons in the knees. http://www.mayoclinic.com/health/chondromalacia-patella/DS00777 This is very common in bicyclists, where the quads and hamstrings aren't balanced in strength. Some sports strengthen one but not the other which can lead to problems.

I think the treatment for ITB and chondromalacia are different but not necessarily inconsistent (stretching and strengthening exercises are both good for everyone). However, rest is not a treatment for chondromalacia. As soon as possible you would want to start straight leg lifts on your back (quads) and on your stomach (hamstrings); a PT or orthopedist is very useful telling you when you can start.

With some knee problems you can cause permanent damage if you don't get proper treatment, and I know someone that happened to. What you really need a doctor for is ruling out the more serious problems that might be aggravated by the wrong exercise.

Jeremy hess
06-12-2012, 10:58
Just got done seeing the ortho doc no major problems cortisone shots in both knees feeling better already,.....be back on the trail very soon YES!!!!!!

colonel r
06-12-2012, 11:50
Be careful. I went the cortisone route waited 3 weeks and could only hike for 2 days before recurrence.

Things I did to cure it (some things are repeated from above):
lighten the load (for me 37 to 17 lbs)
strengthen the quads, hamstrings, and calves
stretch the IT band
learn to use a wobble board for stability
ice works wonders for the knees, 4X a day
take it slow and build muscle endurance
hike the mtns if you can

Now a YEAR later the problems are solved. It was a very slow process and I have to be constantly aware of backsliding.

Blue Jay
06-12-2012, 15:09
Do you use trekking poles. These help many of us with old knees.

Not even the pole manufacturers make a prevention claim. Since they allow you to hike faster than you would without them they are certainly not preventing anything. Using your "logic" crutches prevent broken legs, which they might because you would have to hike SLOWER and are less likely to over use.

Winds
06-12-2012, 15:20
Not even the pole manufacturers make a prevention claim. Since they allow you to hike faster than you would without them they are certainly not preventing anything. Using your "logic" crutches prevent broken legs, which they might because you would have to hike SLOWER and are less likely to over use.

Hiking poles would be a preventative measure to a great many ailments if used properly.

Last year I broke my leg, clean through and dislodged. NOW, had I been using crutches, that wouldn't have happened for sure! Also, if everyone wore a helmet to bed, falling out and getting concussions would decrease as well.

Bottom line: Wear your helmet more to bed. Or, and I've yet to see cortisone shots actually play a major role to heal anything. :(

Jeremy hess
06-12-2012, 16:26
I use poles and love them they have saved me on many occasions. While i have been in recovery mode for almost two months i am anxious to get back out in the trail.....lighter and smarter than before.....cortisone seems to be working even after a few hours.....forgot what it feels like to not be in pain...awesome

The Old Chief
06-12-2012, 16:27
Be careful. I went the cortisone route waited 3 weeks and could only hike for 2 days before recurrence.

Things I did to cure it (some things are repeated from above):
lighten the load (for me 37 to 17 lbs)
strengthen the quads, hamstrings, and calves
stretch the IT band
learn to use a wobble board for stability
ice works wonders for the knees, 4X a day
take it slow and build muscle endurance
hike the mtns if you can

Now a YEAR later the problems are solved. It was a very slow process and I have to be constantly aware of backsliding.AA

Amen to what you posted. Just got through with physical therapy after surgery on my left knee in April. Told the PT I wanted my therapy geared toward hiking and these things are what I did. The wobble board is especially helpful and something easy to build and use all the time to stay in shape for hiking-- along with the stretching. I found out that torn cartilage is not going to heal itself and cortizone is very temporary. Mega doses of advil will relieve the pain but just as soon as you try to hike any distance it will return.

Winds
06-12-2012, 18:04
I use poles and love them they have saved me on many occasions. While i have been in recovery mode for almost two months i am anxious to get back out in the trail.....lighter and smarter than before.....cortisone seems to be working even after a few hours.....forgot what it feels like to not be in pain...awesome

Oh, amen to the relief in your pain Jeremy. I do wish you the best in your hiking endeavors. I've had cortisone shots in the past, just be careful to heal well.

Jeremy hess
06-12-2012, 20:27
Thank you i plan on making an attempt doing PA to ME in july. Doc says i should be good to go

fiddlehead
06-12-2012, 20:41
Something that I just learned (over 60 now, but we never stop learning, aye?)
Shoe fit and type make a big difference.
I jog a lot (just ran the Phuket half-marathon 3 days ago) and switched to minimalist shoes about 2 years ago because I was having knee problems and these shoes helped a lot.
I got a new pair of tennis shoes and tried to run in them (I play tennis 3 days a week too).
My knee pain came back in only 4 kms of running.

So, I just ran the 21 km. half-marathon and guess what? no knee problems.

By the way, I skimmed over this thread and would like to comment that any doctor that tries to squirt cortisone into my knees would be the one that I would run away from. Fast.

rocketsocks
06-12-2012, 21:27
I've had three cortisone shots in my hand/wrist after three surgeries,I can't say it helped much,or reduced any inflamation.

Grits
06-12-2012, 21:40
Good Thread an here is a good video of the proper way to use hiking poles. From how to use the straps and length to right pole and left foot forward/left pole right foot forward. http://www.youtube.com/watch?v=skXVMA5nShA

Pedaling Fool
06-13-2012, 09:01
Everyone wants a shot or a pill to fix what ails them and then they complain about the powerful pharmaceutical industry. Are we really that stupid or is it laziness :confused:

max patch
06-13-2012, 09:09
Years ago I had knee issues and I went to a sports doc who told me to bike (real or stationary) to increase blood flow to the knee and then do a series of weight exercises followed by icing. Not only worked great, but over the years whenever if I start to have problems this exercise program fixes them. I believe if I did this every day I'd never had a problem but weight training to me is sooo boring.