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  1. #1
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    Default Knee/Hip issues on trail

    I have been hiking sections of the AT as well as other trails for the last 20 years or so - I generally hike around 10 to 15 miles per day (with the occasional 20 miler) Living on the coast of NC, I don't get to hike the hills on a regular basis. After 3 or 4 days of hiking, I have issues with my hips and knees getting very sore.

    Is this a common thing? I am planning on hiking the AT in a few years and would like to get ahead of this, if possible. Is this something that gets better as you hike a few weeks? Are there exercises I can do to strengthen muscles in my legs to make this better?

    Any insight around this would be appreciated.

    Doug

  2. #2

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    I had issues when backpacking due to using a 3/4 pad that was too thin. Once I when to thicker full length pad the issues went away.

  3. #3

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    I had knee issues for a long time resulting from hiking and in the past several years a general hip problem. What worked for me was talking with my doctor about it and then being referred for physical therapy. With my knee, I just figured I had a bad knee and was getting older. When I finally did talk to my doctor, I was diagnosed with ITBS, Iliotibial band syndrome. This affects the tracking of the kneecap and the PT worked with me on strategies to resolve it and I have found what works for me to keep it at bay. With my hips, again I discussed with my doctor but the PT was a little more insightful and she noticed that I had a slight imbalance in my right leg length. She gently suggested it might be a little bit of arthritis development in my hip area. The solution was a heel lift in my right shoe which very much helps. Also stretching exercises to loosen muscles. I was also getting some soreness in my back at the time and the PT explained that problems with one can be involved with problems of the other. If you can, mention it to your doctor.

    Stretching, PT, yoga, these all help generally to improve flexibility and work some of the muscles that are underused. Too much sitting for instance in an office environment can lead to locking up muscles.
    "Sleepy alligator in the noonday sun
    Sleepin by the river just like he usually done
    Call for his whisky
    He can call for his tea
    Call all he wanta but he can't call me..."
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  4. #4
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    The hip pain could be caused by the weight of your pack distributed by the hip belt. I usually experience some soreness there on my section hikes. I'm sure that would fade eventually, as the body became accustomed to bearing the weight at those points.

    I'm 61 now and always have a bit of knee pain and usually some routine aches and pains. I find it bearable and would rather avoid doctors at all costs. They seem prone to prescribing medications, doing procedures, and telling people they only have three days to live. So I carry on, no meds, dealing with routine aches and pains, enjoying the trail and life in general. (Not everybody has the luxury of being so cavalier, of course.)

  5. #5

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    Quote Originally Posted by Dan Roper View Post
    The hip pain could be caused by the weight of your pack distributed by the hip belt. I usually experience some soreness there on my section hikes. I'm sure that would fade eventually, as the body became accustomed to bearing the weight at those points.

    I'm 61 now and always have a bit of knee pain and usually some routine aches and pains. I find it bearable and would rather avoid doctors at all costs. They seem prone to prescribing medications, doing procedures, and telling people they only have three days to live. So I carry on, no meds, dealing with routine aches and pains, enjoying the trail and life in general. (Not everybody has the luxury of being so cavalier, of course.)
    That's unfortunate you can't find a doctor you trust, it's not always easy. They're not all good and some are in it for the money. I have had the same primary care doctor for over a decade and I trust him very highly. There are times I tell him about different aches and pains and he'll check them, I'll suggest maybe I need to go the gym more and that's it. He might say come back if it doesn't resolve. With the new(er) E-medical records either he or a nurse pretty much always asks about it on my next visit. He would do that before E-medical too but a little less often. For problems I've had, he has suggested PT first and he's actually said to me that he likes to prescribe PT first before other interventions but not all patients like to go to PT. (He's a DO not an MD.)

    I had that suck it up attitude too but too many times of having pain a few days in on a hike and sometimes gimping around for a few days at home afterwards I finally did ask my doctor about it. And when I found out, I was really disappointed that I hadn't had it checked out because it was correctable. That it was correctable, that was like a blessing knowing that I would be able to keep hiking. Even for my hip, I was thinking I was getting older, maybe I needed to stretch more, go to the gym more, yada yada yada. It got so bad there was no position I could sleep in at night. I just rotated 90 degrees every 15-20 minutes sometimes less. I would still be suffering if I hadn't gotten it checked as there is hardly any chance I would have figured that out.

    Getting a yearly checkup is a sound idea, particularly if you have health insurance. It's an excellent opportunity to discuss reoccurring problems. Lots of things are correctable but not if you don't mention it to the doctor.
    "Sleepy alligator in the noonday sun
    Sleepin by the river just like he usually done
    Call for his whisky
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    Call all he wanta but he can't call me..."
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  6. #6
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    Last year I was having pain in my right hip and my knees (separate from the knee arthritis pain I've grown used to), and requested a referral for physical therapy. I cannot overstate how incredibly helpful that was. My PT identified issues that were easily resolved by learning some new stretches and simple strength training -- particularly the core muscles. I was skeptical at first, but I learned that there might be a good reason they refer to it as The Core: those muscles really are the core of everything you do, whether you realize it or not!

    A good Physical Therapist is worth their weight in gold.
    fortis fortuna adjuvat

  7. #7
    Registered User JNI64's Avatar
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    I too would suggest a doctor's visit. Maybe add a joint supplement like glucosamine chondroitin or fish oil.
    And I always, always recommend a good diet and exercise program with lots of stretching exercises. It will help you in all aspects of life

  8. #8
    Registered User JNI64's Avatar
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    What kind of air mattress are you sleeping on? It's been mentioned but as we get older a good thick comfortable air mattress makes for good recovery sleeping.
    And guys should carry most of the pack weight on the shoulders not the hips.

  9. #9

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    The other thing to consider is 3 months of MSM glucosamine chondroitan can help joint issues. It is not a instant fix but if

  10. #10

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    Even if you are in good shape at 46, the first few days of backpacking will make you pretty sore. Muscles and joints.

    If you don’t experience these things except when hiking, then you can [U]probably[U] expect them to subside after a few weeks.

    I also live in a flat area. In my late 40’s to early 50’s I did 2-3 day trips with my daughters and felt like heck at the end. Assumed I was too old for thru hiking. Did a 2 week trip when 57 and felt pretty good. Thru hiked (SOBO) at 59 and other than a miniscus tear 3 days into it that took me off for a couple of days had no issues. Did lots of 20+ mile days. Did use knee braces preventatively. I do take an MSM supplement and did on my hike.

    Old saying is that you can buy gear that is light, high quality and cheap…pick two. Hopefully at your age you can pick the first two. I didn’t go gram weenie and use a scale, but I did research and used my wallet to buy pretty light pack, tent, sleep system and stove.

    Shoes—dial these in. There’s a lot of ways to go, solution for one is torture for another. Once you find what works for you, get 5-6 pairs. Don’t wait. That’s the only item I would want to have to get along the way, hoping an outfitter has what you need. Plus shoe companies drop models out all the time and the improvements aren’t always so.

    Best of luck

  11. #11

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    …wouldn’t want to buy along the way.

  12. #12
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    Quote Originally Posted by TwoSpirits View Post
    A good Physical Therapist is worth their weight in gold.
    And a bad one will perform a wallet extraction procedure over a period of weeks. Sadly my experience with PTs is that they often mix in pseudoscience ... you may need to to watch out what your insurance will even cover; I know of one that drew the line at an unproven modality (Low Level Laser Therapy, LLLT) that a PT wanted to do on me that would have been out of pocket expense. Frankly there's often things they cover that are also unproven ... but they are so popular they feel pressure to offer them.

    I'm surprised no one has mentioned hiking poles yet. I likely have ITBS as well and they have been a difference maker for me, more on the downhill than the uphill. Poles can be dual-use as well, depending on your shelter. And don't forget the option of rest ... and dialing back your mileage goals to be within your pain tolerance.

    As for living where it's flat, I suspect there's no good substitute for hiking with a pack uphill. Have you tried a treadmill that can elevate? Or a stairmaster? Or just a set of stairs? That's the closest thing I can think of. As an analogy, I occasionally bike in my hilly subdivision, but I also have bike rollers at home for when the weather is bad for it. But IME it's not as good a workout as going up and down the actual hills. I suspect the same may be true of hiking. For your sake, hopefully not, but it may be the case.

  13. #13
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    I haven't had knee pain from hiking but have experienced hip issues. I did part of the Long Trail with bursitis in my right hip a few years ago and it got progressively worse as the hike went on. Fortunately, it resolved after I finished and took a few weeks off. Then last summer, just as I finished the Long Trail, I experienced very bad right hip pain that set in without any warning. I could barely walk. I took about a week off and then started training for a long distance bike trip (probably not a wise decision). Now 8 months later and after 3 months of PT, it is only marginally better. The PT docs told me to expect up to 12 months to heal and full recovery is not assured. The injury is gluteal tendinopathy / trochanteric bursitis (also called greater trochanteric pain syndrome). At this point, I am not sure if I will ever be able to return to backpacking. So my recommendation is take the pain seriously and go to a doctor or physical therapist so that you can hopefully nip it in the bud before it becomes a chronic condition. Good luck to you.

  14. #14

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    Quote Originally Posted by fudgefoot View Post
    I haven't had knee pain from hiking but have experienced hip issues. I did part of the Long Trail with bursitis in my right hip a few years ago and it got progressively worse as the hike went on. Fortunately, it resolved after I finished and took a few weeks off. Then last summer, just as I finished the Long Trail, I experienced very bad right hip pain that set in without any warning. I could barely walk. I took about a week off and then started training for a long distance bike trip (probably not a wise decision). Now 8 months later and after 3 months of PT, it is only marginally better. The PT docs told me to expect up to 12 months to heal and full recovery is not assured. The injury is gluteal tendinopathy / trochanteric bursitis (also called greater trochanteric pain syndrome). At this point, I am not sure if I will ever be able to return to backpacking. So my recommendation is take the pain seriously and go to a doctor or physical therapist so that you can hopefully nip it in the bud before it becomes a chronic condition. Good luck to you.
    That's the bursa that was hurting me, although it wasn't tendinopathy, just the imbalance. If you have any reason to suspect arthritis, maybe have them check your leg length. My parents both had hip replacements, it's common I know, but my Dad had a real shortening of one leg from the arthritis and the hip replacements.
    "Sleepy alligator in the noonday sun
    Sleepin by the river just like he usually done
    Call for his whisky
    He can call for his tea
    Call all he wanta but he can't call me..."
    Robert Hunter & Ron McKernan

    Whiteblaze.net User Agreement.

  15. #15

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    Quote Originally Posted by Time Zone View Post
    And a bad one will perform a wallet extraction procedure over a period of weeks. Sadly my experience with PTs is that they often mix in pseudoscience ... you may need to to watch out what your insurance will even cover; I know of one that drew the line at an unproven modality (Low Level Laser Therapy, LLLT) that a PT wanted to do on me that would have been out of pocket expense. Frankly there's often things they cover that are also unproven ... but they are so popular they feel pressure to offer them.

    I'm surprised no one has mentioned hiking poles yet. I likely have as well and they have been a difference maker for me, more on the downhill than the uphill. Poles can be dual-use as well, depending on your shelter. And don't forget the option of rest ... and dialing back your mileage goals to be within your pain tolerance.

    As for living where it's flat, I suspect there's no good substitute for hiking with a pack uphill. Have you tried a treadmill that can elevate? Or a stairmaster? Or just a set of stairs? That's the closest thing I can think of. As an analogy, I occasionally bike in my hilly subdivision, but I also have bike rollers at home for when the weather is bad for it. But IME it's not as good a workout as going up and down the actual hills. I suspect the same may be true of hiking. For your sake, hopefully not, but it may be the case.
    I was using hiking poles before and while my ITBS problem first appeared a few years back while on a ridge in the Pemi. Don't get me wrong, I love my poles, but they didn't save me from hurting myself. I was walking all wrong in those days with the toes on one foot pointed wrong. Was using them just south of Monson when my hip made an odd crunching sound a couple years later too heh. I've learned to listen better to my body and changed some other things about how I hike as well so knees and hips hold together. Poles are important as you not, as is how you walk and hydration is super important as well. Those soft body tissues that hold us together work best when they aren't drying out.

    Also have to agree with you about the need for training if you live in the flat lands but like to hike mountains. I am a couple of hours from anything pointy so have to make a point of training locally with a pack. Finding something you can go up and down with weight on your back really helps everything work better later. It doesn't have to be very tall, but steep is important. You want an incline that makes your ankles work the acute and obtuse angles or the tendons won't work when you get on trail for real. Stairs are good for leg strength, but don't work the lower leg like a ramp which is how most trails are.

    I made this video a while back talking about how we train to get ready for the season. The whole family likes to backpack together at times and no one is allowed to complain so training is important It also really helps to prevent injuries which is also important!!

    “The man who goes alone can start today; but he who travels with another must wait until that other is ready...”~Henry David Thoreau

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  16. #16

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    The fact that it takes 3-4 days to present itself makes it sound like you have some sort of inflammation building up over that time. If I had to take a bet, I'd say it's mild arthritis in your joints. But I'm not a doctor. And self-diagnosis is useless. There are literally a dozen and a half different reasons why this could be happening. And the only way to know what's really going on is through imaging and diagnostic tests. Go see an orthopedist, so you don't have to guess anymore.

  17. #17
    Registered User Venchka's Avatar
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    Quote Originally Posted by Alligator View Post
    I had knee issues for a long time resulting from hiking and in the past several years a general hip problem. What worked for me was talking with my doctor about it and then being referred for physical therapy. With my knee, I just figured I had a bad knee and was getting older. When I finally did talk to my doctor, I was diagnosed with ITBS, Iliotibial band syndrome. This affects the tracking of the kneecap and the PT worked with me on strategies to resolve it and I have found what works for me to keep it at bay. With my hips, again I discussed with my doctor but the PT was a little more insightful and she noticed that I had a slight imbalance in my right leg length. She gently suggested it might be a little bit of arthritis development in my hip area. The solution was a heel lift in my right shoe which very much helps. Also stretching exercises to loosen muscles. I was also getting some soreness in my back at the time and the PT explained that problems with one can be involved with problems of the other. If you can, mention it to your doctor.

    Stretching, PT, yoga, these all help generally to improve flexibility and work some of the muscles that are underused. Too much sitting for instance in an office environment can lead to locking up muscles.
    DITTO. DITTO. AND DITTO!
    Physical Therapy! In my case: Right Upper Hamstring tendinitis coupled with left leg shorter than right leg.
    I outfitted all of my shoes with 3/8” lifts and prescribed strength and stretching exercises. I dropped 30 pounds on my own. I’m good to go now!
    I can’t say enough good things about Physical Therapy!
    Wayne

  18. #18

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    Back to the OP. What’s your general level of fitness? What is your pack weight?

  19. #19

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    Just tossing in an idea here, what is the condition/age of the footgear worn? I have found over the years different brands and types of footwear can cause problems as they wear down that can be difficult to interpret. Blistering is typically the first problem I get when a pair of shoes or boots starts to reach the point of no return, however some mid-high boots have created some knee problems that went away nearly instantly after I replaced them. It may be worth a look to see if a different shoe can relieve the problem.

  20. #20
    Registered User One Half's Avatar
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    I have been doing sections this summer and on my 3rd(?) section I had to call #theotherhalf to pick me up on day 2 of a planned 5 day trip due to a knee issue. I called my physical therapist and discussed symptoms, mainly the pain is when going downhill, left knee bends (right foot leading) and I experience pain in left knee. She told me that my glute med is not firing correctly or is not strong enough (endurance) for the miles I was doing. We discussed what to do as far as "rehab" and I ignored it for 2 weeks "because too busy" and went for another 3 day hike and on day 3 spent 3 HOURS going 4.5 miles DOWNHILL taking a variety of baby steps and side steps. Anyway, I have committed to working on it for the next 2 weeks before "testing" it a little.
    Bottom line - see a physical therapist AND follow the program they lay out! Don't be like me (pig headed)
    https://tinyurl.com/MyFDresults

    A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world. ~Paul Dudley White

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