Knee swelling / knee pain while hiking down hill

Here's the background / scenario.  My knees swell and I have pretty significant knee pain when walking down hill for an extended period.  The swelling and pain lasts for the better part of a week if I do more than a mile or so.  Up hill is fine but down hill becomes an irritation within 1 mile and significant pain within 2 miles.  I've had my knees x-rayed and the cartilage looks fine (good / consistent gap in the joint).  The DR believes I have an issue with the strength in the muscles / tendons that wrap around the front of my knee and connect at a point in the base.  I did some PT and worked on eccentric exercises (stepping off a small box jump to the ground with weights in hand).  This has seemed to help with daily soreness.  I try to limit the amount of weight I carry, have tried wrapping my knees, and use trekking poles.  

Does anyone else deal with this issue?  If so, do you have any other suggestions on how to deal with this?  It's getting to the point I don't want to go into the back country anymore.  At one point the DR gave me the old (your not in your 20's anymore).  I'm 37.  I should be able to handle a 10 mile hike.     

Do you use trekking poles? I find them invaluable, and relieving some of the jarring to my joints is just one of the benefits (especially with a pack).

Yes, I do use trekking poles.  They definitely do help.  

For me, cycling 30 min 3x/week keeps the knee pain away. More is good too.

outofstep80 wrote:

  I did some PT and worked on eccentric exercises (stepping off a small box jump to the ground with weights in hand).  This has seemed to help with daily soreness.  I

Do more PT, perhaps find a different physical therapist to help you out. Physical trainers might help as well designing a well rounded leg specific workout. Do not forget antagonist muscles and stretching.  Have someone take a look at your stride - people who land their feet heel first tend to have knee problems, they are exacerbated going downhill.

I bet once you can do 10 controlled one legged squats, aka pistols, your knee problems will go away.

amarius wrote:

Do more PT, perhaps find a different physical therapist to help you out. Physical trainers might help as well designing a well rounded leg specific workout. Do not forget antagonist muscles and stretching.  Have someone take a look at your stride - people who land their feet heel first tend to have knee problems, they are exacerbated going downhill.

I bet once you can do 10 controlled one legged squats, aka pistols, your knee problems will go away.

Yeah, when I did PT they told me a walk a little goofy.  My heels come down first and the outside of my foot if that makes sense.  When you walk what part of your foot comes down first?  I thought everyone landed on their heels.  

Edit: Oh, I've been working on squats and one legged squats on a bosu ball as well to help with the stability of the knee.  Right now I'm doing 10 per leg but I'm putting the other leg behind me (not the front) and only going down to 90 degrees.  

I've had this problem since my mid 20s.  I am 39.  

I went to the PT, and she laughed at how inflexible my hamstrings are.  She said that may be pulling my knee cap in a weird way, which then causes inflammation.  

Lot's of routine stretching seems to help.  A little preemptive ibruprofin too.

Guy with two knee rebuilts, patellar tendonitis, AT band, runner's knee, etc., etc.  Squats help, but that's only one exercise out of likely many others that may help straighten you out.  I have a tendency to get knee pain in my bum knee after hiking on uneven terrain (scree fields, etc.) and I've found that it's due in part to the outside of my quad getting really tight and compressing the knee joint.  I get a foam roller and work out the outside of my quads/AT band and it helps immeasurably.  Often it's the area directly above the knee that's really tight.  Once I roll that out, the knee pain goes away.  

Echoing what other have already said.  Stretch regularly, strengthen it, try a light brace when carrying weight (compression style ones have worked well for me), and find the NSAID that works best for you.  Naproxen (Aleve) works a lot better than ibuprofen for me but everyone's bodies respond differently.  Getting to a point you can exercise without swelling will be key to moving past the current issue and you have to back off when it does swell or it won't improve long term.  Also, if you don't like the response you're getting from your doctor go to a new one.

I actually had similar problems about a year ago. Found out about it on the downhill portion of a rather long descent. By the time I got to the car my entire leg was stiff. I had limited swelling in total, but the pain was bad and lasted a few days.

I found, for myself, that the main thing that helps is rolling out my IT band daily and after hard activity. If I roll out my legs (painful work) I don't seem to get knee issues. It also helps to do stretches for the IT band too. 

Eccentric quad work (the lowering part of a squat/lunge) has helped me. I use a smith machine and pick a relatively easy weight. Lower with one leg to work on the eccentric strength of that quad, then when at the bottom, bring the other foot onto the ground and do a regular squat on the way up. Also reverse step ups (be in front of a box facing away from it and step backwards with one leg to get on top of it) has helped me with knee pain when going downhill. 

And I'll echo other people, STRETCHING AND MOBILITY. IT band is key, since that can pull the patella laterally. Calf and hamstring flexibility will be key as well, as well as your quads. This may be getting too in depth but a huge reason why my left knee hurt me was due to lack of ankle mobility on the left side. Just a thought.

All of hte above, +:

Diagnosed with NO a.c.l. (doc calls me walking miracle) due to rolling race car, destroying knees 30+ years ago (i'm now 61).

I WOULD NOT WALK DOWNHILL 100m without these on. (sorry for shouting)

https://smile.amazon.com/gp/product/B005D2U76W/ref=ox_sc_sfl_title_4?ie=UTF8&psc=1&smid=ATVPDKIKX0DER

Go to ortho, get recommendation, but i swear by my braces.

And dedicate an hour a day to body maintenance, PT, strength, stretch. It only gets harder, sorer, etc.

Definitely a lot of useful information here.  Appreciate all the advice.  I'm optimistic that with a few tweaks to my routine I'll be in a better position.      

Oops.  As others have noted, I meant "IT' band, not "AT" band.  Muscrat mentioned a brace, but I've have good luck with just a simple Chopat strap.  Inexpensive and works pretty well.  Also, while NSAIDs are great when you have inflammation, unless that inflammation is due to a particular injury that will heal on its own, you need to figure out what the source of the swelling/soreness is.  

Fat Dad wrote:

Guy with two knee rebuilts, patellar tendonitis, AT band, runner's knee, etc., etc.  Squats help, but that's only one exercise out of likely many others that may help straighten you out. 

Do you have any exercises besides squats that may help?

If you're going to a PT, find one that if familiar with PRI (postural restoration institute).
This is new evidence based practice and is all about how we load our bodies based on the posture we obtain from breathing (16-24,000 breaths a day influences our lives!)

and many others above captured a lot of the rest of good ideas.

good luck!

After i rolled the race car, and was told i would never run again, walk without full leg braces, etc., i took up deep water P.T. Basically you stand neck deep in water and do leg lifts, run in place, squats, using water as resistance. In a year i was running, walking w/o braces, cross country skiing, backpacking w/heavy pack. 

Wish i had access to a pool! Stationary bike works well, i like the airdyne (SP?). 

Rest is rust.

I had the same issue. Saw several orthos and PTs and just about to give up until I saw amazing PT in Boulder. Identified imbalance in quad resulting in altered tracking of knee cap. Some friction massage and stretching and all better!

Paul Deger wrote:

I had the same issue. Saw several orthos and PTs and just about to give up until I saw amazing PT in Boulder. Identified imbalance in quad resulting in altered tracking of knee cap. Some friction massage and stretching and all better!

Any tips on specific stretches?

I’m working on a knee and hip problem at the moment so ultimate results are unknown but my PT has prescribed a series of glute activation and strengthening.  He believes I’ve got strong muscles but they fail to fire properly, which causes me to be quad dominant.  

I also started doing some mobility work that really seems to be helping.  It’s a program online that I paid for but has an assessment test for 8-9 joints from neck to toes.  If you fail for any particular testyou do the corrective stuff for that joint a couple times a day.  I’ve only been doing the hip protocol because I wanted to start with something sustainable to see if it works.  It has so far so I’ll probably throw in ankle or lumbar stuff soon.  I don’t want to spam the forum with the program so shoot me a PM if you’re interested in getting the name.  I’m not affiliated with them in any way.

This sounds like IT Band Syndrome, which is also referred to as runner's knee. I've been dealing with it for a few years.100% treatable with a consistent and motivated approach. Lots of resources available on youtube or at knee-pain-explained.com

PM me if you want to chat.