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Knees in pain when hiking downhill
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May 30, 2016
Hi friends,

I've been hiking for many years now and just recently on my hikes back downhill, my knees began to experience excruciating pain. Just wondering if any of you experienced the same thing and whether you have any advice for strengthening the knees or perhaps even a cause? Wondering if compression sleeves will do any good too. Going to see a doctor as soon as I can but I'm miles away from home.

Thank you,
Chris
Chris Joe
From Arcadia, CA
Joined Apr 28, 2015
75 points
May 30, 2016
My 64 year old knees (with three operations) are in agony on all downhill jaunts - unless I use trekking poles. The difference is amazing. My only regret is that I didn't start using them many years earlier than I did. acrophobe
Joined Jul 30, 2010
1 points
May 30, 2016
Rock Climbing Photo: .
I've had this for a while (since High School). Eat ibuprofen, don't overdo it, and TRAIN. Seriously... it always crops up when I do my first 6+ mile hike of the season. I've found it bothers me least when I do a bunch of smaller hikes (2-4 miles) leading up to a big one. B-Mkll
From Bozeman, MT
Joined Nov 2, 2012
1,651 points
May 30, 2016
Might be IT band issues.

Try foam rolling and stretching. You also may need to do some strengthening. It's a very common issue with runners so a quick google search will help out.
ScottR
From Cambridge, MA
Joined Jul 23, 2014
0 points
May 30, 2016
Rock Climbing Photo: Estes Park Yart
+1 for trekking poles.

After years of street skating as a wee yout my knees sometimes just get pissed off with the long approaches.
Keeping the hips and ankles strong w/ single leg exercises (lunges, pistols...etc) helps but the trekking poles are totally worth it.
Brent Apgar
From Out of the Loop
Joined Oct 20, 2007
176 points
May 30, 2016
Rock Climbing Photo: Bolton, VT
Trekking poles, ice. Nick Votto
Joined Jul 27, 2008
338 points
May 30, 2016
Rock Climbing Photo: John Sherman
Hurts on the lower outside of your knee?

sounds like IT band, you and others here. You're strong and fine and next thing you know out of nowhere (seemingly) it hurts like hell.

Was my right knee 1.5 years ago, first experience

Thought I was cripple, stopped running completely, over months and months I unknowingly was strengthening it, getting back into running, it was fine, ran hard up until the winter

Tried to get back into running after this winter, probably started on a 5-miler

Now its my left knee.

I think climbing is really bad for it because you're using that muscle and getting it tense to climb up and then hiking back down with your pack and straining it.

I'm still learning but its from tightness, dehydration, weakness

Use trekking poles descending
Hydrate
Foam roll your legs everywhere
Stretch feet, calves, legs, back -- its all connected
Strengthen with hip abduction (you dont need bands) and wall sits, then you can advance into squats and other stuff
Tom Sherman
From Bristol, RI
Joined Feb 23, 2013
432 points
May 30, 2016
Rock Climbing Photo: sweet belay on El Cap Spire, Salathe Wall El Capit...
I get pain in the dead center and bottom of my knee caps if I use my quads to much while hiking downhill, try straighter legs, smaller steps, and most importantly engaging your butt muscle. Its like distance running, if you run with your butt, you can run forever. ParkerKempf
From atlanta, GA
Joined Jul 16, 2011
262 points
May 30, 2016
Sounds like patellar tendinitis It's common in downhill runs and walks. +1 for trekking poles to take off some of the shock load and to engage in Quadriceps stretches. wing thing
Joined Jun 18, 2013
83 points
May 30, 2016
Incredibly helpful input, everyone.

Thank you so much!
Chris Joe
From Arcadia, CA
Joined Apr 28, 2015
75 points
Administrator
May 30, 2016
Rock Climbing Photo: Mastigouche
Avoid taking ibuprofen for consecutive periods, it slows and reverses healing. Luc
From Montreal, Quebec
Joined Nov 27, 2006
8,841 points
May 30, 2016
Take some time off from hiking or other jarring activities and see an orthopedist. FrankPS
From Atascadero, CA
Joined Nov 19, 2009
284 points
May 31, 2016
Rock Climbing Photo: KenR below Wahoo gullies
I find that careful progressive Training makes big difference. Start with a little downhill, perhaps a small hill where can do laps and stop if it doesn't feel right (rather than hiking up a big hill where you're then committed to getting back down the whole way).

I also incrementally increase the weight I'm carrying in my pack.

. (and of course hiking poles) .

Ken
kenr
Joined Oct 29, 2010
7,293 points
May 31, 2016
Rock Climbing Photo: Annapolis Rock, MD
Another vote for trekking poles - reduces the load on your knees both up and downhill and once you get it down it will feel completely weird hauling a pack without them.

If you don't get surgery for the knees, consider a good physical therapist. They will assess it, stretch you out and put you on a workout regimen. It may be you need to build up adjacent leg muscle groups which can take some of the load off that area. Good luck with it.
Matthew Williams 1
From Pittsburgh, Pennsylvania
Joined Nov 26, 2014
88 points
May 31, 2016
Rock Climbing Photo: Rump roast II, pistol whipped, Indian Creek  Photo...
A few possibilities:

IT band
condromalacia, patellofemoral pain syndrome
meniscus problems
patellar tendonitis
sprained ligament
stress fracture


Potential helpers:
trekking poles.
Rx orthotics
PT/soft tissue work and training out of balance musculature
RICE or hot/cold therapies
Ultrasound
Electrical muscle stimulation/E-stim/TENS
anti-inflammatory meds, diet, supplementation
joint and/or bone supplements

Of course treatments need to be appropriate to the actual injury

Seeing the ortho or PT is the way to start
mountainhick
From Black Hawk, CO
Joined Mar 19, 2009
222 points
Jun 1, 2016
I had the same pain. Started with going downhill. Progressed to where I couldn't bike and couldn't walk across town.

Short answer: PT diagnosed it, had me do a bunch of exercises to strengthen hamstrings and medial glut. After a few months, knee was better than ever.


Longer answer: Doctor said I was just getting old but would refer me to an ortho if I wanted. I said yes. Had x-rays done. Went to ortho, he looked at x-rays, said nothing looked torn or abnormal, probably just getting old. But if I wanted, he'd refer me to a PT. I said yes, despite having had limited luck with PTs in the past.

Here's the key: get a good PT (one who has her doctoral degree).

Muscle imbalance was causing my knee cap to slide diagonally, causing inflammation and pain.

Had to do the strengthening I mentioned above plus re-learn how to do squats (no knees over toes).

Good luck!!
ibSteve
Joined Apr 29, 2016
0 points
Jun 2, 2016
Tom Sherman wrote:
Hurts on the lower outside of your knee? sounds like IT band, you and others here. You're strong and fine and next thing you know out of nowhere (seemingly) it hurts like hell. Was my right knee 1.5 years ago, first experience Thought I was cripple, stopped running completely, over months and months I unknowingly was strengthening it, getting back into running, it was fine, ran hard up until the winter Tried to get back into running after this winter, probably started on a 5-miler Now its my left knee. I think climbing is really bad for it because you're using that muscle and getting it tense to climb up and then hiking back down with your pack and straining it. I'm still learning but its from tightness, dehydration, weakness Use trekking poles descending Hydrate Foam roll your legs everywhere Stretch feet, calves, legs, back -- its all connected Strengthen with hip abduction (you dont need bands) and wall sits, then you can advance into squats and other stuff


Tom if you have IT band pain try an assessment of your glute medius strength. Stand on a platform with one foot out to the side, hands on your hips. Drop your pelvis on the outside leg side, then try to bring it up by engaging your glute medius (outside of your butt). You can put a finger there to see how well it engages (yes poke yourself in the butt).
My bet is that you will have a hard time doing this just like I did.

I went through a progression of exercises recommended by a PT friend. Clamshells, add band at knee when they become easy
Lateral leg raise with bands at ankle, progress to ankle weight
Lateral band traverse

After progressing in strength with all of those I maintain glute med strength while working my posterior chain by doing one leg romanian deadlifts. As a bonus this REALLY improved my heel hooking strength, getting up mantle top outs is so easy now it's not even funny.

My IT band pain came out of nowhere 19 miles into my first trial marathon. I could barely hobble across the finish. I tried foam rolling and all the stretches, while I felt fine in "normal" life the sharp pain popped back up within a mile of running. It wasn't until speaking with a PT and being advised to strengthen my glute medius that things got better. I've never had a flare up of IT band pain since and do a fair amount of long hikes and runs.
Nick Drake
From Newcastle, WA
Joined Jan 20, 2015
393 points
Jul 8, 2016
Could be IT band tightness.. Try to strengthen inner thighs, and other stabilizer muscles Rosalieva
From southshore MA
Joined Jul 1, 2014
5 points
Jul 8, 2016
IT band (I really have no idea, but everyone else is saying IT band. It seems like the right thing to say). FrankPS
From Atascadero, CA
Joined Nov 19, 2009
284 points
Jul 9, 2016
Rock Climbing Photo: Valley
+1 trekking poles

Doctor Referral to Specialist for Professional Assessment. Undoubtedly then referred to Physical Therapy. Surgery has as much potential to hurt as it does help, hence last resort.
Ranivorous Troglodyte
From Lake Forest, CA
Joined Apr 28, 2015
1,310 points
Jul 9, 2016
Rock Climbing Photo: Me
In my case I had pain under the front edge of my patella (runners knee) coming down steep hills. poor knee control, as a result of weak hips, and my quads also needed strength despite having endurance, to control the kneecap.

It was obvious when I tried Bulgarian split squats, my left knee tracks above my foot but my right knee "collapses" inwards like I was knock kneed. And, the left knee does the same thing when I start adding weight.

Glutes med & min, VMO were named by my sports doc, and I have also added in hip abduction in general. Clams, box step ups, split squats, and another set of work for the VMO.
Patrick Shyvers
From Fort Collins, CO
Joined Jul 16, 2013
16 points
Jul 9, 2016
My version of knee pain turned out to be patellar tendinitis. Mainly aggravated by going down hills or trails, like you.

I (a doctor) was sure I had patellofemoral syndrome and went to see a very experienced orthopedic surgeon. He didn't know what I had but recommended that I stop running, which seemed to actually make the problem a little worse. He and I were both wrong and it took a thorough PT with a sports background to figure it out.

So I would recommend ignoring my colleagues and I, as well as any Internet diagnosticians here, and going to see a PT with an open mind and a solid reputation for working on athletes.
Optimistic
From New Paltz
Joined Aug 29, 2007
328 points


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