Questions about knee pain.

[Patrick Coffey]

Hello,

This is my first post on BPL so any advice is greatly appreciated. I am planning on thru hiking the AT with my partner this summer, but have recently developed pain in my left knee. Since I have no insurance, but do have a membership to BPL, I figured I would throw out some questions and see what kind of a response I get.

I have been living and working in Yellowstone National Park for the last 3 summers. My partner and I hike every weekend we have off. I am 6'5" and about 245lbs. This last summer my knee started bothering me after long hikes on it. I am almost positive it is my IT band from the research I have done. It gets most aggravated on long downhills and when I run. It is a pain on the outside of my knee. I have recently been wearing a knee brace and it is helping significantly, but it is something I would like to address as much as I can before the start of the AT. I have been doing stretches, rolling with a foam roll, and hip strengthening exercises, but wanted to see what advice I could get from the community. My pack weight has lightened over the years and my goal weight for the AT is about 15-20lbs before food and water. Does anyone have any suggestions?

I haven't seen any posts like this, and I understand that I will be receiving opinions, not doctors orders, but any advice is greatly appreciated.

[Bob Gross]

One opinion is to go see a specialist, even if it costs some money. You want to do this now, long before you head out on the AT. If you wait until you get out in the middle of West Virginia, it will get ugly and get expensive.

Some sports medicine specialists get pretty good at this stuff. In some cases, those are physicians, and in some other cases the physicians hand it off to the physical therapists. Getting the diagnosis right is half the battle, and then getting a proper treatment program is the other half.

When I had a related knee problem, one very good PT gave me exercises to do twice per day, and after a month or so, the entire problem was licked.

After all that is said, you might want to learn to walk like a Sherpa, since you reported this problem from long downhills. The Sherpa people walk with a shorter and quicker stride (the opposite of a 245-pound American). They walk with their knees flexed a bit, and this reduces the force on the actual knee joint. Instead, it increases the force on the muscles and soft tissues that can handle it. They walk just slightly bow-legged, and this improves balance with a wider stance.

–B.G.–

[Anonymous]

"I haven't seen any posts like this, and I understand that I will be receiving opinions, not doctors orders, but any advice is greatly appreciated."

PM Jennifer Mitol. She has an advanced degree in physical therapy and is not only very knowledgeable, but also very willing to advise fellow BPLer's with problems.

[Scott S]

I've had ITBS a few times. If you browse running forums, you will find many ITBS sufferers, including me, swear by "Walt Reynolds' ITB special." The name sounds goofy, but doing this simple exercise daily (work up to 50 reps a day) will usually clear up my ITBS within a couple of weeks.

There's a good description here: http://onemillionruns.blogspot.com/2006/10/walt-reynolds-itb-special.html It will feel awkward at first, but it gets easier. You will know it is working when you feel stretching/fatigue in the outside of your thigh.

(BTW, if you find the above link confusing, you can find many other examples and videos online. Just google Walt Reynolds ITB.)

[Patrick Coffey]

Y'all are awesome! Thank you so much for all the help and advice. I don't feel so helpless anymore.

@Bob, I was wondering if you could post a video of yourself demonstrating that sherpa walk ;)

@Tom, I took your advice and PMed Jen, she got back to me with some great advice, thank you so much.

@Scott, That exercise is awesome, I can definitely feel it working out my hip and it sounds like that is exactly what I need right now.

[Nico .]

Check out the site: http://www.mobilitywod.com

("WOD" stands for Workout of the Day").

He's got lots of good exercises, stretches, etc to help athletes with various ailments like this. If you search his site, you will find videos, write-ups, etc. IT tightness is pretty common, so there's bound to be a lot of good info out there for how to treat it and (in the future) prevent or minimize its recurrence.

I use some of his info to help rehab my shoulder tear in addition to what my PT gives me.

[Anonymous]

"@Tom, I took your advice and PMed Jen, she got back to me with some great advice, thank you so much."

Glad to be of help. It sounds like you're on your way to crawling on top of this injury, which is good news to all of us. Go for it Patrick, and I hope you have a great season wherever you hike.

[Michael Flanagan]

Patrick,

I had some knee problems years back when hiking in the Catskills. I was diagnosed with ITBS in my LEFT knee. From what I remember, I was told that a pre-hike stretch was very important. The way I was shown how to do it (again, for the LEFT knee) was to lie on on my RIGHT side on a flat surface such as a bed or table. Then, bring my left leg (the one with the painful knee) out over the side of the bed/table and let it hang down across my right leg and down toward the ground. The purpose was to stretch the ITB as much as possible. As I understand it, the ITB runs from the hip down (I think) to the ankle area on the outside portion (anterior?) of the leg. I was told that the ITB, when not stretched out enough, will rub against some prominences on the bones in the knee area and will become inflamed and painful. I would lie in that position for a good 10 to 15 minutes to stretch out the ITB. Bottom line – it worked for me.

I'm not a doctor, don't even play one on TV so, as they say, YMMV.

That's all I can offer. Good luck.

[Backpack Jack]

Patrick,

I've had the same pain going down, though I never had it diagnosed, the group I was with thought that it was my IT also.

I use to hike in Danner 8" boots, I've since changed over to minimulist shoes and the pain is almost gone. The reason being, is it changed my down hill speed and stride/gate like Bob mentioned, plus when you wear minimulist shoes it makes you pay more attention on were you place your next step, instead of just tramping through the forest trails.

I think like others have said with the proper stretching before and after hikes is also key to keeping the pain at bay as long as possible, just my 0.02

Jack

[Roger Caffin]

Funny thing is, knee pain is often caused by poorly fitting shoes. They push the rest of your leg out of its normal motion.

Try switching to really minimal shoes: no arch support, no pronation control, no gel soles, no orthotics, just a plain flat inner sole. (Keds or tennies?) Then work up to distance slowly: let your ankle get fit and recover.

My 2c. May or may not help.

Cheers

[Jeff M.]

I found stretching helped my IT Band issues. For whatever reason, I had extremely tight hips. Stretching and strengthening them made a huge difference.

[James Castleberry]

Medical prices are so out of control for those without insurance now, that I don't think it is really practical for a lot of people to see a doctor. In an ideal world, yes, but not in today's profit-driven medical system. I have health insurance and considered going to see a doc for my recent knee troubles, but I honestly don't trust them to provide treatment that is in my best financial and medical interests. If I have trauma or infection, yes, but only for something like that.
Here's what I did:
1) Researched symptoms and identified probable injury. Sounds like you've done that.
2) Researched possible treatments, surgical and non-surgical. In my case, my research led me to believe that the injury (partial torn meniscus) might heal on its own, so I wanted to give that a try. If I felt I really should go see a doctor I would have, but the research showed mixed results on that.
3) Took Gloucasimine/Condroitan for past three months.
4) Rested knee for about two months and then focused on stretching.
5) Tried progressively harder hikes starting with easy hike at GGG in late Jan and progressing to more difficult hikes up Yosemite Falls and Snow Creek Trails in Feb to test how it felt.
Conclusion: Knee is getting better and doesn't inhibit my activity anymore, but I still feel it pop once in a while and it still hurts occasionally.
I stretch a lot and that's how I've been able to gauge improvement, whether or not I can do this or that stretch without pain.
Maybe IT band issues are different.

[Mark Verber]

lots of good advise already. The combination of minimalist footwear (and the related barefoot walking style) cleared up my knee pain after a couple of months and has kept me pain free for 6 plus years now.

–Mark

[Mary D]

Just some comments on James' comments: Yes, do your research! Being fully informed is very important. On the other hand, self-diagnosis can be risky, even for a physician who has the knowledge and education. There is a ton of spurious and inaccurate information out there on the internet (the modern equivalent of snake oil and Lydia Pinkham), so be careful to stick with the more reputable sources.

If the suggestions given here, especially from Jennifer, don't work: Consider a physical therapist. Or look for a sports medicine specialist. You may need both. The PT would be the cheaper option. Sometimes delaying treatment can make things worse.

What I've learned from my own problems: Once there has been an injury, especially one involving any joint or ligaments or the spine, it's vitally important to keep the supporting muscles strengthened. As suggested, shoe changes may help. Trekking poles can also be extremely helpful on those long downhills.

I had a severe knee injury (skiing) 25 years ago this month–I basically ripped all the ligaments and had to have them replaced (with pieces of patellar tendon, the only one that didn't get torn). That of course means my patellar tendon is also weaker. Any time I let my knee exercises (including using a bicycle) go, it starts hurting. I also have to be careful of overuse injuries, especially when training, working up very gradually when increasing exercise levels.

I do still wear a neoprene brace for hours-long steep downhill stretches with a pack. I try not to wear it otherwise, though, because constant use of the brace weakens the muscles that I need to be stronger.

Good luck!

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