Diagnose Me – and help be get in better trail shape

[Bob Shuff]

Wasn’t sure where to post this – mods can re-direct if necessary.

Just got back from an overnight backpack – the Palm Canyon Trail from just off of CA-74 (Near the PCT Paradise Cafe stop) to the Trading Post near Palm Springs.  We did ~8.5 miles to Aqua Bonita Springs on Friday and another ~7 miles Saturday to Palm Canyon proper.  Total ascent per Gaia was ~200′, with a decent of ~3600′.  Rated easy by the trip leader and I would have agreed considering “it’s all downhill”.

I’m a relatively lightweight backpacker: ~12 lbs baseweight before I tossed in the 1  lb chair and extra jacket at the trailhead.  We do carry more water in drought-stricken CA than most I read about – about 2.6 liters at the trailhead, but the pack still felt light throughout the day.  I thought I was in moderately good shape for my 57 years, and have been backpacking off and on since I was young; more trips a few years ago with my son in boy scounts, and most recently a 10 mi. loop with him at Bryce Canyon (Riggs Spring) last May.  I ride a stationairy bike 3+ times/wk and walk more than I get out on trail lately;  cardio was not a problem.

The issue is decending.  The day started out cold and the crew set a brisk pace.  I know I’m a slower hiker and everyone was fine hiking at their own pace with a short day planned.  With my slower pace I take less breaks, and on this trip no meaningful pack-off breaks either day.    I arrived last to the campsite at noon.  As the morning wore on I starting feeling pain in my ankles, knees and hips on any big down steps.  That slowed me down more – and it was mostly down-hill.  Even with trekking poles my left foot slipped a couple of times on lose gravel, and I caught myself before taking a spill (I’m definitely retiring my older Alta Timp Trails for a new pair I have waiting in the wings).

I was waddling around camp and hiked in pain the next day.  I’m still feeling it in the front of my left ankle and outside back of my left knee two days later.  I’m used to having sore muscles, but this seems different.  It happened to me previously coming down from the San Gorgonio highlands after a day of peaks and long downhills back to the car.  I recently started taking glucosamine and chondroitin.  FWIW…I also take Metformin and another diabetes med to control my A1C – don’t know if any of this is related to the pain.  My thoughts looking back on it are:

1.  You’re getting old, and don’t hike enough.  The bike trainer is OK for cardio, but not a substitute for trail miles.  Reset expectations or start getting out for a lot more day hikes between backpacking trips.  You can exercise to hike faster and have less pain.

2.  Maybe I should revisit boots versus zero drop Alta shoes, and/or consider wrapping my ankles and wearing a knee brace.  I have been wearing trail runners for 10 years backpacking and like the cushioning of the Timp Trails, but I have a pair of Hanwag Tudela Light GTX boots for some previous snow camps, and recently picked up some Lems Boulder Boot Mids I was planning to use as casual shoes.

3.  Maybe the early slips were worse than I realized.  Maybe taking pack-off breaks and elevating my feet would have helped – but this would have slowed me down more compared to others.

4.  Should I get a medical opinion?  I try to avoid unecessary procedures, but I’m not opposed if something is wrong and correctable.

5.  It’s OK to hike slower downhill.  Plan accordingly, although it might limit what groups I hike with.

Other suggestions?  Thanks for anyone who read my entire post, and thanks in advance for feedback.  I’d like to get back to a point where I can do multi-day trips in the SoCal mountains and Sierra this spring and summer, with groups that are doing 10-15 miles per day.

[Matthew / BPL]

I’d talk with a PT. I suspect your stabilizer muscles are not getting any kind of workout when you are doing cardio on the bike. That instability takes a toll and shifts loads to ankles and knees in weird ways.

I suspect you will end up doing weird one-legged squats on foam pads and other exercisers that emphasize instability to get all the little muscles firing.

Also, trail miles will help.

Lastly, my PT doesn’t want me in boots. She wants me wearing Cascadias (stuff, supportive, with drop but not getting in the way of my ankle taking loads).

Obvious disclaimer that your situation may be nothing like mine. Good luck!

[Bob Shuff]

Thanks for the quick reply.  There was a PT I just met on the hike.  She was the fastest of the crew so we didn’t get to chat on the trail.  I haven’t had PT on the legs, but did for lower back and wrist problems with success in the past.  Your suggestion makes sense.

I didn’t mention it, but I wear custom orthotics, which I can’t recommend enough.  That solved my overpronation and any other foot problems years ago.  I get a new pair every year w/ insurance and use them in almost all my shoes from dress to casual to hiking.  No foot problems on this hike!

[Matthew / BPL]

Good luck!

[W I S N E R !]

I have had amazing success with knee rehab/strengthening/pain relief thanks to Athletic Truth Group and “Knees Over Toes Guy” and their routines for knee strength and PT. I’d suggest a search/look there.

[bjc]

You’re dealing with eccentric muscle contraction when descending so your cycling routine won’t help with that.  Here is a reasonable article explaining the issue. 57 is young!

https://www.livestrong.com/article/550997-does-walking-downhill-build-muscle/

[Bob B]

anecdotal thoughts from someone w/ no formal medical education…

“outside back of my left knee” …if you’re talking about where the IT band connects to the knee then this sounds familiar. i had a lot of trouble w/ that spot too, and i narrowed it down to me pivoting/twisting on my inside foot while taking tight turns on downhills. i would plant my inside foot, and then kinda roate on it until my inside foot was pointing perpendicular to the direction i was facing, which put a lot of twisting torque on the other knee where the IT band connects. this would get exacerbated by the weight of my pack as i’d turn. i don’t know why i started doing this all the sudden because it’s kinda goofy but hey – that’s what happened and i’m real glad i figured it out.

now i ‘m careful to plant my outside foot and trekking pole first and then open up to continue downhill. (i think i kinda remember learning about this footwork in football and soccer back in the day maybe?)

i guess the high level advice there is “listen to your body”, although that’s easier said than done.

for me personally, riding a bike isn’t enough to train for backpacking. it’s great low impact cardio, but i have to do some HILLS and tall steps (up and down) w/ weight in the pack. nothing else seems to substitute, although i also floss on 1 foot and brush on the other :)

[Mark Wetherington]

I’ve had some IT band issues over the years (and I’m fairly young at 35) that had similar symptoms as you. Most notably it being the downhills where the issue really rears it head. I’ve had good luck with using a foam roller and some acupuncture work to get things released and loosened up. Made a huge improvement for me.

[YoPrawn]

Bodies are so complex that it’s more of a trial and error approach going off of internet forum advice. Only way is to train one’s self in their disorder/issue or hire someone else to do it professionally.

[Bruce Tolley]

+ 1 What Matt K said.

You need train for backpacking bearing weight. Cycling is good for the heart muscle but is not helping with the muscles that help you walk.

57 is not too young for arthritis, so see a professional and find a good PT.

It is work to fight gravity when walking downhill. Some random trivia from my memory that I might have heard here at BPL (from Bob Gross perhaps??). There was a health study done years ago by researchers with the Swiss Army where every male adult has to serve. They divided the study group randomly into two groups. For the periodic training throughout the year,  one group marched up and down the Alps while the other group marched up but got to ride the trams down the hills.  After a couple of years, they found that the group that marched up and down the Alps had better cardiovascular health and better fitness than the group that just marched up the hills and rode the trams downhill.

Cheers

[dirtbag]

#1 and #5. Sort of but not 100%. 57 is NOT old unless you are a lazy hump that sits on couch all day and never moves.. then I could see an issue and age being a factor. It doesnt sound like that from what you say.. so get that thought out of your head and move on!!!

[Arthur]

Long time ago, I asked a trainer to help me get in shape for a long hike.  He said to walk back out the door, put on a pack and start walking slow and short at first.  His point was that you must train IN the activity you are planning or doing.

[Todd T]

bjc posted https://www.livestrong.com/article/550997-does-walking-downhill-build-muscle/

Quote:

While it may seem easy-going as you walk downhill, you actually use three times more energy than you do as you walk uphill.

As someone who’s been walking for more than 6 decades, I call Baloney Sandwich.

[bjc]

Todd: I agree with you about the greater metabolic energy used in going uphill. I was posting this in terms of explaining the issue of pain from eccentric muscle contraction and missed that little tidbit. The interesting thing about the issue is that there are studies that show greater and faster fatigue in muscles contracting eccentrically and that the fatigue cannot be explained from a metabolic standpoint. I can say that whenever I’ve helped cyclists move into tri’s I have to warn them that there are going to be some early days of some not fun discomfort. I also suspect that because of your years of walking and my equally long years of running/walking we are much more efficient at both uphill and downhill movement.

[Bob Shuff]

Thanks all for the responses and encouragement.  Several leads to research while I schedule a video appt with my primary MD.  I think I need to see him first if I want insurance to cover any PT.  I also started listening to  BPL Podcast focused on foot and ankle pain as well – definitely a common thread about training.  I guess I knew that might be the answer, but with acute pain I don’t want to exasperate an injury if some medical intervention and/or rehab is needed first.  I just don’t have any family experience with IT band or arthritis issues.

So no one said reduce to reduce my pack weight?  With the last minute chair and jacket I calculate I was probably just over 15 lbs – so I’m turning my Lightweight badge back in until the next trek.  The chair was worth it since we got to camp at noon and sitting cross legged, even with my GG thinlight pad, would have been painful.  The jacket was only needed for the first 10 minutes of hiking, and I had a down puffy already in the pack.  That one I should have known better – I would have at least been under 14 lbs.  Still in pain, but feeling better about pack weight.

[Arthur]

The other thing nobody asked about is BMI or similar metrics.   Big difference in 35 vs 15 on your musculoskeletal system.

[M. C]

Hey Bob, I did an online strength training program for ankles that really helped – it is offered by a PT. https://linktr.ee/dr.lisa.dpt . The exercises are very different from what I have ever done and they really improved my strength and reduce other leg injuries.

[bjc]

Arthur you’re absolutely correct about that issue as are the comments about pack weight. Eccentrically contracted muscles can produce more force, but when the load exceeds the strength of the muscle it can cause damage to muscle and/or connective tissue. It’s what gets so many marathoners in trouble coming down the Newton hills in the Boston Marathon late in the race. Already fatigued muscles can’t handle the load. It’s no accident that elite distance runners have high strength to weight ratios. It’s also why   many middle and back of the pack runners have to go down stairs backwards for awhile after such a race!

[jscott]

I’m also curious about the body weight of the op. That may be a factor, on downhills especially. That said, even a light pack increases the load on hips and ankles quite a bit.

speaking of Bob Gross, he once also shared advice that he got from sherpas in the Himalayas: take very short steps. Try to keep your feet centered under your hips. Think of good downhill skiing form. If you need to pick up the pace, simply increase your step speed.

I try not to wear supportive wraps on my feet, but I have issues that flare up from time to time due to anatomy. I have a very good ankle wrap that does in fact help when quite a bit, and give good support. I suggest using one with a sleeve (sock) design that then allows a wrap from both sides.

[Bill in Roswell]

Fitfortrips.com can tailor a plan for you. Plenty of free exercise info/videos.

[Bob Shuff]

BMI by a quick online calculator would be 25-ish – getting better over recent years.  Along with that I should state in addition to base weight at 15lb 2.6 oz, I had just over 8 lb of consumables and just over 5 lb of worn gear.   That puts my “total” weight just north of 201 lb walking down the trail.  I hadn’t looked at the total-total lately, but ten years ago I was over 205 lb body weight alone with a heavier pack, and I’m sure that extra 30+ lbs had a cumulative effect on joints and connecting tissue that I’m feeling today.  Since I’m not having shoulder pain, I figure losing a pound (or gram) anywhere will help, and losing body weight will be best as long as it’s not lean muscle mass.

Another take away (filed in the obvious but forgotten category) is although I’m barefoot most of the day – working at home with a stand-up desk, my normal shoes I wear for daily use are not zero-drop like my Altra Timp Trail shoe I’ve been hiking with for years.  Listening to just the first part of the BPL Podcast 54, John Zomboro suggested unless you train barefoot or with minimal shoes daily, weekend hikers like me might benefit from more support.  I like the Timp because of the wide toe box, cushioning, and built-in velcro heel, and with my othordics I am getting targeted support.  But I wonder if introducing the zero drop only for hiking is setting up a recipe for joint issues, especially when I’m not training with it daily.

I originally mentioned sore ankle, knee and hips, and they were all sore at day 1 and for 24-48 hours.  3 days later the hips are fine, the knee feels OK, but the left ankle is still sore – better, but not even close to pre-hike normal.  I do have a video appt next week with my MD, and will research the recommendations above.  Thanks again for the support and feedback.

[jscott]

Bob, pain is a bad indicator. So something’s not working. I would guess that you’re on the right track in looking at different shoes/boots for hiking. This is the sort of thing that’s very individual. I don’t think there are hard and fast rules that apply to everyone. In short, each one of us has to experiment to find what’s right. Best of luck!

p.s. I use Keen boots for backpacking–huge toe box, which I need, and better support and protection. Some here will have a fit with this, but these boots work for me.

[BC Bob]

I would agree that pain on the outside of the knee is likely the Iliotibial (IT) Band.  I get that problem and do strengthening exercises for it.  I’m 67 and still hike and backpack but my muscles get weak pretty quickly if I’m not out 2-3 times a week for a hike on varied terrain.  I also bike hills every week but as others note, it’s not the same, especially for hiking down hill.

I used to wear orthotics.  I’m now a convert to thinking it probably wasn’t a good idea, at least for me.  I’d highly recommend these two videos with Irene Davis, founding Director of the Spaulding National Running Center at the Harvard Medical School.  The first is also available as a podcast.

https://www.youtube.com/watch?v=L7iHfxOrqJI

https://www.youtube.com/watch?v=I1QZS7BWgAo

[Steve H]

Often what you’re describing is a (undesirable) compensation for under active muscles.  Weak agonist muscles aren’t pulling their weight so others do – creating problems.  You may want to consider training (with load) your posterior chain (muscles in back like glutes, hamstrings & erector spinae).  I found myself neglecting those muscles/exercises because of a bad knee (excuse), but once I decided to find exercises I COULD do that work the posterior chain I found it beneficial. Perhaps something to look into.

[Brian W]

I like a lot of cushion in my trail runners, especially for the downhills. Trek poles also help. I’m buying HOKAs tonight after wearing out my Altra Olympus.

Biking is not the same as walking. You might be fine with your cardio, but your tendons and muscles aren’t used to the walking.

If you can’t get out for training hikes, walk on a treadmill. One approach a PT guy gave me was to max out the incline and walk backwards for ten minutes at 2 mph to help with some muscle imbalances. I still do it after a walk.

The other issue might be volume. The current recommendation is for 150-300 minutes of cardio a week. That’s 30 minutes 5 days a week. Sticking to that might help too.

At the end of the day, a sports medicine PT might be your best option.

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