Knee Pain Only When Hiking

I should add, the good part is, after some rest, the pain is gone later that day.

That is unfortunately common. Given your age and physical activity, you probably have arthritis. Repetitive motion of hiking or even just walking long distances will aggravate the arthritis more than a few minutes of strenuous activity. If you do indeed have arthritis you are options are probably anti-inflammatories, injections, or having your knee scoped to clean out the arthritis.

Good luck.

“My cardio is swimming, elliptical and stair machine.”

Which is pretty good preparation for going uphill, but not for going downhill.  Which is what leaves me sore after a hike before I’ve conditioned for the hiking season.  What works best for me is to go up and DOWN the stairs at home for just 10 minutes a day before my morning shower.  I read the paper or do Sudoko on my tablet and, if I’m prepping for a backpacking or hunting trip, I’ll start with two weeks (one week at your younger age) of no added weight and then add 10 pounds a week.

Similarly, when I’m traveling, I skip the hotel gym and just go to the fire-escape stairwell.  It’s usually cooler and then I can do 10-15 stories of stairs in each direction before turning around which is even better preparation.

I work on the ninth floor and there are 3 parking levels. A couple of times a day I go down to the P3 level and back up. That downhill isn’t enough to trigger pain in either knee.

Dr. Google seems to indicate that I need to strengthen the leg muscles more, always use the trekking poles and go downhill slower.

My cardio level and brain say I can do much more, but the knees overrule. My son’s final hike for the merit badge is 20 miles. That will be on the Mt. Vernon trail into DC, check out some monuments and back out. Pretty much flat.

As the great philosopher, Mick Jagger, said, what a drag it is getting old.

BPL member Jennifer Mitol is a PT and has a blog that has a post on BACKPACKING WITH KNEE PAIN .

“Cleaning out arthritis” is not an actual procedure humans are capable of doing. If you see a doctor who suggests something invasive for those symptoms, run to another doctor no matter how much your knees are hurting as you go out the door.

Personally, I once I got over the thought that they just looked ridiculous, I found trekking poles to be the best thing ever for hilly terrain.

BPL member Jennifer Mitol is a PT and has a blog that has a post on BACKPACKING WITH KNEE PAIN .

Good article. Thank you!

+1 to what Link posted.  I would also recommend going to see a PT, if for no other reason that to get it checked out and verify there is nothing really wrong.

Jennifer’s article is indeed great!

However, I wouldn’t be in too much of a hurry to jump to your own self-diagnosed conclusions, or to get unnecessarily despondent. I would spend some money and go to a local sports PT. Although at your age you are likely to have at least some arthritis there’s a good chance it’s mostly a more straightforward biomechanical issue.

Personally I suffered similar issues in my early 50s – downhill pain after 10 miles or so. After weeks of self diagnosing and worrying I spoke to my Physio on a visit for an ongoing neck problem and he diagnosed my problem as IT Band pain. Some simple stretches and exercises solved it quickly for me. I still do the stretches (and several others for different muscle groups) before during and after each hike and it has changed my whole experience.

Anyway, best wishes finding a solution and for a great shared hiking experience with your son!

For any suggestions, it’s important to know where the pain is.  You said it’s while hiking downhill so I’m guessing the pain is on the outside of your knee, just below the mid-level of your kneecap.  True?

You said it’s while hiking downhill so I’m guessing the pain is on the outside of your knee, just below the mid-level of your kneecap. True?

Yes. And it hasn’t been both knees at the same time. One time it was the right, next time was the left.

May I suggest visiting a Orthopedic doctor that specializes in Sports Medicine OR is connected with a professional sports team. My wife has had issues with her left knee and after consolation with a Sports Medicine Orthopedic doctor and x-ray in his office, the issue was plainly visible. His dx was the beginning of arthritis and bone to bone contact was occurring at times to give her pain and discomfort. In both cases the knee was injected with Methylprednisolone 40mg. that lasted for extended periods. This solved her issue for now and I’m relaying this information for your decision making process. (Sue and I both are 77 years young and still adventuring.)

Once again I strongly suggest visiting a Orthopedic doctor that specializes in Sports Medicine OR is connected with a professional sports team.

I too have had IT band issues, first in my 20’s due to an extremely aggressive workout schedule and again around 40 and the most recent was last fall which had me bailing a couple days early on a longer backpacking trip.  I have been doing the stretching and excersises to help, and the IT issues seems to have abated, but in the process, and most likely my enthusiasm to embrace the “more is better” approach, I have aggravated some Plantar Fasciitis in both feet and arthritis in my right knee.

A year after my PCT thru with little to no knee pain, I adopted a pair of fixed length ski poles in Yellowstone on my SOBO CDT thru in 1984, long before trekking poles became popular here in the US, due to IT band problems that eventually caused me to leave the trail in RMNP.  I have to remind myself while I hike with pain now, that I used to hike in pain before – sometimes for weeks on end.  As David T mentioned, I have found stairs to be one of the better strengthening excercises for knees along with stretching.   On trail, I am working on taking breaks every couple of hours and soaking feet and knees in cold water or snow when available, as it really helps with pain and overnight recovery.

I have the same problem. kinetic tape has been so incredibly helpful. You can grab it at target or online. I was hesitant in believing that some tape would solve my knee issues but boy was I surprised! Good luck!

Holly, what issues are you experiencing and how are you wrapping your knees?

My non-professional, arm-chair diagnosis would be IT Band Syndrome, as others have mentioned.

I’ve had IT Band problems many times.  For me at least, I’ve found stretching and using a roller to be a waste of time.  In fact, one stretching exercise I did a year ago damaged some knee ligaments (I think) that still give me problems when doing yoga.

From what I read in the recent research, IT Band Syndrome is thought to be a compression syndrome these days, rather than a friction syndrome.

What I’ve found to work is hip strengthening exercises.  I do seven exercises once a week, most with a ground-level cable on my home gym (with ankle cuff).  There are stretchy bands out there (eg Therband) that one can use as well.

Second, I’ve found that it helps a lot to slow down my pace a bit.  NO jumping, dropping, hopping as I go down hill.  Deliberate steps, one foot on the ground at all times.  If I violate that, I get IT Band pain after a short while.

Google IT Band and hip strengthening exercises.

Some articles and videos I found helpful…..

Iliotibial Band Syndrome Blog 1
https://www.youtube.com/watch?v=ADsAe7r_w3A

Iliotibial Band Syndrome Blog 2: Exercise Rehabilitation
https://www.youtube.com/watch?v=oKWbEeOxWIQ

Strengthening beats stretching when it comes to this common running injury
Alex Hutchinson
The Globe and Mail
Published Sunday, Jun. 24, 2012 4:00PM EDT
https://tgam.ca/2tk9dXI

Injury Series: Biomechanical solutions for iliotibial band syndrome
Friday, February 10, 2012
http://www.runningwritings.com/2012/02/injury-series-biomechanical-solutions.html

Good info. Sigh, looks like I should make an appointment with the INOVA sports medicine people. I’ve been happy just going to the doctor once a year for my physical for being an assistant scoutmaster at summer camp.

Up and down that hill at Camp Ottari will certainly be interesting this year. Well, DOWN the hill will.

I wouldn’t be going to any doc for just a one time knee pain during a 15 mile hike. If it recurred over and over, maybe.

It’s happened on 3 recent hikes, but don’t worry, since I have no pain in regular, day to day life, I’ll most likely keep putting it off. :)

I agree with John. Pain while engaging in more than usual levels of activity is pretty much the definition of being in your 40s. If the only thing that bothered me after a 15 mile hike was some knee pain that went away that same day, I’d call it a win.

If you’re in great shape it may be you’re just not using your muscles; as you go downhill and land with a straight leg instead of a bent knee your joints receive a lot of shock with each step instead of absorbing with your muscles.  Try keeping your knees bent as you descend; you will find your quads around your knees will do a lot more work but put less stress on your knee.

I discovered this technique (Sherpa walk) from this post by Bob Gross: https://backpackinglight.com/forums/topic/91064/#post-2101845

Or it could be Patella Femoral Tendinitis or IT Band Syndrome, which takes PT to fix.

+1 on the Blog 2 video link above.

For another perspective see

Be Very cautious if you visit an orthopedic surgeon.  They only have one hammer in the toolbox. They are trusted, picture oriented, and persuasive. And commit serious sins of omission. (Personal experience over 3 decades.)

If this is a hip stabilizer issue you can identify and resolve it with “two-a-days” for a  week of the exercises in Blog 2.  It’s that simple.

At least make sure any orthopedic surgeon you see has his boat already paid for.

I have been following the Navy Seal way for a while and it got me back on the trail and even running parts of it.  I get 35-50 miles a week on trail in the hills where I live and the methods in the Seal video got me to a point where I run larger portions of my hikes and even downhill with no long term ill effects.

I also have become more aware of the biomechanics of walking and my personal technique.  I am more conscious of foot, knee, and hip alignment as I walk and try to retrain 56 years of bad habits.   Keeping my knee slightly bent going downhill has done wonders for my knee and traction control.  I have a long stride for my height and used to just throw my leg out and land on my heel with the knee and leg fully extended causing hip and knee to absorb the bulk of the impact.  Now I kind of squat down and take smaller faster steps, allowing the leg muscles and ligaments to absorb the shock.  When I stop and rest I don’t sit with my legs extended and elevated with the knee hyper-extended.  I also have added a small inflatable pillow that I sleep with under my knees when on my back and between my knees when on my side, both at home and on the trail.

So far so good.  Once I ruled out a mechanical issue that would be further damaged by using the joint, I tried different things, all the while listening got my body and making notes on what was working and what wasn’t.  If some thing felt wrong or “off”, I stopped and rested or change up my approach.

I have plans for many more years of back country travel and wish I had taken better care of my knees.  I can’t change the past but I am trying to make sure that  going forward I am minimizing the wear and tear as much as possible.