Backpacking with knee pain

One of the most common injuries to sideline hikers is knee pain. It can start slowly…that dull ache behind your kneecap that grows and grows as you keep pretending it’s not there. Or it can happen suddenly with a quick awkward step or even a stumble.

The second requires a bit of first aid, and if the pain persists more than a few days, possibly a trip to your neighborhood PT.

Let’s spend some time talking about the first one, which is far more common and you can usually treat it yourself.

Pain behind or around the kneecap is called patellofemoral pain and is very common in hikers. And runners. And bicyclists. And walkers. We can’t seem to agree on EXACTLY why it hurts, but everyone does seem to agree that it involves a problem with how the patella rubs against the grooves of your knee. In some people there’s too much pressure on certain spots on the undersurface of the patella (like hot spots), and in other folks it involves weak muscles that allow the knee to move too much when you stand on it.

For both of those types, you can take a lot of the pressure off the kneecap by strengthening the muscles at your hips

While it may seem like you need to strengthen the muscles around your knee, the fact is that for the vast majority of us those muscles are just fine – if anything they’re too strong and work too much. But if your hip and butt muscles aren’t strong enough to support your weight when you stand on one leg (which is what happens every time you take a step), your femur actually rotates inward a bit – because your butt muscles aren’t strong enough to hold it in place.

Try it: stand on one leg in a pair of shorts, do a little squat and see if your knee stays in a straight line over your toes. If it collapses in a bit then you DEFINITELY need to strengthen those butt muscles. If you can do a pretty good job holding everything in place, it’s possible that the problem only happens when you get tired. Try it after a long run, or at the end of a hike. Or even better, with your fully-loaded pack on. That’s a lot of extra control those poor butt muscles need to exert and sometimes they’re just not trained enough to do it.

Here are some of my favorite exercises to target the gluteus medius, hip external rotators, and hamstrings, taken from an article in the Journal of Orthopaedic and Sports Physical Therapy (2009):

The first is called a clam: Lie on your side with your heels and knees together, knees bent to about 45 deg, your head comfortable.  Keep your heels together and raise your knee (like a clamshell), making sure that your hips and back do not roll backwards.  You don’t need to lift up very much – just enough to feel a pull in your buttock or the top of your hip.  Do about 20 on each side, 2-3 sets each.
Next is a straight leg raise on your side.  The key here is not to let the very strong little muscle in the FRONT of your hip do all the work.  In order to keep from cheating, lie with your shoulders, back and heels against a wall.  Slide your foot up the wall, then back down.  This will keep you from rolling backwards and letting the stronger front muscle do all the work.  Again, do about 20 on each side, 2-3 times.  With this one, if done correctly, you may only get about 10 or so before needing a rest…that’s OK.  It’s more important that you do 5 good ones than 20 bad ones.  The whole point of this is to use the correct muscle and teach your body to stop cheating – leading to injury.
Next is what I call a windmill – stand on one leg and keep it straight, then bend at the waist to the floor, lifting your other leg straight behind you (think warrior pose from yoga).  This is what golfers do when they bend down to pick a golf ball out of the cup.  Try and do 15-20 in a row without putting your other leg down, and go at a slightly faster pace than you normally would do an exercise.  Again, both sides, 2-3 sets.
Lunges – both to the front and to the sides, are always good to strengthen the gluteus muscles.
 If you have any elastic bands, loop one around your ankles (you don’t want it to be too stiff) and walk sideways about 20 feet.  Here, make sure your toes keep pointing forward.  They will want to point in the direction you are walking, but this biases that strong anterior hip muscle and doesn’t work the gluteus medius in the back.  Face the same direction as you walk to the left, then to the right.  Try about 5 laps of 20 – 30 feet in each direction.
What’s nice about this set of exercises is that it is a great routine for a lot of lower extremity problems: ITB syndrome, “over pronation,” low back pain, even achilles tendinopathy.  So many of the problems in our back and legs comes from not having enough strength and control over the middle of our bodies, which tends to throw so many things off.
Hope this helps!

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CARROT QUINN

dispatches from the wild

Wandering the Wild

Backpacking the Pacific Crest Trail and Beyond

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