Hiking injuries

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 excellent pictures from the Journal of Orthopaedic and Sports Physical Therapy: