Knee pain after hiking is a very common problem. Most hikers just want to get out and explore the great outdoors, but sometimes knee pain stops us in our tracks. It can be really disappointing if you have a trip you’ve been planning for a while, you’re all packed up and set off, only to be crippled by a pain in your knee only a few miles in. There are lots of different possible causes for knee pain, but its usually due to overtaxing your joints, or not having the correct equipment.
Your knees take a lot of stress throughout your daily life, just walking up the stairs puts on pressure equal to four times your body weight. When you’re backpacking, add a fully loaded backpack and climbing up a mountain, it’s no wonder joint pain is such a common problem for hikers.
There’s a huge list of possible causes of knee pain for hikers. Some examples include tendonitis, sprains and muscle strains, arthritis- all of them have the power to ruin your hiking trip. There are also some chronic and pre-existing conditions that could be exacerbated by the strain of hiking. Improperly treating knee injuries, or not taking the proper precautions to protect your knees, can lead to worse injuries further down the line. For this reason, it’s better to get out ahead of the problem and learn about the common causes of knee pain, and how to prevent it.
Causes of knee pain
The IT Band
Your IT band (iliotibial band) it the connective tissue that runs along the exterior of your thigh, between the knee and the hip. This is a very strong and also very sensitive piece of tissue (or fascia), which doesn’t stretch. One way to think of it is as a very strong string between your hip and knee, which allows for stable movement, essentially keeping you on your feet every time you take a step. The most common problem with the IT band is it can, unfortunately, get into a situation where it’s pulled over the knee, and can start rubbing the knee joint.
Because the IT band cannot stretch, the problems with it actually stem from weak connective muscles, like your quads, calves, glutes, and hips, or tightness problems with the same muscles. It’s also possible for IT band syndrome to cause inflammation for other reasons, but muscle problems are the most common and easiest to solve.
Problems with your IT band most commonly stem from a modern-day problem for all of us- too much sitting. The majority of people now spend hours every day sitting, most commonly behind a computer screen. This can lead to weak gluteus muscles (bum muscles), and tight hip flexors (the muscles that operate your hips). When you experience these problems and then go on a hike, your quads are forced to work harder than they should to make up for the missing strength from your glutes. This leads to pain in the quads and IT band, therefore an incorrect walking gait due to “pulling” on the knee.
In hikers of all ages, chondromalacia can present some problems. Also known as runner’s knee, it’s caused by the lower leg twisting inward when walking or running. This can be caused by over-worn hiking boots, or muscular weakness in the quads and hamstrings, commonly in older hikers. In younger explorers, the pain from chondromalacia is often caused by over-stressing and overworking joints, or sometimes trauma.
The actual condition is where the cartilage under the patella (kneecap) deteriorates and softens. The symptoms include a feeling of grinding and pain, and sometimes taking a few days of rest can alleviate the symptoms. However, sometimes the pain can be caused by improper knee alignment and the problem won’t be solved by rest, so you should always seek a doctor’s advice if you’re unsure.
Because your knees and hips bear the most weight of your body, they’re vulnerable to injury. Each time you take a step, a force of three to six times your body weight is exerted on your knee, and that’s just on level ground. Add in a heavy backpack, and that’s a huge amount of weight on your knees. Walking downhill adds even more strain, with the force again being three to four times greater.
To help with this, walk slowly and steadily down steep inclines, never with locked knees. You can also try zig-zagging down the hill to make the incline less steep, and if possible you can plan hikes where the majority of downhill walking happens towards the end. Your pack should be lighter then, having consumed food and fuel.
If you feel a persistent ache under your kneecap, it’s most likely that your knee is not tracking correctly, or that the cartilage is worn down. Hiking downhill or sitting down for long periods, for example in a kayak, can worsen such an injury. To get relief from this, something as simple as an insole for your shoe could help, but always talk to a doctor before deciding on any serious treatment. If the pain appears mid-trip, apply an ice pack and try taking an anti-inflammatory.
Sharp, shooting pain just above or below the knee is most often tendonitis. This is caused by an inflamed tendon, most commonly from overuse. Tight hamstrings, weak quadriceps, and a sudden swift increase in the amount of hiking you’re doing can all be a cause of tendonitis. At the first sign of this pain, try to ice the area and rest straight away. The pain should lessen within a few days, and if not, seek the advice of a medical professional. If you’re in the middle of a hike, try to lighten your load if possible, and use a cool stream to lessen the swelling in your joints.
The anterior cruciate ligament, or ACL, is the knee’s main stabilizer. Tearing it is a less common injury for hiking, as it more often occurs during basketball or tennis, but it can happen if a fall causes twisting and hyperextension of the knee. If your knee buckles when you try to stand, there’s a chance that you’ve torn your ACL. If this happens, try using trekking poles as crutches, keep your knee bent and your weight on your toes, and go straight to a doctor. Don’t be tempted to wrap the knee up in anything, as this could increase swelling.
What to do before your hike
There are a number of things you can do in preparation for a hike, to lessen the chances of experiencing knee pain. Inflammation is one simple common cause of knee pain, and one way you can fight it is with your diet. Some foods contain special properties that help fight inflammation, such as tomatoes, leafy greens, nuts, oranges, and many more. Including these foods in your diet may help you fight knee pain the natural way, without medications.
There are certain exercises you can do if you’re experiencing knee pain, to strengthen your muscles and keep your joints flexible. Having your leg muscles in top condition means they will better support your knees, and this will naturally reduce your knee pain when hiking. Aim to target your quadriceps, hamstrings, calves, and IT band. You can use such exercises as a stationary bike, leg extensions, and squats to help you achieve stronger legs overall and alleviate some of that pesky knee pain.
You should also supplement all your workouts with some form of stretching routine. This will improve flexibility, muscle tone, and even aid in healing. All these are beneficial to improving your knees’ health. Finally, although it sounds obvious, make sure to stay hydrated. Dehydrated muscles will cramp more easily, and the awkward walking gait that comes from cramped muscles can worsen knee pain.
Solutions to knee pain
When you’re on the trail, your first port of call when experiencing knee pain should be anti-inflammatory painkillers, such as ibuprofen. Be careful not to be too liberal with it, however, as it can lessen the effects when you are truly in pain.
Many people have found a solution to knee pain in using hiking poles, also known as trekking poles. They can help reduce the impact on your knees and take some of the strain off. Hiking poles provide support and redistribute your weight to your arms and shoulders, lessening the impact of each step- on a long hike, this reduction in force can make a huge difference. For example, using hiking poles on a 25 degree downhill incline can reduce the force on your knees by 12-15 percent.
Choosing the right shoes is paramount when hiking- if they’re ill-fitting, this will eventually upset your walking gait and cause problems with your knees inevitably. Footwear will always be a very important element when hiking; you’ve probably heard the phrase many times before; “A pound on your feet equals five on your back.”
Lighter weight hiking shoes can make a big difference when it comes to knee pain, so you may want to consider making the switch from hiking boots to trail shoes. Although one benefit of hiking boots is the increased support and protection from the trail, boot stiffness comes along with it. This means that every time you hit a patch of uneven ground, your whole body must twist and contort to prevent you from overbalancing.
It’s also a good idea to choose well-cushioned shoes, to help absorb the impact of each step. This will ease some of the pressure on your knees, which could be what’s causing your discomfort. Another thing to consider is the weight of your backpack. Are you carrying more than necessary? All the weight on your back is also more weight on your knees, and every time you take a step it’s more and more pressure on them. Compression socks can also help keep your feet comfy on long hikes. Work towards hiking light, your joints will thank you, and your next hike will hopefully be pain-free.
Many hikers opt to use a knee brace to help with pain while hiking. They work to provide extra support by stabilizing the weakest points on your knee. There are many different types of knee brace options available, including sleeves, supports, and stabilizers. Each of these will be designed for a different purpose, be it for compression, stability or ligament support for example. Speaking to a doctor will help you determine which is the right choice for you. If you’re setting off on your first hike after a knee injury, pick a short an easy one, ease your body and your knee joints back into it.
Building up some glute strength will also go a long way towards lessening knee pain while hiking. By balancing out those muscles with your quads, you will stop them from tiring too soon when hiking. The easiest training for glutes is the simple squat; check how to do it correctly here. Also very beneficial is the reverse leg press (also known as the pendulum quadruped hip extension).
Physical therapy can be very helpful for those suffering from chondromalacia. By focusing on improving muscle strength and balance in the quadriceps, hamstrings, and adductors. Having your muscles properly balanced will actually help prevent knee misalignment. Typically, non-weight-bearing exercises are recommended, such as swimming or using a stationary bike.
To try and prevent chondromalacia patellae, and the annoying pain that could stop your hikes in their tracks, there are a few recommendations you could follow:
- Avoid repeated stress on your knees- try wearing kneepads if you spend a lot of time on your knees.
- Work towards creating muscle balance in your legs, and strengthen the muscles.
- Wear properly fitting shoes, consider adding inserts that correct potential flat feet by lifting your arches. This will decrease the amount of pressure placed on your kneecaps.
Some people with IT band pain have found success with foam rolling. However, if you don’t have a hot pain in your IT band, just around the knee, the issue is probably tight muscles rather than the IT band itself, so foam rolling isn’t the right treatment.
After your hike, you should stretch again, to help reduce any pain later on. After exercising your muscles become tight and sore, and this tightness can make knee pain harder to deal with. Stretching after your hike will help to prevent normal soreness from becoming stiffness and pain, and will help you maintain flexibility for the next day as well.
If you’ve taken all the precautions you can, and still find yourself in pain after a hike, it’s time to try and promote the healing of your knee joint or joints. You can always employ the RICE method, which is to rest, ice, compress, and elevate your knee. You can use this along with anti-inflammatory drugs to decrease pain and swelling. Once the pain is gone, start to gradually stretch and strengthen your knee, back to hiking shape.
Although it may be hard, it’s important to rest if you’re experiencing a lot of knee pain. You might be tempted to push through the pain to complete your hike, but this could cause long-lasting damage. It’s much more worth it to abandon your hike one day in order to give you knees a rest and make sure they’ll be healthy for next time, so you can hike pain-free in the future.
Knee pain is so common while hiking, but that doesn’t mean you have to suffer from it. There are plenty of methods you can utilize to make your hikes pain free, just putting in a little effort to stretch every day is so worth it. You can lose the feeling of dread, when you’re looking forward to a beautiful hike but know the pain in your knees is coming- we want you to put those days behind you.
Whatever the underlying issue behind your knee pain, with a little effort and experimentation you should be able to solve it and happily hike pain-free, with your knees all the better for it. Now you have plenty of techniques to employ and solutions to try, so your knee pain after hiking should be much less of a hindrance.
It could be as easy as adding some insoles to your shoes or investing in a pair of trekking poles, or the problem could be a little harder to solve. Physical therapy is always an excellent route to go down for sports-related injuries, and you can use it to make sure you’re reaching your body’s full potential. You could be up to 25 miles a day in no time!
Please note, all this advice is just recommendations to help alleviate your pain, and you should always consult a doctor before making serious medical decisions. If you’re experiencing serious pain, never try to continue with your hike. Lighten your load if possible, and head to a doctor straight away. The last thing any hiker wants is to accidentally worsen an injury, making it longer before they can get back out on the trails.
Bonus tip: If you’re interested in going the extra mile and learning some great knee stretches that can prevent future injuries, check out the video below!