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I can hike uphill practically all day. However as very soon after I start a descent, pain builds on the outside of my knee. What is causing this and can I do anything to prevent/mitigate it (other than Ibuprofen)?

Edit: I talked to my doc and the location of the pain is very important in the cause. Note that this is pain on the outside (side) of the knee specifically, as opposed to pain in the knee or below/under the kneecap.

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8 Answers 8

Talked to my doc today during a visit for something else. It's Iliotibial Band Syndrome. The ligament that runs along the outside of the knee becomes irritated and inflamed. It's often caused by over-pronation and poor gait which is exacerbated on the weight bearing leg (not the landing leg) when going downhill. Once injured, the only good solution is rest and anti-inflammatory medication while it heals.

There are specific exercises and stretches that will work to prevent the injury. Specifically you have to stretch the band itself and build the muscles above the knee

Pain from excess force on the downhill would usually present below or in the kneecap, not to the side.

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I am not a doctor. But I have found a solution to my knee pain (which I think might be the same area): a lot of leg strength exercise. If my quads are strong enough, I can walk down hill (with a heavy pack on), landing heel first. This takes the pressure of my knee, and I can walk faster. Again, I am not a doctor. –  theJollySin Dec 16 '13 at 17:10
Also, I've learned that preemptively putting an ace bandage or similar brace around my knee helps my knees feel way better after a really long hike, especially in a mountaineering environment. –  Blackbear Jun 23 '14 at 19:14
I too ahve suffered IT band syndrome from peak bagging too many days in a row...I found with adequate stretching of the glute and IT band the pain subsided from the knee, and again to prevent the pain I strengthened adn took more weight to my quads which does work! –  AM_Hawk Aug 18 '14 at 3:04
core exercises essential in addition to things like squat lunges, these things are always subtly linked –  adolf garlic Feb 4 at 8:46
Core exercises won't affect the IT band at all really. –  Russell Steen Feb 8 at 17:52

I have experienced the same when trail running. I can pretty consistently reproduce the symptoms on downhill stretches when running distances that are much longer than my regular runs, when starting to hit the trails again after not running for a while, and when running downhill at a faster pace than I would run uphill.

The following is my hypothesis, meaning I don't have any published facts to back this up:

When going uphill we are fighting gravety in a pretty static way. It is not likely that we would go any faster or for longer distances than our muscle-mass permits.

When going downhill on the other hand, we have momentum that our muscles have to slow down. Fightling gravety becomes less static and more dynamic, especially with steeper slopes and higher speeds. We can keep going even when our muscles are fatiguing, and we can go faster than our muscles can effectively slow down, which passes the stress of slowing down on to our skeletal system (mainly our joints.) This can be compounded by heavy heal-striking (less cushioning by our muscles) and a heavy pack (providing a larger mass, which increases the momentum.)

My advice would be to take downhill stretches at a much slower pace (on my trail runs I am MUCH slower going downhill than uphill!), avoid steep slopes until you build up the specific muscles you use for descending, don't take as much stuff when moving on steep terrain and transition to a midd-foot-strike when you notice your knee is hurting (a word of caution: practice this! If you are a heavy heel-striker this can be very tiring for your calfs and you can damage your achilles-tendon if you don't strengthen it first.)

I take this kind of pain pretty seriously. To me it is a sign that even though I have the conditioning, I am missing the muscles to do what I am doing when my knees hurt.

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Using hiking poles helps take some weight off your knees when descending. –  furtive Mar 20 '13 at 4:57
protein powder in your diet to help build up your muscles. –  Michael Martinez Feb 5 at 0:10

In addition to the suggestions above, regular use of walking or trekking poles are a great help in alleviating knee and hip problems.

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I no longer walk without my trekking poles - definitely help my knees and hip (I currently get an inflamed hip flexor on long treks, but working on this!) –  Aravona Aug 18 '14 at 7:32

I've had this, too. You're just stressing different ligaments than when traveling uphill. I think it's a matter of getting the right exercise, which is to say, do the same thing on training hikes.

I've also experienced pain in that area after crossing an ice-cold creek, then hiking after. Alleve is my drug of choice since I can take it at the beginning of the day and it lasts all the way through.

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Makes perfect sense as the cold would stiffen up the tendon. –  Russell Steen Mar 25 '13 at 13:11

There's a strap called Cho Pat that my dr. told me about -- it helps immensely.

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You can also mimic this using your bandanna. –  ppl Jun 23 '14 at 18:45
Please explain more, thanks –  Russell Steen Feb 6 at 18:24

I just got back from hiking Inyo county Bishop Ca. area call Sage flat and when coming down my outside knees began to hurt and by the time we got down it was hard to take steps. I hoped over night it would feel better so i could hike the next day, It did and we decided to take the lower trail which is flatter but again coming back i started to feel my knee again this time I met a hiker who was wearing nylon knee brace, the are a pull on over the knee with a hole over the knee bone with boning for support on the side he said they help him. also he said take a mussel relaxer if it gets bad and poles help too. today I made it back down taking slow wider steps lifting my leg at the knee higher that helped. Good luck and good hiking.

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It's a problem with the momentum that your body builds up. While going uphill, you exert force to climb. And the gravity tries to pull you down. While going downhill though, the gravity still pulls you down. Now your body builds up a higher momentum and the default action of your brain is to arrest this momentum(Else you will end up running at an ever increasing pace while going downhill). This means that the force on knees is significantly higher. This is the reason why you might face some pain in your toes as well. Toe and knee take the brunt of the "slow-down" functionality. It's quite normal and the effect is reduced if you take a sideways path than a straight down one. Also walking slow does help. Again, the answer lies in physics.

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This doesn't apply to the specific pain mentioned, which actually doesn't affect my toes at all. –  Russell Steen Feb 6 at 18:23

Change shoes.

Visit a physiotherapist, and take your current shoes -- both the ones you use on trips, and the ones you wear every day. A good physio can learn a lot from reading the wear patterns on your shoes.

If you go to a doc, go to a sports doc. Call the coach at your local high school or college and ask who's good.

Part of the problem is sudden shocks, Learn to keep a spring in your step going down hill. This will usually mean slowing down. One technique I've used is to take rapid, but very short steps. This doesn't work in big talus, or trails with lots of roots and holes. Land on a bent knee.

In addition to the various stretches and strenthening routines, get ready for trips by going to your local skyscraper, large stadium or river valley park, and do stairs. Lots and lots of stairs. This is where you practices you bouncy springy stride.

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