Other than good shoes and a stick, what are some ways to preserve your knees on long hikes?

Question

My knees aren’t in the best shape, one in particular. I had a rather devastating 13 hour up-and-down hike on day two of a three day hike, and the last day my knees were hurting every step. What are some ways to take some load off the knees, or other ways to prevent this? Not including ‘taking more time for the hike’. Assume already decent footwear and some kind of stick to balance and spread weight.

Edit: Some good advice is given here, I accepted the answer with less obvious tips but be sure to read all the other answers too.

Answer 1

As excellent as the previous responses have been (and they all have great advice), I'd add that you want to be FLEXIBLE. Stretching is crucial, and not just for your knees. Hip flexors are a very important part of the equation too.

Stretch all the muscle groups in your lower body. Your knees will be affected primarily by your quad (thigh) muscles, but all your lower-body muscle groups will affect your knees to some degree.

And don't just stretch immediately before your hike; do it for a good couple of weeks beforehand to get your body accustomed to it.

Answer 2

Carrying less weight makes a big difference. My packing follows the "be prepared" style more than the ultralight one, but even I admit it's easy to carry too much.

Stepping cautiously especially on descents and trying to avoid dropping too much on one step are both important.

A pair of trekking poles is very helpful, and you might need to lengthen them for descents/shorten them for ascents.

Answer 3

Make sure you are using your knees correctly.

Body mechanics is a big deal. My doctor was on the road to a knee replacement 25 years ago, and decided he really did not want that. So he learned Tai Chi from an real expert. Tai Chi, as designed, is to train proper body mechanics (in a martial arts context). This made him rethink how he used his knees, and that was the end of the problem! I think martial arts experts that competent are hard to find, so I would talk to a sports medicine doctor. I would be cautious about talking to knee doctors, because they are not in the prevention business, they are in the replacement business.

I find when my knees hurt, I remember my martial arts training and shift my body mechanics, and it helps a lot. Of course it's nearly too late at that point; better to use good body mechanics all the time.

---

The following is not well-rounded and is far too incomplete to be a lesson on the subject, in a topic that doesn't even lend itself to stating in words. But people asked, so let me try a few things.

Keep your knee with your toe... without actually showing you, what that means is keep 3 lines all in the same plane: hip-knee, knee-heel, and heel-toe. It helps to stretch and open up your hips.

Interesting fact: people have two hips. People often carry them rigidly and locked; it helps to unlock them.

Don't lock your knees, i.e. Don't put them at limits of travel, and especially don't ask them to carry weight.

---

Imagine a vector line showing how your weight is being carried from your knee to your foot. You want that vector going more-or-less straight down your leg (e.g. Tibia bone), not going through empty space to your midfoot or toe (requiring you to use power to avoid falling forward; the issue isn't the use of power, it's what the stance does to your knee). Since the tibia enters the foot somewhat forward of the heel, that means most of your weight will be on the heel with some on the toe. (If you think about it, that makes sense, right? Less weight on the toes, which allows them to function as trim stabilizers and sensors.)

Since your foot is in a rather heavy hiking boot, it's easy to lose track of these subtleties and just think of the entire foot as a single immobile hammerhead-like object at the end of your tibia. That is how you forget good body mechanics.

That leads to thinking it's a hammer you stomp down, either before or as you put weight on it. Especially if the military has trained you to do that for the cool sound it makes. Impact loads are much worse than static loads (ask a bridge engineer). (And the military tells you to stop stomping on bridges. It's no better for your knees than the bridge). So stop stomping, absolutely, 100%. Consciously place (soft-land) your foot on the surface, then transfer weight to it.

If your footfalls are making more noise than a carefully placed foot, that probably indicates poor placement.

There is no speed limit; you can consciously place as fast as you are able. The point is to rely on placement skills you are learning dynamically for this here surface, not robotically repeating skills you learned 30 years ago.

None of this advice is any substitute for a sports medicine doctor and/or highly competent martial arts training. Tai Chi is a top choice, being an internal martial art (about you and your body rather than external actions), and also providing a context for daily practice.

Answer 4

Assuming you are not opposed to it, preemptively taking an anti-inflammatory such as ibuprofen before your knees start hurting and then re-dosing later if it is a long hike can help to keep swelling / inflammation down.

[Edit regarding anti-inflammatories: By all means consult your doctor about safe dosing & frequency before beginning use in your activities. Depending on a number of factors, including drug interactions, some or no use of different medications may be safe for you. Also be aware that unless prescribed by your doctor medications are not intended for long term, frequent use. Be responsible & informed in your use of all medications. No sense damaging your body long term for short term gains. Know what medications are safe & appropriate for you.]

Another thing that can help when going down a particularly steep downhill; if the trail is wide enough try zigzagging your path. This will slow you down some, although probably less than if you were trying to descend while in pain. Zigzagging essentially decreases the slope that you are descending, thereby decreasing the impact on your joints with each step.

Also, make sure that your hiking poles, or stick, are the correct height for you. If you have to reach your arm downward significantly to bear weight or stabilizing force on the pole it will not do very much to help. ETA: two proper hiking poles of correct length will serve you much better than just one stick or pole.

Answer 5

Well, I would say taking more time is a very valid option. Also if you know you have knee trouble you could reduce distances to an extent where you do not have to walk for hours with exhausted muscles. From my experience, pushing yourself over the point where the joints lose sufficient muscle support is when you start to have fun the next days.

Therefore, preparation and training well in advance of the trip is very important, and you should not go on a long trip if you are out of shape. I did ignore this a few times in the past, and it was not a big issue, but I had to take the consequences during the first, let's say 3 or 4 days.

Honestly speaking, I would also say that after a 13 h walk almost everybody will feel the strain in one way or another, especially if you carry extra weight as usually on a multi-day trip, and knee pain is extremely common. So you might also have to face the fact that there is no reasonably healthy way to avoid it, unless you have a lot of time for getting used to the strain by training.

Another option is to analyze if there are any aspects in your walking technique which cause your knee problems. I have no idea how that is exactly done, maybe other people can comment on that.

Answer 6

A friend of mine with knee problems uses some kind of "knee support bandages" for all of his hiking, claiming that they help him a lot. I'm unsure about the right term for that purpose (there are certainly many variants), but you get the idea from the pictures, and probably they can tell you more at a local pharmacy or medical store.

Answer 7

(None of the other answer combines all of the points which I think are critical)

• Train. Joints (like tendons) need slower and steadier training than muscles, i.e. they react slower to training impulses. You should not be doing 12 hour plus hikes unless you have been training for at least several hours per week for years. This also applies to carrying weight. If you need to carry a lot of weight for the trip you are training for, carry a similar amount during training even if you don't need it then, preferably using the same backpack.
• Strength. Strength training for all the muscles around the joint. Those muscles can help stabilize the joint.
• Stretch. I don't know the theoretical background here. Stretching is good for your joints, believe me. Also it just feels good after a hard work out once you get used to it.
• Technique. It's very difficult to put your foot down with the heel first so that there is no shock, especially when walking down. Focus on that. You could also just put the front of your foot down first, then use your muscles to slow down so that your heel just kisses the ground instead of hitting it. That will use a huge amount of strength-endurance in your lower legs if you are not used to it (it's the way most fast marathon runners run - not particularly efficient at low speeds I think, but very good on the joints). The Achilles tendon also needs to strengthen to support this and tendons also strengthen more slowly than muscle, just like joints. That's why someone suggested walking backwards, if you walk down backwards the front of your feet automatically touch the ground first.

Answer 8

Apart of what has already been said, I have some additions:

• Walking backwards on the descent
  Obviously, this only works if the terrain allows it (e.g. paved streets or at least some kind of easy path - be careful and safe!). It takes away a lot of strain on your knees and you can use that as a break for your knees while still continuing to walk. Besides, you will use your muscles in a different way when doing so, so you can also relax the muscles (more or less) that you would use when normally descending. Don't do that while ascending though, you would even put more strain on your knees.
• Using suitable sticks
  There are myriads of different sticks out there. However, in my opinion, not all of them are suitable to help you on the descent. In order to make use of the sticks properly, you must be able to put your weight into them. For sticks to help you on the descent, you have to place the sticks in front of you, which means you have to curl up your wrists. With all the normal sticks out there, that means putting your weight onto your curled up wrists, which creates pain or at least discomfort on long hikes, which in turn makes you not want to additionally put pressure on your wrists. I found sticks that make it possible to have a different grip (perpendicular to the stick!) on them a lot more helpful. The Leki Aergon Grips partly fulfill that purpose. I myself use the Aergomed grips, which is basically Leki's Wanderfreund Series, because that was the only stick I could find that I can almost use like crutches and that I can put my whole weight into. I look really stupid using these and I feel like a grandpa, but they actually do their job.
  Disclaimer: I'm not affiliated with Leki in any kind. This is just my personal experience. Please inform yourself and also consider other companies.

• Using sticks properly
  As renesis already mentioned, you should definitely use two poles. Not only for better effectiveness, but also for body symmetry. When using two sticks, there are different ways to use them on the descent. (Note: these patterns are not for ascending!¹) Experiment with it and use the pattern that you feel the most effective to relieve your pain.
  The pattern I use is putting down:

  right stick, right foot (next to the stick), left stick, left foot.

  You could also do:

  left stick, right foot (same height as the left stick), right stick, left foot.

  I felt my hips twisting a lot using the latter pattern and it's sort of not my thing, but every once in a while, I switch to it just to have some variety. Anyway, as I mentioned before, it's important that you use the sticks by putting at least some of your weight into them. If you just carry them around and poke the ground with them (as I see many people doing so in the mountains), they won't help you.

• Foot/Knee placement
  You might have heard that from other sports as well already and it's a rather common concept not to let your knee exceed your toes. This is not a black and white principle and there are some details to it. I'm mentioning it because this is what happens when descending. Especially, you won't be able to keep your whole foot on the ground while the knee exceeds the toes (at least for the rear leg). I think it's unavoidable that this happens when descending. On the other hand, you usually don't lift heavy weights while doing so. However, this is done for a rather long time (e.g. around 5 hours roughly in your case?). The point is: Even though you probably cannot avoid it, if you know which motions the pain is coming from, you may be able to avoid exaggerated movements that involve your knee exceeding the toes. Stuff mentioned by others here like slowing down and taking smaller steps are also a consequence of this principle.

---

¹ The pattern for ascending that I use is

(simultaneously: left foot, right stick), (simultaneously: right foot, left stick)

It's also the only pattern I have seen other people using on the ascent (apart from random placement, which I don't consider a proper pattern, which also seems inefficient).

Answer 9

Insoles

There's lots of good answers here, but one I haven't seen mentioned is insoles. You've asked for advice other than good boots but it's possible that the importance of insoles is something that you may have overlooked.

Expensive boots tend to have cheap insoles. In fact, almost all shoes have cheap insoles. Good insoles are often customer specific: everyone's foot is different, and high quality insoles with excellent arch support and an ankle cup will cost around £30 - therefore it's not in a shoe manufacturer's interest to provide expensive insoles to customers who will likely replace them with their own favoured brand or fit anyway.

So what has this got to do with knees?

When the arch of your foot is not supported correctly, your foot flattens when you walk. This pushes your toes forward, slightly twists your ankle and puts strain on your knee, and ultimately on your hips and back. Misaligning your foot misaligns your entire body - it's amazing the number of people whose seemingly chronic joint issues (ankles, knees, hips, shoulders) can be fixed by insoles.

It's a tiny misalignment but when you're making literally tens of thousands of steps a day, multiple days in a row, those tiny increments add up. It's much less important if you aren't very active.

Not to mention that as you become more fatigued, you struggle to step correctly with the correct form, which further exacerbates the issues.

Knee pain can be caused by a huge number of reasons. But it doesn't hurt to spend £30 and get fitted with a good pair of insoles - you can switch them out between different shoes as well, so you only need one pair. It might just fix your problems.

Sources: Me; a chronic knee pain sufferer after long hikes who has been much more comfortable with insoles following lots of failed physiotherapy.

Answer 10

Three things have helped me and my knees a lot.

1. Preparation. Don't go from doing nothing and then 3 days in the mountains. Take smaller trips, maybe biking a bit or go "rucking" (twice regular backpack load, but go slow and on steady ground) and combine with...
2. ...Physical balance exercises with weights. Preferrably according to recommendations from a physio. PTs can work, YMMV, but in my experience they are usually uneducated blowhards - physios are prime.
3. Don't forget hip muscles. Backpacks are best when you can use your hips/glutes to carry and balance it; if and when your hips are getting tired, this task falls to the knees - and they are not fit for that purpose, especially if they are already a concern.

And, as you say - good shoes, a stick, and keeping the load light.

A caveat lector. Don't get used to walking with sticks, it is harmful for the overall balance. You are supposed to walk without sticks - don't teach your body otherwise (until it is absolutely necessary). You have to keep those small muscles in knees, hips and back active. But a single or set of good walking stick(s) can help a lot some parts of the trip.

Answer 11

Here is some advice for someone who has had three knee replacements. Be sure that when you hike you are using proper walking form by rolling from heel to toe. Also balancing your self by pairing your stick hand with the opposite foot. Prior to having no choice but surgery (RA), I found this method most helpful.

Answer 12

As you said in your comment: you had three surgeries and there’s only so much training you can do. Well, this might not be the advice you want to hear, but if your knee is too bad to take training then it might be too bad to hike distances like that. I know we all want to stay young and do the same things we did when we have been doing all our lives, but there are times when you just have to accept that... well... you got old.

Like I said: probably not what you want to hear. If you’re convinced long hikes are not causing more damage: Kill the pain or learn to accept it (hard, I realize that, but not impossible) or go on shorter hikes...

Answer 13

What helped me, may well be available in your area

Feldenkreis classes (a very gentle stretching modality) gave me a flexibility and lightness that I found surprising. I’m over 60.

After a few classes I was walking up escalators and felt I was using half the normal energy. It sounds strange but I felt I was a cat!

I also suggest improving your core strength, because once the knee is aggravated, the rest of the body, back hips etc try to compensate. If you’re carrying a pack it does not take long, for me at least, for back pain to start.

Answer 14

While I have not had knee problems myself on long hikes, others in my traveling group use KT elastic athletic tape around the knee joints for long bike rides. The tape stretches on the move of the strong muscles and then its natural contraction force aids the other part of the motion cycle.

This may or may not help, but did not seem to be in any other answers, so I add it here for whatever it's worth.

Answer 15

For running, I had knee problems when I 'landed' on my heel after every step. This forces the shock going directly into your knee.

I 'fixed' this force by landing every step on my mid foot.

I can imagine for walking when you want to roll your foot as much as possible it is hard, but you can try to reduce the force by:

• insoles (but note that this costs more energy, but your knee is more important)
• shoes with a slightly large sole or at least larger heel (not too big)

Also prevent shocks:

• Avoid jumping (especially down) by walking around downhills
• When you have to jump, do with both feet (but watch out to stay balanced)
• Remove your gear/backpack before jumping a bigger distance downwards
• Put tape or a specific 'medical' band around your knees

Other tips: - It helps to prevent inclines or declines at all, or to minimize them by instead of walking in a straight line up or down, to zig-zag with a lower grade. - Lower the weight in your back pack - Train your leg muscles to make them stronger

Answer 16

Simple knee support bandages as suggested here are not going to help. Good knee braces will. This is the one I use. I have knee problems and had difficulty hiking, skiing and running. With a couple of those things I can hike and ski without a problem and even run if I'm careful.