36

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.

  • 7
    Training to strengthen your knees in advance is by far the best thing you can do. – topshot Sep 16 at 12:33
  • 2
    I don't know how so many answers (12 so far) have overlooked the possibility of a hinged brace, knee support wrap and the like. – Quora Feans Sep 16 at 13:02
  • Ditto on what topshot said. Consider also that maybe some pain is desirable in moderation, for the very sake of strengthening your knees and gaining endurance. If you're always about avoiding pain then you will have a hard time overcoming it. – Andrew Sep 16 at 15:15
  • 2
    Sure but I’ve had 3 knee surgeries and a lot of cartilage is just gone so there’s only so much I can train. – Sebastiaan van den Broek Sep 16 at 15:17
  • Have you tried using 2 poles? I had a single one for the descent on Fuji and I have never been so envious of people with 2 of them as I was then. – Raystafarian Sep 19 at 6:22

16 Answers 16

25

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.

  • 9
    @SebastiaanvandenBroek That sounds like a really strong indication that Thunderbuck's advice might be right on for your case. Heavy lifting is a somewhat "count-productive" activity to hiking, as it means muscle mass and as you said often also shortened muscles, which both don't help hiking. I would even say try to stretch regularly, not just weeks before walking. Stretching after the workout helps too, but make sure you are very gentle then, you don't want to stretch too hard/long after excerture. – imsodin Sep 15 at 7:19
  • 2
    There is no scientific evidence for stretching. In fact, I read a study many years ago that concluded there was a small increase in risk for injury if you stretched. – d-b Sep 16 at 16:34
  • 3
    @d-b That's so wrong. Being flexible is never a disadvantage. Having weak muscles and lacking good proprioception is what injures you, not having more flexible ligaments. Doing a combination of flexibility, strength, and balance training is the best way to avoid injuries. – Gabriel C. Sep 16 at 20:01
  • 2
    @GabrielC. Please source that stretching is good to prevent injuries. – d-b Sep 16 at 20:38
  • 3
    @d-b no source here (will leave that to op) but exp. w tendonitis/physio: short muscles keep tendons tighter/induce more stress than long ones, even during rest periods, which increases strain and causes inflammation in blood-poor environments. Foam-rolling, stretching etc. are all helpful to produce longer muscles that allow tendons better recovery. Lots of 'knee pain' or other types of pain are due to tendons being inflamed. Increased injury may be due to having greater range of movement meaning you're less sprain-resistant. Doubt this compensates aforementioned effects though. – Hirek Sep 16 at 21:09
33

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.

  • And it isn't just the pack you should look at for keeping weight down. The walkers adage, which apparently originated with Edmund Hillary, ' one pound off your feet equals five pounds off your back, apparently has a lot of truth to it. adventure.howstuffworks.com/outdoor-activities/hiking/… I certainly do better with hip pain in lighter barefoot style shoes than stiff soled, ankle high hefty boots, – Spagirl Sep 19 at 11:41
13

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.

  • 22
    I have a comment about ibuprofen and the kind: While your answer is correct regarding the anti-inflammatory aspect, I'd still be a little careful with ibu, since it's also a pain killer. Usually, if you feel pain somewhere, your body will automatically try to avoid it. If you don't feel the pain, you stay in your (maybe bad?) walking pattern, which might hurt your knees even more, even though you're not even feeling it. See also Harper's answer about body mechanics. I have the same issue and I prefer to be able to feel and avoid the pain (by taking breaks). – Michi Sep 15 at 9:20
  • 2
    Just for awareness, taking too much ibuprofen is also bad for your stomach, I had a PPI (proton pump inhibitor) prescribed with ibuprofen when I hurt my back to protect my stomach from the dose (which was only 400mg, a standard 2 tablet intake), so dosing up without consulting a doctor long term (this was a weeks worth of meds) is not a good idea, depending on how long a trek would be. – Aravona Sep 16 at 8:13
  • 1
    @Sue, I guess your point is what I was eluding to with "Assuming you are not opposed to it". I was just putting the onus on the OP / reader to know what usage of medications is safe (or acceptable) / safe for them. That said, the answer could certainly err on the side of caution & remind people to consider carefully how and when they use medications. FWIW, at a minimum every weekend I do a 8-14 mile light hike & couple IBp help see my arthritic knees through, although I will use more if doing loaded backpacking. My norm will obviously not work for everyone. I'll make an edit. – renesis Sep 17 at 2:29
  • 1
    @renesis with that edit I think the answer is good :) – Aravona Sep 17 at 8:05
  • 1
    renesis, thanks for your very kind comment! I appreciate the edit. I deleted my comment requesting it! After you've had a chance to see this I'll delete it too. No need for me to clutter up an already lengthy discussion. I'm really glad you can take ibu and it works for you. I know a large number of people do it too! In my admittedly limited experience, zig-zag has always helped, so this is my favorite answer. Happy hiking! – Sue Saddest Farewell TGO GL Sep 20 at 2:03
12

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.

  • 1
    any particular points about using your knees properly that could be added to this? – BKlassen Sep 16 at 15:02
  • @BKlassen I'll give it a swing, but I'm a Tai Chi student, not a doctor. I might be able to tell a good teacher from a bad one. – Harper - Reinstate Monica Sep 16 at 20:00
  • The heel-toe line is often parallel with the ground, and the hip-knee line is often perpendicular. How do you propose keeping them in the same plane? – WBT Sep 17 at 13:49
  • @WBT as long as the hip-knee line intersects the heel-toe line, they are planar. I don't mean even-with-the-ground planes. The plane I am referring to will be typically vertical-ish. – Harper - Reinstate Monica Sep 17 at 17:26
  • @Harper Ah, that makes sense. Separate planes for each leg, then. – WBT Sep 17 at 18:58
8

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.

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.
  • Front foot walking can kill your achilles tendons really quick. I am speaking from experience, nursing a set of tendonitis as we speak. And that was just from changing shoes to a set that has less drop. – Stian Yttervik Sep 15 at 19:13
  • @StianYttervik Tendons are another thing, besides joints, that take longer to train. Yes, if you do it untrained and ignore the pain that tells you to stop, then you will quickly develop problems there. I've been forefoot running for years and the worst I got was some mild pain that lasted for a day, because I listen to my body and train sensibly. I added a warning to the answer. – Nobody Sep 15 at 19:55
  • 1
    Yeah, what I was trying to say was: Don't just start frontfoot walking out of nowhere. That requires at least quadruple the preparation as a normal trip would need. I am a midfoot runner myself and just wanted to try shoes that pronate earlier. One trip and some walks was all it took to irritate the heck out of my tendons. I am wiser for trying, but recovery is slow. – Stian Yttervik Sep 15 at 20:00
  • 1
    @StianYttervik I wish you much success in your endeavor and I hope the warning I added to my answer will prevent others from sharing your pain. :) – Nobody Sep 15 at 20:02
  • This is the best answer, IMO. I hike around 1000km per year (average 20km per weekend), do strength training in the gym, and do some running. I still I feel I could train more for the longer >30km days where I end up with aching tendons around the knees. – Gabriel C. Sep 16 at 20:22
6

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).

5

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.

  • A light compression bandage or brace (depending on several factors) alleviates the pain. All things being equal as has been mentioned in the other answers. Although I think it has more to do with keeping any swelling down than providing actual support. But pre-emptive dosing of IBU and wearing the bandage before starting the hike (rather than waiting for any pain to start) are tremendously beneficial. I really like this one futuro-usa.com/3M/en_US/futuro-us/products/~/… – Jonathan Fite Sep 15 at 18:31
5

3 things have helped me and my knees alot.

  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 (untill 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.

  • 1
    Can confirm the "don't get used to walking with sticks" though. What also helped me to activate those muscles is switching from full blown-over-the-ankle-boots to light shoes that only go right below the ankle. I use them on most tours where I know that the terrain won't be too difficult. – Michi Sep 15 at 16:17
  • @Michi Agreed. I usually go with my lightest (less than 300g) shoes unless it is blindingly obvious I have to go for ankle+ ones. And those are also less than 600g. Weight trumps stability (at least for me) every time. – Stian Yttervik Sep 15 at 19:06
  • @StianYttervik One of the top answers. But even though I use my trail runners and heavier boots about equally, On steep downhills, even if I'm running I feel way better having a stiffer sole. I don't know why, but it feels less punishing with my heavier boots even without a pack and I can go as fast if not faster (I have no clue why as logically it should be the other way around). – Gabriel C. Sep 16 at 20:26
5

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.

  • Careful with stabilizing insoles like Superfeet. I used them for a while trying to fix a foot issue but it actually created a knee issue when I never had it before. When I ditched them, the knee issue mostly went away. Replaced mechanical stabilization with more training and all issues seem contained now. – Gabriel C. Sep 16 at 20:31
2

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.

2

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.

2

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...

1

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.

0

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.

0

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

Not the answer you're looking for? Browse other questions tagged or ask your own question.