I am going for an 11-day mountain trek in a month, during which we will cover about 120km and ascend/descend about 1000m per day. The last time I did this I had to drop out after the 8th day due to knee pain (I was the fifth in a group of 12 to drop out). I think the main reason I had this problem was that I didn’t adequately train in advance. I had been doing lots of biking and a bit of hiking (mostly to break in my boots), but not a lot of up and down. My problem knee has ‘popped’ with extension for many years (probably due to cross country ski stress many years ago), so that might have been a warning sign.
This time around I am training better (started two months ago), and I feel that my legs are a lot stronger. But occasionally I feel a twinge in my bad knee which is a bit concerning.
So what I am interested in knowing is what I should do during the trek to reduce the risk of knee problems? Any special preps or stretching in the mornings? Any particular stepping technique? I will be using trekking poles of course. Anything I should do in the evening? What about a knee brace, or analgesics?
Where are you trekking, what are the trail conditions?
If you are descending a steep loose slope off-trail or on a steep rough trail where you have to make a big step down, correct technique with the poles is important, and you should practice this. Reach fully forward and down with the poles, bending at the waist. Plant your poles in a stable spot below you, BEND FULLY AT THE WAIST and move your center of mass forward putting more of your weight on the poles, then step down.
A lot of people are nervous about putting their center of mass forward like this and trusting their poles, but the technique is the only safe way to descend steep and loose slopes. You’re approximating more what a 4-legged animal does. It has the added benefit of taking a lot of the downhill stress off your knees.
The “forward propulsion” use of poles is not important, that’s a matter of taste and won’t make any different to your knees.
Aside from that, take a lot of ibuprofen while hiking unless you have any other medical condition that contra-indicates NSAIDs.
Oh, and of course if your doing major hikes like this you should spend some money on ultralight gear to get you pack weight down to the absolute minimum. If you have knee problems, you’re not making yourself safer by packing all your fears and carrying a heavy pack.
No personal experience but I know that Eddie Hall swears by patella supports, for his continued ability to squat extreme weights.
Unless you want to run several multi-day tests on yourself, in advance, there’s no way to know what’s going to be the right solution. It doesn’t hurt to throw in every possible option.
I find it hard to believe that something like that would stay in place on a hike, unless its strapped so tight that it would be uncomfortable. I think one of the “sleeve” type athletic knee braces might be better for hiking, but I too have no experience of using them. There are dozens of them.
First, it would probably be good to know what is actually wrong with your knee. That would go a long way toward knowing how to protect it.
I would think that if it’s something to do with instability, your best bet would be to have strengthened your leg muscles considerably over the past six months or so- strong muscles equal strong and more stable joints, more or less.
Beyond that, I would think that something like those neoprene sleeves combined with nightly Aleve might be your best bet.
I’m not a doctor though, so take that with a large grain of salt.
Unless contraindicated, take an NSAID while you are hiking. I don’t know about naproxen, but there’s some evidence that ibuprofen may actually inhibit recovery. Taking it overnight would be solely for comfort if you absolutely need it - if your muscles are so sore that you can’t sleep.
this. also local muscle strengthening, as was noted.
also, standard elastic neoprene and similar knee supports really don’t provide much benefit beyond the kinesthetic sensation they give. specific types of braces that might be beneficial would depend on your knee pathology,
plus, chronic nsaid use is associated with other issues like gi and cardiac and renal risks too. also as noted by @Riemann it can suppress inflammation enough to lose the beneficial/healing benefits of mild inflammatory response after a workout.
I use the ones by Incrediwear. I’m not sure they support the knees all that much, but just having that compression in place really cuts down on the pain.
I hike a lot in the Sierra during the summer months, and trails are all sorts of steep and rocky and gravelly. Some trails are like ball bearings. Over the winter I prepared for a 4-night trek in Patagonia, and I use hiking poles and rely on them mainly for the downhills, for stability as well as preserving my knees. As mentioned above by @Riemann, you need to work on your form and technique with the poles to find what works for you. Make sure your training distances and elevation gain/loss approaches what you will do on the trip. The only other thing I’d add to is to practice smaller steps, heel-to-toe, especially on the downhills, as well as gentle stretching at the end of each day’s walking.
Where are you going? Are you carrying all your own gear and food? The route seems very doable at around 12km/day with +/- 1000m
Would an anti-inflamatory help? Ask your doctor, but I have problems with my left foot, and I take a prescription anti-inflammatory that really helps my situation.
I second the suggestion about weight. Lighten the load in your pack. And, if you’re like me, shed more pounds from your belly. That is all total weight straining your knees.
Third, really getting your hiking pole technique worked out.
Is there a maximum grade on the trail? I find up to 8% is fine, but get sapped if the grade is greater than that.
I agree that NSAIDs are most effective for my knees when i use them prophylactically, so they are at full effect while i am using the knee.
I also have a knee brace that has metal bars and provides lateral support. I haven’t needed it in a while, but it has been helpful. I’ve never found the neoprene things do much for my knees.
My trek is the Tour du Mont Blanc in Switzerland/France/Italy. The trails are well-established and not particularly difficult. As we will be going hut to hut, I will not be carrying very much, probably less than 10kg.
I don’t actually know what is wrong with my knee. I didn’t see a doctor after that previous trek where I dropped out, and by the time I went to a physiotherapist a month later, the knee was mostly back to normal.
I just saw my physio (getting treated for chronic neck pain, another problem…) who gave me a few additional exercises to do at home to strengthen the muscles around my knee. She said there isn’t a whole lot that I can do during the trek, and it is much more important to prepare in advance.
She said a knee brace might help a little bit, but is more for relieving pain than anything. She also cautioned against using anti-inflammatories as they will only mask the pain and possibly lead to more damage.
My current hiking poles have a slight knob on top that I grab from above when descending steep slopes. But it seems to me that a pole with a proper T shape on top would be more effective. Do those exist? A quick Google search only came up with the knobby ones.
I don’t mean to pick on you, but I’d suggest you be more aggressive in trying to figure out what is going on with your knee, what you need to do to correct it, and what activities you may need to cut out.
Over the past 6 months I’ve been developing increased leg symptoms which it turns out are from hip arthritis. The first step was PT, but I’ll be the first to admit I didn’t give it my best effort after some exercises exacerbated things. I’m not exactly sure what I will end up doing, but IMO just hoping for the best is not the best approach. And not every condition is best treated with strengthening exercises.
Good luck - both with the trek and getting to grips with your knee.
I would not take ibuprofen while training for your hike for this reason. If you need pain relief to even train, then your knee is probably not in good enough shape to sensibly attempt the hike.
But for the hike itself, I don’t agree with her. Virtually all the risk of more damage comes from doing the hike at all. If you’ve made a decision that you feel the knee is not too serious, life is short, and you want to do it, then I think you should give yourself the best possible chance. Ibuprofen is not such a strong analgesic that it will allow you to push through serious injury. And when you’re out in the remote backcountry you are introducing other risks by hiking in discomfort. Favoring a sore knee may lead to some other injury. Hiking with knee discomfort may affect your concentration, leading you to make a navigation error or to trip and fall.
Since, as we mentioned, there’s evidence that ibuprofen inhibits recovery, my approach is to take it while hiking (as needed), but to try to go without it overnight - both to improve recovery, and to allow the analgesic to wear off so that I can get a sense of whether the injury is any better or worse.
Two years ago we did the Hiker’s Haute Route, which coincides with the TMB part of the way. It’s amazing terrain and you will have a great time.
My wife has some knee issues so our big trips require training, gear, and planning. As mentioned above, see a doctor, get a diagnosis, and get PT if you need it. They will put you on a schedule of exercises to strengthen what needs to be strengthened and fix what needs fixing. Your hiking shoes, insoles, any possible knee brace should be checked out and you should have experience on all of them. Lightweight hiking poles can help for many types of knee pain and also for many hiking ailments.
Pack light! Are they shuttling your gear from hotel/hut to hotel/hut? If so, this isn’t much of an issue. Some of your days will go through towns so you can grab food along the way, or get a trail lunch from your lodging the night before.
This is from part of the route that was shared with the TMB. Cows are commonplace.
