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Knees

How do you prepare for the rigorous physical requirements of high elevation adventure? Strength and endurance are key, but are only part of a more complex equation. How do you prepare for changes in altitude, exposure, diet, etc.? How do you mentally prepare? Learn from others and share what you know about training in advance for outdoor adventures.
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Postby BSquared » Wed Feb 07, 2007 7:18 am

Trekker wrote:Where is the knee pain located? ... Depending on your answer, I can probably give you a fair idea of where your problem is located.


Well now, that's an offer I can't refuse! Hang on, let me go up to the second floor (...walks up stairs...). OK, doesn't hurt much now, but here's what I found: first, only the left knee hurts (either knee can hurt, but it's rarely both. When one knee hurts, it usually does so for at least several weeks, sometimes months). The pain appears to be right on the edge of the kneecap, low and on the right side (that's the "in" side). [Sorry, I'm a biologist but a plant biologist and so never really got completely clear about words like "medial" and "lateral," so I can't sling the proper lingo.] I don't hear any popping sounds now, but frequently when I'm finished with a day's jog both knees will emit a sort of squishing or gurgling or creaking sound, very softly, when I sit down or make other large knee movements.

The fact that my knee doesn't hurt when hiking is interesting. I can see why hiking on uneven terrain would be less stressful than the extremely repetitive motion of either jogging or stair-stepping (or walking up stairs), but what's interesting is that after a day of hiking the knee actually seems to recover, that is, it hurts less (or not at all) for the next few days of jogging or stairstepping. Hmmm...

Ideas?



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Postby Trekker » Wed Feb 07, 2007 12:55 pm

Based on what you've told me, my guess at this point would be Patellofemoral Syndrome; that is, your patella is not tracking properly. There are a few different types of tracking problems. Try doing a single leg squat while standing on a step, and see what your knee does. If it turns in, you may have lateral tracking problems. And look at your legs when you do your Quad (leg?) presses, and see if the leg turns in or out. Try it with one leg at a lighter weight too. Do your knees hurt or feel stiff after long periods of sitting (like in a movie)?

Assuming this is the case, generally the greater the angle of the knee when squatting or stepping up, the greater the stress on the knee cap. If you have tracking problems, this will especially be the case. Jogging will tend to aggravate it, but the reason has to do with more than just the angle of the knee, since that is not great, depending instead on what muscle imbalances you have and the impact of jogging. The stairsteppers may be causing pain due to the knee flexion angle and the fact that they lock your foot in place, which is actually an alteration of normal foot placement in walking for some people depending on the machine used. Remember also that most people are spending a great deal of time sitting during the week. When you are hiking, if it's on the weekend, you are more active throughout the day, you USUALLY do not work out as intensely, at least at the start, which gives you a chance to warm up, the angle of the knee is usually not as great as on a stairstepper or stairs, unless you are doing fairly steep uphill, the impact is not as great as jogging, except possibly on steep downhills, and maybe most importantly the usage of the leg muscles in balancing and stabilizing, as well as movement, is more natural and more coordinated with the rest of the body.

Depending on how you answer this, I'll have a few more questions. :)
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Postby BSquared » Thu Feb 08, 2007 7:34 am

Trekker wrote:Try doing a single leg squat while standing on a step, and see what your knee does. If it turns in, you may have lateral tracking problems. And look at your legs when you do your Quad (leg?) presses, and see if the leg turns in or out. Try it with one leg at a lighter weight too. Do your knees hurt or feel stiff after long periods of sitting (like in a movie)?


OK, finally had a chance to do some one-leg squats, and it looks like my knees are moving pretty straight — if there's any turning at all, though, it's slightly in. They're definitely quite straight when I do the quad presses, whether with one leg or two. During the squats (done last night before bed) the knees were definitely making obvious crackling, popping sounds (but no pain or other noticeable feeling associated with the sounds). No, sitting for a long time doesn't make them hurt or feel stiff.

New diagnosis? :nod:
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Postby Trekker » Thu Feb 08, 2007 12:15 pm

Not necessarily. There could be a number of factors involved; that's only one test. When you do the single leg squat, is your foot pointed straight, and do you shift your hips to either side? There doesn't have to be a lot of inner rotation for you to start having problems. See if you are compensating somewhere else to keep the leg straight. Do you have any lower back or hip pain? Also, when you lie on your back, how far can you bring your leg up while keeping it totally straight (like a hamstring stretch)? Do each leg separately. Keep the other leg straight on the ground. Does it reach 90 degrees or greater? Any difference on either leg? Do you feel the other leg lifting up from the ground?

Any way you could send me a pic of you doing the single leg squat, preferably in shorts so I can see your knee?

Also, are you overpronating on your foot when you do the squats? It'll look like your foot is collapsing inwards.
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Postby hardcharger » Mon Nov 19, 2007 9:53 am

Hi Folks,

I need some help,after 4 or 5 miles of a long hike/climb my quadraceps
start cramping big time,they get so tight that i have to stop and kneel down.I have been only hiking/climbing for about 4 weeks.On Saturday
i went on a brutal (IMO) 10-12 mile jaunt with Tomcat & Snow Nymph,
those two are hiking/climbing animals.When i got home Sunday night
and hoped in the shower my right knee looked like a cantalope on
steriods,it is still pretty swollen this morning,what is a guy to do?
I am hooked,but don't want to kill myself,any advice?
Thank you.


Jim
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Postby mikehike » Mon Nov 19, 2007 9:23 pm

I had the same paine in my right knee, inside right. I went to an ortho-sports doctor he thought I might have a slight tear in the maniscus which I guess is common, had an MRI and it came back negative. He told me to back off it for 90 days....90days??? yikes....I did that now it feels great.

He wanted me to come back and get fitted with a sports-knee brace I still haven't done that yet. My ankles do pronate, so maybe thats the cause.
I would also massage the areas which have paine, not sure if that helps, I was thinking it helps the circulation. I still haven't resumed jogging because I am gun-shy, so now I just bike and hike.
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Postby Sierra Maclure » Tue Nov 20, 2007 9:57 am

I'm a guide for REI Adventures and my knee turned into a canteloupe (I know what you're talking about) after coming down from Clouds Rest to Yos Valley floor - 6,000 feet of drop on a lot of big rock stairs. I was really alarmed. I had another trip coming up and called my doc from Tuolumne Meadows to see what to do, thinking I needed surgery - it looked so bad. He told me to "ice it til you get frostbite." He's a sports med doc and knows what I do and knows that I'm not going to stop doing it. So, I went to the store, got a bag of ice and a cooler, put the ice in 2 zip-locs and ace bandaged it to my knee front and back. I slept with it like that in my sleeping bag and a couple times during the day and voila! swelling went down. I took it easy on the next trip and I always lower myself with my poles on the downhill now. That was a few years ago. No problems since.

You're right about Snow-Nymph and Tom Cat. I've been watching them on the web for years and am totally amazed. I hope to meet them some day and hopefully hike with them if I can keep up. But I'm less of a peak bagger and more of a lake swimmer and sipper of bourbon watching the shadows change.

Good luck with the knee. There is hope.
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Postby Trekker » Tue Nov 20, 2007 6:34 pm

Hardcharger, I'm going to assume you are staying hydrated and taking in electrolytes based on the experience of the individuals you are hiking with. Sounds like you are trying to do more than your body can handle. The cramps that you are experiencing are probably related to either glycogen (muscle carbohydrate) depletion and/or neural (nervous system) fatigue. You need to lower your expectations and start with less strenuous hikes with lower mileage and elevation gains. X-country hiking on desert peaks is also more challenging to the neuromuscular system than trail hiking. Yes, Snowy and Tomcat ARE animals; they also do this every weekend and have been doing it for years. Since they have done many hikes together, they are also very aware of each other's pace. Trying to keep up with other's pace if it is faster than yours is a sure-fire recipe for disaster. What's your nutrition like? I don't know too much about Tomcat's nutrition, other than he likes a beer (or 2 or 3 :D ) after a hike, but I know Snowy is pretty dialed in with hers in terms of hiking and post-hiking nutrition. If you want to keep up with athletes like these (and they ARE athletes; make no mistake about that) you have to treat your body like an athlete. If you are not doing some sort of endurance training, you might want to start, coupled with some weight training for the legs. Otherwise, you just need to start out with easier hikes and work up to the more strenuous ones, otherwise you will keep having the problems you are encountering. Your knee swelling up is probably a reaction to altered knee mechanics in response to extreme fatigue of the muscles. If you want to avoid injury, be more realistic in terms of your body's capabilities.
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Postby hardcharger » Tue Nov 20, 2007 8:26 pm

Thank you mikehike.

Thank you Sierra Maclure:sipping bourbon and watching the shadows change,think i'll give up peak bagging.Sierra Maclure,sounds like a character from the 1950's TV show Sky King.I didn't think anybody
sipped bourbon anymore.



Trekker,thanks for your thoughts,think i'll heed them.Snowy has a lot of good things to say about you.



Jim :)
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Postby Snow Nymph » Tue Nov 20, 2007 11:29 pm

HC, listen to Trekker. He always has good advice. He's helped me out a lot!

Take it easy this weekend and ice that knee! I'll bring hiking sticks for you on the next hike.
Expose yourself to your deepest fear; after that, fear has no power, and the fear of freedom shrinks and vanishes. You are free . . . . Jim Morrison


http://snownymph.smugmug.com/
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Postby giantbrookie » Sat Feb 02, 2008 5:41 pm

Weight training and flexibility have always been the keys for me. I'm 48 and have had fairly major knee issues since my knee injury (ligament damage from side impact in basketball game) at the age of 17. I had my second major injury and an operation at 18 and a second operation at age 38. That's the "bad" (right) side that has been victimized by a number of nasty injuries, all but one being basketball related (the one exception was a skiing injury). My "good" side has been battered, too, with the worst injury being a hyper extension when I came up a tad short jumping across a stream with a full pack (aged 28 at the time). What has kept me functional all these years has been weightlifting to build up the quads and hammies, coupled with various flexibility exercises. One can do a number of other types of training, but only weightlifting can isolate one's weak side (or parts). No matter how symmetric I thought I was in running, jumping, etc., I would find that I was favoring my bad side. Even doing 2 times the number of quad sets on my weak side, it would still be less developed owing to me favoring it during various activities. I quit basketball about 2.5 years ago and my weight training routine has finally come close to equalizing the size between the two thighs.
Since my fishing (etc.) website is still down, you can be distracted by geology stuff at: http://www.fresnostate.edu/csm/ees/facu ... ayshi.html
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Re: Knees

Postby mfassett » Fri Feb 08, 2008 11:48 pm

crap, did you just say "quit basketball?"

Man...

The idea of that sends chills down my spine, as that and ice hockey are my favorite sports (do each 2x/week). I'm 44, and I know my time is coming though.

I have had knee troubles on my last few long hikes, and have used trekking poles for many years now. My biggest problem is the last ~6 inches in stepping down from a boulder with a full pack... without the poles it's just about impossible, but with the poles it's still a bit harry. Maybe I need to do the weight training.. hard to believe as my quads are quite strong.
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