Got Knee Pain, Read This!

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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maverick
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Got Knee Pain, Read This!

Post by maverick » Thu May 14, 2009 2:27 pm

I have trained dozens of people, who have had excruciating to mild discomfort in the knees, especially when hiking down hill, and these following techniques have helped in most cases.

They have been doing squats, reverse lunges, step-ups, side step-ups, Romanian deads, and Bulgarian split squats to strengthen there hips, hams, and quads, also been having them do yoga, there is a dvd "Yoga for Athletes", which has a section for a specific sport exercises, and a sub section for a specific body part (for example:hips, shoulders,legs).

Many folks at the gym have no idea how to use there hips during squats, deadlifts, rdl's which can lead to improper lifting, muscle imbalances, and injuries.

During squats, lunges, Bulgarian squats, and set-ups the knee should be in line with your toes, and not extend beyond you knees (especially when starting or injured), which can be achieved by pushing back the hips instead of starting the movement by bending the knees, or using your lower back to lift the weight instead of your much stronger hips when ascending, learning the "hip hinge" movement is extremely important!

When descending, ascending, or crossing rocky terrain, most backpackers are not conscious of where there knee track is, which can lead to pain and injury or overuse injuries in the long-run, this is where proper strengthening exercises come into play.

Besides strengthening the muscles around the knee (VMO), it is paramount to engage the strongest muscles of the body, your hips (glutes), when descending and ascending, bending your knees slightly and leaning forward slightly, pushing your hips back slightly and contracting your glutes, this will take stress off your knees and lower back.
Push your hips back enough so that your shoulders are above or close to above your feet, don't overdue this by making it look like your trying to do a good morning exercise. The key is that you knees do not extend past your toes, and the weight of your upper body should be supported by your much stronger hip muscles and poles.

To see the difference walk down a fight of stairs with your upper torso straight and you will notice you knees will go past your toes when you sift your weight onto your front foot while stepping down (with a heavy pack the knee moves even further past the toes), now instead , consciously push you hips back slightly and bending your knees, you'll feel a big difference, I guarantee!

Of coarse descending in a zig-zag fashion is all ways recommended where feasible, but this sometimes is not.

Check your knees while your hiking during the day to see where your knees are in relations to your toes, especially during the latter part of the day, when one gets tired, and especially trying to cross over tricky terrain later in the day.

Employing these techniques may alleviate your knee pain after those dreadful descents and extended your backpacking years.

During descents, especially steep ones, use the above technique, once you have mastered it, and move faster than normal, it is the breaking action that stress the knee, faster movement will lessen this breaking damage.

Make sure if you try these exercises get a trainer to show you how to preform them properly so you do not learn improper form, and that you do not injure yourself.








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Re: Got Knee Pain, Read This!

Post by Skibum » Sun May 17, 2009 1:53 pm

Good stuff Maverick. I'm just starting to experience lateral miniscus pain on steep downhill, or side sloping. Daily Yoga practice definitly helps. I am leary of using any kind of knee brace, my reasoning being, that the knee might lose strenth and become "dependant" on one.

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Re: Got Knee Pain, Read This!

Post by maverick » Sun May 17, 2009 6:32 pm

Hi Skibum

Have you seen a doctor to make sure its not a tear or due to arthritis?

Do you take glucosamine to help heal your joints? Make sure you take it for several weeks otherwise you will not get any positive effects.
If you have swelling do the usual RICE (Rest, Ice, Compression, Elevation).

Do gentle exercise for you quadriceps taking care not to aggravate the symptoms. See a doctor to get an exact diagnoses so you can properly address the underlying cause if it continues to bother you.

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Re: Got Knee Pain, Read This!

Post by Skibum » Tue May 19, 2009 3:29 pm

Hi Maverick,

Yes, I do take a Condroitin/Glucosamine supplement. And I believe it has definitly helped.

No swelling. I only experience pain towards the end of a long day on the trail. No, have not seen a doctor yet, I'll mention it in my upcoming work physical. I'm thinking arthritus.

Take care,

J

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Re: Got Knee Pain, Read This!

Post by Rosabella » Thu Jun 04, 2009 5:54 am

Skibum wrote:...... I am leary of using any kind of knee brace, my reasoning being, that the knee might lose strenth and become "dependant" on one.
So, I'm wondering about this same issue. Last summer I hurt my knee in a dance class. It took a while to heal, but finally stopped bothering me. A few months ago I started doing my “stadiums” at the high school and re-injured it.

I finally went to the doctor and he said that I had partial separation of the patella. He told me it wasn’t bad and that I should wear a knee brace for a month or so to support the patella.

So, it’s been a well over a month, now, and I’m really torn on whether I should continue to wear the brace. On one hand I think that I’d just as soon keep wearing it because I don’t want to take a chance hurting my knee again and possibly affect my JMT hike this summer… “what can it hurt”. But I’m also concerned about exactly what skibum said…. Is there a chance that I’m actually weakening the knee by wearing the brace for support now?

I’m really conscious of where I place my knee (over me toes)… years of ballet has reinforced that awareness. I guess my question is this – if I am going out every day and walking/hiking/climbing to strengthen my knee as well as training, is it beneficial to continue to wear the knee brace?

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Re: Got Knee Pain, Read This!

Post by maverick » Fri Jun 05, 2009 4:41 pm

Hi Rosabella

For a partial sep of the patella you need to give it 6-8 weeks to heal with the brace on.
Tell your doctor about your plans for the summer, and voice you concerns about wearing the brace, and ask about what exercises you should be doing for a full and speedy recovery.

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Re: Got Knee Pain, Read This!

Post by quentinc » Sun Sep 13, 2009 12:21 pm

Hi Maverick,

I have just recently been experiencing knee pain on the uphill. I think this is the result of recently being goaded into (i) cycling up a steep hill after not been on a bike forever, and (ii) descending from the Matterhorn on a scree slope instead of the rock I came up on (as you can see, I'm disclaiming any personal responsibility). I have a history of knee problems, but have long since developed my own peculiar technique for descents which has worked fine. But uphill pain is something new. Does the same technique (hips back) help going up?

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Re: Got Knee Pain, Read This!

Post by maverick » Tue Sep 15, 2009 12:31 pm

No, you should try to keep your torso as straight as possible.
Check to see whether your knees are in line with your toes and not veering off track.
Also when you plant your lead leg don't just use your quads, but forcefully contract your glutes to move up/forward, glutes/hips are the strongest muscles in our bodies and we should take advantage of this.
Just as a reminder that when we compensate for some weakness in our muscles by altering the natural gait/stride/form we throw off our muscle/bodies natural balance which will come back to bite us in form of an injury/inflammation.
I am sure you have heard that you should not only work out your quads but also your hams otherwise our quads/ham strength ratio will be out balance causing patella pain.
Step ups, and lunges onto a platform should not cause knee pain while strengthening your glutes/hams/quads.

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Re: Got Knee Pain, Read This!

Post by quentinc » Wed Sep 16, 2009 2:15 pm

Thanks Mav. On a hike yesterday I discovered I could avoid pain by doing two things. First, pointing my right foot out a bit. I understand what you are saying about the dangers of compensation, and that will be a temporary thing only (although I am naturally a bit pigeon toed anyway). Second was squeezing the muscles of my right leg right before landing on my right foot. That probably involves my contracting the glutes too, whether I'm aware of it or not.

I'll try step-ups after this bout subsides. Also, what about a weighted leg raise (strapping a light weight around the ankle, lying on the back, raising the leg without bending the knee)? My orthopedist once told me those can help stabilize the knee joint.

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Re: Got Knee Pain, Read This!

Post by maverick » Thu Sep 17, 2009 1:01 pm

Hi Q

Leg raises are okay, but leg extensions should be avoided unless they are done properly and even then it definitely would be near the bottom of my recommended exercise list.

When taking a step up hill and your front foot comes into contact with the ground and you prepare to take another step contract your glutes and push thru your feet like if you were trying to smear something of the bottom of your shoe.

Same goes for cycling, when you reach the 6 o'clock position you should do the same smearing action with you foot to activate you hams and glutes, a lot of people try to grind/push thru using only there quads.

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