Knee pain (severe) downhill

[tree_doctor]

I'm an occasional section hiker (in other words, I do 20mi hikes 1-2x/year and train minimally in between).

Last month we did 20 miles in GA with some significant downhill (wearing 40lb packs), and I could tell we pushed ourselves a little too hard (again, minimal training beforehand).
By the end, my knee felt like I was smacking bone against bone and was in just the most severe pain. Walking was difficult for a few days.

By the end of the week, I felt minimal or no pain, but across the next month some movements brought back pain periodically.

1 month later we hit the trail again. I cruised up the hills no problem, but as soon as we did even a slight downhill, the stabbing pain returned. It only got worse as we hiked.

The pain seems to be deep in my knee (i.e., behind the knee cap) and possibly also slightly to the side (i.e., lateral).

Has anyone else suffered this kind of injury or anything similar?
What was the diagnosis? (I'm trying to figure out what this is).

• My initial thoughts were maybe either tendonitis or IT band syndrome

Any treatment suggestions?

Due to lousy insurance and employment, I can't see a doctor about this for another 3 months.

[nsherry61]

#1: GO TO A DOCTOR TO GET A DIAGNOSIS, NOT A INTERNET FORUM!!!!!!!!!!!!!

That said, IT band issues present on the outside of the knee, not in the back.
Tendinitis is generally associated with tendons which surround your kneed, but are not inside, under the knee cap.

You are likely dealing with wear behind your knee cap which may be attributed to patellar tracking issues which will lead to recommendations of physical therapy which will probably do nothing to help.

Treatment: GO SEE A DOCTOR!!

All the above listed issues will typically respond well to rest, ice, and anti-inflammatories.
In general, the only long-term solution is regular moderate exercise and a methodical increase in intensity and duration of exercise over time instead of a weekend or week of backpacking without a month or two of physical preparation.

Also, carry a lighter pack. Just dropping 15 lbs from your carried load or even 15 lbs of body weight might make a critical difference.

[Praha4]

tree doc

been there done that

from what you describe it sounds like probably either of these 2 or a combination of both:

Illotibial Band Syndrome: my first and worst ITBS hit me on the Blood Mountain downhill into Neels Gap, on a 2009 section hike. Stretching and strengthening is the best way to lick this. Learn the proper stretching exercises for the ITB.
http://www.sportsinjuryclinic.net/sp...-band-syndrome


Runners Knee: again learn the physical therapy exercises, strengthen your quads and stretching are the key

http://www.sportsinjuryclinic.net/sp...-pain-syndrome

and many here use a knee sleeve or Cho-Pat dual action knee brace

Cho-Pats are awesome, check them out

http://cho-pat.com/products/knee/dua...on-knee-strap/

[jefals]

knee problems on the downhills have ended 2 of my hikes in the last few years. for one thing I'm 70 years old, so that's one factor. Super heavy pack is another. Trying to come down the hill too fast is still another.
My orthopedic doc has recommended a cortisone injection before going out for a serious backpacking adventure.
For training, I have found a 3 mile loop trail close to home with about 270 feet of climbing. I can do as many multiples as I want. Even one time with a full pack was hurting my knees. Folks here at WB have advised me to get used to the distance I want first, with a light pack, and then gradually add weight to the pack. This seems to be working for me.

Sooo, that's my story. For all I know, it might not work for you. Could even be dangerous! I agree strongly with recommendations to Check With Your Doctor.

[Heliotrope]

As a licensed Doctor I have to agree with Nsherry61. Only a doctor can accurately diagnose the source of pain. The pain can evolve from muscle, tendon, cartilage, bone, bursae and other connective tissue structures. Sometimes very hard to diagnose yourself even if you're a practitioner. I would recommend avoiding anything that causes pain. If you're only out for one or two days there's no reason why your pack weight should be any more than 15 pounds. 40 lbs may not sound like much but your body isn't liking it. The older you are the more gradually you should add intensity and volume to your athletic activities. Good luck.


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[Slo-go'en]

Obviously you need to find the root of the problem but to prevent it from happening again, you need to lighten the load. A 40 pound pack for a 20 mile hike is absurd. Good, light weight gear is expensive and I can understand one's reluctance to spend a lot of money if your only using it for a couple of days out of a year. But then hurting yourself can cost a lot more. If your also overweight (and it seems most everyone is these days) getting a handle on that too will have long term benefits.

The down hills in Georgia really aren't that steep, so if your having problems there you'd be in deep trouble in NH! A knee brace typically helps a lot. There are various degrees of braces depending on how much extra support you need. I find a simple compression sleeve helps me on really steep descents.

[TTT]

Homemade recipes: Try drinking a few teaspoons of nutmeg with a glass of milk. It sorted out the arthritis in my hand in less than an hour. Japanese karate dudes with all the black belts drink gelatin to improve flexibility.

[TexasBob]

Do you use hiking poles? They can take a lot of the strain off your knees on downhills.

[Dogwood]

#1: GO TO A DOCTOR TO GET A DIAGNOSIS, NOT A INTERNET FORUM!!!!!!!!!!!!!

That said, IT band issues present on the outside of the knee, not in the back.
Tendinitis is generally associated with tendons which surround your kneed, but are not inside, under the knee cap.

You are likely dealing with wear behind your knee cap which may be attributed to patellar tracking issues which will lead to recommendations of physical therapy which will probably do nothing to help.

Treatment: GO SEE A DOCTOR!!

All the above listed issues will typically respond well to rest, ice, and anti-inflammatories.
In general, the only long-term solution is regular moderate exercise and a methodical increase in intensity and duration of exercise over time instead of a weekend or week of backpacking without a month or two of physical preparation.

Also, carry a lighter pack. Just dropping 15 lbs from your carried load or even 15 lbs of body weight might make a critical difference.

As a licensed Doctor I have to agree with Nsherry61. Only a doctor can accurately diagnose the source of pain. The pain can evolve from muscle, tendon, cartilage, bone, bursae and other connective tissue structures. Sometimes very hard to diagnose yourself even if you're a practitioner. I would recommend avoiding anything that causes pain. If you're only out for one or two days there's no reason why your pack weight should be any more than 15 pounds. 40 lbs may not sound like much but your body isn't liking it. The older you are the more gradually you should add intensity and volume to your athletic activities. Good luck.


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THIS^^^.

Questions: are you locking your knees on the down hills or in other words plodding heavily on descents, taking a wide gait(all too commonly observed on down hills), descending fast(commonly observed!), leaning too far forward(not balancing your wt over the hips) putting excess force on knees? One of the greatest benefits of using trekking poles is taking force off the body on down hills. Still, don't let trekking poles used on down hills result in any of the above.

[fiddlehead]

Glucosomine works for me.

[Dogwood]

Glucosomine works for me.

Stop with the quackery.

An anti inflammatory diet and lifestyle may help too. Most of the supplements I take both on and off trail are joint and muscle recovery related. They absolutely do help. If I miss more than 3 days of these varied supplements I definitely start feeling it. FWIW, physical training, considering proper hiking technique(DARN RIGHT there's always something to learn especially about the things we assume we know it all about or are that simple that we can ignore!), and supplements were major components in recovering from stretched knee ligaments from a pit bull attack.

[MockingJay]

I've had similar issues which I'm assuming are ITB related. Being a section hiker from flat land who often goes from the couch to the trail, it's easy to get out there without much in the way of shakedown hikes. I can usually crush the uphills but then my knee would act up on the down hill. I found that stretching really well before, during, and after a hike has helped. A LOT. I've also used a knee brace to keep things together but stretching has been the key to getting past it. Also, don't overdo it the first day back on the trail. Too many miles too fast will mess you up.

[Puddlefish]

Smaller steps downhill helped with a lot of my leg pain.

[BuckeyeBill]

You said that because of insurance issues you can't go see the doctor for three months, which means that maybe you have a new job that has a waiting period of 90 days? I do know that many doctors will work with you on a payment schedule. No doctor should turn you away for lack of payment. Call your doctor and see if he can give you a referral to a specialist. It can't hurt to ask. While you can get great advice here for equipment, trails and other related topics, health issues are best handled by your doctor. You should also check to see if there is a clinic that offers low cost treatments.

[Uncle Joe]

Yes, see a doctor as soon as you can. In the meantime, rest the knee and ice it. If it were IT it would likely be the outside of the knee. I get similar pain on the bike, however, if I'm seated to low. It's usually a sign my seat post has slipped. So it's possible it's stressed and nothing too permanent. But again, see a doctor. Were it me and a doctor was out of the question, I'd be stretching, resting, and icing my knee.

[DLP]

+1 to see a doctor

I had knee pain for months after feeling some popping in my knee going over a pass. The pain would come and go. I googled it to death for 4 months and guessed it was IT band, sprained this, torn that, arthritis, tendonitis, etc, etc, etc.

Second doctor I saw diagnosed it as gout. She was correct. I would have NEVER guessed gout.

See a doctor.

[FlyPaper]

As a person who has had knee trouble (including bilateral knee surgery), here are a few suggestions and observations:

First, stretch hamstrings and calves consistently. Tightness in the back of the leg results in a lot of sheer pressure on the knee cap. Stretching will help a lot. (or if it doesn't help with your situation, I don't think it will hurt). If you go to a therapist, they'll probably have you stretching, but they may not explain why.

Second, look on youtube for therapy. I know this sounds like quackery, but there are tons of helpful videos on youtube. You may misdiagnose your own problem, but it is unlikely you're going to make your situation worse by doing exercises for the wrong issue. Just don't do anything that causes excessive pain. And there is a good chance you'll recognize what's helping and improve your own situation. When you finally do go to the doctor, they may just tell you you're getting older and have to build up more gradually. You already know that. The best case is they'll send you to do therapy. If you're waiting 3 months to see a doctor, you might as well see if you can find something on youtube now.

Doctors don't always help as much as they could. A long time ago I went to the doctor for foot pain that occurred while jogging. The doctor suggested rest and ibuprofen. I could have figured that out myself. I had to almost beg to be sent to a specialist that would help me to both run and not feel the pain.

[One Half]

Look for a good personal trainer with a certification in corrective exercise. They should do both static and movement based assessments and then spend a couple sessions teaching you how to do the corrections for your imbalances. It can take a few sessions to figure out how to unlock your body's key. Then a few weeks of consistently following the program should significantly improve the situation or possibly eliminate the problem completely. Garauntee if you go to a doc they will either prescribe you something or tell you that you need shots or surgery. And 99% of the time they will be wrong.


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[stephanD]

I would go for a torn meniscus. I had one myself, and the symptoms you describe match mine, but the only way to know is with an MRI.

[Time Zone]

Until you can see a medical doctor and have a diagnosis, I would suggest that you incorporate hiking poles into your gear. I had very similar symptoms and spent a full year resting. The downhill never got 100% pain-free, even after all that rest and alternative strengthening (mostly bicycling). But I got hiking poles, and they enabled me to hike with fairly minimal discomfort. I don't think I could hike for long without them.

You might also look into issues of downhill gait and speed. There may be techniques that are less likely to cause pain, but I'm unaware of any consensus method.