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Knee injuries and your solutions.

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  • Knee injuries and your solutions.

    What sorts of knee injuries/pains do you have or have you had? How do/did you deal with the problem? Got any recommendations for prevention?
    Project-100: 100 peaks, one winter.

  • #2
    I'll go first. I've had a left-sided patello-femoral problem that has waxed and waned for decades. It limited my training for Project 46 but I did the 10-days of hiking pain-free. But then the training, preparatory hiking and execution of Project Full Deck really did a number on it and I decided to stop hiking for one month until it settled down. One month became two became three and so on for 6 months of layoff with little relief. I was thinking I would have to put Project 100 off for a year. Finally, I got the associate chiropractor in my office to examine me. He found de-activated hip abductors (especially with 45 degrees of hip flexion) and weak adductors along with tight quads and a weak Vastus Medialis Oblique.

    He got me going on rehab exercises at the gym, most notably:
    • standing hip hikes,
    • adductor planks,
    • leg extension machine with external rotation of the hip,
    • descending, eccentric single-legged bridging with feet widely spread
    • hip abduction machine.

    The first thing I noted was how weak my affected leg was compared to the other side. The 2nd thing I noted was how slow the progress was but I stuck to it like glue, 3x/week for 4 months. Now I have almost no pain but if I overdo it, it will act up. I am careful with the knee-dominant gym exercises and in doing weighted hill climbs as part of my current training regime. I carry rocks uphill and drop them there to avoid overloading it on the way down.

    As a preventive measure my advice to anyone would be to do the adductor planks (excellent cross-core training!) and the hip hikes. I do the planks with 20 lbs on my side and I do 3 series of 10. I do 3x3 series of 12 hip hikes with a 30 lb. kettle bell in each hand. Between each series of 3x12 I do a farmer's walk (60 secs) with the kettle bells.

    Let me know if you want a description of any of the exercises.
    Project-100: 100 peaks, one winter.


    • #3
      Iíve had several bad sprains and one slight meniscus tear in my left knee, which led to me favoring it and over working my right knee. Went to a chiro, PT, and an ortho and they all told me very different things but agree that the left knee is now arthritic. Final answer.

      My solution has been to simply listen to my body and do the things that feel right while finding ways to experiment with the things that donít. Iíve dramatically cut back on running but have stepped up my road bike riding substantially. I still do squats, lunges, leg extensions, and other exercises, but cautiously. I never wear any type of supporting equipment when I train, but I always do while hiking or if competing in a race. I tried a couple different types of neoprene/hook and loop braces with varying degrees of success, but in general spent more time dealing with chafing from playing tug oí war with them all day. Early this summer I switched over to a compression sleeve type of brace and itís been excellent so far. I use a UFlex Athletics knee sleeve (non-copperÖ copper seems gimmicky) and itís been working so well that I just recently ordered their ankle brace as well (two fractures and numerous sprains for my right ankle).

      Lately I've also been taking 250mg of naproxen before descending, which helps prevent the post hike aches.
      My mind was wandering like the wild geese in the west.


      • #4
        Following to get preventative exercise ideas - one of my knees felt really sore for the last few hours of my last hike, so I've been doing some online videos to strengthen, but looking to pick up any advice from the experienced here. If I can help it, I'd like to avoid ever calling the rangers to rescue me from something I could've prepared better for.

        p.s. just googled "adductor planks" and recoiled upon recognizing my least favourite exercise... now belated seeing why I have to do them anyway. The ol exercise catch-22 I guess.


        • #5
          Mine is meniscus tears, both knees. Left one more serious, right one slight. At this point there is no practical fix for the actual issue. It's at the point where it degrades my performance a little (for example, I have had to greatly limit trail running - for all intents and purposes I have stopped running). But it's not at the point where I would do better with any kind of surgery. I too wear braces for some activities, notably for downhill skiing.

          In my case, impact and heavily loaded activities like a heavy pack do not bother the knees. In fact they often feel better after carrying a heavy load. I think that's because forced approximation keeps everything in alignment. The activities I have to avoid are un-weighted "open chain" activities like running and jumping. These offer the chance for some part of the torn meniscus to get in the wrong position, which will greatly aggravate symptoms for several days.

          Muscle imbalances can definitely aggravate any knee problem. In my case, similar to you guys, it's stronger quads and IT Band, and weaker adductors and VMO. The other muscles that participate in the meniscus problem are the popliteus and the peroneus muscles. These will fire to try to "protect" the joint, but they actually pull it out of alignment and make the symptoms worse.

          I roll the IT, and I am starting another round of adductor strengthening soon. Just trying to keep the knees intact for as long as possible before I need surgery, and hoping for more advancements in the field.


          • #6
            Originally posted by tcd View Post
            hoping for more advancements in the field.
            You mean something better than a walker?
            Project-100: 100 peaks, one winter.


            • mastergrasshopper
              mastergrasshopper commented
              Editing a comment
              not a fan of hiking poles so even the mention of a walker gives me heart palpitations
              do they have walkers in carbon fiber with add on carbide tips ?

          • #7
            I've now had five knee surgeries in the last three years! Four meniscus tears, and the eventual total replacement in my right knee. It's taken a bit over a year for it to be well healed, but it seems to be doing fine now.

            After PT ended, I worked with a personal trainer who emphasized muscle endurance exercises...his theory is that parts of the thigh become unbalanced after longer hikes because these muscles become fatigued. His other working theory is that machine exercises, both strength and cardio machines, tend to only work the slow-twitch muscles, and fast-twitch muscles are often left undeveloped. With this, my leg exercises are a series of supersets that combine one standard, stable machine or fixed lift with one that is unbalanced. Three sets of 12 reps for each exercise, and three different supersets, and my legs are done! But, it seems to work.
            Examples of the exercise pairs are Seated Leg Press with Wall Bosu Ball Squats with a Kettlebell; Weighted Walking Lunges with Bosu Ball Squats; Lunges, but stepping onto a Bosu, followed by Hack Squats...and so on. One solid, one unstable.
            Eventually, all things merge into one, and a river runs through it.The river was cut by the world's great flood and runs over rocks from the basement of time. On some of the rocks are timeless raindrops. Under the rocks are the words, and some of the words are theirs. I am haunted by waters.


            • #8
              As long as we are all dispensing free medical advice, I had tendonitis and went to see a PT. She gave me several exercises to do, which I can not really remember, but it involved strengthening the joint in a variety of ways. She also gave me stretching exercises. Many years later, I still do the stretches. Problem is 99% gone.
              Tom Rankin - 5444W "In the depths of Summer, I finally learned that there lay within me an invincible Winter"

              Proud Member #0003 of ADKHP Foundation
              Volunteer Balsam Lake Mountain
              Past President Catskill 3500 Club
              CEO Views And Brews!

              Trail maintainer for the Dry Brook Ridge trail from Mill Brook Road to just past the Lean-to


              • #9
                Originally posted by Neil View Post
                You mean something better than a walker?

                Yes! Currently I am watching the stem cell technology, and also the NuVisc implant. These are potential treatment when and if my knees finally go in the crapper...


                • mastergrasshopper
                  mastergrasshopper commented
                  Editing a comment
                  Pray and hope for stem cell !!!!!!
                  in the meantime do any and all VMO / hip flexors all the stuff Neil was talking about.

              • #10
                I'm not going to provide any detailed medical analysis since I don't have one. I wear ACE adjustable knee braces and have done so for many years. If I don't I'll feel it in my right knee - even after my favorite short hike (Hadley Mt 1500 ft climb three miles RT) and I know because I occasionally do that without braces. The left brace I wear is just a precaution.



                • #11
                  I guess I have been lucky with knee issues. In 2006 I sprained one (right knee) slipping on a root descending Blake toward Elk Lake during a driving up, was still able to walk, and then immediately got angry/determined and power hiked the rest of the way out to the car. I never got it checked out, but I had to go up and down stairs sideways for over a month while wearing an ace knee brace....for a desk job. Five or six years ago I heard something pop in my left knee while rounding a corner/jumping a curb during a run in my neighborhood. I walked a few steps until the initial shooting pain dissipated, then finished my run. After finishing that run, my knee would "freeze" if I kept it in either a bent or straight position for anything longer than a minute or two, and it was very painful to undo that freeze. About three weeks after that I inadvertently squatted down to pick something up, heard and felt another pop, and then it suddenly felt completely fine. I think I may have dislocated my kneecap, if that's even possible. In general, other than the eye doc and dentist, I don't go to doctors. I usually give injuries time to heal, and if after a few weeks of taking it easy I don't feel improvement, I think about getting it checked out. To date, the problems have always fixed themselves (including my torn hip flexor, and subsequent torn hammy). I think casual regular running and drumming (working the pedals) helps keep everything strong and loose around my knees and ankles....or, maybe it is just plain luck, or that I'm blessed with a fairly even gait. Either way, I consider myself lucky, and hope it continues.


                  • #12
                    I've never had hiking related knee pain, but I had painful IT band issues 18 months ago from running. It started when I really ramped up my running miles. I'd learned that running slower and keeping my heart rate down meant I could run much, much further. I think the injury came from adding miles much too quickly. I went from running three to six miles to sixteen miles in two weeks. On the third week I had a sharp stabbing pain in the outside of my right knee, just above the joint.

                    My solutions were:

                    1. Rest a lot. I think I took a full two weeks off of running.

                    2. Increase miles slowly, both during recovery and once I was back to normal. I was training for a half marathon and needed to run further. I limited myself to an absolute maximum of 10% more miles reach week with a target of 7.5%.

                    3. Foam roller. It seems to help when I roll both my muscles and my IT band. I think tight muscles pull my knee out of alignment.

                    4. I pay more attention to my gait. I think I dinnertime run with my toes out, and that seems to make things worse. I haven't been to a running coach about it, but it seems to help to remember to keep my toes more straight ahead.

                    5. Don't run on the edge of the road. This doesn't really have a hiking corollary, but a steep slant on the edge really wears on my legs. I try to move to the top of the crown whenever possible.

                    Rest and ramping up slowly seemed to be the biggest impact. I did hike once, Nippletop and Dial, during my recovery. I'm increasingly a fan of dissimilar training. I think my runs help my hikes and my hikes help my runs.
                    46/46 11/46W


                    • Groundpounder
                      Groundpounder commented
                      Editing a comment
                      Ouch! I know what you are saying. After running through the oppressive heat and humidity of summer, I always want to extend my miles when the weather gets cooler because I feel like Superman! They say there is a 10% rule to adding mileage, but I've always been ok with adding 20%. Anything more than that I usually feel minor nags of pain somewhere.

                      As for the edge of the road/crown issue, thankfully I live in a somewhat low traffic neighborhood so I mix up which leg is downhill on the various sidewalks and roads along my route.

                      When your IT band issues popped up did you just transition to a new pair of shoes? I rotate two pairs, and it seems to help me...mostly because I'm never exclusively going from totally worn out shoes to a brand new pair.

                      I do agree that runs help hikes and vice-versa! Since I took up running I can storm up mountains (except in brutal heat), and I typically have zero knee pain after a tough hike like I used to have.

                  • #13
                    Well I don't have any medical advice for serious injuries, but for keeping your knees greased......

                    Wellesse liquid Joint Movement Glucosamine extra strength w/ chondroitin, hyaluronic acid, and MSM by Nature's Way. Sugar free. Berry flavor. 33.8 oz

                    "LIQUID GOLD"
                    Catskills: 39/39, 26W/35W
                    ADK: 46/46


                    • #14
                      I had a posthole related left knee injury when I was eleven. Later I had a big loose body removed through an arthroscopy. Ever since if I push too hard I get left patella pain. What works for me is when I start feeling pain in my left knee I switch more of the load to the right knee.

                      So going up that means I conciously use my right leg when I need to go over a bigger step or rock requiring more bending of the leading knee. This is when forces on the patella are greatest. Going down I will lead with my left leg and let my right knee do the bending and take the forces.

                      After a while of doing this my left patella sometimes doesn't hurt anymore and I can resume hiking normally.

                      It's also very important to be not go to fast and take a pounding on descents. In my case both muscle and articulation breakdown is a function of intensity * time.


                      • #15
                        I haven't had a knee injury perse, I have had crippling knee pain from hiking where stretching had very little affect.

                        When I had the pain it was always on the lateral (out)side, predominately on the right knee. I really could not discern or remember when/if I ever injured it.

                        I was sitting with "Adventurous" one evening in Wilmington at a gathering and she had mentioned similar issues that were resolved with inserts

                        I purchased a pair of Sole at around $45-55 dollars.

                        I have not had any issues yet, and I'm going on 10 years now.
                        If by chance some day you're not feeling well and you should remember some silly thing I've said or done and it brings back a smile to your face or a chuckle to your heart, then my purpose as your clown has been fulfilled ~ Red Skelton