The “Hiker’s Knee”

Healthy sport: Hiking downhill without knee pain.

by “Dr. T.”, March 2016

Hikers knee, i.e. pain from going downhill for a longer time, is not a medical condition, if it is only related to hiking downhill. It is rather a signal of pain and inflammation from the untrained knee and typically after one or two days of resting the knees are fully recovered. It is important to understand the cause of pain and where in the knee it is located to give the best support, treatment and rehabilitation. If in doubt, your GP or sports physician may diagnose you. If the knee is in normal condition, but just strained from physical activity, it can be useful to support it until the muscles around the joint get stronger and can manage the activity (in this case walking downhill).

For training it helps to understand which ligaments / muscles are getting strained and to stretch and train these between hikes. Most people are not regular hikers and will benefit from supporting their knees while walking downhill. This can be done by different knee straps. I find the Cho-Pat knee support the best due to the extra side support on the ligaments (silicone tube inside) as I adjust them to give extra support to the lateral ligaments below the knee. However, many can benefit from just a single knee strap above or below the knee cap that is easier to transport and costs less. Cho-Pat is easy to find on-line and costs around 55 Euros.

NOTE: Only use bandages and straps while moving and so you can feel the free flow of blood; do not use  themwhen the movement stops. Knee bands should not sit too loose or too tight and when ordering measure for the right size.

In addition to a knee strap I find it helpful to use trekking poles, particular those with shock absorbers that will bounce 1-2 cm when you put weight on the pole. This helps the joints in your upper body and allows for more pressure relief of the knees when going up and down hill. The poles also provide extra balance, if you have a heavy back-pack. 

I prefer the Leki Carbon Titanium trekking poles or the Corklite Antishock with shock absorber and with a firm lock rather than the pole at the bottom in the picture without a lock, as the rotating lock in the bottom has given me several unpleasant surprises when it suddenly gave way and collapsed. Another important detail is the small stopper cap in the bottom of the stick on the top that avoids getting stuck in mud (and when pulling them out one of the parts without a grip lock gets stuck and eventually this destroys the sticks). One should also take care to choose the right band for the pole handle to allow for more pressure and comfort under weight.IMG_8427This brings us to the last, and probably most important item: Choosing the right hiking boots. Simply put, the boots have to fit the purpose. As an example in the picture below (1) is for high altitude mountain hiking, (2) for mountain hiking in easier terrain or multi-day trekking (4) for one day light hiking in dry areas. Hiking in uneven terrain always requires boots with strong ankle support; shoes without ankle support (3) are not suitable for mountain hiking. AND: Remember to tighten the boots extra when going downhill.

This article is inspired by my own experience. My first serious downhill hike was in Grindelwald at age 10, where I felt sharp pain in both knees. Making my bag lighter, changing direction or pressure on the knee by using trekking poles all alleviated the pain, but never enough. In 2012 I bought the Cho-Pat and that gave me the relief required so I could increase my hiking. In 2014, after many days of hiking with support, the pain was gone, also without support. Conclusion: Train with support to avoid pain until you do not need the support anymore. 

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