The summer months are an ideal time to get out into the mountains, get some fresh air, beat the heat, and enjoy hiking in some of this country’s most scenic mountains! Often, nagging aches and pains in the knees are not an issue while walking on level ground, but the added challenge of aggressive elevation changes and negotiating rocky terrain has a way of amplifying and exposing underlying weaknesses.
One common source of knee pain with extended hiking comes from the contact between your kneecap (patella) and femur, commonly referred to as patellofemoral pain syndrome. As your knee bends and straightens, your patella should slide smoothly up and down in the groove made by the end of your femur. Increasing the amount of force through the knee (for example, stepping down a steep slope) and compressing the kneecap or altering the alignment of the patella’s normal track are both potential sources of pain at this joint. The good news is that strengthening the hips will address both sources!
So much of knee positioning, rotation, and alignment is controlled at the hip. Engaging your gluteal muscles as you descend a slope will decrease the force exerted by the quadriceps, which will decrease the compression force pulling through the patella. Keeping your hips strong and retraining your knee to maintain good alignment (neutral orientation with normal patellar tracking) will also prevent your knee from collapsing into a position called dynamic valgus – a position where the femur rotates inward and the knee drops in towards the opposite leg. This position really stresses the structures in the knee but can be prevented if the gluteal muscles – muscles that move the leg in directions opposite to the dynamic valgus position – are kept strong and engaged with every step.
Here are a couple great exercises for starting to
strengthen your gluteal muscles at home:
fire hydrants (with/without band)
fwd/bwd monster walks in squat position (with band at ankles)
We are only human and even the strongest muscles fatigue eventually. To decrease the cumulative pounding over long hikes, use trekking poles to decrease the weight through each knee with every step and limit the effects of fatigue on lower extremity alignment. They will help propel you up each hill and slow your descent on steep downward slopes. Ideal sequencing and rhythm of arms and legs will allow for the opposite foot and pole to strike the ground at the same time. They will improve balance deficits and decrease risk of falls… mine have even saved my life! (learn from my mistake – don’t hike over large boulders in the rain!)
Don’t let knee pain keep you from conquering the next 14er and enjoying those spectacular views!
(There are many causes for knee pain – if you are having clicking, popping, catching, or locking in your knee or are not able to straighten/bend your leg completely please see your physical therapist to assess your symptoms and evaluate for further pathology.)
Steve Rayner PT, DPT