Walking Well: Good Knees

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For injury prevention, common sense suggests that hikers should go slowly and carefully downhill. Not all hikers can adapt to this style change, however. Although the temptation to go downhill fast is strong, hikers should realize the consequences. Avoid overflexing the knees by taking smaller steps. Try not to pound the ground unnecessarily; instead, try to walk lightly (difficult with a fifty-pound pack!). Any unnecessary jumps put enormous pressure on the joints and should only be undertaken when unavoidable. I find that it helps to grab every tree trunk and branch to have the arms share some of the stress and exert greater control and balance. Many hikers find that a stick does about the same thing. I am convinced that mine saved my life several times while also protecting my legs. I recommend using a hiking stick. (I currently own and advise using two ski poles.)

Treatment

Some hikers who have had knee problems find that knee braces help. Others use Ace bandages and feel that they help. Ibuprofen (Motrin, Nuprin, Advil) is an anti-inflammatory. It should be used to reduce the reaction in and around the knee joints.

When a long-distance runner develops an inflamed knee, the effective treatment is an ice pack for twenty minutes three to four times daily, some decreased activity, and an anti-inflammatory drug such as ibuprofen. This regimen must be strikingly modified for thru-hikers. Cold water soaking in the creek is great for foot problems, and the same result can be achieved for knees by periodically pouring cold water from a cup onto a bandanna wrapped around the knee for five to ten minutes. Knee pain and swelling that is moderate or severe requires rest on or off the trail plus medical treatment. Do not rely on drug administration alone if the injury is more than mild. I suspect that a fair number of thru-hikes have been terminated, wisely so, for just this reason.

Case Histories

Although I have had running-induced knee problems on several occasions, I had no hiking-induced knee problems on my AT thru-hike until approaching Carter Notch in New Hampshire's White Mountains hut from the north. It was late in the day and I was hurrying to arrive in time for supper. The last two miles are a steep continuous downhill; I first felt one and then both knees start to hurt when nearing the notch. They were OK that night, but the next day they were somewhat distressing, so I bought an Ace bandage at the trailside store at Pinkham Notch. I used the bandage and took ibuprofen for two days. The joints healed, and I have had no problem since then, because I have been more careful on downhills.

I have examined and recommended action for many hikers with knee pain. One case stands out: a retired naval captain with a painful knee consulted me. I suggested cold packs, ibuprofen, rest, and gait modification. He went down to the spring and, after soaking, returned in fifteen minutes reporting,"Doc, it feels better already." He did everything I suggested and markedly improved over the next few days that I could observe him. (He wrote me later that the treatment was fully effective.) Longer-term feedback is difficult to get on the trail, but when favorable is very rewarding to both the physician and the patient.

I have reports of hikers proceeding with badly swollen, painful knees sustained by high drug doses who clearly should have stopped for diagnosis, treatment, and recuperation. It is important to know what the pathological process in the knee is. Preferably a well-qualified sports medicine or orthopedic specialist should make the diagnosis and recommend treatment. Follow the advice! Don't delay diagnosis and treatment.