Knee Pain is a common symptom in hikers, runners, skiers, and cyclists. One of the most common types is pain around or behind the kneecaps, which is often diagnosed as Chondromalacia, Patellofemoral Stress Syndrome, or more commonly “runner’s knee.” The symptoms of this type of knee pain worsen when walking up or down stairs, walking uphill, running, jumping or activities that force the knee to bear weight as it is straightened, like rock climbing.

In older hikers, Chondromalacia is often caused by over pronation where the lower leg twists inward when walking or running. This can be caused by worn hiking boots or muscular weakness in the quadriceps and hamstrings. In younger hikers, the pain is often caused by trauma or overuse.

As a hiker, I have suffered from knee pain for the past 10 years and manage my condition by avoiding activities that require jumping, running, and the breast stroke where my quadriceps rotate in the opposite direction as my lower legs. I use hiking poles now to reduce the impact of my backpack weight going downhill and I make sure that my boot soles are not worn and prone to inward rotation of my foot. I also do a lot of exercise during the week that targets my quadriceps and hamstrings: I ride a stationary bike about 100 miles per week and do a wide variety of weight lifting exercises that target my legs, like lunges, step ups, Bulgarian split squats and hyperextensions. These are all bodyweight exercises and don’t require the use of weights

I discovered these preventative exercises after a very successful round of treatment by a physical therapist. I injured my left knee very badly on a hiking trip in Scotland about 10 years ago to the point where it locked up on me for about 8 weeks. I visited several medical specialists who all wanted to perform surgery but couldn’t tell me for certain what was wrong or whether surgical intervention would work. Instead, I opted for physical therapy and I was lucky to find a therapist who not only cured me but educated me about the functional mechanics of human movement. Be skeptical if you have knee pain and your doctor recommends surgery. Physical therapy can provide you with an alternative cure and help you understand how prevent a recurrence.

If you experience pain on the trail after a hard day of walking, bring along some ibuprofen to reduce the inflammation at night and stretch your quadriceps before sleep You may also find that wearing a knee brace is helpful. Many of my older hiking buddies, like Paul (above), use hiking poles and Cho-Pat braces and swear by them.

Disclaimer: I’m not a doctor, so if your knee pain or swelling persist, please seek medical advice.

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