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Knee Pain – A Hiker’s Guide

Double Cho-Pat Knee Braces on the Appalachian Trail
Double Cho-Pat Knee Braces on the Appalachian Trail

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 20 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 to reduce the impact of my backpack weight going downhill and I make sure that my shoe 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, 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 20 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 knee 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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22 comments

  1. Most people want an easy fix – like a strap – although I agree that long term exercises are the best cure if the issue you face is fixable by exercise.

  2. @Heather .. I feel your “pain” The R2R is a very addicting& Amazing hike,,, I had a issue with my Left knee 3 weeks after I returned Home..OUCH,,

  3. V helpful! Thank you for sharing this info.

  4. Just experiencing this “hiker’s knee” right now. Good to know it is a common thing. How do you speed up the healing process?

  5. I have read a lot of Blogs and articles about hiking with knee pain and found your article the best. thank you. I will look up the Cho-Pat knee braces, as I have a few different ones but they all seem to help for the short while, may be I am using the wrong ones. I have done a few hikes and am about to do the Everest Base came in 4 months so will try any suggestions to make it easier. The part about exercising to strengthen the legs is definitely good, as I have been doing this and found it helps while hiking though it took some time but saved me around $4000.00 on knee clean up.

    I hope to follow my physio’s and PT’s exercises targeted on the right areas to get better strength on my legs so I can keep hiking till my bucket list is done.

  6. Wow, thank you sir.
    Read this, and definitely give it try. Did note every single info I can find.
    I have knee pain when hiking downhill, not that painful during the hike but I can really feel it and give me jolt sometimes.
    May I know for how long this therapy work? (to even not-so completely cure, just to ease the pain)
    do you have any formula for the work-out?

    Thank so much in advance.

    • If you need this brace, your condition may be permanent. I’d consult a doctor if you haven’t already. Th nice thing about these braces is that will make it possible for you to hike, even if your condition is permanent.

  7. hi. i am suffering from a knee problem on the outer side of my right knee. i am quite a competative athlete and do race walking and middle distance running. thourght it could be related to some of the hikers knee problems sceen as the simptoms seem quite similar. i have just been refered to phisio by my doctor and told to look up some iliotibial band excersis. Do you know if there’s anything else i could do?

    • Try getting yourself a pair of Pacer Poles from the UK, if only to correct your posture. I found that my ITB completely went away when I started using them, my pace increased and I stand much straighter at rests. The owner is a physio. Check them out.

      • I purchased a pair of pacerpoles after reading this post last year. Easily the BEST investment I have made in terms of hiking/backpacking. The benefits are phenomenal: Increased stride, Good posture, Stability, Ease crossing rivers, and even using them to offer assistance to other hiking buddies!

        I got ITB syndrome while backpacking after being super sick and bed ridden for about 4 months. I looked for many solutions and the Pacerpoles are phenomenal. I mixed them with Cho-pat knee straps and hiking is amazing now!

        If you are debating buying either of the items, I recommend it! Invest in yourself; you are worth it! Pain free is the way to be!

      • Tyler, I am so glad to hear about your Pacer Pole experience. They are a fantastic product.

  8. Unlike Becky’s situation, my knee pain was related to being out of shape, unless you consider round to be a desirable shape. My hiking knee pain went away when I dumped half my pack weight and then an equal amount of belt weight. Now, I weigh less wearing my backpack than I did without.

    I have met people who had knee problems from over training and running on streets. That hasn’t been an issue with me because I only run if there’s a ball, bee, or a bear involved.

    I have to “ditto” the Pacer Poles. I’ve used hiking poles for about seven years and Pacers for the last year or two. Pacers are the nicest ones yet and because of the strength of the dollar when I got them (or was that really the weakness of the pound?) actually cost less even though they were shipped across the pond than my Lekis cost here. Pacer’s website has videos showing the correct way to use them and their printed instructions are informative as well. My biggest pain problem in the arthritis in my wrists and hands and the wonderful hand grip on the Pacers completely eliminates that.

  9. Is there any issues with chafing?

  10. I just wanted to say thank you. I’ve been debating if I should stop hiking. After reading your article it has given me hope.

  11. Alexander goulet

    Thanks for sharing. I also strongly agree that Physio Therapy should be the first course of action for “Hiker’s Knee”. I hurt my knee going downhill on a hike in Switzerland a few days ago, and some light body weight squats, lunges and some stretching, along with some ibuprofen have helped a lot. Same as you, downhill and uphill after I hurt it was very painful. But I have since regained much of my mobility and have slowly started going uphill again. In the future, leading up to these hikes, I will prepare my knees with more proactive exercising.

  12. age 67 and suffering from knee pain after 2 weeks of hiking in the mountains. Where can I find a list of the exercises to do to strengthen my knees. Love to hike / walk and sure do not want to stop. I also have some foot pain from arthritis if you have any ideas how to help that.

  13. I’m just turning 65 and had an interesting 3 day backcountry trip with a 40lb pack. First night my knees were uncomfortable but the ibuprofen fixed that. Most of it was level but I had 4km of steep undulating rocky and root exposed bush walk. I had to pack out in heavy rain. I wore a flexible knee velcro brace/wrap and was surprised I had no issues, not even two or three days post, and I’m over weight. I do moderate (20min.) kettlebell and 45min walk jog routines. I imagine it’s the goblet squats and windmill routines with the kettlebell that helped me the most but not certain.

    • …I used trekking poles as well a Black Diamond Trailback and a sturdier Sherlite tracks staff for my favoured side.

    • Both of those exercises do stretch out the fascia and keep the knee area loose, thereby preventing impingement. You might also want to try single leg deadlifts, even without weights. I also find them very helpful along with single leg squats.

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