UKC

i suffer with extreme knee pain normally on the sides of both knees when walking down mountains after a long day out.it comes on after some time but then becomes extremely painful in a very short time after, to the point i sometimes need to walk downhill backwards to eliviate the pain.uphill is not a problem apart from the obvious fatigue that sets in after a while.
i am aware it is due to the fact that different muscles are used walking downhill than uphill.
i am planning a trip in august that will involve a long ascent and a very long descent and would like to try and get some more longevity in my knees prior to my trip
does anybody know of any specific exercise... in the gym perhaps that can help strenghten the downhill knee muscles!

In reply to colina:

I found squats helped my knees. I also use walking poles - I know some people don't agree with them, but I've found them very useful for reducing the load on my knees when going downhill.

In reply to colina:

sounds like it could be your ITBs

might be worth a visit to a physio to find out what stretching and strengthening exercises would help

In reply to colina: I suffered from something similar for a few years and thought that I would have to give up climbing. In my case simple hamstring stretching cured the problem after a couple of weeks and I have never had a recurrence.

Al

In reply to Removed User:ive just started using poles clair for that specific reason but find them a little awquard and slow going downhill to be honest..squats are something ive been doing for a while but although they have improved my leg muscles ,doesnt seem to make a difference where my knees are concerned. but thanks for your input.

In reply to colina:

I get the same - seems to come and go. Do you do a lot of running?

Walking poles helped me fantastically... also mean I can generally move a lot quicker over rough terrain too...

Will be interested to hear what people think causes this?

In reply to ste_d:
a trip to the physio may well be in order ste cause my shoulder joints are painful aswell, kill 2 birds with one stone maybe, i'm falling apart man!
just glad i'm not a horse.

In reply to colina: Doctor and physio failed to diagnose my symptoms, I had to go to a specialist sports injury expert. He knew straight away.

Al

In reply to colina: a couple of years ago i had sharp pains to the outside of both knees on long steep descents, trip to the physio diagnosed itb problems...the prescribed stretches have helped to manage the problem but they have not eradicated the pain completely

in general i'm pretty sceptical about physios until i'm absolutely desperate

Commom problem sore Knees in the mountains especially going downhill and as you get older!
Some good suggestions to help i.e. Walking Poles, personally wouldn't be without them nowadays on the hill really help on those big mountain days. Hamstring stretching as already mentioned this really helped me and i mean regular stretching try and do some every day. Keep your weight down also helps.
Build up the leg muscle particularly the inside muscle by the knee the VM muscle it's known as, helps stablise the knee.
Finally apart from physio advice (Not always great especially re diagnosis but good to get the excercises right) Consider a 'Biomechanical assessment' no, it's not painfull at all!!! It basically checks your body alignment i.e. are your feet over-pronating or under pronatiing or have you just got very poor posture? Often as a result specific made insoles will be made to rectify this (not cheap) But done well they really work. I also cut down on my running and went biking as an alternative. Also make sure your boots and any other footware is supportive i.e there is a world of difference between a Meindle Vaccuum boot and a Brasher Hillmaster! Finally, try this guy, Brilliant: Andrew Stanley, works out of Settle www.reboundclinic.co.uk Hope you sort the problem good picture of hoy by the way!

In reply to colina: Might also be cartilage problem, I suffered from exactly the same for a good few years and this year (June) had a tidy up. First winter trip out this year was a couple of weeks ago and hey presto no problem, poles are good as well, have used them for a few years now. Was told by physinto build up quads as they support the knee and take a lot of strain off the joint.

In reply to colina:

My physiotherapist recommended I do squats with my legs seperated, but tied together with a theraband.


Also, persevere with the poles. I resisted for a long time but once you get used to them, they do help.

In reply to colina: i have the same problem and have solved it with I.T band streches on a foam roller youtube.com/watch?v=c9aJtO0VCqw&

cheers phil

In reply to colina:
I had a similar problem earlier on this year, mainly brought on when running, but also when walking. It was exruciating once it kicked in. After a trip to the doctor (told I was old, not even 40!), then to a running shop to check my gait (fine), I finally went to a physio. Once session and I was told to improve the strength in my quads. I was given some exercises, had to buy a football and some weights and am now virtually cured! There can be loads of reasons for what is wrong, some more complicated than others. I would definitely recommend a trip to the physio and I hope you can get sorted out quickly.

In reply to colina: Ah yeah i get the same thing, mainly on the inside of my left knee, down the side. Slows me right down too. It has had me quite bad before the day after a big day out on the hill, It would be nice to know what to do to stop it...

In reply to colina: seems like im not the only one with this problem and it is encouraging to know that there is maybe a solution.i
will scrape a few bob together and book in at my local sports physio with a view to strenghtening the quads /hamstrings etc ,will also check out the video too.thanks for everyones thoughts and yes it is a good picture of the old man of hoy .a really great day out in my prime!
will also persevere with the crutches (i mean poles).

In reply to colina:

see if you can perform the Klatt test as this should easily show if its a weak/lazy VMO or possibly something else (might as well find the cause rather than just the symptom).

In reply to colina:

use a gym ball to rest your back on whilst your doing a squat. and stretch a lot that will help with your knee joint.
josh.

In reply to colina: There's an unbelievable amount of crapola spouted here! It's only lactic acid dude, totally harmless and totally natural. Just give it some, man-up and push on through the pain barrier. It will be worth it as you will actually strengthen your legs and et voila: the pain will eventually vanish!!

In reply to colina: Allow me to give some advice from my professional position as a podiatrist.

Frontal knee problems are most commonly associated with excessive pronation of the forefoot, most commonly associated with a rearfoot varus, anatomical fixed position forefoot or occasionally a limb length difference (not an unusual occurance). Such issues of movement create compansatory movement elsewhere in the foot and lower limb, even including the torso - for every movement in one direction there is a compensatory movement in the opposite direction.

When you walk, or run, downhil this creates increased impact/intensity across the forefoot as the impact is greater there if you have reduced movement at the heel etc and you will be doing more forefoot loading. Such a knee pain is also commonly associated with back pain across the lip of the pelvis.

Some of the issues that cause this problem are quite often not easily rectified by one thing but many things collectively can help and even resolve it.

Stretching of the ankle, knee and hip are clear in that they help movement to occur and compensatory movement be reduced. But this isn't the only solution. Strengthening exercises, specifically of the quads, also helps desist that impact.

Orthoses may help or be needed in the long run for some but these are not always the panacea for all foot problems. To help as a simple orthoses, try a heel raise (felt or sorbathane may do it) but don't make it more than 5mm thick. This brings the heel into play more effectively and again reduces the movement.

If this doesn't help I would always advgise seeing a sports-injury podiatrist who can give you advice on all of these facets as well as assess open and closed chain motion (non-weight bearing and weight bearing)of the foot to see what other help can be provided.

In reply to the power:

hi phil,just checked the vid.looks like the foam roller exercise may hit the i t band so will look at getting one from somewhere.not sure where though?

In reply to Cathcart_Alpinist:

'Here' as in your post?

In reply to colina: I found a combination of things helped.

Superfeet footbeds work!

Knee exercises need to be done regularly, not just when walking. Try standing about 3 feet from a wall, lean on the wall with one foot forward and the knee bent, push back with the other knee straight and feel the pull on the back of your knee. Hold for 30 seconds then swap legs. Also stand on one foot, bend the other knee and hold the foot up as high as you can to feel the pull at the front of the knee.

Poles take a lot of the pressure off you knees, I only tend to use them on descent.

Wear boots that don't have too high an ankle at the back whist still giving ankle support, if necessary wear trainers.

Try everything and see what works for you.

In reply to cas smerdon:

But descent is exactly where the problem lies, as headlined by the OP. Poles are therefore by far the best aid and, as you say, they're really only useful on descent (unless you're carrying a very heavy load - but that's a completely different subject.) Uphill walking can actually benefit damaged knees, probably more than any exercises you've mentioned above. Obviously, though, if you have a bad knee you have to be constantly careful in the hills to not make a bad move.

In reply to colina:

I bought mine online for about £6 I think

In reply to colina: I suffered with the same thing to the extent that I came downhill on my backside. Sports clinc suggested the IT band stretches as on the you tube clip but the most useful was to sit on the floor with the foam roll under your leg just above the knee, lean back on your elbows and raise your foot, hold for eight seconds, repeat 20 times.Gradually add resistance with ankle weights.This seems to build up muscle and helps to stabilize the knee cap. It worked for me so may be worth a try.Good luck with it.

In reply to colina:

I see you've got lots of good physio advice but I'd just like to underline Gordon's point about using poles. I'm told they take about a third of the weight off your knees if used properly and once you're used to them they won't slow you either uphill or down. In my experience they make a huge difference to reducing lower body stresses on a typical hill day.

In reply to john spence: can you explain this a bit better john .do u mean put something under your knee like a hard pillow maybe and just lift your ankle or lift your lower leg?

In reply to colina: Im not sure if it will be the same, but i have a problem with the patella, if you check on the internet there are exercises to make the internal muscle stronger and the pain will dissapear.... i went to a doctor in llanberis and that's what he told me check it...

In reply to Gary Gibson:

>

Wot he said.

I was going to suggest that you see a podiatrist, and then one pops up on the forums.

When I started walking back in the early 90's, I too developed knee pain on the sides of my knees. I went to every specialist that I could find and had MRI scans here, there and everywhere.

The condition got so bad that it was even painful walking up and down stairs. Not exactly good if you like hill walking.

In 1993 I was referred to a podiatrist who assessed the way I walked and then made a pair of prosthetic insoles for me. At first I hated them as they were exceptionally painful to walk with for anything more than an hour. However within 6 months I was back on the hill pain free.

I have now been wearing prosthetic insoles for 18 years, day in and day out, with no knee pain, apart from the odd sports injury here and there.

Ask your GP or Physio to refer you to a podiatrist.

In reply to colina:

sit on the floor,legs out straight,put cushion or foam roll under your leg just above the knee and raise your lower leg, hold then lower. Adding weights and raising the height of the roll as you progress.

In reply to colina:

That sounds something like what I felt when I was suffering with my ITB, the ITB (illotobial band?) runs down the outside of your knee and is used for stability when going downhill.
The problem I had was it had become inflamed and rubbed across the bone when I moved downhill. I have got rid of it now but it took about 6 weeks of almost complete rest and applying ice to it regularly for the first few days. If it is a problem with the ITB no amount of exercises will help it infact they will only make it worse.

In reply to Gary Gibson:

Hi gary - just ahad a quick look at products online and noted that the heel inserts don't claim any knee benefit whereas the insole products do. Any reason for this?

In reply to Bulls Crack: This is probably because there is no form of compensation in a heel lift whereas in the full foot insole there maybe. What I mean by compensation is that the full inserts will have a medial posting - a sort of raised support to the inside of the insole. In the case of my comments all the heel lift does is bring the heel more into play during the gait cycle and thus reduce some of the forefoot movement, which in this case may well be enough.

In reply to colina:

With me it was IT band causing similar sounding problem. Foam roller exercises plus strengthening exercises for my bum helped. Basically I lacked stability in holding my knees in the right position as well as having a tight band which pulled knee caps over so combination of sorting out the knots in the band with strengthening the appropriate muscles. Part of the issue for me was also boot fit, they really needed to be tight enough so my feet didn't have the ability to wallow. I now have insoles, and on some descents use poles. I find I don't need poles on the really steep or the really gradual downhills just those that are in betwween!

I would recommend seeking physio advice, there are so many possibilities.

In reply to AlisonSmiles: thanks all,plenty of good advice here.

In reply to The Lemming:


Orthotic (straightening, re-aligning), not prosthetic (replacing a missing body part).

Unless the soles of your feet had somehow gone missing?!

</pedant>

I had very bad ITBS in my right knee a few years back. My GP diagnosed it, and recommended physio. I had three or four sessions of ultrasound, which did help, and was advised to do squats regularly to help the muscles surrounding and supporting the knee. I do the exercises every day and while I do still get the odd twinge it's nothing like as bad as it used to be.

I suspect an old skiing injury may have been the initial trigger for mine.

In reply to colina: As others have said, it could be I.T.B. tightness.

I had this a few years ago. For me, it all started after trying to do a 16mile hill run with little training/build up...

I was always fine on the way up, and then I got a steady build-up to insufferable pain on the outside of my knees. (Just above Gerdy's Teburcile in this pic: http://www.aafp.org/afp/2005/0415/afp20050415p1545-f1.jpg

Strangely, I found poles made it much worse. I had to resort to a few weeks of rest, lots of stretching (see below) and then slowly building it up by doing smaller hillwalks and short runs.

I never used on of those rollers. Instead, I did these stretches:

1) youtube.com/watch?v=aQ7xSCJWa3I&
2) youtube.com/watch?v=8p6FtlqpAYg& / http://www.bodyresults.com/E290-90.asp
3) youtube.com/watch?v=gE6mJ0VjK7Y&

Also, like others have said, best plan is to see a specialist.

In reply to colina:

I had the same. Went to the NHS Physio who gave me muscle toning exercises and stretches to do. Also had orthotic footbeds made which corrected my feet. Not had much of an issue since and climbing appears to have helped me too.

In reply to colina: I've had this a couple of times..the last time was just excruciating!!

After much exploration it turned out I needed to work on my IT bands and needed better footbeds in my walking boots. Beyond that it's as others have said, strengthen the quads. I STRONGLY recommend deep squats and deadlifts. Amazing exercises that frankly I think everyone should be doing regardless...they're that important. When I say deep I mean squatting to the point where your bum gets down to heel level (and if anyone is about to say that squats are bad for your knees...please stop yourself and go and do some research, that myth was debunked a long time ago).

You have to bear in mind that when you walk up hills you're using most of the largest muscles in the body in a manner that is completely natural and distributes weight properly.

But when you walk down a hill...your leg doesn't flex very much by comparison but it will be partly bent most of the time. So a great deal of the downward force is directed out through the front of your knee, as opposed to down through the skeleton. That puts a huge strain on the smaller muscles round the knee. When you walk backwards you change the direction the force goes through the knee...hence it being less painful.

Practice, stretching, conditioning and lower body strength exercises will all help. Also rest frequently on long down slopes or try zig zagging down more.

Whoever said it was lactic acid build up...........seriously??!!! Respectfully...that's the biggest piece of "crapola" in this thread

In reply to kuju:

I suffered badly from this last winter, on one longer trip I could hardly walk at the end of it. Turned out the only problem I had was strength - I started running again, which made my knees bad at first but built up slowly and with proper stretching. After 3 or 4 months the problem went away on its own.

I agree with many other members, you are having problems with your IT bands. I also used a foam roller and stretches from youtube, and totally solved my problem. The only thing I would add is to avoid activities that cause the pain until you get the IT bands healed and properly stretched. There are a lot of injuries where you can work through the pain, but not with the IT bands -- it will just make the problem worse. Good luck in finding a solution.

In reply to colina:

A friend of mine is 62 the same age as me & bad knees were impeding her skiing, so we went the whole hog. A replacement knee. Radical but working very well after 10 months recuperation.

In reply to Afghanwolf:
bit drastic getting a pair of new knees wolf ,hopefully wont come to that just yet .thanks for your input though along with everyone else.
the IT band does sound feesible so will be doing the exercises that many of you have suggested ,im sure that will definatly help on the longer walk downs . bloody nuisance though,you would think the walk downhill would be the easy part !
.

In reply to colina: Try this

http://www.amazon.co.uk/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/15...

Have used this to help sort out lots of running niggles over the last few years. If you don't want to buy the book, there is lots of free stuff on line if you google trigger points. Sometimes ( not all the time) pain in a joint is referred there from trigger points in the muscles connected to it. This book shows you which muscles refer pain where, and how to treat them.

In reply to colina:

Smashed my femur in my kneecap over 40 yrs ago and always suffer knee pain now. Apart from strengthening try using a vulcan neoprene knee suppoprt. In extreme form they come with a brace but you should not need that. They keep the muscles warm, enhance elasticity etc.(they will get a bit smelly after a few days but who cares)

Also try poles. I became a convert yrs ago when they were considered a bit wimpy in the UK but the French used them all the time. I have seen a figure somewhere that they relieve about 3/4 ton pressure on the knee joints when descending an average 3000 ft mpuntain.

In reply to colina: I was about to recommend the Trigger Point Therapy workbook by Clair Davies, but someone already has. It has helped me a lot with knee pain. Also walking poles to reduce the load on your knees.

In reply to colina:
I had this problem once many years ago and like you I had to walk down from the Glyders backwards. As you can imagine it took some time, but it did relieve the excruciating pain. Went to see my Doctor. He said when you are coming downhill the knee joint is extended whilst the foot is raised and then drops back into socket as it hits the ground. If it is misaligned it hits the other side of the joint before it slots in. This is very painful. This is due to the fact that the small muscle(mentioned in one of the earlier posts) alongside the joint is, in many people, under-developed. He recommended the following exercise to strengthen the muscle. Set two dining room chairs facing each other. Sit on one and extend your legs straight out so that your feet and calves are on the other. Slowly raise one leg, it's important to keep the leg straight at all times. Hold it up about 10 inches for 10 seconds or so, then slowly lower. Repeat with the other leg. If you can see the knee you will see the muscle working. Repeat the exercise three or four times on each leg. Set aside time for this exercise each day. As the muscle gets stronger you can try weighting the foot by strap-around weights or by wearing boots or both. This is what I did and it built up the muscles so they aligned the joint perfectly. I have never had a problem since and that was over 30 years ago. If this is the problem with your knee, give it a try.

In reply to colina:

I had this problem, and it was sorted with a pair of insoles.

Walking downhill was incredibly painful - the knee pain would start on the descent, and quickly reach the stage where I couldn't put weight on my knees without being in a fair bit of discomfort. I went to a podiatrist, who pointed out that I over-pronate badly, so he fitted me with a pair of off-the-shelf insoles which just raise my arches. I noticed a massive improvement very quickly, after a year's worth of pain in the mountains. I'd recommend being assessed for the same thing, but that's just my tuppence worth.

Katherine

In reply to colina: I've got dodgy knees and have had to walk down from Clog backwards.Since then I have realised that the best solution is just to walk uphill only.We can but dream....

Mitch

In reply to colina:

I feel you're pain. I get pain under my kneecap and it sometimes locks up due to previous sports injuries. Try Kinesio tape, you can buy pre cut knee applications from Boots http://www.kinesioprecut.co.uk/precut/precut-knee.jsp

It's very, very good and it's solved a lot of my previous aches from old injuries. It lasts for up to 5 days and you can buy a roll and tape yourself. I taped my friends knee for a patella problem and she went from being in pain walking to doing a 2 hour dance show, the difference being the tape so it might be worth trying. You can find your local practitioner here http://www.kinesiotaping.co.uk/?gclid=CO_NnP_ixq0CFVQLfAodkTb2gw

Swimming would help strengthen you knees whilst not adding to any wear and tear. Possibly doing lunges might help or a good leg strenghtener is can do a squat with you back to a wall (so your legs are at 90 degrees) and hold it for as long as you can. But I would go and see your doctor so you've got a starting point to know which treatment route to follow. Especially as the pain is extreme and it could be caused by a number of things so seek professional advice. Good luck and enjoy your trip.

In reply to lucie_b: thanks lucie