Knee injury prevention for hikers

Knee injury prevention for hikers is a much happier topic than knee rehabilitation or knee surgery, wouldn't you agree?

I am firmly in the camp of PREVENTION. But of course, that requires a daily investment in exercise and nutrition, a willingness to pay attention to subtle changes or warning signs in my body, and some background knowledge about how the knee is designed to work for a hiker. It's a price I am willing to pay for fully functional knees, and I hope you are, too.

Let's look at the structure of the knee. As you're reading, use gentle fingertips to probe your knee a little. Can you feel your kneecap sitting on top of your leg bones? The kneecap (patella) is a little triangle of bone which increases the leveraging power of the strong set of muscles on the front of the thigh (quadriceps), and protects the knee joint from impact. With each step a hiker takes, the patella maintains the position of the anchoring cables (tendons) of thigh muscles so they don't go "off track". It is possible to overstress this groove, leading to "runner's knee" (patellofemoral stress syndrome), although it's not as common in hikers as it is in runners because hikers tend to move over varied terrain rather than running the same route day in and day out.

Beneath the kneecap is the largest, most complex joint in your body. The largest bone of the leg (tibia) is called the shin bone, and we all know how much it hurts when you get kicked there, because there's not a lot of padding on the front of the leg. The shinbone has a broad surface which fits nicely into the thigh bone (femur), making a stable joint for movement and transference of weight from the upper body. Of course the knee joint isn't bone-on-bone (Ouch!), unless osteoarthritis has inflamed or destroyed the cushioning material called cartilage.

And the bones don't just sit there, they are held together by ligaments ("ligate", to bind). Athletes get into trouble when they tear a ligament. Ever heard of the ACL, and the surgery to repair it when it tears? The anterior cruciate ligament is just one of the strong connective tissue straps that hold your knee together.

There's another, much smaller, bone (fibula) which you can feel as a bony knob on the side of your knee not in contact with the other leg (the lateral aspect). The fibula doesn't do much for the knee joint's strength, except provide a place for muscles to anchor.

So what does all of this anatomy have to do with knee injury prevention for hikers? Simply this: pay attention to signs of wear and tear on the bones, ligaments or cartilage. Creaky, sore knees might be a signal to back off your exertion level, or to increase the amount of conditioning you do pre-trail. Stress fractures, shinsplints, arthritis can show up as knee pain. And the "grin and bear it" approach will work for awhile, as will masking the pain with over-the-counter medications. But ignoring knee pain is not a wise long term strategy. Your knees are your ticket into the back country. When they send you a postcard (pain, swelling, loss of mobility), read it and respond to it!

Now for the muscles. The knee joint has a limited range of motion, compared with your shoulder joint. Your knee can only bend so far, and can be damaged by extreme motions sustained in falls or trauma. You have muscles reaching up from the leg to anchor in the knee area, and you have muscles reaching down from the thigh seeking a place to anchor on the leg bones. This makes sense when you think about how you can move your knee: it's like a hinge on a door, allowing the door to swing freely but only so far. When you bend your knee and bring it up to your waist, you are using one set of muscles. When you try to touch your buttocks with your foot, you are bending the knee differently and calling upon other muscles to perform this action. And when you kick a fallen branch off the trail, that involves more muscles. What I'm driving at here is that there are a lot of tendons anchoring all those muscles to bones in the knee area. These tendons can be pulled off the bone when the knee is asked (or forced) to perform extreme motions.

Here are some ideas for knee injury prevention. Have strong muscles and stable connections between them and the bones beneath them. This requires regular exercise, such as daily walks on varied terrain (pounding the pavement is not a great idea day after day). Cross training to strengthen the knee joint works, too: swimming, biking come to mind. Weight training strengthens the thigh muscles, which can protect this joint.

Stretching before a hike is a kind way to alert your knees that some serious work will follow. Get the blood flowing through your muscles and lubricate your joints with gentle movements BEFORE you hoist that heavy pack and head off on your hike.

Protect the integrity of your ligaments by watching where you put your feet. If you are hiking across a talus slope or rocky area, be alert for loose rocks that will take your feet out from under you, requiring some fancy footwork that could tweak your knees past their normal range of motion. Don't run on the trail with lots of weight on your back. Lose weight if you're above your ideal weight range, and take a load off your knees.

Some hikers wear knee braces to protect this precious area of mobility. Others wear orthotics in their boots to help with alignment of knee. Do some research on the types of knee support available to you.

Knee injury prevention for hikers is a serious topic, and I can't do justice to it here. If you have questions or need resources for a knee issue, please contact me using the form below. I'm not a medical doctor, but I've had some knee issues myself. And my training as a naprapath and a massage therapist comes in handy. I'll do what I can to put credible, current information into your hands. It's my goal to help you find high quality trail time, and your healthy knees are an important part of that pursuit.

Knee injury prevention for hikers brings up other concerns about injury prevention. Read more here.