Marykaa's Fitness Log 10

WENESDAY, June 14th 2006

DAY OFF
My knees are better but I still feel them, so I'm taking a "sick leave" from training..Maybe it's in Yoga classes, with the extreme stretching we do, that I hurt myself, I don't know.. but I took it as an opportunity to learn more about knee pain and hiking..

Backpacker.com on knee pain

Manual For Your Knees
Say "good-bye" to knee pain on the trail

By Gina DeMillo, May 2002

Photo by John Burcham

I'm not a gambling woman. So when Southwest Editor Annette McGivney suggested we backpack down one of the nastiest trails in the Grand Canyon to test some new joint-saving techniques, I said, "No, thanks, I've done enough damage to my knees." Turns out Annette had an ace up her sleeve, in the person of Cynthia Billings. A Flagstaff-based physical therapist who works at the Grand Canyon National Park medical clinic, Billings had promised to teach us a few simple techniques guaranteed to cure our aches and pains. I quickly reconsidered. A rim-to-river hike was on my life list, and I'd get step-by-step advice from a knee expert while watching sunlight dance on redrock walls. It sure beat another visit to my local sports clinic.

The New Hance Trail dished out 8 hours of sharp switchbacks and steep dropoffs, the kind of pounding that would usually leave us soaking sore knees in the nearest cold creek. Yet the only thing we chilled in the Colorado River that night was a small bottle of rum. And 3 days later, after almost 11,000 feet of elevation gain and loss, we emerged without a twinge of knee pain. A miracle? Nope. Just a slew of knee-saving tips that really work.

At Home

>>Squat And Crunch

Billings put us on a pretrip regimen of exercises designed to strengthen the muscles surrounding our knees, but also our ankles, shoulders, and stomach. Stronger ankle and trunk muscles improve balance, reducing the stumbles and awkward steps that can strain or rupture knees. Billings recommends lunges, squats, and stomach crunches three times a week, starting 3 to 6 weeks before your trip. "Do three sets of as many quality reps as you can manage, with a minute or so rest in between."

>>Surf A Sofa Cushion

Weak ankles lead to more knee twists, so spend extra time strengthening those joints. Stand on one foot on a pillow or similar unstable surface and try to maintain your balance. Repeat with the other foot. As your balance improves, add a controlled dip, mimicking the posture of a deep uphill or downhill step.

>>Reduce And Replenish

During trip planning, find ways to lessen demands on your knees. Avoid routes that require big-mileage days, multiple mountain passes, or long hours of rock-hopping. Schedule time for rest breaks and unexpected delays. Pack extra snacks to boost your energy and muscle recovery, and stay well hydrated.

>>Lighten Up

Billings suggests packing as lightly as possible, because less weight on your back means more stability and less joint pounding. Only a mile down the winding, rocky New Hance Trail, I paused to celebrate having left my book, camp chair, and other luxuries behind

>>Break 'Em In

Boots and knees, that is. Choose the right boot, wear it while you train, and your knees will thank you, says Kirby L. Turnage, M.D., an orthopedic surgeon and seasoned hiker. "Lightweight boots put less strain across the knee," notes Dr. Turnage, but it's more important to train with the boot you'll wear on the trail. "Before a recent winter hike in Colorado, I wore my heavy boots and a loaded pack on the stairclimber at the gym. I got a lot of laughs, but once I hit the trail, I was able to hike 8 hours a day on steep trails without a problem," he says.

>>Support Your Feet

If you tend toward flat-footedness or pronation, ask your boot salesperson for quality insoles that support your arches. "Excessive pronation causes problems for your foot and ankle and strains the inside of your knee," according to Dr. Turnage. If pain continues even with the over-the-counter insoles, see an orthopedist who can prescribe custom orthotics.

On The Trail

>>Grow More Legs

Trekking poles made our loads seem even lighter by offering more stability and balance. "Oftentimes, it's the twisting move people do to regain their balance that ruins their knees," says Billings. "Without poles, you have only your muscles and ligaments to balance you. With poles, you have 3 or 4 points of contact."

When lowering yourself down steep drop-offs, use the double-pole plant technique, placing both poles simultaneously and easing yourself down. Use the poles as extensions of your arms, as shown above. (See Body Language, December 2001, for more on proper pole use.) "Just beware of telescoping poles," says Northwest Editor John Harlin. "I've taken bad tumbles when loose pole sections collapsed under heavy pressure."

>>Stretch, Don't Strain

"When my knees start to twinge, I drop my pack for a stretch break that brings blessed relief," says Northwest Editor John Harlin, who has taken his joints up and over hundreds of mountains. Loosening your muscles eases the strain on tendons and ligaments, reducing the likelihood of inflammation and tearing. Stretch for 10 to 15 minutes after any cool-down period, such as lunch or an afternoon siesta, focusing on quads, hamstrings, calves, and ankles.

>>Climb Down The Ladder

Billings also suggested that we maneuver backward down steep drop-offs. "Many backpackers find it easier to use their stronger uphill muscles (hamstrings and glutes) to lower themselves off boulders and ledges." Though hiking in reverse was a bit intimidating, stepping backward reduced the jolt to our knees.

>>Unbuckle Thy Knees

Dr. Turnage and Billings agree that landing on locked knees is like driving a car without shocks; the jolt can send pain throughout your body. "Try to step down in a less concussive manner," says Dr. Turnage. "Allow your knees to bend and your muscles to absorb the weight." Billings adds that if your knees tend to lock, you should work on strengthening your leg muscles at home and lightening your pack weight.

>>Look Before You Leap

If a drop-off is too big to step down, don't jump. "When you've been hiking 8 hours, your muscles will be fatigued, and rock hopping or jumping as you descend could lead to a serious twist or break," says Billings.

"I'll sit down and slide over a big step," says Mike Frick, a Grand Canyon backpacking guide. Hopping the occasional stream is fine, but if your trip involves several crossings, change into sandals and wade across.

>>Squat No More

Whether you're driving tent stakes into the ground or cooking over a tiny stove, squatting stresses ankles and knees. "At the end of the day, when your muscles are tired, you're more likely to injure yourself by squatting," says Billings. If you have to get down low, kneel on something soft, like a fleece jacket. Better yet, raise your stove up on a rock so you can sit or stand to cook.

>>Treat Pain Early

At the first twinge of pain, perform preventive joint maintenance. Stretch. Lie down and elevate your ankles and knees above your heart (use a rock or tree trunk as a footrest). If your ankle is unstable, your knee may twist to compensate, so extra support for your ankles could mean less pain in your knees. Try taping your ankles or wearing an athletic ankle brace.

If you begin to feel pain on either side of your kneecap, try this makeshift knee brace:

Step 1. Place a patch of tape (athletic tape is best, though medical or duct tape will do) behind your knee and on the side opposite the pain.

Step 2. Tear a second piece of tape long enough to wrap around your knee. Anchor one end of the tape on the patched side of your knee, then tear the strip lengthwise and pull each end around your kneecap, as shown above.

Step 3. Secure the loose ends on the other side of your knee. Frick, who regularly carries 90-pound packs for his clients, says you shouldn't be afraid to look to a stronger hiking partner for help. "Ask your friend to carry some of your gear. It's amazing how losing a few pounds makes your knees happy."

>>Follow No Leader

"We backpackers often trace the footsteps of the hiker in front of us," says Billings. But following in the footsteps of someone who is much taller or stronger than you could mean added stress on your knees. "If you're shorter, look for ways to take smaller steps, especially going downhill. Create miniswitchbacks as you hike, and don't step up or down a ledge that's too big for you if there's a way to go around it" (see the photo above left).

>>Check Your Alignment

At 6' and 5'10", respectively, Annette and I were accustomed to using our gangly legs to step around or over obstacles, often at awkward angles. Our long, sometimes clumsy steps resulted in twinges of knee pain. The reasoning: When your alignment is off, your muscles and ligaments have to work harder to keep your ankle from rolling and your kneecap tracking straight. "It's just like a car," reports Billings. "Bad alignment is no big deal if you're just going a few miles. But drive a lot farther and you'll wear out your tires."

Billings said the pain would subside if we kept both legs in alignment as we walked. "With each step you take, make sure to keep your hips, knees, and feet parallel to each other," advises Billings. "If one knee is facing forward, the other shouldn't be twisted to the right or left."

In Camp

>>Free Your Feet

...and your knees will smile. Changing into camp shoes or sandals "gives your feet and lower legs huge relief by improving circulation and relieving pressure on your heels and ankles," advises Billings. "Plus the lighter, more comfortable shoes can help relax your gait, which eases strain on your knees."

>>Massage, Anyone?

Nothing helps muscles recover from a long day on the trail like a massage. Take turns with your partner kneading calves, quads, and hamstrings. "Light massage is best-almost like stroking a dog," says Billings.

>>Skinny-Dip Soak

Jump in a chilly lake or river, and you'll do wonders for your circulation and muscle and joint recovery. It might make you smell better, too.

No More Knee Pain

Our experts showed us how to prevent the most common backpacking knee injuries.

Injured ACL (Anterior Cruciate Ligament)
Symptoms: Swelling; instability of your knee following twisting or "pop" sound
Prevention:
* At home: Strengthen quads and hamstrings
* On the trail: Avoid twisting and locking knees; use trekking poles and lighten your load

Posterior Knee Pain
Symptoms: Pain behind your knee; could be related to a torn meniscus (see below)
Prevention:
* On the trail: Avoid forceful twisting; have a friend hoist your pack onto your back; take breaks to stretch leg muscles
* In camp: Avoid squatting

Strained Collateral Ligament(s)
Symptoms: Pain on either side of your knee; stiffness and pain following a fall; instability of your knee
Prevention:
* At home: Practice balancing to prevent falls on the trail
* On the trail: Avoid hopping over obstacles or jumping down; use trekking poles for stability

Anterior Knee Pain (Patellofemoral Syndrome)
Symptoms: Pain over or below your kneecap; pain when hiking downhill; more common in women because their wider hip angles cause the knee to track differently
Prevention:
* At home: Strengthen your quads
* On the trail: Avoid long sections of downhill hiking; lighten your load; use an over-the-counter neoprene sleeve to help keep knee tissues warm and apply gentle pressure
* In camp: Avoid squatting

Torn Meniscus (the cushion between your femur, or thigh bone, and tibia, or shin)
Symptoms: Swelling; pain on either side of your knee; buckling or locking of the joint when it's in a bent position
Prevention:
* At home: Improve balance and strengthen ankles and knees
* On the trail: Avoid forceful twisting; have a friend hoist your pack onto your back; use trekking poles
* In camp: Avoid squatting