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Knee pain does not mean you have to stop what you love! If you enjoy hiking, tramping, mountain running, even walking up and down the mount here is some advice for you.

People often experience knee pain when walking up and down hills, especially in an overnight or multi day tramp. This blog will address different approaches you can do to reduce the load on your knee joint and therefore decrease knee pain.

Our knee has two joints, one where the thigh bone (femur) and the shin bone(tibia) meet, called the tibiofemoral joint. The other joint is between our kneecap (patella) and the thigh bone (femur) called the patellofemoral joint.

Strength Exercises
Biomechanics the way we move, is an important aspect to work on. When walking downhill, your tibiofemoral joint has a compressive force of 7-8.5 times your body weight, even more for females.[1] When running, there is 4 or more times your body weight or more your knee has to absorb.

Firstly, we want to offload the shock absorbed by the joint and ensure our muscles take this load. We do this by strengthening the proximal muscles which include our gluteal and core muscles. Off loaded (non-weighted) exercises e.g. side planks, clams etc. are a good place to start strength work. Working into a loaded position such as lunges, bulgarians and step ups are then going to make it more functional for walking.

Ensuring our other leg muscles are also strong is beneficial, such as calf muscles, quadriceps, hamstrings and your feet muscles. This aims to offload the knee joint and make the surrounding muscles absorb the load. Seeing a physio or other movement specialist will be vital to make sure your technique is good to target the right muscles, otherwise there is no point in doing these!

Walking Technique
To decrease the body weight compressive force your knee joint has to absorb, you can shift your weight onto your heels, sit back, keep your knees bent and land softly when walking downhill. Slow and controlled is the secret. Running downhill or walking with straight legs is not beneficial.

When increasing your speed on any incline or terrain, make sure you do not increase your stride. Lengthening your stride, increases the load on your knee.
When walking uphill try pushing through your heel and squeezing your gluteal. Aim to not let your knee go over your toe or drop inwards.

Other Helpful Tips
The lighter your tramping pack, the less load through your knees.  Clearly there are health and safety essentials for tramping but try not to overpack. Same with your own body weight. The less you weigh, the less load your knees/legs need to absorb when going downhill or have to push uphill.

Shoes Comfort is essential. Hiking boots versus trail shoes is the big debate and this depends on what you feel comfortable wearing. Make sure you have completed some big walks in your shoes before undertaking a multi-day hike avoid those blisters!

Hiking poles
I am a big believer in hiking poles. They can offload your knees by 30%! So, if you have any knee issues or are worried about hiking, I recommend investing in some poles. They will last you a lifetime. Make sure you get adjustable hiking poles. Poles should be longer when going downhill and shorter when walking uphill.

Note: When walking on flat surfaces your elbows should be at 90 degrees. This is to protect your shoulders.

After walking or running, especially on a multi-day hike, recovery is key. Stretch or roll your thighs/quadriceps, calves, glutes and hamstrings at the end of walking activity. If you're out in the bush, find something you can use e.g. drink bottle for rolling your thighs.

Primers or muscle activation before starting for the day is a lot better than stretching. Ask your physio to provide some glute primers.
You can add nutritional supplements to help recovery or decrease inflammation such as omega 3's, ginger and turmeric, but consult a nutritionist for more advice regarding this.

If you have any questions or concerns re any knee pain you may have please contact us to talk a qualified Physiotherapist

Written by Annaliese Horne Physiotherapist

[1] Kuster, M., Wood, G.A., Sakurai, S. et al. Downhill walking: A stressful task for the anterior cruciate ligament?. Knee Surg, Sports traumatol, Arthroscopy 2, 2'7 (1994).