Preventing Knee Pain While Hiking

​Knee is pain is one of the most common issues hikers face on the trail. And, unfortunately, a lot of the information out there on preventing knee pain while hiking is lacklustre (at best).

​To help, this article and video explores a range of strategies, ideas and exercises a hiker can use to reduce the chance of knee pain and discomfort on their adventures.
​

How To Reduce Knee Pain While Hiking 

Inside this video we cover:

• Why knee pain is SO common for hikers and backpackers 
• Why the ‘typical’ solution for knee pain while hiking often falls short
• 3 very important areas of training which can help with knee pain
• Some of my favourite exercise examples for preventing knee pain 
• A few extra strategies and tips to help hikers with knee pain 

​
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Want to download our free Hiker's Knee Prevention Guide?

You can get it here: https://www.summitstrength.com.au/hikers-knee.html

How to Strengthen Your Knees for Hiking

​Today, we are getting into some detail around preventing knee pain while hiking.

This is probably one of the biggest common issues I hear from hikers on a daily basis.

When you jump online and look at videos and blogs on this topic, the quality of information tends to be pretty average.

All too often, I see recommendations either:

• Very surface level (such as 'strengthen your legs' or 'build up your hiking slowly'
  
  
• Too focused on one or two areas (and missing the broader picture)
  
  

So today, we are going to be going into quite a bit of detail in a range of different areas that can make a genuine difference to knee pain while hiking (and, hopefully, fill in some gaps of knowledge that many hikers struggle with).

This is what we will cover:
​

• Why is knee pain so common for hikers
• Why the typical solution often falls short
• Three important areas of training and physical development that can make a big difference
• Some of my favourite exercises for this
• A few extra tips to round out the ideas
  
  

To be clear before we start:

I am not a physiotherapist. I am not a physical therapist. Or a physiologist. I do not make diagnoses on hikers' knee pain. I do not talk about rehab from surgery or from immediate, acute issues. If you are looking for advice on early-stage rehab/injury or are trying to diagnose your issue, please go and see a physiotherapist or physical therapist.

My role in this context is what is called a 'return to performance' specialist.

Traditional physio or physical therapy is great at getting people ready and comfortable for everyday life. But there is a BIG gap between the demands on your body for day to day, and the demands of hiking (e.g. long hours on uneven terrain, carrying a pack, steep ascents and descents).

And this 'gap' is one of the major reasons why so many hikers struggle with pain.

What I specialise in is helping hikers and mountaineers fill this gap. To build them up and help their body better handle the very specific demands of the trails and the mountains.

If you struggle with knee pain, and you are unsure if any of the particular ideas or strategies talked about in this article will be right for you, then I strongly recommend you talk with your physio or physical therapist for guidance. 

If you would like to learn more about this subject, you can check out this video: The Gap Between Rehab And Hiking  Performance.

So with that being said, let's get into it:

Why Knee Pain Is So Common For Hikers

There are a few reasons why knee pain is so common on the trail:

Descents

Going downhill puts significantly more force through the knees.

Add super steep terrain and heavy packs, and this stress can skyrocket.

Uneven Terrain

Rocks, roots, mud, scree, river crossings. All of these are common when hiking.

During even the most gentle hike, the knee ends up in many weird and wonderful positions.

Over time (if the knee is not ready for this), this can cause irritation.

Fatigue

Often overlooked, this can play a major role in knee pain on the trail.

Over a long or tough day of hiking, it is common to get tired. Our muscles get fatigued, our legs get heavy and our energy drops.

Many hikers will often finish their hikes absolutely exhausted.

Fatigue in itself is a risk factor for the presentation of pain. On top of this, when we are tired, we typically lose focus and concentration. So our likelihood of taking bad steps/routes on the trail, having trips and stumbles (all of which can aggravate the knees), increases.

Mismatch In Training And Preparations

Many people train in ways that are great for general fitness and to prepare them for the demands of everyday life. But this will often not quite be right to prepare them for the trail.

And if your legs are not ready for hours of uneven terrain, or carrying a loaded pack, or supporting you over an extended, steep descent, this can be a major factor.

(This is one of the reasons why many hikers get so confused about knee pain - because they are training SO hard in the gym, but nothing seems to make a difference...)
​

Why The Typical Solution For Knee Pain While Hiking Often Falls Short

Usually, when someone asks online how to fix knee pain while hiking, people immediately recommend a knee brace or taping.

There is nothing wrong with these things. They can help with stability and support. And they can help the knee feel more comfortable.

But if that is all you do, you are making a big mistake.

Because this is just a band-aid solution, at best.

If you take the brace away, if it fails, or you simply forget it, the knee pain will likely come back.

So, yes, use the brace if you want. But also make sure you are taking steps to strengthen and build up your knee so you are not reliant on a brace.

How To Train Your Knees For Hiking ​

Strength Training

Structured strength training is one of the single best things a hiker can do to help their knees.

Building the supporting muscles around the knee can greatly reduce pain and increase resilience (not to mention, improve your hiking in a range of other ways!).

A major mistake many people make when it comes to strength training for knee pain is thinking one muscle is the problem.

People will say things like:

• Your quadriceps are weak, so if you build them up, your knees will be better
• Your glutes are 'inactive', so if we get them working, the knee pain will be gone
  
  

This type of advice is very old school (though it still does get used today). One muscle is very, very rarely the whole story.

There are four major muscle groups that support the knees:

• Quadriceps (front of the thighs)
• Hamstrings (back of the thighs)
• Glutes (bum)
• Calves (back of the lower legs)
  
  

*These are not the only muscles that support the knee, but they are the major ones we are talking about today.

When looking at strength training, we want to ensure you are developing each of these four areas (and if you are working on each of these, you are covering most of your bases).

Some people may need more specific work on other areas (depending on their own individual situation/issue), but as a general recommendation, this covers the majority of hikers.

Some example exercises that work each of these areas:

• Quadciceps can be worked with step-ups, squats, lunges, step downs and pistol squat variations
• Hamstrings can be strengthened with deadlifts, single-leg deadlifts and hamstring curl variations
• Glutes can be trained with glute bridges, hip thrusts or even mini-band walks
• Calves can be trained with calf raise variations
  ​

Here are a few of my favourite strength exercises for knee pain while hiking:

1) Assisted Eccentric Pistol Squat 

​This is a great exercise for a hiker to develop eccentric quadricep strength.

This is how you do it:

• Start holding 2 poles and with box/chair/couch beneath you
• Push your bum back and slowly yourself (on 1 leg) to the bench for 4-6 seconds
• Stand up on 2 legs
• Repeat
   
  

*If this is too hard, use a higher box (or put a pillow/plate underneath you) *If this is too easy, use a lower box
​
2) Single Leg Glute Bridge 

​A great exercise to develop strength and endurance through the glutes and hamstrings.

This is how you do it:

• Start lying on the floor
• Bring both feet close to the bum
• Raise one foot into the aim and squeeze glutes tight
• Push hips up to the sky and squeeze your glute tight for 1-2 seconds
• Slowly lower under control
  
  

*You should feel this in the glutes (bum) and the hamstrings on the leg which is on the floor.

*If this is too hard, put two legs on the floor. If this is too easy, place a dumbbell or a loaded pack accross your hips. 

3) Assisted Single Leg Deadlift 

A great exercise to develop strength and endurance through the hamstrings and the glutes (as well as challenge ankle stability). 

Using some assistance can be a great aid if you struggle with balance from a full single leg deadlift.

This is how you do it:

• Use a broom/trekking pole/foam roller to help balance here.
• Start with slight bend at knee of the leg on the floor (and keep pretty much the same angle here throughout)
• Tip at the hips, push the leg in the air backwards, and tip your torso over
• Tip over as far as you comfortably can (before the knee wants to bend)
• Slight pause at bottom
• On way up, squeeze the glutes tight
  
  

*You should feel this in the hamstrings and glutes on the leg on the floor *Hold onto the pole as much as you need, but as little as possible.

*if this is too easy, hold a dumbbell or pack in your spare hand. If this is too hard, try a 'split stance deadlift'. 
​
​4) Single Leg Calf Raise:

This is a simple exercise for hikers to build calf strength and endurance. ​

This is how you do it:

• Put foot on a step, plate or rise
• Slowly push up at high as you can go
• Pause at top
• Slowly lower to bottom
• Repeat

*You can do this barefoot or with shoes - whatever is more comfortable.

*If this is too easy, use a heavier weight. If this is too difficult, try it as bodyweight, from the floor or on two legs. 
​

Mobility

Mobility is range of motion through the joints.

It is often overlooked in knee pain beyond generic advice like "do some stretching" or "join yoga".

The issue is that the advice is vague. When we are talking about mobility for knee pain, we want to be aiming for specific mobility in joints that matter.  

A simple way to look at this is through a system called ' The Joint By Joint Approach'.'

*This system isn't perfect, but it is simple and easy to understand and apply

In the body, most joints can fall into one of two categories:

• Stable joints (these joints don't want a huge amount of movement outside certain angles of motion)
• Mobile joints (these joints want lots of free and easy movement)
  
  

The knees are stable joints. They like flexion and extension. But they don't want a lot of twisting or sideways movement.

The ankles and hips are mobile joints. They want lots of movement in many directions. Unfortunately, is very common for hikers to have tight calves or hips.

The issue here is when the body is moving in a way that wants movement from the ankles and/or hips (such as descents), but these areas are restricted, then the body has to find movement somewhere else.

In this context, it will often allow more movement through the knee (which is not ideal). And this compensation can often be a contributor to irritation and pain.

So, long story short, if your ankles or hips are tight, doing some targeted mobility work can be very beneficial.​

Two of my favourite mobility exercises for knee pain while hiking include:
​

• The knee to wall stretch (for the ankles)
• The modified worlds greatest stretch (for the hips and, also, the upper back)
  

Need some direction on how to apply strength and mobility training to help your knees?

​You can a free 12-week strength and mobility program for hikers knee here: Hikers Knee Prevention Guide 

Conditioning

One major risk factor for knee pain on the trail is fatigue and exhaustion.

It is very common for hikers to push to a point where they get absolutely fatigued and exhausted.

You probably know the feeling:
​

• You are huffing and puffing
• Your legs feel like concrete
• You lose concentration
  
  

And everything you do just feels harder than is should.

This is pretty common for a lot of hikers! Especially when tackling challenging trails that they are not used to.

This can affect your pain.

Fatigue in itself, is a risk factor pain. When you are tired, your 'sensitivity' to pain can go up.

On top of this, the muscles that support your knees, are usually getting tired as well. Meaning, they are not doing their job quite as well (jelly legs on steep descents are the classic example of this for hikers).

On top of that, when you are exhausted, you are also much more likely to take a misstep. Your focus, attention and concentation be reduced (plus your reaction speed can be impaired).

Meaning, stepping in a pothole, on a loose rock, having a stlip, stumble of fall is more likely. PLUS if your reaction speed is down) you might be less likely to 'catch' yourself when you do face these issues.

All of these can aggravate the knee.

So, long story short, fatigue and exhaustion are things we want to minimise as much as possible.

How do you reduce fatigue and exhaustion while hiking?

Well, one of the best ways to combat this is regular and consistent conditioning sessions.

Cardiovascular training, which is relevant for hiking.

You can use this to build your aerobic fitness and your endurance. And reduce the fatigue you feel on the trail. And on top of that, being in a better condition will greatly affect your confidence and enjoyement on the trail as well!

There are many ways you can do conditioning training for the trial.

A few great examples of conditioning workouts for hikers include:

• Loaded pack walking (e.g. put on a pack and walk around the local neighbourhood)
• Stair or hill climbing
• Stairmaser or box step workouts
• Longer interval work on a stationary bike or elliptical

There are countless ways of going about this. But the general rule of thumb is simple:​

Build your fitness so you can avoid hitting that exhaustion point on your hiking adventures.
​

​Extra Tips And Strategies For Knee Pain While Hiking 

Load Management

Load management is simply managing the amount of stress going through your body. In this context, managing the amount of load that goes over your knees (day to day and week to week).

One of the most significant risk factors for irritated knees is making big sudden jumps in load.

E.g. you do a certain amount of training/hiking for a number of weesk. Then suddently one week you do WAY more.

This is incredibly common with hikers.

A typical pattern I see from hikers in training is osmething like this:

• They do a three hour hike
• Next week they do a four hour hike
• The next week the jump up the a secon hour hike
  
  

And they get in pain.

If you struggle with knee pain you need to be very intetnional about this.

A few tips for load management:

If you hike every week or most weeks:

• Build slowly and steadily.
• Avoid big jumps in distance, elevation or pack weight each week. 
  
  

If you hike inconsistently (once every few weeks or more):
​

• Pick distances that are well within your capabilities (especially if you have not been out for a while)
• Do not push yourself to your limits after a long break
  
  

If you have been hiking regularly and then take a few weeks off (due to sickness, travel, weather, etc.):

• Do not jump right back to where you were before
• Ease back into hiking for a week or two and rebuild from there
  ​

If you plotted your hiking distances on a calendar or graph, the line should not leap upward suddenly. We want a nice, smooth progression.

If you need some idea on how to plan your hiking, in a way which ensures a slow and steady build for your knees, this is a great tutorial: How To Plan Your Training Hikes.

Footwear Changes

People often ask:

"Is there a best shoe or boot for knee pain while hiking?"

And people LOVE to recommend all types of footwear for knee pain (zero drop shoes, trail runners, hiking shoes, high top boots and everything else under the sun).

I am not a big advocate of any single type of footwear when it comes to knee pain while hiking.

Everyone is different. And has different needs, preferences and types of hiking they like to do.

But this is a crucial point when it comes to footwear:

Changing footwear (and going from a mid-cut boot to a zero-drop shoe, or from a trail runner to a high top boot, etc) can often be an aggravator for the knees.

When you change footwear (and have a different level of support), you change (slightly) the stresses going through your feet, legs and knees.

Every type of footwear interacts with your body slightly differently.

So if you switch footwear (and keep your same hiking volume/challenge), some muscles and/or areas of the legs will suddenly experience a big jump in stress. And this can often be a contributor to aggravation and discomfort.

So if you change footwear for your hiking (and you struggle with knee pain), I strongly recommend you be very intentional about how you introduce it:
​

• Reduce your hiking for a few weeks (either distance, pack weight, elevation or a combination)
• Slowly rebuild back to your normal over the wekes
  
  

Skipping this is one of the reasons why hikers say things like:

"I tried zero drop shoes and I got knee pain"

or
​
"I switched to high top boots and it made everything worse"​

In most cases it isn't the footwear itself, but how you introduce it. 

Fatigue Management

We mentioned earlier about the importance of conditoning to reduce fatigue. But your training and fintess is not the only thing which contributes to fatiue.

Three simple things which can reduce fatigue while hiking:

1) Make sure you eat enough.

Most hikers under eat on the trail. Yes, you can 'survive' on hikes by eating pretty much anything (or nothing).

But you want to thrive (and do everything you can to minimis fatigue) you want to put a bit more thought here.

One of the most simple things you can do here is regular snacking. In between your hiking meals, aim to reguarly snack. I like to get my hikers to have a bit or two of something every hour (ideally, something high carbohydate, low protein, low fat, low fibre - which will give easily accessible energy, and be easy to digest on the move).

And finally, make sure you eat your meals! 

2) Stay hydated.

Hydration plays a big role in energy while hiking. Aim to reguarly drink water (come up with a reminder system for yourself if you have a habit of forgetting). Stay on top of this.

3) Manage your pacing.

If you are hiking at a pace where you are constantly getting out of breath and huffing and puffing, slow down! This simple strategy can go a long way to conserving energy.

Learning efficient pacing is one of the most valuable skills for a hiker to reduce fatigue.

To learn more about pacing for hiking, you can check out this article and video: Energy Efficient Pacing For Hikers

Be Diligent About Post-Hike Recovery 

After your hikes (either at home, or in camp) spending a little bit of time focusing on recovery can go a long way to helping the knees stay comfortable (both overnight and the next day).

This can be as simple as spending 10 minutes doing some stretching and/or self massage

*If at home, you can do self-massage with a foam roller or massage ball. If on the trail, a water bottle or trekking pole works just as good.

Giving the legs and muscles a little bit of love, and helping them relax, can make a genuine difference for the knees.

A couple of my favourite options for this include:

• Quadriceps release (with a foam roller or water bottle)
• Calf release (with a foam roller or water bottle) 
  ​
  

Want more ideas about stretching and self massage for hikers? Check out this article: The Best Stretches For Hikers 

​Exposure To Triggers

Many hikers will realise there are certain 'triggers' which will often lead to their knees feeling uncomfortable.

Common examples of these for hikers include:

• Steep descents
• Certain types of uneven terrain
• Pack carrying (e.g after a certain amount of weight, the knees get sore)
• Pushing past a certain distance (e.g. after X kilometres, the knees get uncomfortable)
• Quicker hiking speeds (than their natural pace)
  
  

While identifying what triggers aggravate your knees is valualbe, it can often lead you into a trap.

This is a common situation:
​

1. Someone does lots of hiking, and all is well
2. One day, they do a hike with lots of elevation change, and they realise that their knees got uncomfortable from all the downhills
3. After identifying this, they decide to avoid this trigger and protect the knees
4. They keep on hiking, trying their best to avoid any hikes with too many steep downhills
5. This works, for a while
6. But, at some point, they go on another hike with lots of descents (maybe they didn't read hte track notes properly, or they take a wrong turn on hte trial, or a friend invites them on a hike or just feel like testing htings out)
7. They go on this hike with lots of elevation change, the knee pain comes back
8. So they decide to avoid elevation again, for a while...
9. And the cycle repeats
   ​

This is a very, very common story for many hikers.

The issue here if if there are certain triggers for your knee while hiking, we don't want to avoid them completely. Instead, we want to introduce them to the knee in a way that is controlled and manageable. So the knees can get comfortable with this challenge. And then slowly build this up.

An example of how this might look (using downhills as a trigger as an example):

• You identify downhills are a trigger
• You decide to avoid any major downhills on your hikers temporarily
• During the week, you start doing a bit of stair or hill training to practice these downhills
• You start at a level which the knees are 100% comfortable with
• Over the weeks, you slowly build this up
• After 4-6 weeks (once you are feeling a bit more comfortable and confident), you start to reintroduce more and more downhills into your weekend hiking
  
  

In theory, this sounds simple. But in practice, there is a bit of an art to making this happen.

Because many people will begin this 'exposure therapy' and will just do too much too soon, and striaght away get into pain again.

The key is to find an amount you can do 100% comfortable and build from there.

For example:

You might try a stair session. The first time you do this, you may spend ten minutes climbing up and down and your knees get sore. So you let them recover. And then next week, you do the stairs again - but this time for only seven minutes.

If the knees do not get sore this time, great. Then next time maybe go up to eight minutes. And then nine. And then ten. And keep on building.

Alternatively, if you do the seven minutes and it still hurts, then you might drop down to fibe minutes.

The key is just keep on doing trial and error until you find a level which works for you, and slowly build up form there.​

This may sound a bit tedious, but if you really struggle with knee pain while hiking, this can be one of the most important area of training you can do.

​Use Trekking Poles

Trekking poles can take A LOT of pressure off your knees while hiking (especially during descents). On top of this they can be a great aid for balance and stability too. ​

If you struggle with knee pain, these should be a must for pretty much every hike. 

Summary

Knee pain while hiking is never much fun. And it is an easy way to ruin your enjoyment and confidence on the trail. But if you take your training seriously, and take the right steps to build up your knees, it is almost always possible to make a significant change to your knees.

And get back to properly enjoying your hikes again.

If you were a hiker who struggled with knee pain, and needed some help putting this information into action, you can check out our online personal training for hikers here:

https://www.summitstrength.com.au/online.html

Yours in trekking,

Rowan 

P.s. if you want to see some of our success stories of helping out hikers with knee pain, you can check out this page: Summit Strength Knee Pain Reviews