Preventing Knee Pain For Mountaineers

In this podcast and article, we explore how a mountaineer can prevent knee pain from ruining their training and mountain adventures.​

​Knee pain is an incredibly common issue for mountaineers. And it is something which I have had quite a bit of experience dealing with.  
 
Unfortunately, mountaineers generally are at a relatively high risk of knee pain. And, even worse, no one really seems to know how to prevent it.
 
Sure, you can always find the advice of "strengthen up your legs" and "make sure you gradually build up your training" but does this really help? In my opinion, it is too vague to make any meaningful change.
 
So today, I explore in detail the process I use to help my mountaineers overcome their knee pain. So they can enjoy pain-free movement, perform at their best and fully enjoy their adventures.
 
Inside this episode:

• Why knee pain is so common for mountaineers
• A quick anatomy lesson about joints and their primary functions
• How restrictions in certain joints can lead to pain in the knees
• Why strength and stability work is so essential for protecting your knees (plus a few of my favourite exercises to help here)
• Why common sense ain't common (and why you need to think about this when choosing types of exercise)
• The most simple rule for knee pain prevention (which most mountaineers try to ignore)

How To Prevent Knee Pain While Mountaineering 

​
​Knee pain is one of the most common complaints I hear from mountaineers around the world. 

It affects beginners prepping for their first expedition, and it affects lifelong mountaineers who have done some of the biggest peaks in the world. And pretty much everyone in between.

It is a plague in the mountaineering community.

So today, we are going through several very important points around knee pain prevention. 

These are the same principles I use with my online training for mountaineering clients. 

If applied intelligently and consistently, they can go a long way to helping prevent knee pain from ruining your training, your confidence and your time on the mountain.

Why Is Knee Pain So Common For Mountaineers? 

​There are a number of reasons that contribute to this:

1) Endurance Training (By Definition) Brings A Huge Amount Of Training Load

To prepare for mountaineering, long hours of training repeated over time are necessary. But mountaineers have a tendency to overdo things.

Every training session you do (whether it is cardio or strength) will put a certain amount of stress on the joints.

This can be 'good' stress if you do enough to stimulate the body to adapt (which is what we are trying to do with our training). But this can turn into 'bad' stress when we just continually do too much, and do not give the body time to recover.

A typical example here is mountaineers who are doing long runs 3-6 days a week (and not putting much thought into structuring progression or rest over the weeks).

Unfortunately, many mountaineers struggle to find this balance of training and end up constantly overloading the knees (leading to pain).

2) Mountaineering Has A Lot Of Descents

Going downhill when walking, hiking, or running puts significantly more pressure on the knees.

Hiking downhill without a load can produce almost six times more force than walking on flat ground.

Add a pack or turn this into downhill running. That force will only get higher.

If the body is strong enough, and you program well, the body can tolerate this (and it can be a great training stimulus).

If the body is not ready for this (or you do too much of this stimulus), it becomes a recipe for knee pain.

3) Mountaineers Are Not Typically Big Fans Of Strength Training (And Poorly Apply It)

Strength training is one of the best things you can do to prevent pain and injury.

For knee pain prevention, it plays a massive role.

But the mountaineering community (as a generalisation) tends to skip over strength work.

Or, the few that do strength training tend to do mostly 'general strength' work (which is fine, to a point) but neglect types of training which can be great for knee pain (such as single leg work, slower eccentric loading, etc).

4) Poor Education

If you search for " knee pain for mountaineers online, you will find some really basic, and hit-and-miss information. So this will often lead mountaineers to focus on the wrong areas. Or just being frustrated at the general advice, and just trying to push through the issues.

A note on physiotherapists:

Physiotherapists exist for a reason, and if you are dealing with pain and haven't seen one, this is your first priority.


The following advice is for mountaineers who have already seen a physio, and are out of the initial stages of acute injury or pain (or those who have found that the traditional 'rehab' approach hasn't quite gotten them where they need to be for the mountains).

If you want to learn more about this subject and why so many rehab/recovery programs fail in the mountaineering world, you can check out this video: The Gap Between Rehab and Performance.

Knee pain can affect any mountaineer.

I have worked with both ends of the experience spectrum, from 'beginner' mountaineers who struggle with this, all the way to lifelong mountaineers tackling some of the tallest mountains in the world.

One was a guy in his late twenties prepping for his first expedition in Nepal (climbing Mera Peak).

He was spending long days on his feet for work, was doing a ton of running for his training, and was getting in pain. And he had no idea what he should be doing to prevent the knee pain. And he was at a point where he was getting really stressed thinking he would not be able to complete his training, his technical courses (to learn the skills he needed for the mountain) or his actual climb.

On the other end of things, I have worked wth a lifelong mountaineer and guide with multiple eight-thousand-meter peaks under her belt. She had spent years pushing through the pain (which she could do), but it held her back from improving her performance (and it was affecting her work as a guide).

Two completely different mountaineers. Same problem. Same solution.

Both saw major improvements after applying the full system I am about to share.

To be clear: I am not a physiotherapist. I do not diagnose injuries, and I do not deal with acute situations. If you have recently had an injury or flare-up, go and see a physio (this is your first priority).

What I specialise in is helping mountaineers who are outside the acute phase, who have mild knee pain that interferes with their training and their time in the mountains. The goal is to help them perform at their best and enjoy the experience. This is the context of what we are exploring today.

There are four areas we are covering today:
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1. Mobility
2. Strength
3. Exercise choice
4. Workload.

These are not the only things that contribute to knee pain while mountaineering. But there are four major factors that, if you put some attention and focus into them, can make a difference.
​

​Mobility For Knee Pain

Let's start with a quick mobility lesson:

Most joints in the body tend to want to be one of two things:

1. Stable (not a huge amount of movement outside certain angles of motion)
2. Mobile (lots of free and easy movement)
   
   

The knee wants to be stable. The ankles and hips want to be mobile.

Many mountaineers tend to have tight ankles and tight hips.

This can come from a range of reasons:

1. Sitting all day (which can affect the hips)
2. Poor footwear
3. Past injuries
4. Daily habits
   
   

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/tight, 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 can be a contributor to pain.

*This model is called the 'Joint By Joint Approach'. It is not perfect. But it can be really useful to give a simple understanding of how the joints work with each other, and how they can contribute to pain.

To improve this, we want to focus on building mobility through the ankles and the hips, to allow them to move how they naturally want.

I like to do this through a combination of three different things:

1. Self-massage/Myofascial Release

Using a foam roller, massage ball or water bottle and rolling up and down the muscles.

This can provide short-term increases in range of motion, and also often gives some nice pain relief.

If used in isolation, this will not make long-term changes to your mobility - but it can be great when combined with other things.​

Two simple examples of self myofacsial release for the knee include:

• Calf release
• Quadriceps release

*Both of these can be done with a foam roller if at home, or with a water bottle if on the trail/mountain. 

​2. Static Stretching

Static stretching often gets a bad wrap. And doing a few twenty-second stretches once in a while isn't going to do much for you...

To see a genuine change in range of motion, you need consistent and regular exposure.

Places I like to add a minute or three of stretching include:

1. Rest periods during strength workouts
2. End of strength/cardio workouts
3. Before bed (this can be a nice aid to your sleep!)
   
   

On top of this, I will typically have my mountaineers do a short 'mobility' routine once or twice a week as part of their weekly program (which is about 10-15 minutes of a selection of self-massage and static stretching). 

A couple of simple examples of static stretching to help the knee include: 

• Calf stretch off step
• Couch stretch ​

3. Proper Warm Ups

Five minutes spent mobilising the ankles and hips before training or before a day on the trail/mountain can make a genuine difference for those who struggle with knee pain.

Two of my favourite exercises for this include:

1. The Knee To Wall Stretch (for the ankles)
2. The World's Greatest Stretch (for the hips)
   ​
   

​Strength Training For Knee Pain
​
If you are struggling with knee pain, structured strength training is essential.

Specifically for the knees, we want to target:

1. The quadriceps (front of your thighs)
2. Glutes (your bum)
3. Hamstrings (back of your thighs)
4. Calves (back of your lower legs)
   
   

Each of these plays a crucial role in supporting and stabilising the knees.

(There are other muscles that play a role in supporting the knees, but these are the four main priorities.)

The problem here is that most mountaineers will tend to spend the majority of their strength training (if they are doing any!) working on their quads.

*Squats, lunges and step-ups are some of the most favourite exercises in the mountaineering world, but they all train the same area!

More often than not, we see the glutes, hamstrings and calves being neglected.

A simple rule of thumb is for every exercise you do for the front of your legs (e.g. quads), do one for the back of your legs (hamstrings/glutes).

So if you do a squat, pair that with a deadlift.

If you do a lunge, pair that with a single-leg glute bridge.

If you do a step up, pair that with a hamstring curl.

Train the legs in balance.

*The calves don't fall into this 'balance' (you don't have to train the front of the shins as much as your calves). Just make sure to include calf training in your week!

Some of my favourite strength exercises for knee pain include:

• Step downs (for the quads and glutes)
• Single leg deadlift variations (for the hamstrings and glutes)
• Squat variations (for the quads)
• Single leg glute bridges (for the glutes) 
• Straight and bent leg calf raises (for the calves)​ ​

Exercise Choice

This is where common sense matters.

Running five to seven days a week (which many mountaineers do!) while dealing with knee pain is usually a mistake.

If you are doing cardio most days, that is fine. But mix up your exercise modalities. Swap a couple of sessions per week for cycling. Yes, it might be less 'specific'. But it will still give you a great aerobic stimulus, and it will give the knees a bit of a break.

Another good idea (if you struggle with knee pain) is to limit high-impact gym work like box jumps, squat jumps and lunge jumps. Yes, these exercises can give you a good muscle burn (and get the heart rate up). But not all is great if you are struggling with knee pain. And don't get me started on burpees...

Also, monitor your downhill exposure.

If the knee is sensitive, a few good ideas:

• When trail running, walk the steep descents.
• When doing loaded hill intervals, use water jugs (or a drybag full of water) for your load, and empty the water at the top of each climb
• If doing stairs, find a stairwell where you can climb up, and then an elevator to the bottom.

All of these options are perfectly valid for a mountaineer. And it will allow you to get a good training effect while also managing how much stress goes through your knees.

A simple rule of thumb that can summarise this:

"If an exercise or workout hurts your knees, find an alternative".​

There is always another option to keep your training moving forward, but it will give your knees some space.
​

​Load Management

Mountaineers love overdoing it with their training. They just do too much volume in their week. Try to fit in too many sessions. And give the body no space to recover. And they will just go and go and go, until the body begins to break down.

There is so much I could say about load management for mountaineers, but to keep things simple, here are some important points:

• Have a gradual build-up in your training volumes and intensities (if you do not have a structured plan on how you are going to progress your hiking/running/cardio over the months - please make one!)
  
  
• Respect recovery days (you should be having at least one full day off each week from any impact and challenging training)
  
  
• Be smart about returning to training (if you have time off due to sicknesses/travel/scheduling - do not jump right back into your old workload). Take some time to ease back into things, and let your body refamiliarise itself with the training stressors.
  
  

If you do struggle wth managing your training load (and really can't find the balance between doing everything you can to prepare for the mountains, and not running yourself into the ground), then I strongly urge you to work with a coach who can help.
​

​Extra Considerations For Knee Pain

Beyond these four areas we have touched on today, there are many other factors that can contribute to knee pain while mountaineering, which you should consider.

These include:

1. Pack load
2. Sleep
3. Nutrition
4. Hydration
5. Stress
6. Lifestyle
7. Fatigue management

Each of these will play a significant role in your knee pain journey. And any mountaineer who struggles with their knees should put some time and attention into each of them (for both on and off the mountain).

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Knee pain while mountaineering sucks. It can take a huge amount of enjoyment from both your training and mountaineering. And it can easily ruin your confidence for the mountains.

If you struggle with knee pain, please be proactive about it. Do the right things in your training. Look after your body. And be smart about it. And I promise you, you can make a change.

And if you did need help with this, you can check out our online personal training for mountaineering here:

https://summitstrength.com.au/mountaineer

Yours in adventure.

Rowan