Hi this is Dr. Kip Thompson with Catalyst Chiropractic and Rehabilitation, your chiropractor in Beaverton, OR. We have a lot of hikers here in Portland. One of the most common complaints I hear from our hiker patients is knee pain when hiking downhill. The reason for that is when you are walking downhill you have 3-4 times more force on your legs than when walking on an even surface. We take 2 approaches to combat knee pain when hiking downhill: First, reduce the amount of load going through the joint. Second, make yourself more resilient by increasing your capacity to bear the loads placed on the legs when hiking downhill (strengthen your legs).
There are three ways to reduce load while walking downhill. The first way is to just slow down. As you can imagine, the faster you are traveling, the more impact you will have on your legs and knees as you are stepping downhill. The second way to reduce knee pain while hiking downhill is to bend your hips and knees more. The straighter your legs are and the more upright you are, the greater the impact on your joints, particularly the knees. Putting a slight bend in the hips and knees as you are walking downhill helps your muscles absorb more of the shock, taking stress off the knee joint. Lastly, you can use a hiking stick or trekking poles. These tools have been shown to reduce impact on your lower extremities by up to 25% while hiking, and that is why they’re important, especially for hikers with knee pain while going downhill.
Here are some examples of things we’ve done with some of our patients suffering from knee pain to help them become more strong and stable in the knees. Again, these are just examples of exercise techniques. To find out what is right for your situation, we would need to perform a thorough examination and come up with an individualized treatment and recovery plan. On your first visit at Catalyst Chiropractic and Rehabilitation, one of the first things I look at is your ability to stand on one leg while keeping your hips level and not losing balance. It’s surprising how often we find someone who can’t stand on one foot for longer than 10 seconds, yet never even realized they have a balance problem. If you are not able to adequately stabilize your hips while standing on one foot, this can translate into abnormal stress on your knees and result in knee pain. What I could have you do is practice one leg stands. Stand on one foot for as long as you can without losing balance or letting your pelvis tilt to one side. The goal is to be able to do that for 60 seconds. If you can’t do it, you could work up to it by performing 3 reps on each side for as long as you can before losing control. Then repeat that daily to gradually improve stability and balance.
The second exercise I’d like to demo is called quad sets. This exercise is commonly used early in knee rehabilitation to strengthen the quadriceps muscles and add stability to the knee. Lie flat on your back and rest a pillow or rolled up towel under your knee. Then contract your quads, which will straighten your knee and push downward into the pillow. Hold this for 10 seconds at a time, performing multiple repetitions of 10 seconds each.
Ultimately you will need to progress to more functional movements that mimic what you will actually encounter on the trail. A more progressive way to strengthen your quads is to start doing some squats. We mimic the downhill motion by elevating the heels by placing an object underneath your heels. From there, slowly lower into a squat position, then quickly return to standing posture. I like to use the cadence of 2 counts going down and 1 count coming up to emphasize that lowering motion that happens with every step while hiking downhill.
One last, more difficult progression is a 1 leg decline squat. This is set up the same was as the two leg decline squat that I just demoed, but it is performed with only one leg in the lowering phase of the exercise. Then use both legs to come back to starting position. The lowering portion of this exercise is called an eccentric muscle contraction of the quadriceps. Eccentric strengthening exercises are great for rehabbing tendon injuries, which is much of the time part of the cause with knee pain in hikers.
For any questions or to set an appointment to see me, call 503-526-8782 or visit our website at catalystchiroandrehab.com