Knee pain -- overuse or actual injury?

So a friend and I had our unofficial kickoff to our training for the summer alpine season this weekend (when you live in the Midwest and only get one or two trips per season, you tend to get fat and lazy in the fall so a Dec or Jan start to training is necessary). I haven't been working out a ton since September, but I haven't been sedentary either, regardless the planned volume of work was much higher than anything since June.

We spent Friday night in tents with overnight lows somewhere in the low teens. Saturday we got a late start, and planned to finish our day in the dark. We were planning on hiking from the Quartzite campground at Devil's Lake State Park to Parfrey's Glen State Natural Area and back (16-20 miles round-trip with a fair amount of elevation gain and loss in each direction) with light packs (20-25lbs mostly water, food, spare clothes, we had a stove and could have spent the night out if we needed to). Conditions were not ideal as we spent most of the route post-holing to mid-shin on average and past our knees in the heavy drifts, this was made worse by increasing weight of the softening snow created by Saturday's temps in the mid to upper 30's.

I felt fine all day, and took the lead breaking trail. It took us about 6 hours to hike the first leg of the trip to Parfrey's Glen. We got there a little after sunset and took about a half our break to down some food and water. At no point during any of this did my knees bother me, but then about a mile into the return leg of the trip I started limping and favoring my left leg, then my right leg went, and before I knew it I could barely bend my knees, so we turned around and I lumbered back down the trail into Parfrey's glen where we called a friend for a ride back to our tents.

Standing straight legged did not bother the knees, but bending them, or lifting them, so that the knee had to hold the weight of something hanging from it was excruciating. The pain came from the outside lower portion of the knee (if facing the knees and imagining the kneecaps as clock faces the pain would have been just outside of the 4-5 region on my left knee and just outside the 7-8 region on my right knee). It seemed that standing still, and giving the knees a break made the pain worse once activity was resumed, allowing them to "tighten up" was not helpful. At first the resumption of activity would begin to "loosen them up" and cause a decrease in pain, but eventually this effect dissipated.

When we got back to camp I put a neoprene knee brace on one knee and wrapped the other with an Ace bandage. For a while this helped a lot and I was able to function at around 75%, where prior to the brace and bandage I'd say I was about 25%. Saturday night was rough, and I did a lot of slow-motion tossing and turning, because at that point any quick movement in my legs was extremely painful and staying in one position for too long was also extremely painful.

Sunday morning was a little better, and I was able to take the brace and bandage off, and get around with some medium discomfort and an obvious limp. I spent 3.5 hours driving home. I put a neoprene brace on each knee and spent a few hours doing some light activity that involved the occasional walking and standing. Upon returning home climbing the stairs was a chore, and fairly painful, but not as bad as Saturday night. I spent the rest of the afternoon playing Playstation and watching movies without the knee braces and only experienced pain when I moved wrong, or held my legs in one position to long. Sleeping Sunday night was much better and I only experienced minor discomfort.

Today has been virtually pain free.

Any thoughts?

If I'm reading your description of the pain area then I've experienced something similar. I do a lot of canyoneering in the summer which requires more hiking than climbing does, as a result I climb more, but I tend to be really careful when I hike now-a-days esp. canyons which have a tendency to have a lot of scrambling and high stepping. In short good stretching before and mild warming-up has helped me also a good pack which I don't have is a logical next step and perhaps some strength training and/or hiking with a very light pack. Ice I'm always told is better than heat. I massage the sides of my knees with Tiger Balm when I'm done with a mildly painful hike and then some ice. So it sounds like overuse.

This year they're doing better, I think they're stronger and I hike with a bit more caution. At any rate take it easy cause ruining a knee scares the crap out of me!

Best,

Richard

Sounds like your Iliotibial Band is acting up.

I have had the exact same symptoms you've described and from very similar activities (a long hard slog over rough terrain, after spending too much time chain smoking marlboro mediums)

Do some internet searching...lots advice on stretching routines. I've found that if I regularly stretch out my IT band, then the symptoms you describe generally do not reoccur.

Best of luck

To be honest it felt like overuse (abuse?) to me, and since I'm staring down the barrel of my 29th birthday I was hoping the answer would be something other than "you're getting older and you can't jump off the couch into a 16 mile day anymore..." -- but I guess that is the problem.

i second the IT band diagnosis. i had pretty severe knee pain while cycling and found that IT-specific stretching (and switching to $9 platform pedals) really helped. the unusual thing about it that i learned is that the IT-band tightness can originate all the way up the outside of your thigh into your glutes, but will manifest itself as pain only at the knee when it rubs against the joint during repetitive motion. my condition was/is mild enough that if i keep up with stretching (at least once every 2 days), i can maintain decent output on the bike during my commute and train as much climbing/running/whatever as i want.

brl wrote:i second the IT band diagnosis. i had pretty severe knee pain while cycling and found that IT-specific stretching (and switching to $9 platform pedals) really helped. the unusual thing about it that i learned is that the IT-band tightness can originate all the way up the outside of your thigh into your glutes, but will manifest itself as pain only at the knee when it rubs against the joint during repetitive motion. my condition was/is mild enough that if i keep up with stretching (at least once every 2 days), i can maintain decent output on the bike during my commute and train as much climbing/running/whatever as i want.

sounds like IT stuff.
But don't take our word for it, if you have insurance go to a doctor who does sports medicine and then go to a Physical Therapist who can set you up with a stretching and strengthening routine.

If you don't have insurance, um then feel free and take our word for it.
If it is IT get a foam roller and stretch that baby out.

Joint pain begins around 30!

JLP wrote:I stretch my IT bands by crossing my legs and touching my toes before running, among other stretches.

James, take it from someone who is 31--it's all downhill from 29.

I think the postholing could have something to do with the pain too. That's not a motion that we ever use in real life, so basically, I think it sounds like you over did it. I used to have IT band problems when I was running a lot, but it was almost always because I would try to do too much too soon. You're not 27 anymore, so maybe it would be better to work up to the 16 mile hike.

If you guys think it is "all downhill" after you turn 30, you are in for a rude awakening when you hit 40 or beyond...... Just something to look forward to......