Downhill Knee Pain?

As for your experience what may be a cause of a knee pain on the top of a knee cup when going downhill?
It's not starting right away but after I put some mileage.

Note: I already got some photos and still need to review them with a doctor.

Yeah, I get this pretty often. Exact same symptoms and onset. For me, it’s tight quads. I make sure to really really stretch my quads before going downhill, just the normal heel-to-butt stretch. If they start hurting at all, I stop on the trail and stretch for a few minutes, 30 seconds at a time each leg. Has worked wonders for me, and on a recent backpacking trip with my brother he had the same pain and I told him to stretch this way and it went away.

Another thing that helped me was building up the stabilizer muscles around the knees. I specifically thought learning how to slackline was an awesome way to build those up and I had much less knee discomfort after I learned. 

It could be a variety of things. For me it is/was a torn meniscus. I've had two arthroscopic surgeries on my right knee and its pretty good. My left knee meniscus is partially torn, but tends to 'lay flat in place' or something and is generally ok. That being said the worst pain is prolonged downhill or running on the road. Trekking poles are a life/knee saver for the downhill.

I just had a phone call with my GP.
Nothing was broken or teared in my knees (except for regular age related changes).

Fluid in both suprapatellar spaces was due to inflammation that was due to overuse (combined with early signs of arthritis).
She recommended to decrease physical activities. :(

I am curious to know what MP patients with similar cases can advise.

Yury wrote:

I just had a phone call with my GP.
Nothing was broken or teared in my knees (except for regular age related changes).

Fluid in both suprapatellar spaces was due to inflammation that was due to overuse (combined with early signs of arthritis).
She recommended to decrease physical activities. :(

I am curious to know what MP patients with similar cases can advise.

You would probably be better off seeing an orthopedist, in person, than a GP over the phone. Orthopedists specialize in joint pain.  You might get the same diagnosis, but it would give me more confidence coming from a specialist.

Could be a million things but I wonder if you have any significant knee valgus.  Check out various videos/blogs from Squat University.

https://squatuniversity.com/2017/07/20/how-to-fix-knee-cave/

That's an old blog post but he has plenty of newer content on it, especially on YouTube.

Time for some trekking poles, I thought I was going to have to quit roped climbing at one point because of knee pain carrying loads. Trekking poles were literally a miracle cure for me.

BigCountry wrote: Time for some trekking poles

Agree and recommend spending a bit more for lightweight, tent-pole style collapsible poles. You don't want an excuse not to take them for approaches, and even to carry them on a climb for an alpine descent.

This post is not applicable to the original poster. IT Band Syndrome sucks though, and hopefully some day someone searching the forums comes upon it and it saves them some suffering. If you don't have pain on the outside side of your knee, you can skip this post.

Often downhill initiated pain is on the outside side of the knee, IT Band Syndrome. Inflammation. Can be somewhat alleviated immediately with foam rolling, stretching, and anti-inflammatories... or even just the padded handle end of a trekking pole dug around on the side of your butt, or targeting sitting while taking rest breaks on branches or rocks which dig into the butt muscles. Not comfy, but very effective in keeping the muscles loose. You can even roll out on trail with a nalgene (ouch) or rock (real ouch). Ideally you are proactive with rolling, stretching, and anti-inflammatories before and after any big days with a lot of miles and/or elevation gain/loss. Like 12-20min of rolling/stretching before and after every big day. For the foam rolling, you don't want to roll directly on the IT Band, this is an important detail that MANY YouTube vids cover incorrectly. If you already have pain/inflammation, you will just make it worse and delay your recovery by rolling directly on it. Better yet do strengthening exercises too such as side leg lifts on other days.

Many people say it can take a long time to recovery from an IT Band Syndrome flare up, like months... and it can, if you let it get real bad, then don't address it properly. Knock the inflammation down with anti-inflammatories, foam rolling, and stretching ASAP, and you can start putting on the miles (reduced) in a week or two. Once you have recovered from it once you get a better idea of how to deal with it next time, once you have recovered twice, you know what you need to do to prevent it in the first place.

The IT Band is a static band of connective tissue running along the outside side of your leg from roughly just below the knee joint to about mid hip where it branches off a bit. The inflammation is caused from repeated use. If the muscles around the area are loose, you wont tend to get problems. If they are tight, you will. Maybe not immediately. Maybe it will pop up as a problem after you have done your 3rd lap that week of a sweet 7mi trail with a nice climb and nice long downhill run that is just so much fun... Too bad its so hard on the knees and you are a gumby who doesn't stretch and roll like I used to be. Since the band is static, stretching it is of very limited help. IMHO any targeted stretching of the IT Band you try, is more likely using the band to put pressure on the muscles below, and potentially loosening them slightly... but foam rolling around and not on the IT band does a great job already.

So many runners swear on turmeric + piperine (for bio absorption efficiency) as an anti-inflammatory. You can also make some great "golden tea" drinks with turmeric, black pepper, milk, ginger, and whatever else. Many recipes. I personally do turmeric extract caps, plus 220-440mg Naproxen Sodium as prophylaxis before long days with a lot of vert. Its like a MUCH longer lasting Ibuprofen with more anti-inflammatory effect.

If you sit a lot as part of your job / life, you may need to strengthen and lengthen the associated nearby muscles much more than those who are on their feet more often daily.

Some resources:
https://www.youtube.com/watch?v=-q9z_H5quZ8 - Chase Mountains - Knee Pain when hiking? Start Here
https://www.youtube.com/watch?v=bGsOfRH4UEI - Chase Mountains - IT Band Syndrome fixed on trail
https://www.youtube.com/c/TheKneesovertoesguy - Knees Over Toes Guy - comes across as too much of an info-mercial, etc... but the exercises are legit. Tibialis Raise and Side Leg Lifts are what I use the most. Many other good ones I should use though.

My right knee was getting so bad last year that I had to stop climbing at areas that required hikes to get to.  The knee felt extremely loose and unstable along with pretty severe pain.  Hiking up or down hill was out of the question.   I mentioned this to my doctor I see for chronic back pain and he thought I might benefit from PRP therapy.  They take some of your blood, spin it and inject the platelets into the area you are having an issue with.  I read some reviews that had mixed results and asked my doctor if it might work on my knee why not try it on my back, he said there was no way it would work on my back and any doctor who said it would work is just going for your wallet.   I decided to try it, it took less than an hour.  I walked every day afterward but no hiking or steep hills for 4 weeks.   I have to say that the change was remarkable, very little to no pain, the loose unstable feeling in the knee is completely gone.  I was fully skeptical going into it but I wanted to give it a shot before turning to knee surgery.  I even gave up telemark skiing due to the knee pain and went over to the dark side of Alpine Touring because it was easier on my knee, this season O was back to telemarking with no pain.   Obviously PRP won't work for everyone but it worked for me and might be worth looking into.