by UpAndDownMountains » Tue Jan 05, 2021 12:32 am
Soon after the enforced break from hiking due to the first lockdown, I developed some knee pain which I'm yet to properly recover from. I'm seeing a physio but am interested in any others' general or similar experience of runners' knee / ITBS and thoughts on my own situation. It's a long story, sorry!
The background is, I'm 32 male, slim build and reasonably fit hiker. I've always been active and have been hiking seriously since I was 18 without any problems. In the past few years I've done big treks (10+ days carrying 10kg) in the Alps and Nepal, and my typical UK summer hike in the Lakes/Snowdonia would be multiple mountains 25km+ with 1500m+ ascent/descent in 6-8 hours. In the winter I run 5k occasionally to try and keep my fitness up, and do the odd 20 mile flat bike ride. I worked in an office full time, been working from home since lockdown. As part of my commuting and lunch stroll I used to walk 2 miles daily including 300 staircase steps up and same down.
From mid-September until mid-July (10 months) I didn't do any proper hiking. I'm a fair-weather hiker, normally I'd resume in early April (6 month gap). Neither did I do any of my commuting walks/stairs, some days I didn't walk at all but otherwise I'd do some local walking (pavements) up to 3km starting from my door. In April and May I ran 5k five times, and after that I started biking more regularly (local cycleways and forest trails). I started enjoying the bike more as it was much more enjoyable than walking in the flat urban part of the country I live in, and my fitness improved.
First proper hike was mid-July, I thought I'd take it easy and did 20km with 1000m ascent, easy grassy not steep terrain. No knee pain but my legs were hurting all-over the next day - kind of expected and back to normal the day after. Next weekend I do 15km with 950m ascent in similar terrain but a little steeper on the way down. Setting back down after lunch, I quickly start to feel minor but uncomfortable pain in the outer rears of both knees. I slow down but complete the walk, including a few km on a flat path back to the car. The following days my knees hurt even walking a few hundred metres on flat pavements.
Now I knew something was wrong, I looked up the symptoms and found it was probably runners' knee. I halted hiking for 10 days (just did 1-3km local walks), and did the NHS stretches together with applying ice. After that I ramped up slowly with rest days (but in hindsight probably too quickly) - 7km flat walk (no pain), 10km/550m hike (taking it easy, with poles, faint pain), 12km/650m hike (down with poles, faint pain), 12km flat-ish cycling (no pain). Finally I did a 13km/850m hike, there was a really steep down about halfway in (poor planning) and the pain was pretty bad even going slowly with poles. Finishing back to the car, it's only minor on uphills, but on any down or flat it's getting more painful. The poles barely help, and by the end I'm hobbling and stopping to sit down every few hundred metres.
I take another 10 day break, just local walks, stretches, and ice. It's getting better as it did last time, and I start ramping up slower again. After a bike ride and doing some DIY one day, I've unexpectedly upset it again and I struggle to walk both up and down the stairs, until late that night going upstairs I get a shot of pain on one side and then it's back to normal pain level again.
Another 10 day break. I see the cycle repeating and it's not fixing itself, so I manage to get a physiotherapy referral. Meanwhile I continue with the stretches, ice, small walks and bike rides. Any time I walk or bike a little too long (or mindlessly jog from the shop because it's raining), it starts hurting again and now I've learnt to have route options or someone fetch me before it gets worse.
The physio appointment comes round, and it's online. She has me do some exercises on camera, from which she concludes my knees are weak in terms of stability - they always want to bend inwards under power/impact. I'm assigned an exercise programme of many more squats, step downs, crab walks with band, stretches, and foam rolling. For the next 6 weeks I do these and small walks/rides, seeing the physio every other week. By the end I do a ramp up slowly with no problems until a 11km/600m hike when faint pain started to return by the end of the descent.
I figured the online approach wasn't ideal and didn't feel it would get me back to normal for my active lifestyle, so I booked to see an in-person physiotherapist. He diagnoses me with a tight IT band (ITBS) causing irritation, unsupported (not flat) foot arches, causing pronation (inward rolling) of the knee. And that previously these didn't cause issues because my legs were conditioned. Over the next few months, I see him weekly/bi-weekly for stretches, massages, and ultrasound. I'm given more exercises to do, and on advice I buy some trainers with arch support for daily use. The sessions/exercises become less painful, and slowly ramping up the hiking in parallel to build my strength back and provide indication of progress.
Then maybe November, restrictions/weather kick in again and I'm back to doing local flat long walks again. I know it's still not fixed, as I had some small pain on my final hikes, and sessioning local tiny-hills/staircases eventually bring the pain back.
Originally it was both knees. Then just the right one. Then the left one (this was the really bad one when I had to hobble back to the car, the right was never nearly as bad as that). Then both very slightly. Now the left one is perfectly fine and it's just the right one that starts hurting just on the downhills (or long walk on hard surface). The right also hurts a bit when I get up after sitting still for too long. I'm right-side dominant and my right leg is stronger.
I've racked my brains for what I might have done to cause this, can't think of anything aside from the lack of strenuous hiking causing deconditioning, and ramping up too quickly after that. Same boots as past few years. Never use trekking poles outside the Alps, and now only used them on some of my recovery walks (just the downhills usually). Legs may be stronger in different muscles through increased cycling in lockdown, as it's a low-impact activity and doesn't need leg stability like hiking does. Always had my home working desk/chair set up properly. None of my shoes are wearing unevenly.
I thought it'd be back to normal by now, it's been 5 months since that first painful hike and 4 months since the really bad one when I hobbled back to the car. I've been doing the leg exercises, applying ice, and taking walks daily without fail since I found the problem. Unfortunately I live in a city in a flat part of the country, otherwise I'd hike daily if it helped. I'm staying away from gyms (never been in years) due to the pandemic, sticking to the at-home exercises I've been given.
Thanks in advance for your stories and wisdom.