Thread: Knee overuse, worried my ski season could suck

I'm a complete medical JONG, so bear with me. For this post it may be worth noting that I'm bow-legged.

In the past 5 months I've gotten into hiking a fair bit. I've been able to hike 12-14 miles w/ no knee pain while wearing a 20 lb pack (I weight 130 lbs).

2 weeks ago (11/10/09) I hiked just under 19 miles, lots of ascending and descending. I ended up overworking both of my knees, meaning I had lateral pain on both knees for the last 8 or 9 miles. Not excruciating but definitely not mild either. The next day I was pretty much OK except for the lateral side of my left knee which hurt to put any pressure on.

Fast forward 2 weeks to today. I still can't ascend or descend stairs, or run without feeling the pain in my left knee, lateral side. It's milder pain but gets worse the more I use it. It seems this is clearly a case of overuse. So...

Should I just rest it for another few weeks?
Should I get it looked at?
Just bruised ligaments?

I like to ski bumps, trees and hit cliffs. Am I going to spend all season carving because I pushed myself too hard on a day hike?

goggle IT band friction syndrome and or patello-femoral syndrome

Sounds like IT band to me -- I did the same thing this summer on a long hike.

Hopefully, you've been taking ibuprofen and icing it. I would suggest seeing a good PT to get you set up with a stretching and strengthening regimen.

Good luck.

It's been 2 weeks, so you obviously have something going on. If you care about your knees, suck up the copay and go to a doc. Simple as that.

Originally Posted by Vinman

goggle IT band friction syndrome and or patello-femoral syndrome

Read about it and that sounds pretty accurate, more so than anything else I've been able to come up with. I'm bow-leggeed, walk with pronated feet, and was hiking up and down a lot of vertical in one day. I will take it easy for another 1-2 weeks and get it checked out if I'm still having issues at that point. Thanks yall. Cheers.

Figured I'd report back as a reference for anyone dealing with IT band syndrome (which is definitely what I have). I've had some recent success and will share what has helped. I skied most of the winter with no knee issues. It seems ascending does not irritate either of my knees, which is great obviously: I can skin to my hearts content.

I did have a super random painful flare up when I hiked Tucks with skis and boots on my pack in March. Left knee was in pain before I even reached Hojos. I stupidly continued hiking and basically gave my knee a major set back. Tried a few 4-8 mile day hikes in the White Mountains in May and June. During each hike the ascent felt great and I was positive my knee was going to hold up, only to find myself in pain within 1/2 mile of descending.

In June I basically gave up on hiking for the rest of 2010 as I realized if I wanted to get better then I needed to let it heal for a long time.

In May I foam-rolled my IT band (on left side) every day until it no longer hurt putting my entire weight on it. At first I thought this was helping but no dice. Knee flared up on all descents (3 occasions).

My regimen for the past 3 or 4 weeks has been this:

-Raw ice daily, as many times as possible.
-Foam roller every day - To massage and stretch my glutes and tensor fascia lata.

The reading I've done has suggested that foam rollers can't actually stretch out the IT band, it's the largest tendon in the body and ridiculously strong. The other thing I picked up was that stretching out your tensor fascia lata is potentially very helpful, because it's the only muscle that's directly related to the length of your IT (and you can stretch a muscle, as opposed to tendons which are extremely strong and resilient). I have no idea if this is true or not, but it's been working for me.

Anyway. I couldn't stand not hiking and this week I decided to go on a short test hike (Mt. Moosilauke / 7 miles / 2,400 vert). Felt great going up but figured it was inevitable that my left knee ITBS was going to flare up on the way down... didn't happen. Couldn't believe it. My right knee actually flared up a little, but nothing serious and I feel that if I ice the shit out of it, rest, and roll the TFL and glute on that side I'll be fine. Will find out next week when I go on another hike.

Another thing I found that really helps is to let my abs, glutes and hips do all the work when I'm descending. This allows me to keep my quads, ankles and calfs as relaxed as possible on the descent. I believe that when you take downward steps with a fully flexed tense leg your IT band becomes tight as well, and that's where I was getting the friction. It think a loose lower body translates to a less-tense IT band.

I had lots of problems with ITB when training for a half ironman. A friend of mine is an amazing physio who treated and taught me lots about the injury. Chances are that it is all linked to the position of your hips. As you say, if you can train your abs glutes and hips as well as lower back to work properly then you should be fine. Trouble comes when certain parts of the hip area don't work as hard as they should such as one side of your obliques or one of your glutes. This leads to an imbalance or even your hips working at an angle like mine do which makes muscles in your legs such as the quads work much harder. Everyone's reaction to this kind of imbalance is different and whereas some people might find it gives them a dodgy ankle or hip or lower back, others like ourselves will feel it in the ITB. One of the things I was recommended was going back to basics and doing exercises you might associate with grannies trying to increase life expectancy. Very slow and low abdominal crunches just going far enough to engage the deep abdominals. Reverse leg raises raising it only just off the ground on your weak side making sure you engage your glute properly. I guess with your girlfriend or someone 'close', you could self-asses by seeing if one glute is bigger than the other. Also if you do leg raises (lying down face to ceiling) and see if your hip flexors are doing too much work on one side instead of letting your abs/obliques do the work. Getting this sorted will make the world of difference in the short and long term, good luck. Core strength is the key to absolutely everything, I'm still a long way off but getting there slowly.

Originally Posted by arewolfe

Another thing I found that really helps is to let my abs, glutes and hips do all the work when I'm descending. This allows me to keep my quads, ankles and calfs as relaxed as possible on the descent.

This

and hike with your toes straight ahead or even slightly pigeoned toed. strengthening your glutes will help too.

I'm interested to know what you do to stretch your tensor fascia lata.

Also, I love rolling out my IT band on the foam roller (and my IT band loves it, too.)

I'm of the opinion that my IT band issues (and all my other knees/hip/leg issues) were the result of a collapsed arch on my left foot. To that end, barefoot/minimalist running has not only not hurt me, but actually helped immensely.

Good read on knee pain. Site vs source.

http://www.thecompleteathlete-llc.or...vs-pain-source

The conclusion is obvious. Weak hip stabilizers cause a lack of control of knee and hip flexion with an additional component of adduction and internal rotation. These control issues result in a painful sensation in the patella-femoral joint or the patella tendon.

The key from both a cause and a solution standpoint lies in the sagittal plane dominant strength training so prevalent in the American system. Our American strength training system is classically sagittal plane dominant as well as double leg oriented. It seems clear that the key to solving anterior knee pain lies in control of hip, knee and foot movement in the frontal plane and that single leg exercises must be employed in both strength training and power training to address these issues.

To roll your TFL first do a google images search of where it is on your body. This helps when you go to stretch it since it's a fairly small and short muscle. I'll try to explain how I stretch my left TFL:

1. Lay down on your left side as if you were going to roll your left IT band. Then place the foam roller in the fleshy area between your hip bone and pelvis bone.
2. Rest your left shoulder on the ground. Rest your left leg on the ground. Brace your weight with your right leg. Now you can control how much pressure is applied to the TFL.
3. Fidget around until you can feel pressure on your TFL. You can then roll in two different directions:
I - rolling laterally so that your right shoulder goes back and forth between 90 degrees and 60 degrees (perpendicular to the floor).
II - rolling as you would your IT band [forward and backward].

Let me know if you I didn't explain it well. If I had more time I'd take photos and post them to show how I do it.

^^^ If you haven't figured it out, you need to be naked to perform those glute and TFL rolls. Lock the door and pull down the shades!

Final update: I've hiked 77 miles over the past 30 days and have experienced zero knee pain. It seems to be the result of:

-10 weeks of rest (regular daily walking around, but no hiking)
-applying raw ice to side of knee 3-4 times daily for about 1 month
-stretching TFL with a foam roller and stretching glutes using a wooden rolling pin (idea stolen from Tuckerman).

Thanks. Meant to respond to this. Been rolling out something in my hips, not totally sure if its my TFL or not. My hips are usually a little tight after a long ride or run and it's been good.

Seems like the rolling pin approach could be good for the TFL as well? I've thinnking of getting a tiger tail.

I tried using the rolling pin on TFL but it was too harsh so I use the foam. It's probably doable you just have to be careful how much weight you put on it.

Find a good physio and they'll set you on the path soon enough. Sure, it will cost some $, but you'll probably only need a couple of sessions for diagnosis and to show you the right exercises, and then as long as you do them, then you'll be fine. Try and get a recommended physio from somewhere.

arewolfe, I have the same problems with IT Band as you - for me it came about as overcompensating for a ACL repair I had.

All the advice you've given and from others is spot on, but something that helped me out a lot is missing.

Get really good shoes that are specific for your type of feet, be it pronating or otherwise, and wear them whenever you are walking, hiking etc.

If I hike in a pair of worn out beaters I will be in pain. Put me in a good shoe and I will be fine.

I find I have to buy shoes about every 4-6 months as they break down and don't give me the support I need otherwise.

good luck with your continued recovery

UPDATE:

It's been almost 2 years since I was dealing with ITBS on my hiking descents. My first hike without knee pain was 8/24/10, and I haven't had any sign of ITBS since then. This includes 70 miles of hiking in September 2010, and finishing the NH 4000-footers in August 2011. Most of those hikes were 10-12 miles. One was 14 miles in a day with an overnight pack that weighed about 1/3 my body weight... no knee pain on the descent.


I can't say for sure what made the difference. But it was likely one or a combination of the following:

-Resting my knee for 2 months straight
-Icing the shit out of it daily
-Foam rolling my tensor fascia lata daily
-Adopting a primal/paleo diet in July 2010 at the height of my ITBS problems, which is how I've continued to eat ever since then (my reasons for eating paleo were completely unrelated to my knee problems, but cutting out grains supposedly reduces inflammation, so I've wondered if that was one of the reasons it's gone away).

This winter I didn't ski. Just 2 days in October. My legs are particularly out of shape at this point. This week I went for an 8-mile hike (3,000 vert) and figured that would be the final ITBS test. On the descent I did get jello legs for the first time in many years, and my leg muscles have been sore as shit for 3 days, but I experienced no ITBS flare up.



Unrelated, I've developed tendonitis in my left wrist over the past two months from too much guitar playing and I have to stop playing for a while (major suck). I have been treating it with arnica oil, castor oil, massage therapy, soaking it in epsom salt water, and doing "ice dips" (filling a large cooler with ice and water and dipping my whole arm in it for 5-10 seconds at a time for about an hour).

Thanks for bumping this. IT band syndrome sucks huge donkey balls and my entire life now revolves around trying to beat it so I can do fun stuff again. Maybe I will get tendonitis in my wrist from playing guitar by the time it's over too.

I just want so bad to be able to ski next year.

Huge donkey balls. That's about right. How long have you been dealing with it?

I remember being pretty depressed when I was facing the possibility of not being able to do any serious hiking or backpacking anymore.

I've had patellofemoral/IT band issues since about 9 weeks post op from acl and meniscus surgery. It slowly abated by month 8 and I started to ski fairly regularly but then the IT band pain really clamped down out of nowhere and shut down my ski season from Jan 4th on through to the end.

So now it is 4 months since it bit down hard this winter and it is slowly changing and morphing back into more of a patellar pain as I bike and walk regularly again. This pain is far more tolerable than the dreaded IT band pain which I hope to avoid re aggravating at all cost. I hope I can beat it by basically doing all of my post op p.t. over again and more consistantly. We shall see what next ski season brings.