Back in May, I was diagnosed with Runner's knee again (aka chrondomalacia). Basically, I went from couch potato to walking 15-30 minutes a day to get my cholesterol down, and in better cardio shape for my upcoming RTW trip. About 2 months later, my cholesterol was better, however I started to have pain in both my knees. I followed my doctor's orders and did 2 months of home therapy with stretching, isometrics, and ice, yet 3.5 months later, I'm still having pain. I made an appt with a different doctor (orthopedist) for next week.

I continue to worry about how this will affect me and what I'm able to do on my RTW trip. It's getting down to the wire - I have 2 months until departure. I know from experience that backpacking will involve a lot of walking - in big cities and rural areas alike. I wanted to do a 3-week trek in Nepal and climb a volcano in Bali!

Has anyone had similar knee problems before or during such a long trip? How did you deal with it? Did your situation improve with the increase in exercise?

I am by no means an expert on knee pain. But, I am assuming that in addition to the stretching, isometrics and ice that you also stopped your daily walking. And, then when you started walking again you continued with the home therapy.

That said, you may consider mixing up the isometric exercises you are doing every few weeks to keep the muscles from getting complacent. Alternatively, you might consider doing other than just isometric exercises if they are not doing the trick for you.

Finally, when you start walking again. Walk every other day instead to give your body a chance to rest. As I've gotten older I've become a big fan of having at least 36 hour rest periods.

The other consideration could be the shoes you're wearing, whether you might need orthotics, etc. But those are generally larger considerations for runners than walkers. But, it wouldn't hurt to try a different pair of shoes and/or walking on grass instead of pavement. You could also consider mixing up walking with riding on a stationary bike in the beginning just to strengthen different muscles and give a little variety.

Thanks for the good suggestions. When I'm being good and lifting weights, I usually mix up the routines every 4-6 weeks, so it makes sense that the same concept would apply to the stretching and strengthening exercises for my knees.

I stopped walking once I saw the doctor back in the Spring, however now I'm self conscious that it's counterproductive to *not* be walking or getting some type of regular exercise.

I saw a news piece on CNN this morning which advised that if a patient doesn't see improvement within a standard recovery time frame for the condition, it's best to return to the doctor as the original diagnosis may have been incorrect. Then again, I've also read that it can take 3-6 months to get over Runner's knee!

The knee problem definately needs a correct diagnosis.

Be reminded of how many sports professionals end up retiring due to chronic knee pain and knee injuries. Lots. I might guess it to be the formost cause of retirement for professional sports players.

Knee injuries are to be taken seriously. Your entire body and the ability to walk depend on them. Do not undertake a strenuous backpacking trek on an injured knee. You may live to regret it for the rest of your life.


Sophie9, proud owner of a bad knee

I'm no doctor either, but I don't trust your doctor's original diagnosis. From my own experience with runner's knee and over a decade of being a very serious member of the running community, I find it hard to believe that you could have developed runners knee in such a short period of time given your exercise regime. As far as I've always understood it, this is a degenerative condition that takes a bit of time to develop, i.e., you need to wear the joint out. There might be other factors involved -- how old are you, how much do you drink, and how much do you weigh? (You don't have to answer these questions here; they're just possible contributors to your knee troubles.)

I would secong Sophie9's advice that you don't want to mess around with knee problems. Ten years of running 60-150 miles per week took its toll on my knees and now, 18 years since I've done any real running, they still aren't right. I've mentally adjusted and now see it as a pain management issue and forego the 4-mile walk in to the city to meet my wife when the pain is particulary bad. (On other days, I'll do things as stupid as go for 30+ mile walks and just ice the hell out of my knees and talk a handful of ibuprofen when I get home.) In other words, get the knee problem sorted before you do any permanent damage.

Gosh, these are certainly words of warning being posted. I saw the orthopedist today (he specializes in knee surgeries and replacements).

He pointed out in x-rays that my kneecaps developed abnormally. I asked how common such knees are in the population - he said less than 1% of people have them like me.

I can't help but think that might have some impact on why I'm susceptible to knee pain. Still, since the pain wasn't in the area with the funny bone bits, he said it wasn't likely the cause. He diagnosed me with bilateral patellar tendonitis (aka jumper's knee) and prescribed 4 weeks of physical therapy followed by home treatment. He did raise an eyebrow of concern when I mentioned my planned backpacking trip around the world in 8 weeks.

I thought I was more clear on what to do, however after reading this feedback, I'm less clear. I'm already moving in with my parents in 5 weeks, and I was about to give my notice to resign from work next week.

"Patellar tendinitis causes pain in the patellar tendon, which runs from the kneecap (patella) to the shinbone (tibia). Pain usually centers where the kneecap meets the patellar tendon."

quote:

I stopped walking once I saw the doctor back in the Spring, however now I'm self conscious that it's counterproductive to *not* be walking or getting some type of regular exercise.

This is a good instinct. When I hurt my knees training for a 1/2 marathon, the doctor told me in order for the knees to get better, they need to get used to some of the pounding from running. Counter-intuitive, yes, but still made sense.

I am thinking...if you went from couch potato, it may just be your knees getting used to the new regime. I would be surprised with 15-30minutes of walking that you would develop runners knee. You may also need to stretch your IT band, which is one of the most common new runners injuries. Also, if you are walking at any clip, you may need how to walk correctly, with the correct hip action, etc. And check your socks and shoes...all of those things can cause knee pain.

could it be that you need
orthodic inserts for your feets?
sometimes people's feet are funny-shaped (high arches, etc) and what helps is a form-fitted pad to wear in the shoes.

this pain can be felt in the legs/knees/all over the place but originates in the foots.

zop

Hi Zopa -

I have custom orthotics from about 5 years ago, however I wasn't wearing them much in the past year or so, and definitely wasn't wearing them when I had started my walking regimen that got me injured earlier in the year. I had invested in a nice pair of motion controlled running sneakers instead.

I'm back to wearing the orthotics again, however to be honest, I can't really tell if they make a difference, except that they add about an inch to my height.

I've had knee problems for years and was constantly frustrated with the pain that would occur after my 30 mile hikes. I hike regularly -- anywhere from 2-3 miles daily during the week to 8-10 miles on weekends, so it was not as though I went from sitting around eating bon bons and being fanned by palm fronds to marathoner.

The first visit to a physical therapist was very eye-opening for me -- he told me that generally, the human body was not made to hike 30 miles up and down canyons on a regular basis. But, if that was my goal, that there were all sorts of exercises that I could do. It was expensive, it was hard work, but after 8 weeks, there was a very noticable difference. If you do regular physical therapy for that same amount of time, I would guess that you will have a similar experience.

Part of the issue, as it was explained to me (I have that same knee cap problem) is that the muscles supporting the knee cap are not doing their job because they have not been properly strengthened. The directed physical therapy helps to strengthen them in such a way that, if you maintain the exercises over time, it makes a lasting difference.

Be very clear with your physical therapist about your goals -- it helps them to develop a routine for you that will help you to be able to do what you want to do. Also -- if you use a brace or any sort of support equipment, bring it in to therapy and show it to them. I had been using something that I thought was helpful but turned out to be completely counter productive.

Surprisingly, part of my physical therapy was regular time spent on a bike. Seemed like it would just do more damage, but it strengthens your knee in a way that removes the added pressure of your body weight from walking.

Good luck!

AmazingJules -

Thanks for taking the time to share your experience - I found it very encouraging! I've drawn up a nice list of questions to ask my physical therapist.

In addition to the PT, I've started my own regime of more holistic approaches - healing meditation, massage, journaling, no alcohol, etc. I also might give acupuncture a try.

I think the investment in addressing the problem now will be worth it, as an extended journey with constant knee pain would be less than ideal. I'm also going to give myself permission to take it easy once the trip begins - pay a little extra for a cab, build in more rest days than I might otherwise have done.

Just a quick update -

What a difference a few weeks has made. I've had 7 of 12 physical therapy visits, combined with home exercises, and a fitting for a new set of custom orthotics (my old ones had actually made my problems worse, I found, after I stopped wearing them). Pain is no longer an every day occurrence, and is less intense after days with extra exercise.

My mental energies are once again focused toward the final arrangements for my trip, set to start in 6 weeks!

Keep up the good work and stay with the exercises. Be sure to keep your shoes in good condition or have 2 pairs that you exchange every other day or so...that prevents wearing out one pair of shoes and having a 'new' pair that doesn't fit properly. You may even consider having a spare set or two 'back home' that can be sent to you during the trip, even the orthotics will wear out in that period of time (as you've found out, your feet/stance change over time). Take care of your body...it's what's gonna get you RTW...

my mom had knee pain months before.then she concerned with a doc who suggested her to take physiotherapy. now she had less knee pain. you should concern with a physiotherapists now!

Please be aware that the daily stress of 20k walks over a week or more can seriously degrade your progress, so I might want to postpone those long mountain hikes. If you want to LIMIT your knee damage, wear your brace no matter how ugly it looks. Also, invest in a PAIR of packable walking sticks, and use then in going up and especially DOWN. They're knee savers.

You may find that you're fully recovered from normal walking, but be aware that hiking up and down mountains is a whole other world.

Many long time hikers find that this kind of stress is too much for them, and end up riding bicycles as a new hobby.

If you want to try out your knees on mountains, you might want to start on more hilly mountains and see how you do. Also, when you DO decide to do it, lighten your pack as much as possible, and by that I mean no more than 10% of your weight on your back. Backpack weight translates directly to knee and back strain.

Ok, you can get away with a little more. I did Camino de Santiago which is NOT Nepal, and am not in great shape. My first time I did it with about 15 kilos, ie 33 pounds more or less. I weighed 180 pounds. 1/6th. Problems galore. Then I did it with 9 kilos, 20 pounds or less, Much less problems, same essential body, with better shoes. I used doubled walking sticks, using them to take up my weight down the hills. My arms grew strong, my knees took up half the strain.