I hope I've posted in the correct forum. If not, if an admin could move this I'd appreciate it.

I've experienced two kinds of pain recently on overnight trips. So far it hasn't been a real issue because I've only been out for one night. However, I'm planning longer trips and would not like to find myself incapacitated on the 3rd day.

The first is noticeable only when I'm going downhill. It is a pain in the back of my knee and in the front, under the knee cap, towards the bottom. It's a sharp pain and at one point reduced me to walking with my leg held rigidly straight in order to avoid it.

The second is a pain in the back of my heel. I thought it was a blister beginning but it's not. It feels almost like a stinging. When I press directly on the spot it doesn't hurt, but if I press and then push my finger up or down while holding the pressure I can feel it.

Has anyone had experience with either of these issues? I typically hike in a pair of Salomon XA Pro 3D Ultra's. Total skin-out weight is generally between 25-35 pounds (I'm still working on it!). My muscles seem fairly well conditioned as I never experience fatigue while hiking and have only minor soreness. My theory is that my typical aerobic exercise (stationary bike) does not put enough stress on my joints and that backpacking is then a bit of a shock.

Any thoughts/suggestions?

-Dave

You first one sounds like Patellofemoral Pain Syndrome (otherwise known as Runner's Knee). Actual causes can vary but it's typically a muscular imbalance that causes the knee cap to improperly track. Basically the knee cap gets pulled to one side and causes rubbing and inflammation in the area. I've never heard of this causing pain at the back of the knee though so you could have two separate problems going on here.

Second could be a bone spur.

You can google runner's knee for recommendations on exercises to help prevent it.

Dave,

I have had knee issues for over 20yrs, including 2 ACL reconstruction surgeries. They "work" better today than at any time during that stretch, I'm happy to say!

I owe PART of this improvement to a strap from Mueller (available at Walgreens, etc for cheap). It uses velcro and has a semi-rigid plastic tube inside the front which puts pressure on the ligament below the kneecap. I've seen it work for several folks - It is worth a try. I put it on at the onset of tenderness under the kneecap. It is a miracle worker!

Best of luck, and please report back on progress!

Thanks for the input guys. I'm also asking a friend of mine who's a track coach and marathon runner so if his thoughts match with yours I'll feel pretty darned confident that I've located the causes.

"The second is a pain in the back of my heel. I thought it was a blister beginning but it's not. It feels almost like a stinging. When I press directly on the spot it doesn't hurt, but if I press and then push my finger up or down while holding the pressure I can feel it."

David,
Can you re-create the effect by flexing your toes towards your knee? Maybe with a little side-to-side movement?

If so, probably Plantar Fasciitis. It usually presents in precisely the area you refer to.

Edited by greg23 on 05/29/2009 11:48:56 MDT.

Greg, I just tried that and no pain so hopefully it means I dont have that!!

I agree with Chris that the pain under the kneecap is probably PFS. I had PFS for about a couple of years ago and going downhill is definitely the worst (also, riding a bike for a long period of time was bad for me). PFS is very complex can be tricky in that what works for one person may not work for another. Stretching (especially of the hamstring and calfs and hip rotator muscles) helps many. My kneecap was actually hyper-mobile so stretching did me no good whatsoever. What helped me the most was quadriceps and hip muscle strengthening exercises, especially leg lifts. Another issue that could be involved is poor biomechanics of the feet and ankle. This can be resolved by replacing shoes, being fitted for orthotics, and maybe doing some foot and ankle strengthening/flexibility exercises.

I had very bad PFS which hurt constantly even when I wasn't doing physical activity so it took me awhile to get back to normal. It sounds like it only hurts for you when doing intense physical activity so recovery should be much quicker.

I would seriously recommend seeing an orthopedist who can confirm this diagnosis and maybe even refer you to a physical therapist who can get back to tip top shape. Good luck :D

EDIT

oh and this is a great link about PFS

http://www.drpribut.com/sports/spknees.html

Edited by pedro87 on 05/29/2009 14:48:50 MDT.

Though I ultimately recommend seeing a sports medicine physician, here is my guess as to what you have based on my own experiences:

1st--Patella femoral pain syndrome, as previous posters have mentioned, is probably it. I've been in physical therapy and eventually had surgery for this--patella release. You want to develop your VMO muscle (the tear drop muscle on the inside of your knee). This will help counter the tendency for the kneecap to track too far to the outside of the knee. What's worked best for me was to cycle lots--with a proper bike fit, of course. And stretch your hamstrings like there is no tomorrow.

2nd--If the pain is in the back and not under the heel, then I think you have the beginning of achilles tendinitis. Do VERY gentle stretching for the calves, both straight and bent leg. This tendon receives the least amount of blood flow of all tendons in the body as it is the biggest, so recovery can be quite slow. I would recommend orthotics and support/stability shoes. Shoes with too much cushion will make this worse.

Now go see that doctor.

Edited by iwillchopyou@hotmail.com on 05/29/2009 18:23:20 MDT.

1st, I too, have the same PFS that you mentioned but it goes away quickly and i think i will do some of the mentioned excersizes

2nd, i am prone to achilles tendonitis in my left foot, i always get it when running, mine is caused by over pronation and the solution that worked for me was to get some supportive boots. i use asolo PM400's. they are very heavy in comparison to what you have but for me they are worth the weight. i use them for dayhikes as well and since i don't hike without them i have gotten used to the weight. i saw a podiatrist concerning this issue and she recommended orthodics, but i thought i would try the boots first and it worked for me. but, of course, consult your physician first.

just my 2 cents and probably not worth that.
ben-

Peter, thank you for that link, I have been suffering this for years and thought I was f-ed. Ali

I'm no expert by far, but I also have pain behind and below my knee and more of a tension within the knee when going downhill. I find it flares up more when I go down steep hills that require me to put my weight on my heel or flat foot and lower myself, rather than taking my weight on my thigh muscles walking normally down a hill. It can become almost totally debilitating if I don't take care of it.

Anyway, I find that the stretches for and symptoms of illiotibial band syndrome fit. Here's a link to the wikipedia info, but google it to find more.
http://en.wikipedia.org/wiki/Iliotibial_band_syndrome

I have also found that I can stave off symptoms by starting each walk slowly for the first couple of miles even when I feel great - reminding myself to meander and enjoy the walk as I warm up.

Hope this helps.

can anyone recommend specific stretches for pfs.

I was on crutches for 2 weeks after a hike last summer because of this and would like to avoid this in the future.

At least I think it was this, my doctor just told me to stay off it and let her know if it doesn't get better.

--scott