How to Avoid Knee Pain When Hiking

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How to Avoid Knee Pain When Hiking

Hiking is a strenuous activity.

It will affect most of your joints at some point but your knees will take the brunt of it.

You may not be getting there in a hurry but that destination could be 20 miles that take all daylight hours to reach.

On such a hike you could burn 5000 or more calories a day.

Lack of preparation could cause long term harm.

This is why you should prepare for hiking as you would any other sports discipline.

Aches and pains will come from all exercise regimes – no pain, go gain, right?

But there is good pain and there is bad pain.

A classic good pain is ‘delayed onset muscle soreness’ (DOMS) that will plague you through the second day of a multi-day hike.

In that case, the answer is a hot or cold bath, stretching exercises and then straight back onto the trail!

Knee pain isn’t always good pain and should be reduced or avoided if possible.

The last thing you want is a buggered knee halfway down from an escarpment and needing your mates or other half to carry your kit – or a mountain rescue team to carry you back down!

Where it comes to knee pain there are four elements to minimising knee pain:

  • Stretches
  • Gym preparation
  • Building up to big distances
  • Having the right kit

Let’s look at these four elements in detail.

Different Types of Knee Pain

As a first step, let’s look at the different types of knee pain you are likely to experience, what causes it and how to manage it.

Persistent ache under kneecap

This can show itself after a big descent.

Get a cold pack onto it or get your knee immersed in cold mountain water for 10-15 minutes.

If you do the strength training we discuss later this may alleviate it.

Well-fitting boots and insoles can also prevent the pain.

Your GP or physiotherapist will be able to give the best answer if the pain persists for a few days after the walk.

Sharp, shooting pain above or below the knee

This is most often tendonitis.

Get an ice pack to it and rest as soon as you can.

See your GP or physiotherapist if the pain persists.

The best preparation is fitness and stamina exercise.

In other words, gym work and building your distances up gently!

Pain around the entire knee after a fall

This could be a torn anterior cruciate ligament injury and is the end of the walk.

Your body won’t let you put weight on your knee in this situation.

It will feel weak and will be extremely painful when you put weight on it.

As a first step get your buddies to carry all your weight and try get back to base using your poles as crutches.

Don’t put weight on the knee as you walk.

Don’t be afraid to call for help in this instance – you could do a pile more damage and be off hiking for far longer unless you get seen ASAP.


A marathon runner wouldn’t dare do a run without a decent stretch and nor should a marathon walker!

Before training or the hike itself you should do proper stretches.

This should prevent tears to tendons – you really don’t want a damaged tendon on the hill!

Hamstring stretch

In a seated position, extend one leg to a fully straight position.

Lean your body towards that foot.

Hold for 15 seconds.

Repeat with other leg.

Do this three times.

Iliotibial Band (ITB) Stretch

Standing upright, place your right leg behind your left leg.

Lean to your left and hold position for 15 seconds.

Repeat for each leg three times.

Gym Preparation

As with all joints in your body, you can lessen the impact and pressures on the knees by strengthening the muscles connected to them.

This could well mean an hour in the gym three times a week.

There are a number of exercises recommended for long term knee health.

What follows is only the leg work you should do.

Remember your core and upper body need work as well for carrying your pack and not hurting other areas of your body!

#1 Lunges

Both feet pointed forward, take a step forward and bend your front knee, stretching your rear knee.

You can do this with 10kg or more of extra weight if you want to add to the exertion, though whatever is comfortable to start.

You should try to do 15 per leg in three to four circuits

#2 Squats

With your feet level with your shoulders and your feet/knees pointed slightly outward, lower your body down until your knees are at right angles.

Raise your body again.

Keep your back straight and outstretch your arms for balance.

Can you do 15 per circuit in 3-4 circuits?

To add to the effect you can hold a 10-20kg weight as you do this.

#3 Single Leg Squats

Lifting one foot 10-15cm, lift and lower your body on one foot.

Balance can be tricky but this will certainly work on the leg strength!

Try 10 per foot X4

#4 Knee bends

With your back 30cm from a wall, lower your body to a seated position and lean against the wall.

The next bit is optional:

Hold yourself in position for a minute – the pain can be quite special but is good pain!

Raise your body up to the full standing position.

If bending and raising without the pause, do 10 reps per circuit.

If holding in position, one full rep will do X4 circuits.

#5 Steps

Choose a step of height around 20-30cm.

Either running or walking, take 15-20 step ups per leg with the stepping leg straight before lowering yourself back with the other leg down first.

Can you do four circuits?

#6 Cross trainer or exercise bike

Not everyone has this at home, so you would go to the gym for this.

It can boost your leg strength significantly.

You should have some resistance on the machine to build up leg strength.

Can you do 15 minutes at a decent resistance (say a 10%-15% equivalent gradient)?

This will significantly build leg strength and speed on the hill.

Build Your Distances Up

The gym work above is about strength.

This is all about stamina.

After an autumn and winter hiding from the weather, eating fatty food and cake you’re going to be in no fit state to hike 60 miles across Snowdonia in March!

This is why you should maintain your fitness levels throughout the year if possible with regular shorter walks when the weather permits and your gym training regime.

If new to hiking and walking, be sensible about when your first big hike will be.

Where you are very unfit and want to do a big walk that year, how about aiming for a big hike in late August or early September?

Starting in January with 5-7 mile walks every weekend you should build your length and difficulty throughout the year.

With nine months of preparation, building muscle strength and stamina, you could end up doing a multi-day hike of 10-plus miles a day quite easily.

Start out with a lighter pack if you can – winter clothes necessary in January will be lighter than the water you need in mid summer.

Through the walking you’re not only building fitness but can learn the different techniques that come with walking such as pole use and pain management.

This will include the pole use and getting used to carrying your pack the right way as well as the other skills like navigation and reading the weather on the hill.

The Right Kit

Descending steep slopes can put as much as eight times the force of your bodyweight on your knees.

If you are 80kg that means over half a tonne of force is going on each knee in the descent!

Hiking Poles

Get used to using hiking poles.

It may look an oddity on the hill carrying two poles with you everywhere but where it comes to descending these can be invaluable.

You should place your pole down before you take a step down the slope.

By sharing your weight between the pole and your knees, so you will reduce the impact of your descent on your knees.

Do look at our recent blog on using hiking poles for more information.

Decent Hiking Boots

Hiking boots should provide a certain amount of ankle support.

On a decent day in the hills your feet, ankles and knees will have a lot of demands put upon them.

Once more, the foot, ankle, knee and hip work in concert.

If you don’t look after one part of your leg you could end up hurting others.

You may find that instead of your ankle giving you a nasty message due to lack of proper support, your knee might end up tweaked – not a good way to end the day!


Like boots, this isn’t directly related to your knees but can have an impact.

If you are distributing the load to the parts of you then the forces that will ultimately reach your knees will be in the right locus, minimising the impact.

As with all your kit, don’t be afraid of spending a few quid on a decent backpack with hip support.

Remember, you want to be carrying more weight with your hips and the shoulder straps should be there to balance the load.


Carry some over the counter NSAID painkiller pills in your pack.

Ibuprofen, paracetamol and aspirin can all ease pains as you are hiking.

They tackle inflammation such as DOMS and any twinges of tendonitis.

The legal cannabis derivative CBD is also an anti-inflammatory and this isn’t known to have the same side effects of taking too much that come with the ibuprofen, paracetamol or aspirin.

As an alternative remedy, it is worth considering.

Codeine and other opioid medications work in a different way to the three pharmaceuticals above, essentially telling the body you are not feeling pain as opposed to treating the cause of pain itself.

Pain is a good sensation to have as it tells you there is a problem and allows you to assess it.

That’s why we’d not recommend even over the counter opioid pills unless your doctor prescribes them for other pain.

Knee Brace

Do not wear this just in case you will be injured.

Only have one to hand if you hurt yourself.

If you are prone to a tweaked knee, still don’t wear one until you get a twinge.


Knee braces prevent the muscles from working to support the knee as they should.

They can be counterproductive.

In theory you could end up causing knee problems by wearing one unnecessarily.

Prevention is better than cure

Being out in the wilderness is a freedom but with that comes a level of respect for that freedom.

If you are properly prepared for a big hike, your knees should be one of the best prepared parts of you.

They should have the muscles around them that can both minimise the impact on them from the forces you subject them to.

The tendons and muscles will be supple and capable of big distances.

That comes from pushing yourself for sometimes months to get to the fitness level you need.

You will use the right kit to both load and support your body the right way and minimise the impact of the loads on your knees as you climb and descend.

Anyone, Himalayan expert or country rambler alike could take a bad step on the hill and need to be carried off thanks to a torn ligament but while both will feel awkward, that’s better than having severe tendonitis and DOMS – both easily preventable!

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