4 Reasons Why Your Knee Hurts When Hiking Downhill

Photo by Holly Mandarich on Unsplash

The weather is finally getting better and I have been doing more hiking with my new puppy Josie. As I was hiking I was thinking about some recent complaints from my patients about their knees hurting on the way down. For those of you with knee pain, have you ever wondered why does the knee hurt more on the way down than the way up? Well, I’m going to tell you some of the common reasons why this may be happening to you.

I want you to think of the knee as a very simple joint which is stuck between two complicated ones, specifically your hip and your ankle. The mechanics of the knee are quite simple, it bends and it extends. It also rotates very so slightly during those movements. This rotation if not properly controlled can cause pain in the knee joint. Let me explain.
The ankle and the hip have a lot of mobility and can move in a lot of different directions. Whenever there is something wacky going on in the hip or the ankle joint, your knee will suffer.

Whenever I work with patients who have achy knees, I look at the root cause of what brought it on. A lot of times knee pain is due to weakness of the hip, in particular, the weakness of the gluteus medius (the top muscle of your buttock). This muscle controls the angle of your femur (the leg bone). So whenever there is weakness of the gluteus medius the femur will go slightly in and cause more stress on the inside of the knee. This stress will manifest itself as pain on the inside or the outside of your knee.

Another common offender is the quadriceps muscle group located on the front of your thigh. When this group of muscles shortens (when you are straightening your knee) it is called concentric contraction. When this group of muscles lengthens (when you are bending the knee) it is called eccentric contraction. Now think of walking downhill and making a step down. The muscle on the front of your thigh has to lengthen in order to lower the weight of your body down. This movement has to be done with what we call eccentric control. A lot of time, when the eccentric control of the quadriceps is weak, the angle of patella (the little tiny bone on the front of your knee) will be pulled to the side at a wrong angle and cause you knee pain.

Now let’s look at your ankle. It is pretty common for ankles to be stiff, especially when you never stretch and have a sit down job, run, hike, bike, or wear heels. Sounds familiar? Most of my patients with knee problems have tight calves. Tight calves will make your ankle stiff. When you are walking downhill, there needs to be a certain mobility of the ankle. If the ankle is stiff, the knee will compensate by bending at a wrong angle and cause pain.

If you want to get really nerdy, as I always do, I always look at the pelvis. All too often, pelvis is misaligned which may make one leg longer than the other. Guess what? We have an instinct to have our eyes on the horizon. So to compensate for the difference in the legs, you are going to increase the angle of the femur, thus causing yourself knee pain.

The bottom line is this. Knee pain is a result of some kind of dysfunction that is happening in the hip, ankle, pelvis and the surrounding muscles. Recently I treated a lady who came to me because her knee was hurting during hiking. “I’ve been hiking for years, I don’t know what’s wrong. It must be my age.” – she said.

After an exam we determined that there were several factors causing her knee pain. It turned out that 10 years ago she had a bad ankle sprain. She never got physical therapy for it, or knew what to do about it. After several sessions of manual work on her ankle and hip and teaching her how to move correctly with Pilates exercises, she is now back to hiking and wants to climb a fourteener this summer.
Knee pain is very easily treated but you always should look at other factors that may be causing it. We take care of a lot of knee injuries at Healing in Motion Physical Therapy. I put together a simple guide for my patients to give the some information on what they can do about their knee pain. You can download it HERE.

If you want to talk to us about your particular situation and discuss this further, simply fill out the form HERE or call us at (303)669-0941.

Best wishes and happy hiking.

Elena