Mt. hiking for "used" knees??

[jjo]

Looking for day hikes in the Whites for a trip later this year. (Probably late Summer/early Fall). Now living in the Midwest (Ugh). Would like a relatively easy hike up (knee friendly) and ideally, the Alpine experience above. I'm getting realistic at my advanced age (60's) and purchased trekking poles last week to help the planning effort. Did Caps Ridge to Jeff a few years ago (loved it!!)and the last few years have been doing the safer hikes like Willard, Sugarloaves, Wesh-Dickey etc. Are there any other gems out there for a shorter day hike w the mountain feeling/experience?? I've been considering Ike via Edmonds but wonder if this is too much for this fading geezer?? Still love the Whites and would love your ideas. Thanks...Jerry

 

[SherpaKroto]

Ike via Edmands is a good choice. You could also consider Jackson, Pierce, a hike to Tuckerman's Ravine, Cardigan (not Carrigain), Monadnock, Kearsarge South, Imp Face, Carter Hut, Zeacliff, and Moosilauke (a bit tougher, but Gorge Brook/Carriage Road is fairly easy on the knees). These will all give you excellent views for relatively modest effort.

I'm sure others have many more favorites to add!

 

[Gris]

Shelburne-Moriah...?

 

[DougPaul]

The following are skiable (by non-extreme skiers), so the routes shouldn't be too hard on the knees going down:

Garfield via Garfield Tr. The trail follows an old road for most of the way. Great views from summit. Used to have a firetower.

Moosilauke: Also very nice views. Ski routes: Gorge Brook Tr, Snapper Tr, or the Carriage Rd (from Breezy Point).

Doug

 

[darren]

Everyone else has great suggestions so far, so I will just throw this out there. I will probably get a bunch of guff for it, but here goes nothing. If your knees are a real problem but you still want to get above treeline, drive up Washington and do a day hike from there. You can get a long way down the ridge and back with out too much vert.

But....if you did Caps Ridge last year, then you should have no problem going up Edmonds to Ike or over to Franklin/Monroe. Edmonds is a lot easier on the knees than Caps Ridge.

I've always found going down much harder on the knees than going up. Plan your routes with that in mind. Go up the steep stuff like the Ammonoosuc and going down easier grades like Edmonds or Jewell.

You can pretty much bet that if you dont do too much hiking with lots of vert (which would be tough in N. Ill.) and then you jump right into the Presies, your knees will be really unhappy. You really need to build up the muscles around the knees to keep them stable. Try cycling to keep your knees in shape.

- darren

 

[Quietman]

My 73 yr young father with one replaced knee made it up the Benton trail on Moosilauke last year. He has flexibility issues with the knee and we found this trail was well maintained and fairly easy on the legs. The Kinsman Mountain Trail To N. Kinsman was also relitively leg friendly. But both of these are 7.5 mile round trips with approx. 3,000 elevation gain.
The trip up Mt. Jackson is shorter with less elevation gain and great views.

 

[DougPaul]

Having had knee problems in my past, a couple of suggestions:

* If the footing is good, one can back down. This uses the uphill muscles and is very easy on the knees. With a very small amount of practice one can move quite quickly this way. Try it and see if it helps you.

* Absorbing energy in the muscles (eccentric contractions) is trained somewhat independently of producing energy (concentric contractions). My favorite method of training the eccentric contractions is to walk up and down a small hill (200 ft) near my house with a 30 or 45 lb pack on my back (start with no weight and build up). Short enough that I have no problems, but long enough to build the muscles. In contrast, a bike or stair stepper only trains the concentric contractions.

* Poles can help too.

Doug

 

[jjo]

[
But....if you did Caps Ridge last year, then you should have no problem going up Edmonds to Ike or over to Franklin/Monroe. Edmonds is a lot easier on the knees than Caps Ridge. - darren[/QUOTE]
Thanks, Darren. good ideas. I did Caps Ridge (4 or 5 times before that)about 4 years ago (when I was young ). The other "easier" hikes I've done the last 2-3 years. And the trekking poles should help plus I've been doing lots of SLR knee exercises . Ah, The joys of being over 30 . Enjoy those hills aggressively while you can. Thanks to all for great ideas so far. I'll keep reading here. Ike might be possible...Hmmm
Jerry

 

[audrey]

Nice avatar, jjo! Other hikes: Cherry Mountain (there's just a short scramble at the top), Nancy and Norcross Ponds, Sandwich via Drake's Brook, Carr Mt.

I don't mean to give unwanted advice, but have you tried glucosamine? It's gone mainstream. My doctor told me to stay on it even though it doesn't seem to be having as much effect as it did years ago. I got three years completely pain free out of it.

 

[pedxing]

I second the Glucosamine. My Vet had me give my dog Glucosamine and Condroitin tabs, and flax seed oil for her joint problems. After a month, the improvement was so obvious that, after some research, I started taking them too.

After a painful time coming down Tuckerman's my wife started wearing knee braces one hikes. She feels they are helpful for reducing the stress on her knees.

 

[dave.m]

JJO,

1) A variant on Darren's idea would be to hike up Washington then come down in one of the vans on the autoroad or the Cog Railroad. I'm assuming that it's the going down that gits ya, no?

2) I also assume that you've had the knees looked by a sports related ortho? I've been dealing with several different knee problems for years now and can attest to the fact that how you need to deal differently with different knees problems. The hyper-mobility of my left patella (it would pop to the side of my knee, causing the knee to dislocate) was first controlled with excercises targeting the VMO (bottom inside of the quad) and a very specific brace that holds the knee cap in place. At this point, I just rely on VMO strengthening. My patellar pain in the right knee requires VMO strengthening and constant hamstring stretching. And the deep grinding pain in my right cartilledge requires a brace to correct the increasing bow-leggedness on that side. I look like a stinking cyborg at this point as I now own 3, count 'em, 3 different sport specific braces for 3 different joints. (sigh) Point here is you really need to zero in on what the specific cause for your knee pain is to figure out how to manage it on the trail.

3) Generally speaking, if you are going to hammer your knees, it is better to minimize damage by keeping swelling down while you are hammering. Take your preferred anti-inflamitory a good 1/2 hour before heading down. (aspirin, ibuprophen)

4) I strongly, strongly prefer thick rubber tip on my hikiing poles for the Whites. They offer much, much better grip imo than bare metal tips. IMO, they are a must if you want to take the stress off your knees with poles. Also, I think it is important to use the straps of the poles correctly (straps under your thumbs) like a xc skier to support your body weight going down. Also helps to have a fat topped grip that you can hold like a bull fighter in the palm of your hand while resting your full weight on the top of the pole. NOTE: it took me about a full season of hiking to begin to use the poles effectively. Now, I can't hike comfortably without them.

Hope this is helpful,

 

[jjo]

You're right...

Thanks guys. More good info. I have been taking the Glucosomine/Chron for about 2 years now. It helps a lot! About 6 months ago, I ran out and stopped taking. Couldn't even walk. So I'm convinced. Great stuff! Still take 2 triple strength a day. But back to hiking. Been using the new trekking poles the last few days and they seem to help. Next week, I'll try a longer day hike (watch out Coyotes-i have pepper spray) and give them a test. BTW, what height do you adjust your poles? Thanks much. Jerry

 

[DougPaul]

BTW, what height do you adjust your poles?

Varies. On the level, about armpit length, uphill, a little shorter; downhill, a little longer; extended traverse, one longer, one shorter.

Other factors: are you walking in a ditch, crossing a stream on a log, etc.

Try various lengths and see what you are comfortable with. A vertical pole can help balance, but not propulsion. A tilted pole affects balance and can give propulsion. A skier's double-pole is a very powerful move to propell you forward--use your abdominals.

Use the straps the way an XC skier would (takes the stress off the hand and fingers, also absorbs shock).

Sometimes the poles are in the way, such as when you need your hands on a steep spot. Hang them from your arm for a very short spot, collapse them and hang them from your arm for a medium spot, collapse and stow on pack for a long stretch.

Lots of good info at http://www.dundee.ac.uk/~pjclinch/poles.htm.

Doug

 

[jjo]

JJO,

[I]Point here is you really need to zero in on what the specific cause for your knee pain is to figure out how to manage it on the trail.[/I]

Dave thanks for your thoughts and insight. I had a MRI about a year ago and ortho surgeon said its chondromalacia. He indicated surgery woiuld probably not be necessary and Phys therapy was prescribed. Being that some of the exercises aggravated the sciatic nerve, we eased off. Recently though, i went back on SLR's aggressively which seems to help but I still get an occassional freeze-up(locking, pain in knee area) when I use extensively. Thats why I'm taking a cautious approach on the mountain hiking I plan to do later this year. Im also hoping the poles will help. Thanks again for your tips. You've been there....

 

[DougPaul]

I had a MRI about a year ago and ortho surgeon said its chondromalacia.

Ahh, chondromalacia, my specialty (at least as a victim).

I was shut down for 10 yrs by same. Now have it totally beaten.

The standard advice is to strengthen the quads. The exercises I was given (sitting knee extensions with weights on my foot) damaged the knee faster than they delt with the problem and I had to devise my own exercises.

What I chose was an exercise called "kneecap raising" (described in a medical book as a post-old-style-knee-surgery exercise). I realized that it would strengthen the quads with essentially _no_ wear and tear on the kneecap joint surfaces. A kneecap raise is very simple--it is an isometric contraction of the quads done with the the knee straight the entire time. I did it standing up. Standing on straight legs with my feet separated by a foot or so, I just attempted to hyper-straighten the leg using only the quadracep muscles. (After a bit of practice, I learned to simply think of contracting the quads.) 20 seconds on and 20 seconds off for 10 reps. Start gently (otherwise you can strain the quadraceps tendon) and build up slowly. Do both legs to stay balanced. (I did both legs simultaneously.) Do every other day (standard advice for power building exercies--every day can cause overtraining and weaken the muscles).

By varying one's standing position, one can emphasize the different quadracep musles. Bending forward "turns off" rectus femoris (which
also crosses the hip joint). Twisting one's body side-to-side (which rotates the legs relative to one's body) alternately emphasizes vastus lateralis and vastus medialis--both very important for stabilizing the the kneecap.

After I built a base of strength, I then started walking up and down small hills (200 ft--small enough not to cause pain, big enough for a workout), initially with no weight on my back and then building up to 45 lbs. I don't even think about the chondromalacia any more.

Also, once the quads were built up enough by the kneecap raises, I was able to do the sitting knee extensions with weights with no problems.

The entire process took 6mo to a year for me. I have no idea if you can do it faster.

At no time did the above procedure cause me any pain. If it hurts, you are probably doing something wrong. And if you do get pain a while after doing the exercises, ice it down ASAP to limit the swelling.

Standard disclaimer:
I have no fromal medical training, and of course one cannot properly treat medical problems over the web. There may be other causes of chondromalacia than weak or unbalanced quadraceps. I srongly suggest you check out the above procedure with your doctor or PT before trying it.

BTW, I have discussed this procedure with a friend orthopedic surgeon. He knew about it. My doctors did not. So it would seem that some do know and some do not...

Good luck with it,

Doug

 

[jjo]

I'm encouraged !!!

Ahh, chondromalacia, my specialty (at least as a victim).

I was shut down for 10 yrs by same. Now have it totally beaten
What I chose was an exercise called "kneecap raising" (described in a medical book as a post-old-style-knee-surgery exercise). I realized that it would strengthen the quads with essentially _no_ wear and tear on the kneecap joint surfaces. A kneecap raise is very simple--it is an isometric contraction of the quads done with the the knee straight the entire time.

Doug Thank you . You have also been there and beat it. I'm excited about trying your suggestions. But I'm confused over simple things (most articles assume you know) like where/what are the quads, what/where is VMO, etc, etc/. My initial exrecises prescribed in phys therapy also hurt more than they helped so for over a year, I've done essentially nothing. Recently, the straight leg raises appear to have helped. But I want to do better. I'm encouraged by your guidance as well as Dave M's. I'd love it if you could clarify the exercise approach for a hurting Dumbee like me. Thanks! I hope to see you guys at the top !! Gratefully, Jerry

 

[DougPaul]

jjo,

Let's take the details off-line. PM me with your email address so we can use _real_ email. If need be, we can talk by phone--some things just work better by voice.

Doug

Translations:
* quadraceps: a group of 4 muscles on the front of the thigh. They are prime movers for extending (straightening) the knee.
* patella: kneecap
* quadraceps tendon: connects between the bottom of quadraceps and the kneecap.
* patellar tendon: connects from patella (kneecap) to the front of the shin.
* rectus femoris: the top muscle of the quads: also crosses the hip joint (so it simultaneously extends the knee and flexes the hip)
* vastus medialis: quadraceps muscle that lies closest to the center plane of the body, prime mover for extending the knee
* vastus intermedius: quadraceps muscle that lies along the center of the thigh, prime mover for extending the knee
* vastus lateralis: quadraceps muscle that lies farthest from the center plane of the body, prime mover for extending the knee

The patella has a slightly conical rear surface that slides up and down in a shallow V-groove on the front of the knee joint. It is suspended between the patellar and quadraceps tendons. Since vastus medialis and vastus lateralis connect to the patella from different angles, weakness or imbalance can result in the patella tracking improperly. The wear and tear can result in (surprise!) chondromalacia patella.

I was told that this problem peaks in the college years and tends to diminsh afterward. When I asked my PA if that was because it was cured or because people just gave up, he gave me a rueful look, and said he suspected it was the latter... Well, no hiking makes Dougy a very unhappy boy, so I hung in there until I finally beat it. I can't guarantee that you can beat it, but it is worth a try.

One problem with this injury is that it is viewed as a minor injury that cannot be cured with a dramatic flash of a scalpel. The result is that the suffers can fall between the cracks. The injury may be minor, but it can cause major damage to a hiking lifestyle...

Try searching on terms such as "chondromalacia patella", "kinesiology of the knee", and the muscle names. You should be able to find drawings of the structure of the knee (you shouldn't need the internal structure for this problem) and other info on the problem. Needless to say, keep the 100lb grain of salt handy for any commercial "information".

Doug

 

[jjo]

Doug

Doug...Thanks. Sent you a PM and an email. The address is not registering in the PM. Jerry

 

[dave.m]

But I'm confused over simple things (most articles assume you know) like where/what are the quads, what/where is VMO, etc, etc/. My initial exrecises prescribed in phys therapy also hurt more than they helped so for over a year, I've done essentially nothing. Recently, the straight leg raises appear to have helped. But I want to do better.

Jerry,

I can't emphasize enough how important it is for you to be working on excercises in conjunction with a good sports physical therapists. We can encourage and empathize since we've been there. But, each case is different and it is very possible to do more damage than good by doing what others have done.

Couple of further thoughts....
1) Good PT are really, really hard to find, ime. Ask around and don't be bashful. In particular, ask coaches of local teams who they use and why and try to find somebody who specializes in the knee.

2) IME, there is bad pain and there is pain you have to fight through. For me (this might not be the case for you, consult your own PT), I had to accept some knee pain to do the excercises to strengthen my VMO. Some pain means STOP. Other pain is a cost of business.

3) To find your VMO, straighten you leg, tense your quad and put your fingers on your kneecap. Now, move your hand to the inner edge of the knee cap. Now come up towards your hip until you hit the first bunch of muscle. The VMO is the part of the quad that attaches to the inner side of the knee cap. When tensed (and big) it can look like a second kneecap!

4) Straight legged leg raises are a classic beginning VMO excercise. Once you get past that, you will likely need to be on a weight machine to do seated leg raises (consult your PT!!). My understanding is that the VMO only really engages during the last 10 - 15 degrees of motion as measured from your leg being totally straight. This means that if you get knee pain from doing the full range of motion for the seated leg raise, you can still work the VMO by only doing the top 10-15 degrees of the range of motion. Some machines allow you to set this. Ask the instructor at the gym (or your PT) how to isolate the VMO when doing this excercise.

5) For my patelar tracking problems, this is the #1 thing for me to keep doing. So much so, I spent $100 and bought a used weight gym for my basement!

 

[DougPaul]

A point that I made in private communication with jjo that might be worth mentioning:

A cause-and-effect chain that can cause chondromalacia patella:
1. overpronation (of the foot)--the arch collapses under pressure
2. The foot rotates inward
3. The lower leg rotates inward.
4. and pulls the kneecap out of line

Orthodics or insoles are one method of treatment.