Hiking with Knee Pain: What Physical Therapists Recommend If Hiking Hurts Your Knees

There’s nothing quite like hiking to get your blood pumping and your heart singing. The feeling of sunshine on your face, the sound of the trees rustling, and the sensation of trail under your feet can do both your mind and body so much good. In fact, hiking has been shown to lower your blood pressure, increase your strength, improve your focus, and maybe even enhance your immune system, according to a 2018 review published in the American Journal of Lifestyle Medicine.

“Hiking is a great activity for anyone, because it’s easily accessible: You just have to put on your shoes and go,” says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. 

But what if your knee pain is getting in the way of your hiking? Or if hiking tends to trigger some aches and pains in your knees? It’s common for hiking to sometimes cause knee pain, since you’re walking on an incline or decline and may be doing a little more activity than what your body is used to. The good news is that hiking can be modified for all ability levels, Dr. Kimbrough notes.

So what can you do if you love to hike and want to keep at it? First: Don’t let a little pain deter you. There’s a lot you can do to help reduce knee pain while hiking, including exercises before and after your hike, to help your knees feel stronger and steadier, says Dr. Kimbrough. In fact, staying active — which includes hiking — while you’re still coping with knee pain can help to reduce your pain. 

Here, learn more tips from our physical therapists about how to make hiking with knee pain work for you.

What Causes Knee Pain When Hiking?

You can develop knee pain when hiking even if you’re a seasoned hiker and are in pretty good shape. “Like any activity, you can develop knee pain from the repetitive motion of hiking, whether you’re taking one step in front of another on flat ground, or walking up or down a mountain,” points out Dr. Kimbrough. But here are some other factors that may play a role:

You ramp up hiking very quickly. If you increase your distance too fast, or abruptly switch terrain, your knees may need time to adjust. “If your body isn’t used to it, and you switch your hiking routine around, it takes some getting used to,” points out Dr. Kimbrough. 

You have patellofemoral pain. Sometimes known as hiker’s knee, this is pain that occurs in the front of your knee, or behind your kneecap that can feel worse when you squat, run, or climb. It’s usually due to weak muscles, especially your quads and glutes, and/or tight hamstrings and quads, says Dr. Kimbrough. 

You have other knee conditions. If you already have knee bursitis — inflammation of the cushiony sacs around your knee joint — or tendinitis, hiking can make symptoms worse, says Dr. Kimbrough. The same is true if you’re starting to develop knee arthritis. 

“If you have any of these conditions, it doesn’t mean you shouldn’t enjoy hiking — you just may need to be more conservative, such as going for shorter or gentler hikes so you give your body the chance to build up resilience,” stresses Dr. Kimbrough. 

Hiking and Knee Pain: A Hinge Health Perspective

When our Hinge Health physical therapists hear that members are hiking despite having some knee pain, it’s great news. That’s because one of our key messages is “the doing is the fixing.” In other words, doing the activity you love, even if you feel some discomfort, can actually help your body get stronger and more resilient and ultimately have less pain. 

It’s a common misconception that you should wait until you’re completely “better” to resume doing certain hobbies and activities. When you have knee pain (especially persistent knee pain), continuing or resuming movement is a key part of your treatment. This does not mean you ignore the pain, and push through it. Rather, it’s about nudging into the discomfort by modifying the activities you do. Not only does it help your body get stronger and better able to tolerate the activity, it also teaches an oversensitive pain system that your body is safe and capable. Hiking and doing other pleasurable activities also help address other factors that can influence pain, such as stress and anxiety.

How to Prevent Knee Pain When Hiking

You don’t have to swear off hiking if you’ve got some knee pain. In general, if you just have some mild aches, pains, or soreness, it’s okay to keep trekking, says Dr. Kimbrough. If you develop sharp, shooting knee pain, then you may need to adjust and give yourself a short break. Try to find other gentle movement that works for you until the pain eases and you can begin hiking again. And, as always, be sure to call your doctor if the intense discomfort persists.

Otherwise, whatever factors may be contributing to your knee pain, there are solutions that will work for you.

• Start off slow. “There are three factors to think about when you plan a hike: distance, elevation change, and terrain,” says Dr. Kimbrough. “Focus on just one of those, versus increasing all three at the same time.”

• Warm up and cool down. It’s normal to want to set off on your hike as soon as you hit the trail head. But do a dynamic warm-up before you begin to help ease your muscles into movement, advises Dr. Kimbrough. (See some strengthening and stretching exercises in the next section.) The same holds true once you’ve finished. Instead of just hopping in the car and heading home, walk around a bit and do some gentle stretches to increase blood flow to your knee area.

• Use trekking poles. These can be useful tools to take some of the load off of your knees as you go up and down hills. A 2020 review published in the journal Wilderness and Environmental Medicine found that they lessen the stress on your lower body (including your knee joints) and improve balance and stability. It’s best to use them in both hands, advises Dr. Kimbrough, but if you only have one, use it in the hand that’s opposite that of the knee that hurts. Your pole should also be tall enough that your elbow is at a 90-degree angle while you hike on flat terrain, adds Dr. Kimbrough.

• Wear supportive footwear. If you’re going on a simple hike, on relatively smooth terrain, then your regular sneakers are fine, says Dr. Kimbrough. But on more rugged terrain, you’ll want an actual hiking boot, which provides solid ankle support, she stresses. This in turn may help lessen strain on your knee joint. You can also try an over-the-counter orthotic, especially if you have flat feet. This can lead you to overpronate, which puts more stress on your knees, notes Dr. Kimbrough.

Consider a knee brace. If you already have knee pain, a brace may provide some extra support to help you through your hike.

“It’s very similar to stepping upstairs or over rocks when you hike,” explains Dr. Kimbrough. “This exercise will help to build up more hip strength, and will help to support your knees during hikes.”

Hinge Health physical therapists recommend these exercises to help prevent knee pain when hiking. You can do them to help prevent knee pain and to cope with knee pain after hiking.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Stretch and Savor 

Stop and savor the view. Once you get to the top of the mountain (or a scenic spot on your trail), take advantage of that time to sit, have a snack, refuel on water, and enjoy the view. But also use that time to do some of the stretches mentioned above, says Dr. Kimbrough. “It lengthens your muscles out, so that they are better able to handle the hike back down,” she points out. Remember, you’re putting just as much stress — and sometimes even more — on your knees as you go downhill. It’s good to give those muscles a bit of a break.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because the Hinge Health program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Mitten, D., Overholt, J. R., Haynes, F. I., D’Amore, C. C., & Ady, J. C. (2016). Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits. American Journal of Lifestyle Medicine, 12(4), 302–310. doi.org/10.1177/1559827616658229

2. Bottoni, G., Heinrich, D., Kofler, P., Hasler, M., & Nachbauer, W. (2015). The Effect of Uphill and Downhill Walking on Joint-Position Sense: A Study on Healthy Knees. Journal of Sport Rehabilitation, 24(4), 349–352. doi:10.1123/jsr.2014-0192

3. Hawke, A. L., & Jensen, R. L. (2020). Are Trekking Poles Helping or Hindering Your Hiking Experience? A Review. Wilderness & Environmental Medicine, 31(4). doi:10.1016/j.wem.2020.06.009

4. ‌Barton, C., et al. (2013). Patellar Taping for Patellofemoral Pain: A Systematic Review and Meta-Analysis to Evaluate Clinical Outcomes and Biomechanical Mechanisms. British Journal of Sports Medicine. 2014;48:417-424.doi:10.1136/bjsports-2013-092437.

5. UptoDate: (2022, July). Patellofemoral Pain. https://www.uptodate.com/contents/patellofemoral-pain