Updated on July 23, 2020

Note: If knee pain or swelling is the consequence of twisting or impact, or if it lasts more than 48 hours, or if you feel cracking or popping sensations or lateral instability, see a doctor.

If you have lasting knee pain, you should have it examined by a doctor to check for possible damage to tendons, ligaments, or cartilage. The knee is one of the most commonly injured joints, especially in people who were involved in athletics in their youth, as old knee injuries can return to cause discomfort later in life.

You’ll respond to knee pain the same way you would to most joint pain. The short-term response is rest, cold packs, anti-inflammatories, and controlled movement. 

In the longer term, stretching exercises will improve your range of motion and strength training to build muscles below and above the knee will provide support. Always be aware that problems originating in your hips can place strain on your knees. Include the hips in any stretching and strength training program designed to manage knee pain.

Knee replacement is a major surgery that requires extended rehabilitation, but it doesn’t mean you can’t hike again. Many full and partial knee replacement patients have gone on to many years of happy, healthy, and satisfying hiking. 

As with hip replacement, you’ll need to complete your initial rehabilitation program and ask your doctor and physical therapist for advice on preparing to hike. You’ll have to start slow and carry minimal loads, but with persistence and effort, you can restore full hiking strength.

When you’re on the trail, remember that hiking downhill puts exceptional loads on the knee. The term “hiker’s knee” refers specifically to knee strain derived from walking down steep hills, especially under load. 

If you’re experiencing knee issues or recovering from knee surgery, you will probably want to avoid trails with steep downhill sections until you are fully confident in your knees.

You can protect your knees on downhill sections with good downhill walking technique. Avoid fully extending the knee and especially avoid hitting the ground with a fully extended knee, which transmits shock directly to the knee joint. 

Walk with slightly bent knees on downhill sections, and try to put your feet on the ground with a heel-to-toe movement that cushions the knee. Keep a slow pace and use switchbacks when possible to control the gradient.

If you have knee problems or want to avoid them, consider hiking with a good quality knee brace. You may also want to consider hiking with trekking poles, as they limit the impact of downhill walking on your knees and transfer a lot of the weight into your arms, protecting your knees from becoming even more injured or sore.

Make sure you’re wearing proper footwear with solid ankle support: twisting in the ankles places additional pressure on the knees. Look for well-padded soles and use hiking poles to improve your stability and transfer some of your weight to your arms and shoulders.

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