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After 35 years of wearing a heavy backpack into remote areas, slipping and sliding up and down steep terrain in search of wonder and solitude, I've noticed that more and more sunsets are accompanied by achy knees. Sometimes they start hurting even before day's end.
Diagnosis: worn out parts. Cause: abuse and overuse. Treatment: stop backpacking?
Not just yet.
If, like me, you're a victim of nagging pain there are a host of preventative measures-strengthening exercises, orthotics in your hiking boots, trekking poles, knee braces, stretching, massage-you should discuss with your doctor.
But what if you're strolling blissfully along the trail and suddenly your minor discomfort turns into serious pain? Or you have no history of problems, but a knee buckles when you slip on a slick rock in a stream, or you come down wrong when stepping off a log. Whether you have weak or sound-as-a-dollar knees, there are a lot of ways to injure this most important joint. With some basic knee knowledge under your hipbelt, you'll be able to make it back to the trailhead and head off long-term damage.
First, a brief physiology lesson. It's important, so look at the illustration below and get to know your knees.
Now you'd think with all the cartilage, ligaments, and muscles, your knees would be super sturdy and last forever. But the fact is, of your skeletal system's 187 bone-to-bone connections, none is more vulnerable to wear and tear, or the root cause of as many chronic problems, as the knee. Part of the reason is that the fittings are only moderately snug, and with the extreme demands we put on this joint while hiking, pain is often the result. When discomfort does occur, it usually falls into one of the following categories.
Sprain: If you twist, fall, or bend the wrong way, you can partially or totally sever a ligament, creating this nasty condition. If the force is strong enough, cartilage can be damaged.
Strain: When you use and abuse the muscles around the knee too much, they tear and create this condition as well as a lot of discomfort. Muscles most often strain where they attach to the knee.
Tendinitis: This is an inflamma-
tion of the tendons, usually triggered by overuse.
Ilio-tibial band syndrome: When muscles aren't used to the stress
that accompanies hiking uphill, this condition can arise-especially when you add the weight of a pack into
Patellar compression syndrome: When you've done too much walking, especially downhill, and feel a dull, constant, nagging ache behind your kneecap, you may have this condition.
Chondromalacia of the patella: If the pain never goes away, the cartilage under the kneecap may be disintegrating, a condition often triggered by a past injury or overuse. The cartilage becomes frayed and eroded but interestingly enough, can't emit pain because it has no nerve endings; the discomfort is from the inflamed tissue around the cartilage.
When your knee creates problems in the backcountry, you have to determine how to deal with the pain and whether the situation is serious enough to require evacuation. Most injuries can be stabilized with a splint so you can hobble out with no fear of further damage.
If you heard a popping or other strange noise when the injury occurred, you probably have a serious injury. Wait for help to arrive because you should be carried out.
If there was no obvious noise:
1. Inspect both knees. Do they look the same? If so, rest a while and you'll probably be able to apply a splint and walk out. If there's swelling, discoloration, or an obvious deformity, such as your kneecap in the wrong place, you have a severe injury. In fact, the more the knee swells, or the greater the discoloration, the faster you need medical assistance. Splint it and send someone for help.
2. Gently touch the hurt knee. If there are no immediately recognizable signs of how severe the problem is, try to determine the specific points of pain. For example, does it hurt over the ligaments or tendons? How about when you push down on the kneecap, or wiggle it from side to side? The more specific and intense the pain, the greater the chances of serious damage. Splint and wait for help.
3. Check the range of motion. Can you flex and extend the knee through its full range of motion? If so, that's a good sign that you can probably apply a splint and head out. On the other hand, if it locks up or is too painful to move past a certain point-lost its range of motion, in other words-splint and prepare to be carried out.
4. Test for function. If none of the above apply and the pain isn't too intense, wait one hour, then carefully see if you can stand and put some pressure on the sore knee. Can you walk, do halfway deep-knee bends, or gently bounce up and down? If so, use your best judgment and decide whether you should keep hiking or head back to the trailhead.
Besides splinting, RICE helps speed healing and ease discomfort:
- Rest: Stay off the joint.
- Ice: Apply the coldest thing you have to the knee. Cold water, ice, snow, or a chemical cold pack will work. Never place a frozen item directly on skin; instead wrap it in a bandanna or T-shirt.
- Compression: Wrap the knee in an elastic wrap, but not too tightly.
- Elevation: Keep the knee higher than your heart.
RICE should be applied for 20 to 30 minutes three to four times a day until the pain subsides. Even if the injury doesn't require an evacuation, you'll probably need to stay put for a day or two before heading back to the trailhead.
Over-the-counter anti-inflammatory drugs like ibuprofen help ease pain and speed healing. Take with plenty of food and water.