Knee pain while hiking is just the worst. You’re outside in a beautiful place, tackling a route you’re excited about, enjoying the fresh air and the feeling of freedom. Birds are chirping, idyllic music is playing softly in the background, the squirrels are grinning contentedly…
And then, there it is. That familiar twinge. Maybe it gets worse when pounding downhill, or late in a long day, or under the weight of a heavier pack. Now you’re stepping gingerly and worried you might be doing permanent damage. What if it gets worse? What if you can’t ever hike again?! What if your KNEE EXPLODES right here in the middle of the trail?!!
Or is that just me?
How I Fixed My Own Knee Pain
It might be hard to tell from all the enthusiastic writing about hiking and bicycling on this site, but I struggled with knee pain during outdoor activities for many years. When I first started trail running, with the enthusiasm of a kid on Christmas morning and the body of an unathletic nerd who’d spent far too many hours sitting at a desk, knee pain was a constant companion.
Only through years of persistent work and patience have I gradually managed to strengthen, stretch, and cajole my body into a state of acceptable biomechanics. I still do a lot of maintenance work, and if I’m not careful I get those familiar twinges creeping back in at the worst possible times. This is why I never hit the trail, even still today, without a tool or two for managing emergency aches and pains.
How to ACTUALLY Fix Knee Pain
If you’ve read other posts about knee pain, this one might be different. I’m not going to suggest taking anti-inflammatory medication. I’m not going to recommend knee braces or fancy taping techniques. I’m not going to claim you must support your feet with heavy hiking boots (I actually think most hikers are better off moving to lighter shoes) or even that you need to use hiking poles (though they can help some people).
I’ve seen through experience that the human body can be changed dramatically through strength training and mobility work. For most people, things hurt because we’re moving wrong for various reasons. If we learn to move correctly, the way our tissues and joints are built for, things stop hurting. All the taping, braces, and supportive shoes often just mask the problem (if they help at all), leaving us with lingering frustration and vulnerability to injury.
So instead of suggesting more ways to mask the problem, I’m going to give you real solutions that will not only help you hike with less pain today, but will (if you do them regularly) lead to a world where you no longer need to even think about your knees because your body is so robust.
Quick and Easy Is Only a Temporary Solution
The real solution to knee pain – I hate to be the one to break it to you – is unfortunately not quick and easy. But when you’re several days from civilization and something starts to hurt, you want a fast solution. That’s why I’m going to give you my bag of tricks for quickly managing knee pain while hiking. These are things you can do literally ON the trail, or at your campsite, that can reduce your knee pain with five minutes of effort.
Here’s something I feel really strongly about though: these are NOT the only things you should be doing if you’re serious about fixing your knee pain. Real progress takes patience and time, and a commitment to doing preventative work instead of just reacting to pain when it happens. But these techniques are part of a system that can help you get outside and do what you love while also working on the problem in more sustainable long-term ways. One day I will write a post on those other ways, and it will be a big one! In the meantime, here we go with the “quick and easy” ways to fix knee pain while hiking.
But first, bear with me for just a second while I explain WHY these things will help your knee pain, so that you’ll know how to do them properly.
How Strength and Mobility Prevent Knee Pain While Hiking
First thing first: I’m not a doctor or any other medical professional. I don’t know why, exactly, your knees hurt. But I do know why mine hurt, or used to at least, and I know that the underlying causes are pretty common.
If you think you might have actual structural problems with your knees, it’s definitely worth seeing a medical professional. But if you suffer from plain old aches and pains that seem to come and go, especially if you have desk job syndrome like many of us weekend warriors, there’s a good chance we share a common cause of knee pain: weakness.
You see, our poor knees are in a really tough spot. They don’t really want to move in any direction except forward and back, yet they don’t get much say in the matter. The knees are really just stuck in the middle between two points with much more control: the feet and the hips. Healthy strong hips (and to some extent, feet) will keep our legs moving in healthy ways, without too much twisting or unbalanced pulling on one side or the other. But when our hips and feet get lazy, it’s often the knees that suffer first. I know, life can be so unfair.
To keep your knees happy during physical activity, you need three basic things:
Strength in the right places.
This often means your glutes, a.k.a butt, which is supposed to be one of the most powerful muscle groups in the body but is often weak from being sat on all day. That’s right, you probably have a lazy ass. A lazy ass allows your legs to wobble and rotate in ways they shouldn’t, stressing your knee joints in directions they weren’t mean to move. Lazy feet muscles can’t make up for this and sometimes get injured themselves while trying. A lazy core often comes with lazy glutes and definitely doesn’t help anything.
Mobility in the right places.
The strongest muscles in the world won’t save you if you can’t move smoothly through a normal walking stride. Tight muscles anywhere along the chain, from your hips down through your feet, can lead to forces in places and directions our bodies weren’t meant for. Our bodies are really creative and will find ways to carry us around, even if they have to move in subtly unnatural ways to do it. This is called a compensation pattern, and my body is the world champion of compensation patterns, which is actually a really bad thing.
Your brain carefully coordinating all that great strength and mobility.
Making a muscle strong without practicing coordination is like trying to pound a nail with a sledgehammer: a little dangerous, and also very inefficient. With better control and precision, you could get away with a much smaller hammer and probably have a better chance of accomplishing your goal. If you’ve trained your muscles to work properly in the positions you need them to – like a single leg stance for hikers and runners – you can be athletic and pain-free without as much overall muscle mass.
Ok, so with that basic vocabulary let’s move on to the actual tips for dealing with knee pain on the trail:
Mini Band Glute Exercises
I’m throwing this one at you first because a) if I could only pick one it would be this one, and b) I wanted to surprise you. You thought I was going to say you should stretch or do trail-side yoga? That comes later.
If your knees are cranky because your glutes are lazy, doing exercises with these elastic bands will help by kicking your glutes into high gear. Using your brain to will your glutes into action only goes so far; they need to actually be shown what to do with exercises, and they need to be reminded often. Once they start pulling their weight, there’s a good chance your form – your walking stride, your biomechanics – will change for the better and take the load off your knees.
Whenever I’m tackling a long hiking or bicycling trip, I always have one of these elastic bands in my pack. These aren’t those wimpy little rehab bands; these things are the real deal. I use the heaviest (black) resistance, but someone starting out might get better results with the blue or even green; going too heavy does more harm than good until you’ve learned to activate the right muscles. They weigh very little and take up almost no room (good news for my fellow lightweight hiking enthusiasts).
What do you do with this stretchy band? Lots of things! The goal is to target the muscles in your butt (gluteus maximus) and the back/side area of your hips (gluteus medius). Generally these are the muscles that rotate your leg outwards and extend it backwards. Here are some exercises to get you started. Pick just a couple to start with; any of these are better than nothing. Over time, try them all and create your own mini-workout made up of those you feel most strongly in your glutes.
Caution: If you feel any of these exercises too much in the front/side area of your hip, you’re not activating the right muscles and may be making things worse. You should feel them more toward the back of your body. Experiment with different angles of hip flexion (the angle between your torso and upper leg) and try to imagine squeezing your glute muscles to initiate the movement.
When to do these exercises? As much as possible! I recommend doing them every morning before you start hiking, to get your body ready to use the right muscles even when you’re a little stiff and sore. Bonus: it’s a great way to warm up on cold mornings. You can also stop and do them throughout the day if you feel your glutes getting a little lazy or your knee pain flaring up. I used to do them before every big downhill, which was always when I had the hardest time stabilizing my hips and therefore the worst knee pain.
You knew it was coming. Who among us hasn’t tried to stretch a tight muscle into submission by the side of the trail?
The key to stretching is to do it right, otherwise it’s just a glorified snack break. Which stretches will work best depends on what’s tight for your specific body, and unfortunately that’s not always obvious. If in doubt, try to cover all the bases and see what feels like it makes the biggest difference in the freedom and smoothness of your movement.
How to Stretch
There’s some controversy over the best way to stretch, and whether it’s even effective, and I’m not about to wade into that mess here. What has always worked for me is to remember the purpose of stretching: to remind my brain that a particular muscle needs to relax and lengthen. This means breathing deeply and trying to imagine the muscle relaxing, not straining so hard that I tense up from pain.
It also means holding for at least thirty seconds, sometimes more, or ideally until I can actually feel the muscle relax. Effective stretching isn’t something to do while reading on your phone or talking to friends. It demands your full attention and the mental gymnastics of sitting with a slightly uncomfortable feeling without tensing up against it. It’s basically full-body meditation. So with that in mind…
Stretching Your Quads
Many people with knee pain instinctively want to stretch their quads, the big muscles running down the front of the thigh that extend the knee (like kicking a ball). This isn’t a bad place to start, but I’ve never found the typical standing quad stretch to be very effective. Instead, I prefer the couch stretch for its better leverage. If you didn’t bring a couch with you into the backcountry, you can mimic the effect using a carefully chosen tree or even – if your balance is good – by reaching both hands behind you and pulling your foot toward your butt.
Stretching Your Hamstrings
These are the big muscles on the back of your thighs, and they work to flex your knee (like pulling your heel up toward your butt). Strong hamstrings are a good thing, but when they got too tight they can pull on everything from your knees to your hips in weird ways. Touching your toes will stretch your hamstrings, but I find it hard to relax enough for an effective stretch in this position. Instead I use variations on sitting hamstring stretches: both legs out in front, and one leg at a time.
Stretching Your Adductors
These are the muscles of your inner thigh. They work to pull your leg inward toward the center line of your body, and they can get really tight and stiff without us really noticing because we’re so distracted by our tight quads and hamstrings, which are a bit easier to visualize. The seated straddle split stretch, leaning straight forward as well as toward each leg, is a great way to stretch them.
Stretching Your Glutes
I used to think only strong muscles got too tight, but I learned the hard way: just because your glutes are too weak doesn’t mean they’re too loose. Weak muscles sometimes get extra tight because they’re unprepared for the work they’re supposed to be doing, causing extra strain. So regardless of whether you think your glutes are strong or weak, it’s still a good idea to stretch them.
There are many ways and angles to stretch the muscles in this group. For many of us, just sitting cross-legged and leaning forward is a pretty good stretch. Repeat with your head leaning toward each knee, then switch the leg that’s on top and repeat.
Here are three other simple glute stretches that are easy enough to do while hiking or camping (you can even do the pretzel in your sleeping bag!).
Stretching Your Calves and Feet
Your calf muscles – the back of your lower leg – are closely integrated with your feet and the whole unit can get really tight from hiking. They work to extend your foot downward, as in pointing your toe, which means they especially get a workout while fighting against gravity on uphills. The deeper muscles also help stabilize your foot and ankle, which is a big job especially with a heavy pack.
You can stretch your calves and feet with this simple calf stretch (#1 and 2), or (even better in my experience) by wedging your toe up against something while your heel is on the ground and then leaning forward gradually (#4 in this same article). Try it with your knee bent as well as straight, since that stretches two different groups of muscles. Sometimes I even roll up a sock and wedge it under my big toe, elevating it more than the other toes, and stretch with bent knee to target those deep calf muscles in a slightly different way.
When To Stretch While Hiking
If it’s still warm enough when I get to camp, my favorite time to stretch is after finishing the day’s hike. I’ve even developed a sleeping bag stretching routine that I can do while staying cozy and warm if it’s cold out. I find that doing this routine consistently each night leaves me feeling much looser and better coordinated in the morning.
Another convenient stretch break is lunch time. Even just sitting cross-legged while you eat, or in a seated split, can help your body recover from the monotony of walking all darn day.
If pain does pop up mid-hike, a stretch break can help, but only if it’s long enough to really focus on. A quick standing quad stretch while your hiking partners continue ahead is unlikely to do much but leave you further behind. And if you’re going to stop for a real stretch break, I’d highly recommend adding some glute exercises (as described above) into the routine. It’s no use relaxing overworked muscles without also telling your body which other muscles need to step up and do their fair share.
The only time I don’t recommend stretching: when your body is cold. If it’s too chilly when you get to camp, you’re better off doing a few basic stretches in your sleeping bag, or even nothing at all. Holding deep static stretches when your muscles are cold is ineffective at best, and potentially injury-causing at worst.
Backcountry Massage Techniques
No, I don’t mean asking your hiking partner to give you a back rub, though that’s an option too.
I’m talking about some serious myofascial self release. This technique involves using carefully chosen massage tools – yes, I carry some of these into the backcountry even though I try to be a lightweight hiker – to manually loosen stubbornly tight muscles and connective tissue.
To do this, you will need to get down and roll around in the dirt. That’s part of the fun of backpacking and camping, right? A nice clean slab of granite can be a luxury option, but I have rolled around in all kinds of dirt to get this done and it is almost always worth it.
As with stretching, it’s important to approach this with full focus of your mind and body. The goal is to relax your tissues, not just roll around on something hard while grimacing in pain. When you find the spots that feel most potent, make an effort to breathe deeply and imagine the muscle relaxing all around the massage tool. Yes, sometimes it’s uncomfortable. Dealing with discomfort is a life skill. Consider it training.
Oh, and one more tip: As tempting as it may be, don’t do this on your oh-so-puncture-able inflatable sleeping pad. Please, learn from my mistakes.
Lacrosse Ball or Spikey Ball of Death
Believe it or not, my “spikey ball” is one of my favorite things. It lives in my pack when I’m on the road or trail, and it lives on my bedroom floor when I’m home. If you’re not quite ready for this level of
pain effectiveness you can start with a lacrosse ball (just pick one up at a sports store, they’re cheap). Some people start with a tennis ball, but for most active people I think that’s too soft.
How to use this thing? The general idea is to apply pressure on your muscle of choice, breathing deeply and gradually letting the ball sink further into the tight area, using your body weight to apply more pressure as the muscle starts to relax. Then, once you feel some relaxation happen, try introducing small motions. Depending on where you’re massaging, this could mean moving a joint through its range of motion (bending and straightening your knee perhaps, or flexing your foot at the ankle) while maintaining pressure with the ball, or just rocking side to side a little bit. In either case, if it hurts so much you tense up, you’re doing it wrong.
Where to massage? Be creative. A common pattern for hikers with knee pain is tight quads and IT bands, but the culprit really could be anywhere.
Here are a few ideas to get you started:
Quads / IT band (outside of your upper leg): lie on your side, almost like doing a side plank exercise, and place the ball under the outer side of your thigh. Flex and extend your knee. Move the ball around to cover the whole area between your hip and knee.
Hamstrings: Sit on something flat-ish, like a big log or rock, and put the ball under your upper leg. Extend and flex your knee. Move the ball around to different places to hit the hamstring muscles closer to your inner and outer thigh.
Glutes: Sit on the ball (using your hands to support your weight), rock side to side, rotate your leg at the hip. Don’t forget the sides of your hips too, where your gluteus medius muscle lives.
Calves: Sit with your feet straight out in front of you and place the ball under one calf. Cross the other leg on top at the ankle and use it to apply more weight as needed. Move your foot around at the ankle, and move the ball around to cover the whole area between your ankle and knee.
Feet: While standing, pick up one foot and roll it on top of the ball, using your body weight to add pressure. Since many of the tissues in your feet are connected to your calf, this will also do wonders for tight calves that might be restricting your stride.
Shoulders: This probably isn’t going to help your knees, but it feels darn good after a long day carrying a heavy pack. Lie on your back with the ball under your back, especially in the muscle areas around your shoulder blades. Move your arm gently up and down or around in circles. Move the ball around to different places. Just make sure to avoid direct pressure on your spine.
Before I got my beloved spikey ball, I carried a golf ball in my hiking pack. It’s kind of like the “ultralight” hiker’s version of a lacrosse ball. I hauled that thing the entire length of the John Muir Trail, among other places, and it was worth it. I find it better than the larger spikey ball for foot and calf massages, and I was able to use it for my quads / IT band in a pinch. It didn’t work so well for other muscle groups (too small).
Nalgene “Foam Roller”
If you have a foam roller at home, you know what I’m talking about (and if you don’t, I recommend you get one!). It’s too bulky for the trail, but I’ve found the next best thing is something you might already be hiking with: a hard-sided plastic water bottle. I usually hike with a hydration bladder and lightweight collapsible water bottle, which obviously doesn’t work for this, but I’ve occasionally brought a hard Nalgene instead, just so I could use this technique!
A bottle is definitely harder than a foam roller, so you’ll need to use your arms to support more of your body weight while making sure you can still relax the muscle being rolled. You can otherwise use standard foam rolling techniques, of which there are no shortage on the internet.
This technique is especially good for quads / IT bands (the front and outside of your upper legs), and also works for calves. It can even work for your adductors (inner thighs) with a little creativity, which are hard to get with any of the other techniques.
Here is an absolutely killer tip: On cold evenings, if you’re hiking with a stove, fill your bottle with hot water. Treat your tired legs to a nice warm massage and then take the bottle into your sleeping bag; you’ll stay toasty and relaxed all night long and be ready to hit the trail in the morning. (Important! Make sure the bottle is well sealed or put it inside a dry sack! Soaking your sleeping bag would be really bad.)
How to Use These Techniques
So there you go, that’s my bag of tricks for dealing with emergency knee pain on the trail, or (better yet) preventing it all together. Between loosening tight muscles with massage, stretching them mindfully, and activating the lazy ones, you have a full set of tools to functionally change your biomechanics for the better.
These tips are best used proactively, before anything starts to hurt. If you’re backpacking, a nice routine of morning glute exercises, evening stretching and massaging, and maybe a mini lunch break session can really help keep things working smoothly. If you’re day hiking, a few glute exercise and stretching sessions spaced throughout the day can extend the distance you’re able to hike without pain.
If these tips help you on the trail, guess what, you can do them at home too! I know, it never feels as urgent when you’re at home and nothing hurts, but our bodies need a LOT of repetition to learn new ways of moving. A few weeks or months of using this same routine, even when you’re not hiking, might be enough to rewire your system and allow you to hike with no pain at all next time you hit the trail.
Your Personal Biomechanics Experiment
My best advice when using all these techniques is to get creative and figure out what works best for you. We all have our specific patterns of tightness and weakness. When you start to approach your own body as a project, something you can change and mold into the well-oiled hiking machine you’d like it to be, this all gets so much less frustrating.
You are your own science experiment; no doctor or trainer can know how it feels to move with your particular set of muscles and joints. Start paying attention to the subtle feelings of movement, so you can learn to recognize when a muscle is tight or your stride is getting funky. Consider keeping notes about what works best so you can remember next time.
I hope these quick tricks allow you to hike farther with less pain. I also hope that if you have chronic knee pain when hiking, you’ll start a long-term plan of strengthening and stretching even off the trail. It takes patience and it takes time, but trust me, it’s so worth it. Can you imagine being able to take on any adventure you choose, confident that your body can handle it? Personally I’m still working toward that, but I know it’s possible because I’ve seen the progress so far.
Here’s to getting stronger so we can all play outside more and enjoy the trails!
More Hiking Resources
Since you seem to be into hiking, you might also like these other posts intended to help you stay strong and comfortable outdoors:
- Hiking in trail running shoes: why it’s popular with thru-hikers and the best way to try it
- Tips for shaving weight from your backpack (another way to help with knee pain)
- The best hiking clothes for lightweight backpacking: high-performance choices for when comfort, functionality and weight are all priorities
- More hiking resources: everything from gear recommendations to awesome trail guides to how to pee in the woods.
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