My Oxfam trailwalking husband is up for his fourth event and after years of discussing knees with his team mates, we pulled this together, he the editor and wordsmith, and me the knowhow.
How do you know if your knees are up for the challenge of walking 100km? Ask yourself:
- Do you have knee pain during or after your training walks?
- Is it under the kneecap, on the inside of the knee or at the base?
- Do you get aches in lower back or pain in the ‘glutes’ after training walks?
- How stiff are you knees the day after? Painfully stiff or ‘just worked’ stiff?
If you answered ‘yes’ to one or more of these questions, you’ll need to protect your knees by preparing them properly for Trailwalker. Anybody can walk the last few kilometers to the finish line with a sore knee, but if your knees start acting up at the 30km mark, you’re going to have a most unpleasant time.
Why is Trailwalker so hard on knees?
When you think about it, in our usual lives we don’t do much walking on uneven surfaces. Trailwalker is all about uneven surfaces. Walking on uneven surfaces presents great challenges to the joints of the lower limb, ankles, knees and hips. Constant changes to your balance – sometimes unpredictable changes – greatly varying degrees of contraction of different hip and knee muscles and a rapidly internally and externally-rotating leg all place big demands on your knee. If your muscles connecting around and below the knee are already impaired or imbalanced in recruitment, you may develop pain during and after walking.
You and your ITB
Most commonly, excess tightness down the outer thigh can lead to the kneecap being pulled sidewards, and in a long walk this is repeated over and over and over.
Illiotibial (ITB) tightness and outer quad tightness arises from an imbalance in the strength of your outer quad and inner quad muscle (vastus medialis oblique – VMO). During the repeated motion of a long-distance walk, the more powerful outer quad (the one that gets all the attention at the gym) the repetitive movement can gradually draw the kneecap out to the side. The articular surfaces of the knee joint can be rubbed and the cartilage inflamed.
How well do you know your own bottom?
Believe it or not, ITB and associated knee pain can be exacerbated if you have lazy bottom muscles. You might think you’ve got a fit bottom, but I am always amazed by the number of Pilates clients with weak gluteus maximus and gluteus medius, especially the physically active clients.
Glut max is responsible for pulling your leg back behind you in the hip socket during the leg-off-ground phase of walking. If glut max doesn’t work well your leg is just hinging in the socket and will be pulling on your hip flexors and lower back. Very importantly for your knee, glut med works synergistically with the VMO – the two need each other to work well. If one is weak, or not firing when needed, you are at risk of pain.
Glut med plays two roles in walking:
1. In the standing leg, it is the muscle responsible for stabilising the hips and keeping them level with each other. You don’t want to sink into the hip when you are on one leg as this is straining ligaments in the sacrum/lower back area.
2. Additionally, glut med is responsible for the sidewards movement of our off-ground-leg out to the side as it moves through the swing-through phase.
Quad pain: does that mean four times the discomfort?
Another area of discomfort may be where the quadriceps tendon coming over the kneecap inserts in the pointy bone just below the kneecap. This can become sore and tender after a few checkpoints. The quadriceps needs to be stretched regularly to alleviate the pull.
Enough about the cause of my pain, how do I avoid it?
- Keep your ITB and quads stretched. Use a foam roller to massage your ITB after a walk and stretch quads regularly during the walk (at checkpoints and other times you need to stop.) With each leg, hold your heel up to the glute, keep your knees together and thighs touching, maintaining a level pelvis and a straight spine. Hold it for about 30 counts each time on each leg or you are wasting your effort.
- Make sure before you walk you stretch your hamstrings: a leg up on a fence will do, just be sure to keep your two hip-bones level when you do it. Calf stretches should be included, let your heel hang off the edge of a rock or other surface, and start gently – don’t rip muscle from bone especially before you have warmed up a little!
- When you’re training, on every ascent and descent, practice keeping the centre of your knee in line with the big toe of your foot. This will help you get into the habit of using your inner quad as well as your outer quad, which may reduce the likelihood of ITB pain later if it becomes second nature. If you notice yourself (or your teammates) pushing their knees out to the sides going up or down steep hills, act early and correct to avoid pain later.
- If you find yourself suffering from pain after a long training walk, don’t suffer it in silence; seek help. It most likely won’t just ‘go away’, especially with more training. Instead, it’s likely to stop your Trailwalker campaign and disappoint you, your team and all your supporters. Go seek professional help from a therapist.
- If you experience knee pain during Trailwalker, likewise, don’t suffer it in silence or hope it’ll go away. The sooner you get it seen to, the more likely you are to be able to nip it in the bud. There are a number of stretching, massaging and strapping things that can be done to make it go away, but you must get professional help for it to work. The Trailwalker organisers have arranged for volunteer massage therapists, physiotherapists, chiropractors and other manual therapists to attend many checkpoints. It’s not every day you can see one of these for free, so take advantage of it! An extra 30 minutes at your next checkpoint may just salvage your Trailwalker campaign for this year.
- Visit a studio based Pilates Instructor or your preferred manual therapist to have your glutes and quads assessed for the task ahead. Ask for a set of exercises and stretches customised for your needs.
