How I Managed Downhill Knee Pain Before a High-Elevation Hike

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Today, I'm going to be covering a little tangent from the series that we've been doing on strength training to talk a little bit about application and how to apply some of these principles to a real-life situation that I had with my knee and as we went hiking this weekend in the East and Sierra area.

Now, this is a trip that I had planned for a while. We knew we were going for about six months or so. And not to say that the hikes were necessarily hard, but there were things that we wanted to do. And so we planned a few trails. One of them was the Sherwin Creek, sorry, Sherwin Lakes, kind of out of Sherwin Creek Road and just outside of town. It's not very hard to do. Personally, I like to when we go up towards elevation. We live at sea level. So we go up towards elevation. I like to spend the first day doing something a little bit easier. That's why it's not too taxing. I do get a little bit of elevation effects.

Usually my head the first day does not feel fantastic. So just kind of getting acclimated and just using our time wisely. And the second day we went up towards Duck Pass. We didn't get to Duck Lake, but we went on to Coldwater Creek, Lake Mary area. If you haven't been there before, it's fantastic. Very busy hike. We went up towards some of the lakes that were just prior to it. And we took our dog on these too. So the reason why we're going to be applying some of the principles today is because of the knee condition, as I mentioned. There is a general overlying theme with some of the things that we offer here, at least with Performance Place, to keep people physically active and able and make sure that they still can do safely the things that they want to do, like this trip.

Like I could have easily have said, my knee has been bothering me. I'm worried about it. Let's just not do this trip. But knowing some of the principles and also some of the risk, I can safely say that, look, I'm going to go on this trip. If X, Y, and Z happens, then I may pull the plug. But overall, like if everything stays kind of how it is now, I'm just going to go. But knowing some of these general principles makes it so you can make wiser decisions. Now, I'll tell you at least how the knee pain came about recently. First off, just to know that I have had about probably a, I'm going to say 10-year history of some on and off knee issues.

I've had some trauma to the knee playing baseball. I love playing baseball. It's kind of my thing. I like hiking too. I like other things, you know, but like I'm assuming the risk. And so the knee overall is for super well. I've been able to weight lift, been able to run, been able to sprint, been able to do most of the things that I want to, but periodically it just speak to me. So recently about, I think it was like two weeks ago that we were hiking in an area. We live in Southern California. We live in Orange County. If you guys don't know about Orange County, there's not a ton of hills, but there are some that are kind of like, I'll call them barren.

I don't love them. I know people do like them, but they're no trees. There's no cover. It's all, a lot of it's exposed. So there are just a few of them that just have a little bit of cover. One of them is in Newport Beach, kind of around about 20, 30 minute drive from where we're at. And so we go into there and there's some hill options and just alternative trails. And so we're going through there. It's not a very long trail, but it's a nice one just to start to get your feet moving. And we took the optional trail up, me and my wife did. And coming the way down, I mean, I'd say we were probably about like a mile and a half in.

And then after the elevation up, which isn't a lot, not a ton. It's about a, I think it's about a half mile up. By the way, I don't know if you guys know, I don't use a Garmin and stuff. I don't even track my things. I just go off of the general maps. So I don't know the exact number. I know people do. I don't really care. I will use a trail map and know all the markers on the way with the actual trail. Well, these are urban trails that don't really matter. So we were coming down and my knee started to hurt quite a bit. And again, we weren't too far into mileage. It's not something I haven't been doing recently.

It's not like I've been inactive. So it was odd, but also it's not really enough load or mileage or vert to really create a substantial injury. So although it was very painful and inconvenient, we continued with the remainder of that hike and we just stayed kind of on the flats and took it slow as we went through some downhill. Uphill's fine, flats was fine, but the downhill really was super uncomfortable. And so knowing some of the things that we do at Performance Place and even with our telehealth people do the same thing, there are a few things that can create this type of presentation of knee pain where there's not any real swelling, there's no range of motion loss, it's not like anyone hit me, I didn't feel a pop.

So it's possibly two things that we could do to make it feel theoretically better and manage pain and get it down while we're not losing really any of our fitness. So I can still do things, I can still weight train, I can still walk, I can still jog, I can do maybe not downhill, but I can do all these other things. And so the first thing we do is something called a lumbar spine opener. A lumbar spine opener, for those of you who are not aware that there is a significant amount of knee pain out there in the world that is actually referred from the lumbar spine. I've gotten the question many times about what referral means.

Referral means pain and the location of the pain is not the area of the origination and you don't even need to have the pain in the area where it's originating from. So you don't need to have low back pain, but a lot of people will have stiffness or a more recent history of low back issues. But it'll manifest in their knee. And so a really easy way for people to understand this, at least from a heart attack perspective, is that most people, they can feel chest pain, but a lot of times they complain of the hand stuff and the arm stuff and the face stuff. And so there's referred pain all over. Organs have this.

Joints have it. Muscles have it. Nerves have it. Like there's a lot of things that you have it, but just the location of pain tells us general probability or possibility of what it is, but it doesn't tell us exactly what it is. So for all of you who follow us out there on YouTube, I think one of the most common comments that we get, which I wish, I really hope people are understanding like how the one fact doesn't mean anything, but we get people who say, I had pain here, so what does that mean? Well, that means nothing. Like you need more information. There's not enough information to conclude it, but there's probabilities of things, which is why I decided to do a lumbar spine opener for myself.

And so I did it for a couple of weeks because I know that historically working with people after a few weeks, you pick the right thing to deload the tissue, which is in this case, maybe referring, they usually feel better. They don't have, they may not feel like they're doing anything in that moment, but a lot of times over a couple of weeks, they say, you know what? I do feel a lot better. So that's number one. I did the lumbar spine opener. Really, really simple thing to do. Really low risk. It's super easy, but most people aren't aware how to do it, when to do it, frequency of doing it, which are all important too.

We call that a dosage. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and get you back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Now the other thing that I did too, which since it was inner knee pain, but there was a little bit of outer knee pain, which the outer knee pain usually means that it's low back and furred, which is why I chose that, but I also did knee pumps, knee extension pumps. This is from a principle called the McKenzie method. McKenzie method is, it's pretty fun. I think it's pretty simple in the way you could look at things, and I've used this with many joints of the body. If it hurts to bend one way significantly more than the other, move in the other direction, like pump it, use it as a pump.

And so we think that we're potentially pumping congestion around from the area, decreasing local irritation. In this case, my knee kind of hurt when I bended it more or I bent it more, and so I pumped it into extension. It didn't hurt to do. I did it about 60 times a day, and that over the course of a couple weeks, did it feel like I was stretching anything? No, not at all. But as you can see, I was able to hike the hike. The last thing that I did, at least from a adding more things standpoint, we like to think of management of adding things or subtracting things. You don't always need to add more things, but in this case, I added things.

I did a quad isometric. And I did something called a wall sit, which many of you probably had seen before. The key with this is you have to do it in a range which is not problematic. And so you find a range that challenges the quad but doesn't make the knee really start to speak up, and you challenge that baby. Like you do it to, ideally you find a range which is hard to hold for about 30 seconds, and most people don't do the amount of intensity that we typically suggest in office or in virtuals. We have them do to the point of near failure, and usually we assess that with like, are they shaking?

Can they speak? Are they making other noises? Like these things are usually better measures than them saying, oh, okay, I'm done. Well, you were super calm. And so if you're calm, then it wasn't, you probably weren't to failure. There's a panic that happens with it too. And so I did those every few days. I did four sets each, so roughly about two minutes of work. And then I did my normal strength conditioning. I still went to the gym. I still biked. I still did the step-back lunges, back squats, hip dominant exercises like deadlifting and single leg deadlifting. And I did all my other stuff too.

And so long story short, over the course of two weeks, I just added a few things and then maintained some things. I didn't subtract really much because I knew over that two-week period of time, I wasn't going to lose any fitness. So I didn't really need to tell myself to subtract all of the hills and just go on that same trail and just don't do the optional route. But that is something we sometimes do. You subtract the pain trigger. But I was able to do these hikes. Now, I did take some precautions. We took some trekking poles. Normally, I don't hike with trekking poles, but we had some. It's from a device called a hot tent.

If you guys know what that is, it's like a canvas tent that you can use in the snow, but it needs some support. So I had some trekking poles because I didn't want to buy tent poles. The trekking poles made better sense for me. And so I've never really used them. They were much better than hiking sticks. And I know that it's funny, like I saw people with the same trekking poles and those trekking poles are like an Amazon basic model almost and they're, quote, too heavy compared to the more expensive models. But I don't know if you've ever hiked with hiking sticks. Those things are heavy and they're rough on your hands.

It's like any trekking pole is better than hiking sticks, at least if you want to feel more comfortable. So anyways, we took them. We carried them up. Did we use them on the way up? Nope. Didn't need them. And on the way down, we just had them. I didn't need them. And so it was nice to have those precautions because if you guys have not used trekking poles before, it takes the load from the knee and puts them to the upper body. Whenever you put some weight into the hands, like pressing down, like that helps out with core support too. So if there is a lumbar spine referred part there, that does help with that as well.

So we were able to successfully complete it. I don't know the full element. I think Sherwin Lakes was like what, five miles round trip and a thousand feet elevation. And the other one was six and a half miles and 1100 feet, something like that. It wasn't a lot, but it was certainly more than the test hike that I did two weeks prior. So I did take some precautions. So I hope this gives you guys some context of how we may use some of the strength training. Like I really didn't remove any of those exercises that did not hurt as we have talked about in prior podcasts. I still did knee dominant stuff.

I still went knees over toes. I still worked on the hips. I still did core stuff, upper body, et cetera. Like nothing really changed other than the fact that I added some things that were possible ways to decrease pain in some of our typical cases, the knee pain. But other than that, I really changed a lot. If anything in today's episode resonated with you, visit the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links and a link for a free discovery call with us. We're licensed to work with our outdoor active people via telehealth across many states in the U.S.

at this point. In fact, we cover almost half of the population in the U.S. and we add more states every year. Thanks for listening. Subscribe to the show and we'll see you in the next one.