A balmy 17° morning starting at the Sawtooths while approaching Tuolomne, Yosemite National Park

How I Fixed My Knee Injury in Time to Hike 2,450+ Miles This Summer

An overview of how I went from barely being able to limp to my car to completing the Pacific Crest Trail with zero knee pain.

In late March 2017, my life excitement continued to grow to new extremes. In roughly 100 days, I would be leaving Los Angeles and my undesirable employment behind and disappearing out into the pristine wilderness of the Pacific Crest Trail. My girlfriend, Kait, and I had been planning this for months, and we were about to step foot on a 2,650 mile path I had been anticipating for years.

Only issue was that I couldn’t walk more than 50 feet.

The Pacific Crest Trail, as I’ve mentioned here before, is a 2,650 mile National Scenic Trail, from Mexico to Canada through California, Oregon and Washington. It has over 500,000 feet of vertical change, temperatures from less than 15 ° to over 105 ° and stomps through the majestic Sierra Nevada and Cascade Mountain ranges while visiting dozens of National Parks, National Forests and deserted BLM land.

Trail life is hard. You burn, you freeze, you smell like absolute garbage, you lose dozens of pounds and you often have no feeling in your toes (I didn’t feel any of mine during the month of August, for example). The trail is the most profound, impressive and great achievement of my life, but it sure beat my body way down. Essentially, you need to be in good shape to start, and you hope your body adapts to handle the work load.

To prep for the trail, Kait and I went out frequently to walk and run. One weekend, we went out on a quick 16-mile overnighter, to test gear and continuing building our trail legs. Though the route was flat, something quickly started to go wrong with my knees. By mile 6, I was in deep pain. By camp at mile 8, I could barely walk. By the time we returned to the car the next morning, I thought someone was bashing my kneecaps in with a knife.

Through a combination of poor shoe choice and then-unknown muscular issues I had developed, I had effectively wrecked my left knee. (The right recovered after a few days’ Advil.) I couldn’t bend it, and any pressure or quad flexing resulted in the worst pain I’ve ever felt.

A recap as we crushed the JMT section of the PCT in late September 2017

The Diagnosis

I went to my terrific GP a few days later, still with so much pain in my left knee that it was taking me ten minutes to limp the 1,000 ft. from my car to my office. My doctor manipulated the knee to make sure it wasn’t an ACL/MCL tear, then prescribed Aleve and a week’s rest.

A week later, the pain was worse. Time for a visit to a world-class ortho in the UCLA Hospital system. Within 2 minutes of visiting with me, Dr. Bruce performed a move where he pushed a thumb into my kneecap, twisted my lower leg, and had me flex my quad. I actually screamed in agony, the pain was so incredibly bad. It was, he said, chondromalacia patella.

Chondromalacia patella is the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella). Pain results when the knee and the thigh bone (femur) rub together.

I was quickly prescribed a custom knee brace. It seems most cases of chondromalacia have the kneecap drifting to the outside of the body, but, for some reason, mine was drifting inwards, towards my other leg. Dr. Bruce mentioned underlying cartilage damage that had probably been there for years, and my hike had aggravated the injury badly. The good doctor ordered me off to rehab, not too certain I’d be doing this hike.

Diagnosed…Now What?

Now I knew that the source of my pain was simply my loose kneecap grinding into my femur. Unfortunately, it’s now early April, I’m leaving to start my PCT hike on July 3, and I can’t walk. I jumped into the UCLA Rehab facilities quickly, and worked with the PTs to focus on the following:

Mobility:

Every lower body part was tight and off-balance, particularly my hamstrings and calves. Additional complications with hip mobility don’t help at all. My muscular base was essentially ‘frozen’ from years of sitting in class and at work. I started in on a protocol of static stretches from the PT, gradually adding in my own dynamic mobilizations as well.

Arguably the most beautiful place I’ve ever been — Dolly Vista, just south of Stehekin, Washington.

Strength:

My lower body, though very strong at weight lifting, was chronically weakened from 4 years of sitting at a desk at my corporate job. While I could easily deadlift 300+ lbs. and bridge press 430 lbs, my bodyweight strength was comically weak. They say sitting is the new smoking, and it’s completely true. Chondromalacia, IT-band pain, and many other forms of knee and glute pain can evolve from sitting hours on end, not to mention overall weakness.

In order to solve this issue, I’d need to incorporate unilateral bodyweight movements, focusing on waking up my ‘dead’ glutes, engaging my hamstrings properly and making sure that, as I did any form of squat or bent-knee exercise, my kneecap track outwardly properly. (This means that, as I would lower into a squat, my kneecap would move outward, roughly parallel to the 3rd toe of the corresponding foot.)

I also incorporated a series of hip movements that I stole from a fantastic Tim Ferriss book, called the Reverse Jane Fonda. I believe it’s from Peter Attia, a genius in the strength and longevity space. It’s hard to describe but involves lying on the ground to perform side raises, bicycles, front and back kicks and circles with individual legs.

Additionally, I would also need to focus on foot-strength and reawakening. There’s plenty of research out there explaining how shoes have debilitated generations of humans if you want to understand how most people’s feet are deadened and weak. To counteract any overpronation, I began my workouts with ankle and foot strengthening exercises, as well as torturing them for several minutes with steel bar or spiked lacrosse ball.

I start out on these protocols, and, after 2 months, I’m feeling a lot better. Unfortunately, any time I go for a walk or hike on ground that isn’t flat, the dreaded ‘needle in the knee’ comes rushing back. Panicked, and with only about 30 days left til departure, I started to search for something else to get me back to full strength.

Luckily, whenever you have a question, someone probably answered it on Reddit.

Do Your Kegels!

In the vast world that is the Reddit community, I ended up finding what would cure my knee pain in about 3 minutes of searching. I ended up finding this thread about a concept known as glute kegels. Traditional kegels are a pelvic floor exercise designed to strengthen the region, and are typically done by women. The glute kegel concept is relatively simple: clench your cheeks as hard as possible for 5–10 seconds, for several sets throughout the day. Additionally, when you’re walking, make an effort to clench the glutes as you take a stride, feeling the muscle work on either side.

Although initially sounding silly, the few comments on the glute kegel threads I found seemed promising; many people claimed serious results. A further search revealed that the threads I had found might have been taken from protocols from Dr. Kelly Starrett, a legendary Crossfit and S/C coach. I was hooked after that. So, I started clenching.

I did 3 sets of 10-second clenches multiple times throughout the day. I’d stand up from my desk, pretend to stretch and clench the cheeks extra tight. When I brushed my teeth in the morning and at night, when I walked, when I was warming up for my regular rehab movements — glute kegels constantly.

My knee pain was gone by the week before we left for the trail.

Glacier Peak Wilderness, Northern Washington State.

The Trail

Starting out on the PCT, we had planned for a week of 15-mile days, to ease my knee and our endurance into the trail life. On our first full day, we crushed 20 miles. We followed this up with 19, 24 and 22 mile days. After that, we cranked 20+ miles every day for the rest of the trail (excluding neros/zeros). Not once in that time frame did I have any pain in my knee, and only a few times in the first weeks did I have any swelling/discomfort.

I walked the first 2–3 weeks mostly wearing my brace; one day I didn’t bother to put it on, and never did again (although I carried the damn thing the entire trail). Several times a day, we’d stop and compress our knees and feet with Voodoo Floss — I highly recommend this for anyone doing any type of exercise ever, it’s an essential tool. I also brought a tiny ball to roll out our feet and shins, and ended up being very grateful to have it.

We ended up hiking 2,450 miles of the trail (missed about 150 due to fire closures and other 30–50 due to alternates and one incident involving a thought-missing other hiker). Overall, my body recovered better than almost everyone on trail, and I never needed a day off due to injury. I did walk through a serious foot pain in the Sierras, but eventually it went away.

If you’ve got a thru-hike coming up or if you have knee pain in general, perhaps some of my tips and movements can help you. (Obligatory note: I’m NOT a doctor, none of this is advice.) In addition to rehabbing your body, good footwear is essential and the more UL you are, the better. Impact on knees and lower body increases drastically when walking downhill, so the less weight you have on your back, the better.

Good luck out there — I can’t wait to be back on trail again.

The Movements

Mobility

Strength

  • Single-leg bridges with banded resistance (10 reps, hold for 15–60 secs)
  • Clamshells with banded resistance (10 reps, hold for 15–60 secs)
  • Fire hydrants (10 reps then hold for 15–60 seconds
  • Banded side steps (20 steps each direction, repeat 3x)
  • Single-leg step downs (10–15 reps per leg)
  • Single-leg squats — quarter depth (10–15 reps per leg)
  • Squat holds with Bosu ball (15–120 secs, increasing length)
  • Single-leg balance on Bosu (15–60 secs)
  • Single-leg balance on Bosu with closed eyes (10–20 secs)
  • The Reverse Jane Fonda (2x through)*
  • Planks (60–120 seconds, several sets)
  • Jefferson curls (30–60 secs per rep)*

Foot/Ankle Strengthening

Glute Kegels

  • Hard clench for 10 seconds (10 secs rest, repeat 3x)*
  • Walking clench (focus on engaging each glute on each step)*
Finished. Campo, California.

*indicates movements I added myself, not from a PT