Athlete Question: Can You Help Me Hike Without Pain Again?

Here’s the context:

This came from one of my current in-person athletes over a year ago. She came in with consistent knee pain. She was an avid skier, hiker, and paddle boarder until a ski accident left her with a double ACL tear. An inadequate recovery from those left her knees and hips in compensatory patterns. She had 3 goals:

1. Get out of pain

2. Lose the weight she gained due to decreased activity

3. Get back to hiking, skiing, and paddling

And she has successfully checked off all those boxes (except for skiing…but she’s well on her way to enjoying some fresh powder this winter)

When I have a person come in with pain, I make it clear I'm not a doctor and I don’t treat pain. I’m a movement specialist. I assess and address movement. Limitations in range of motion, control, and strength often lead to compensations which can, not always, lead to pain. One potential way to address the pain is to address the limitations. We can work to improve their limitations in range of motion, control, and strength while we pay attention to how the pain increases or decreases over time. If the pain persists after a few months of intervention, where the compensations have objectively been improved, then they need to seek medical diagnois and care along with continuing their program. 

And when someone comes in with pain I don’t jump to movement assessments right away. I start with lifestyle and daily environment. It’s amazing (or maybe not actually) how many aches and pains are the result of staying stuck in similar positions all day. They simply lack the movement variety necessary to keep the body operating as it should. I don’t love cliches but “movement is medicine” applies here. A lot of times a general mobility, strength, and conditioning program clears up a lot of the “issues.”

With that background established as well as digging into injury history, sleep, nutrition, and hydration we will go through a movement assessment to see what ranges of motion the have access to, what ranges they lack, what coordination, control, and stability they have through those ranges, and finally their relative level of strength through those ranges. 

With that in mind, all her lifestyle and environmental factors didn’t raise any red flags. And given the injury history and inadequate rehab I assumed we would find some factors in the movement screen to address.

A quick assessment helped me to identify what ranges of motion she did and didn’t have access to, where she had compensatory patterns instead of coordination, and what asymmetries she had in her strength from side to side. 

Movement Assessments

• Bodyweight Squat

• Split Squat

• Walking Lunge

• Side Plank

• Lateral Walking Lunge

• Single Leg Calf Raise

• Hamstring Slider Curl

The outcomes:

• She lacked control and stability in any split stance position

• She could only squat half way to hip at knee height without pain

• Knee Valgus, especially the right knee every asymmetrical pattern

• Limited Side Plank ability on right side compared to left

She set a goal of doing a 2 nighter on the PCT this summer. Gave herself 9 months. And we got to work.

We started at ground zero with isolation work for the quads, hamstrings, calves, and glute medius and any multi-joint lower body exercises she could handle to ranges that didn’t induce pain above a 3 out 10. Here are the progressions we worked through for each:

This isolated strength work helped bring up each muscle’s and accompanying tendon’s strength to help transfer to building strength in our integrated, multijoint movements that carry over into the active and athletic life she was trying to get back to. We used 4 main categories of exercises in this area: Squats, Split Squat/Step Ups, Lunges, and Hinge patterns. We trained 2x per week progressing in reps, load, and difficulty over the course of the months leading up to her hike on the PCT back in July. 

There are so many different ways to program and progress these exercises (isolated to integrated) and the way they are loaded and still get great results. The important thing is you pick a system and stick to it. As long as you are seeing progress in being able to do more reps, more load, or moving on to more difficult exercises, stick with it. 

I like to take my athletes preferences as a main consideration when determining how to put these exercises together into a work out. To be fair she can get distracted quickly, so a workout of full isolation exercises was never going to be productive. This is how the majority of our training sessions were set up:

1. Isolated Strength Exercise

2. Integrated Strength Exercise

3. Upper Body Exercise

*3-4 sets, progressing in reps, load, or exercises week to week.

*We would usually work through 3-4 of these blocks in a 55 minute training session

Here is an example using the categories listed above:

A1. High Side Plank + Lift

A2. Bodyweight Walking Lunge

A3. Incline Push Up

B1. Bent Leg Calf Raise Active

B2. Eccentric Goblet Squat

B3. DB Bench Supported Bent Over Row

C1. Bridge Slider Eccentric

C2. KB Deadlift

C3. ½ Kneeling DB Military Press

D1. Side Plank Hip Drop

D2. DB Suitcase Box Step Up

D3. Assisted Pull Up

If you want the full 2x per week program I used to help get her out of pain and back into the mountains join my newsletter, The Evergreen Outpost. Each week I answer a new athlete question and provide you a roadmap that can help you too.

And if you have a question you want answered with a program to get you there shoot me an email. I’ll feature yours next!