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.