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Why is my pain or injury not improving? Why am I unable to hike? What am I missing?!?!

Updated: Nov 17, 2023


hiking downhill knee pain



Are you having Achilles heel pain or plantar fasciitis that won’t improve? Or maybe you can’t seem to make your knee pain downhill go away, no matter what you try? Maybe you’ve tried ALL the things…you’ve googled this issue and are still coming up with minimal progress and you’re either confined to short hikes or you’ve had to stop hiking altogether.

Well, listen up for a very important concept that likely is the missing link to why your pain or issue is not improving.

However, maybe you’re pain-free and have no lingering injuries, but you’re having trouble progressing to harder hikes. You too should read on to find the missing link that may be preventing you from conquering and enjoying your next summit!

hiking uphill pain injury

It's the concept of regional interdependence...or as I prefer to call it victims and culprits.

You likely have heard the term “kinetic chain” before, and basically, it means that your body is connected. (think the kids' song, the hip bone is connected to the knee bone...the knee bone is connected to the...you get the idea). You can think of your body as having different regions…your neck is one region, your upper body (shoulder and upper back) is another, your abdomen and lumbar spine (lower back) which is often coupled together with your hip and pelvic area, and then your upper leg and into your and then your lower leg and then ankle/foot. Those could all be considered regions (granted depending on who you ask the regions might be divided up differently. That part is less important; what’s important is that you view the body as different regions). So that’s what regional means and interdependence means well essentially they affect each other. Basically, regional interdependence means that what happens in one area is DEFINITELY going to affect the other areas. So basically if you’ve got pain in one area let’s say it’s your knee. You could have a problem locally in your knee. This is what most people assume and so they just look at the knee. However, you may have pain in your knee but it’s possible you get imaging (MRI, X-ray) and nothing is really found (other than maybe some swelling and inflammation) but structurally there is nothing wrong. What gives?!?!? It may be that your knee is the victim due to a problem in a different region of your body and that area is the culprit. Your major mistake in fixing your issue may be that you are not getting the root cause of the issue. You think the problem is only in your knee and in reality the actual culprit may lay elsewhere. So perhaps you rest and take it easy and your knee feels better. So you go back to hiking, but you struggle again with the same pain. You never actually identified the root cause and until you do, you will very likely continue to struggle with the same issue. However, let’s also take the example of there IS something wrong with your knee. Let’s say you have a torn meniscus or ACL or knee arthritis. Okay, problem solved, right? Nope. Why did you get that issue in the first place? Some people will just say oh they have bad knees and just leave it at that and feel like they are destined for knee pain. However, maybe you actually have an issue elsewhere in your body, say your hip mobility is terrible. Well, that will put stress on your knees in ways that can cause poor movement patterns and then have abnormal wear and tear on your knees, and then this results in “bad knees”. But see the difference…when you identify the root cause (poor hip mobility), that is something you can address. But until you identify it, you can’t address it.


physical therapy injury pain


I’ve seen a lot of people in my career as a physical therapist, who have a knee replacement, they’re told they are bone on bone, they get a knee replacement, only to go through that VERY hard recovery process and they come out of it and they still have the same knee pain! And that means there’s a culprit somewhere other than where their pain is located. (granted I’m not saying you should not have a knee replacement as I have seen lots of people also where they did what they were supposed to do with their rehab and all culprits were addressed and they are back to hiking). What I am saying is that you need to identify the root cause of your pain. And the most qualified person to help you do that is a doctor of physical therapy who is a movement expert. You can try to solve it on your own by googling or watching YouTube. Or you can know all the potential culprits that may play into your actual pain and be confident that you are FULLY addressing the issue by consulting with a physical therapist.


And for those of you who have no pain or injury, but are struggling to progress to your next big hike. Well, this applies to you as well. See we all move in different ways. And most of us are not fully aware that we might have a deficit in one area (particularly if you have no pain). Well, those limitations may create abnormal movement patterns, which makes you less efficient and thus you can’t quite do what you want to do (reach the summit). By identifying potential areas of limitation BEFORE they become an issue, you are not long preventing injury, you’re also on your way to your best performance with hiking. Seeking consultation from a physical therapist even when you have no pain can benefit you too in your quest to reach your next mountain summit or next bucket list trip.


achieving hike summit pain-free injury-free

What issues are you struggling with in your hikes? What do you want to learn more about? Let me know in the comments below.


If you’re looking for help with an issue that you struggle with on your hikes, you can set up a free consultation call here to figure out your best next step to reach the summit!

Stay tuned next week where we continue the conversation about victims and culprits and take this a step further to understand the process of getting behind the root cause and the different areas that must be fully addressed. Learn more about how to address your issue and kick it to the curb for good!



physical therapist hiking backpacking

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