Iron Mountain, NH, 06/10/07

[threecy]

Iron Mountain, NH

Date Hiked: 06/10/07

Trails(s) Hiked: Trail from Iron Mountain Road

Total Distance: ~2 miles

Difficulty: Easy/Moderate

Conditions: Patch of mud, otherwise dry, only two minor blowdowns (old)

Special Equipment Required: None

Today was the big test in my latest knee rehab - a hike with more than just a few hundred vertical feet. Prior to the hike, I was doing some research on Randy Johnson when I connected a few dots. Seeing the pitching control problems Johnson was having early in his career, Nolan Ryan pulled Johnson aside and recommended that he not land on his heal when pitching. A little while after reading this, it struck me that this might explain why I has having relatively no pain whilst going uphill since my injury, but progressively worse pain on downhills - I do my uphills almost on my toes.

The beginning of the Iron Mountain hike was absolutely beautiful - the trail wanders through a meadow and then through a blueberry field with tremendous views of Mt. Washington and the Wildcats. This is, in fact, the nicest view of the hike.

After crossing the blueberry field, the trail cut through a short set of woods before hitting a large plot of sapplings. It was a bit wet here and at one point it was hard to see where the trail went (to the left and then to the right), but shortly thereafter I was back in the woods.

The woods section of the trail is quite frankly a bit ugly - the trail is eroded, lots of blowdowns on the sides, and not much in way of on trail views.

Before I knew it, I was staring at a pile of large timbers that once made up the frame of the fire tower. While the rocky summit may have once provided great views in all directions, there's very little to see here other than small glimpses through and above the trees.

After looking around the summit a bit, I backtracked three minutes down the trail to a decent viewpoint on top of a large rock on the side. From here, there were nice views of the Wildcats, as well as glimpses of Mt. Washington and Kearsarge North.

The next stop was a few minutes further down, this time on the left side of the trail. There's a really nice ledge here with tremendous views of Mt. Washington and the Wildcats - due to the exposure, there is very little evidence of man (a road or two, the Mt. Washington summit building, and a house are all that's visible if I recall.

I put a special effort into walking all pitches essentially almost on my toes, as well as pausing for a few seconds whenever I felt anything odd in my knee. To my surprise, I was able to make it to the base without any sort of knee support or pain. In fact, it felt decent enough that I was fighting myself not to do another hike. Next stop, something around 1,000 vertical feet in a few days.

Looking north toward Wildcat Mountain

 

[Mike P.]

Keep up the rehab, nice picture!

 

[threecy]

Keep up the rehab, nice picture!

Thanks...had a setback yesterday, so I'm probably off it for awhile again. As bummed as I am that I can't hike (or for that matter ski if winter was tomorrow), I had a sobering moment almost a month ago. I was driving back from doing tiny Milan Hill, frustrated that it was as painful despite being such a short hike. Just as I was thinking that, I passed a house with a guy in his 30s or 40s in a wheel chair. Things could be much worse.

 

[JimG.]

Thanks...had a setback yesterday, so I'm probably off it for awhile again. As bummed as I am that I can't hike (or for that matter ski if winter was tomorrow), I had a sobering moment almost a month ago. I was driving back from doing tiny Milan Hill, frustrated that it was as painful despite being such a short hike. Just as I was thinking that, I passed a house with a guy in his 30s or 40s in a wheel chair. Things could be much worse.

As you have discovered, the heel strike is what puts most stress on the knee. It's why the knee buckles with a torn ACL...there's nothing to stop the hyperextention with the ACL gone so the body compensates by allowing the leg muscles to flex the knee and stop the extention which leads to the buckle.

Eventually, you will have to relearn to walk "heel-toe". Good solid heel strike followed by the rocking motion to the ball of the foot and then the toes. It's the toughest part of rehabbing knees to master and many folks never fully get it. Start now and work up to it slowly. I suggest a knee brace for the downhike, preferably one that limits hyperextention. It will give you more confidence to land on your heel.

Changes in normal "heel-toe" gait can lead to other physical issues, mostly back related. You don't want to wind up there.

 

[threecy]

As you have discovered, the heel strike is what puts most stress on the knee. It's why the knee buckles with a torn ACL...there's nothing to stop the hyperextention with the ACL gone so the body compensates by allowing the leg muscles to flex the knee and stop the extention which leads to the buckle.

Eventually, you will have to relearn to walk "heel-toe". Good solid heel strike followed by the rocking motion to the ball of the foot and then the toes. It's the toughest part of rehabbing knees to master and many folks never fully get it. Start now and work up to it slowly. I suggest a knee brace for the downhike, preferably one that limits hyperextention. It will give you more confidence to land on your heel.

Changes in normal "heel-toe" gait can lead to other physical issues, mostly back related. You don't want to wind up there.

Thank you for the advice...I've been avoiding the heel on downhills, as it (as you said) takes stress off the knee)...its one of those things that I can deal with the pain and walk normally, but I'm very concerned about this becoming chronic (and progressively worse). I've had knee problems before (ligament), but nothing quite as long lasting as this so far (tendinosis is my best guess). The pain is around the medial side of the kneecap (next to it, not under it), focussed in the lower medial corner.

 

[JimG.]

Thank you for the advice...I've been avoiding the heel on downhills, as it (as you said) takes stress off the knee)...its one of those things that I can deal with the pain and walk normally, but I'm very concerned about this becoming chronic (and progressively worse). I've had knee problems before (ligament), but nothing quite as long lasting as this so far (tendinosis is my best guess). The pain is around the medial side of the kneecap (next to it, not under it), focussed in the lower medial corner.

If you have/had ligament issues, arthritis is also a possible reason for your pain. The area you describe as being painful is exactly where I developed arthritis after I tore my ACL and PCL.

I had to have an osteotomy (bone was removed from my tibia to straighten it and shift how I was bearing weight) to relieve pressure on that spot before my ACL/PCL was replaced.

Not saying that's what you have, just mentioning possiblities.

 

[threecy]

If you have/had ligament issues, arthritis is also a possible reason for your pain. The area you describe as being painful is exactly where I developed arthritis after I tore my ACL and PCL.

I had to have an osteotomy (bone was removed from my tibia to straighten it and shift how I was bearing weight) to relieve pressure on that spot before my ACL/PCL was replaced.

Not saying that's what you have, just mentioning possiblities.

I sure hope its not arthritis - I'm only 24! It's not quite the same feeling as I've had with the ligaments (I remember after a day of skiing a few years ago, I could barely get down the stairway).

My first inclination was meniscus, but the pain's in the wrong location and I don't have any clicking or swelling or loss of range of motion. I'm still not quite sure how I hurt it - it came on full throttle when I was walking a flat on the Moats...two theories are either a) when I popped out of a boot slide too quickly on Moosilauke or b) when I feel directly on it coming off Little Haystack. There wasn't any sustained pain after either of those hikes...I did the S+M Moat 2 and 4 days later, respectively.

I've given it 1-2 weeks rest between reinjuring it - it seems to get about 85% better when I do nothing. Also I'm on glucosamine now. I tried doing leg strengthening exercises, but I ran into the same problems I've had in the past with those (ligament/stretching out of knee issues). Was taking Aleve daily, as well as icing daily and keeping it in a brace or wrapped, but I'm shying away from all of those now, as there has been zero swelling since day one and the brace has only contributed to the atrophy I'm developing.

I'll try to baby it for another week or two and see if it continues to improve (though its a bit sore now, its not as bad as it was the first two weeks). After that, I may be resigned to having it like this indefinitely...if it doesn't get worse, I'll deal with it - there's always a good story to tell when you have a limp!

 

[JimG.]

I sure hope its not arthritis - I'm only 24! It's not quite the same feeling as I've had with the ligaments (I remember after a day of skiing a few years ago, I could barely get down the stairway).

My first inclination was meniscus, but the pain's in the wrong location and I don't have any clicking or swelling or loss of range of motion. I'm still not quite sure how I hurt it - it came on full throttle when I was walking a flat on the Moats...two theories are either a) when I popped out of a boot slide too quickly on Moosilauke or b) when I feel directly on it coming off Little Haystack. There wasn't any sustained pain after either of those hikes...I did the S+M Moat 2 and 4 days later, respectively.

I've given it 1-2 weeks rest between reinjuring it - it seems to get about 85% better when I do nothing. Also I'm on glucosamine now. I tried doing leg strengthening exercises, but I ran into the same problems I've had in the past with those (ligament/stretching out of knee issues). Was taking Aleve daily, as well as icing daily and keeping it in a brace or wrapped, but I'm shying away from all of those now, as there has been zero swelling since day one and the brace has only contributed to the atrophy I'm developing.

I'll try to baby it for another week or two and see if it continues to improve (though its a bit sore now, its not as bad as it was the first two weeks). After that, I may be resigned to having it like this indefinitely...if it doesn't get worse, I'll deal with it - there's always a good story to tell when you have a limp!

Have you seen a good orthopedist?

You should before resigning yourself to being that way permanently.

 

[threecy]

Have you seen a good orthopedist?

You should before resigning yourself to being that way permanently.

Nope, not in years...surgery isn't worth it for me at this point. Thinking about trying out a sports trainer though.

 

[JimG.]

Nope, not in years...surgery isn't worth it for me at this point. Thinking about trying out a sports trainer though.

Surgery sucks and is to be avoided at all costs.

I've been through plenty, 4 on my left leg and 2 on my right knee. Hated every one of them.

It's why I have all the internal fixation inside of me still. I have so much metal in my legs that airport detectors light up like Christmas trees. But it doesn't hurt and I can't bear the thought of getting cut open again.

Good luck.