Is rucking detrimental to knee health?

Is Rucking Bad for Your Knees?

Rucking (walking with a weighted backpack) is likely not harmful to knee health when performed with proper technique and appropriate loads, but can potentially increase stress on knee joints if done improperly or with excessive weight.

Understanding Rucking and Knee Health

Occupational Evidence on Knee Loading Activities

• Strong evidence shows that certain occupational activities like kneeling, squatting, and bending increase the risk of developing knee osteoarthritis (OA) 1
• Heavy physical demands in occupational settings show strong evidence for increased knee OA risk 1
• However, there is moderate evidence for no increased risk of knee OA related to walking activities 1
• Climbing stairs or ladders shows strong evidence for no increased risk of knee OA in women 1

Biomechanical Effects of Rucking

• Rucking with weighted backpacks causes incremental changes in lower extremity joint kinetics 2
• Each incremental increase in rucksack load results in:
  • Moderate-to-large increases in knee extension torques during early stance phase 2
  • Small-to-moderate increases in ankle plantarflexion torques during push-off 2
  • Changes in hip extension and flexion torques during different phases of the gait cycle 2

Potential Risks and Considerations

Risk Factors for Knee Problems

• Occupational lifting shows strong evidence for increased risk of hip OA in men, which may have implications for load-bearing activities like rucking 1
• Cumulative physical loads and full-body vibration show moderate evidence for increased risk of hip OA 1
• The single greatest cause of musculoskeletal injury with resistance training is a previous injury 1
• Higher intensity efforts with heavier weights can have adverse effects on the knee joint 1

Recommendations for Safe Practice

• Individuals initiating a rucking program should be carefully screened for cardiovascular limitations and pre-existing orthopedic and musculoskeletal problems 1
• Proper technique, appropriate weight progression, and safety precautions are essential 1
• Exercise should be adjusted to environmental conditions, particularly in hot weather 1
• Obese individuals with knee-loading exposures are at additional risk of knee OA and should be encouraged to lose weight 3

Evidence on Exercise and Knee Health

Benefits of Exercise for Knee Health

• Moderate exercise does not lead to acceleration of knee OA, whether or not there is evidence of pre-existing disease 4
• Exercise appears to improve physical functioning and reduce pain and disability in those with and without knee OA 4
• For individuals with established knee OA, there is good evidence for reduced pain and disability with exercise compared to controls 4
• Self-selected running (which individuals can modify based on symptoms) is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression in people with knee OA 5

Exercise Recommendations

• Joint-specific exercises reduce pain and improve function in patients with knee OA 1
• Quadriceps strengthening exercises are beneficial in the management of knee OA 1
• Aerobic fitness training has long-term benefits for pain and function from knee OA 1
• Regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction are recommended for non-pharmacological treatment of knee OA 1

Practical Guidelines for Rucking

How to Minimize Risk

• Start with lighter loads and gradually increase weight as strength and endurance improve 1, 2
• Maintain proper posture and technique during rucking to distribute weight appropriately 2
• Use appropriate footwear and consider supportive insoles 1
• Allow adequate recovery time between rucking sessions 1
• Stay hydrated before, during, and after rucking, especially in hot weather 1
• Consider using walking poles or other assistive devices to reduce pressure on the affected limb 1

When to Avoid Rucking

• When experiencing acute knee pain or inflammation 1
• With pre-existing knee injuries or severe knee OA 1
• When feeling physically unwell (wait until symptoms of illness have been absent for 2 days) 1
• Immediately after eating (wait at least 2 hours) 1

By following proper technique, using appropriate loads, and considering individual factors like previous injuries and weight, rucking can be performed with minimal risk to knee health for most individuals.