5 Strategies To Combat Downhill Walking Knee Pain | Well+Good

But what about going in the other direction?

“Downhill walking is a great way to improve muscle strength and stability,” says Jason Schuster, DPT, physical therapist and the co-owner of Intricate Art Spine & Body Solutions. “Although it can also create impairments if your muscles and joints are not ready to be introduced to the amplified forces and stresses.” Fortunately, this is easily avoidable if you’re aware of how the muscles, joints, and nervous system work—and spend a little time strengthening your lower body.

The mechanics of downhill walking

Downhill walking requires the muscles on the front of your thighs—the quadriceps—to contract eccentrically, which means they’re working as the fibers lengthen. Consider a standard biceps curl with dumbbells: During the concentric contraction, you lift the weight by bending your elbows, and your biceps shorten. As you lower the weight back down and extend your elbows so that they are straight again, your biceps contract eccentrically because they are lengthening as they help you control the weight rather than letting gravity pull the dumbbell to the floor.

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Dr. Schuster says that eccentric muscle contractions generate more force, which places significantly more stress and compression on tissues like your muscles and joints.

“Wolff’s Law states that tissues respond and adapt to forces placed through them,” he shares. “So, by walking downhill, which increases the forces placed on joints, muscles, tendons, ligaments and bone, you are forcing them to respond by remodeling and getting stronger.”

This activates the majority of the muscles in your lower body, including the pelvic floor, which is vitally important for supporting your pelvic organs and preventing incontinence. “The muscles and joints that people typically feel the most are the quads, glutes, hamstrings, low back muscles, knee joints, and lower back joints,” notes Dr. Schuster.

The musculoskeletal strengthening benefits of downhill walking can even help reduce the risk of arthritis. “[By] placing increased stresses on joints in a controlled manner, you stimulate increased ligamentous strength and increased synovial fluid production inside the joint capsule,” he explains. “Having better synovial fluid production is like changing the oil in your car on a regular basis.”

Why does downhill walking cause joint pain?

While downhill walking is a great way to efficiently strengthen your legs, the added forces induced by gravity can be taxing on your bones and joints, especially your knees.

“Since we are angled downward, the bottom part of the knee joint, the tibial plateau, wants to slide more forward secondary to more angular gravitational force,” says Dr. Schuster, who explains that it is the job of the anterior cruciate ligament (ACL) to stop the tibia from moving forward on the femur. “If your ACL is not in good enough shape, along with your muscles crossing the knee joint, and you go on a long downhill walk, it is going to hurt. Walking downhill also increases shearing forces placed on the menisci, the internal shock absorbers of the knee, which can lead to pain.”

Dr. Schuster adds that in addition to the knees, walking downhill can also be hard on the lower back because it causes lumbar spine extension. This activates the multifidus muscle, the deepest and most important spinal stabilizing muscle in the body. “Multifidus dysfunction is one of the leading causes of low back pain, and pain anywhere in the body, for that matter,” he says.

So what can you do to walk downhill pain-free?

1. Start slowly

To begin incorporating downhill walking into your workout routine without aggravating your joints or muscles, you’ll want to dip your toes into the proverbial waters gradually.

“If you are not in shape or not used to walking downhill, start with flat walking, then move to uphill walking, and then move to downhill walking,” says Dr. Schuster. At that point, start by walking downhill slowly and limiting the distance. Then, gradually increase the speed and duration to avoid tissue overload and damage.

2. Strengthen to stabilize

The stronger your muscles are, the more force or workload they can absorb, sparing your knees, hips, and low back joints from bearing the brunt of the impact: “Performing bodyweight exercises to strengthen the low back, knee, and pelvic and ankle stabilizing muscles is a great way to improve your condition for downhill walking, and life in general.”

A few of Dr. Schuster’s favorites are squats (being mindful to sit back and keep your knees behind toes), supine hamstring curls with your feet on an exercise ball (keep your pelvis level and transverse abdominis tight), supermans, bird dogs, single-leg deadlifts, clams with a band around knees, and planks.

3. Stretch regularly

Don’t neglect stretching. “Tight and short muscles are one of the worst things you can do to joints,” Dr. Schuster says. “This increases joint compression, decreases range of motion, decreases synovial fluid production, decreases blood flow, creates hypoxic and unhealthy tissues, and ultimately leads to pain and other impairments, like arthritis.”

4. Watch your body positioning

It’s critical to pay attention to proper form when walking downhill. “Maintain your pelvis level to the ground, keep knees from going in front of toes, and keep your abs activated,” he says.

5. Mix it up

While downhill walking comes with plenty of benefits, Dr. Schuster encourages walkers to enjoy all types of terrain to maximize fitness benefits and minimize overuse injuries. “Overall, walking with a variety of flat, uphill, and downhill, all in the same walk, is the most dynamic and therapeutic way to walk,” he says.

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