Knee Pain Walking Uphill? Here's What Your Body Is Trying to Tell You

Is walking up hills bad for knees? Not if you take time to stretch and strengthen your leg muscles.
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Walking makes you feel great. It boosts your energy, lifts your mood and revs up your metabolism. However, knee pain walking uphill (or downhill) can also leave you ready to permanently park your walking shoes.

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Knee pain while walking uphill is usually caused by one of a few common knee problems. They're challenging but treatable. In the meantime, limit your walking to flat surface and make sure to stretch after you exercise.

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Warning

If your knee pain doesn't go away when you stop walking uphill, the pain gets worse or your knee keeps giving out, be sure to see a doctor or physical therapist.

You May Have Patellar Tendinitis

"Knee pain while walking uphill could be due to patellar tendinitis," says Gbolahan Okubadejo, MD, NYC-area spinal and orthopedic surgeon. Basically, the tendon in your kneecap (patella) becomes inflamed and irritated.

"Pain in the front knee tends to get worse when walking uphill, and if patellar tendonitis is left untreated, you can develop tears in your tendon," he says.

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"Leg-strengthening exercises and rehabilitation can help strengthen the knee joint and reduce pain," Dr. Okubadejo says. (Keep reading below for examples of these kinds of exercises.)

"Seeing an orthopedic surgeon or knee specialist to discuss your options is another way to relieve knee pain and improve your quality of life."

It Could Be Chondromalacia

Another knee issue that may be at fault is chondromalacia (the breakdown of tissue on the kneecap), Dr. Okubadejo says.

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"If your cartilage is worn down, a person may feel pain as the knee bends and straightens, which causes the bone to rub on rough cartilage," he explains.

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"If you have chondromalacia, you should ice your knee and rest it, and avoid walking uphill," Dr. Okubadejo says. "A brace can also help lessen the pain when walking uphill."

You Might Have Arthritis in Your Knee

"Arthritis can also make walking uphill tricky and painful," Dr. Okubadejo says. "Arthritis is when your knee's cartilage breakdown continues, and the space between the bones in the patella, fibula, and tibia diminishes, and damage develops."

This can actually change the shape of the joint and force bones out of their normal position, causing knee pain, he says.

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Along with the treatment options above, there are a few other ways to address knee pain from arthritis.

"Maintaining your weight, injections such as corticosteroids, surgery (partial knee replacement surgery, arthroscopic surgery, osteotomy, etc.), medications, and elevating the knee can all help reduce knee pain," Dr. Okubadejo says.

It May Be Patellofemoral Pain Syndrome

One of the most common knee problems is patellofemoral pain syndrome (PFPS), and you'll feel this acutely when you're walking uphill or climbing stairs. This condition, also called runner's knee or hiker's knee, can cause knee pain when walking downhill or down stairs, according to Mayo Clinic.

"When we run, the tibia and femur move, which puts pressure on the kneecap," Dr. Okubadejo says. "When too much force is placed on the kneecap, the tissue can become irritated, thus causing pain around the patella."

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Similarly, walking uphill requires repeated bending and straightening of your knee joint which causes the patella to rub against the femur.

While they symptoms of PFPS occur at your knee, the problem might originate at your ankle or hip. Muscle imbalances and foot arch position can contribute to kneecap alignment.

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Treating patellofemoral pain requires a visit to your doctor or physical therapist. For the first few days, your doctor might advise you to rest your knee from aggravating activities, ice it for 15 to 20 minutes every few hours and possibly take anti-inflammatories such as ibuprofen.

When the pain subsides, you'll work on exercises to strengthen the quadriceps, the four muscles in your thigh which help to stabilize the knee cap (see below for more on those).

Patellofemoral pain syndrome typically improves with conservative treatment. In addition to physical therapy, you might need orthotics, or shoe inserts, to help stabilize your feet and ankles while walking, according to Cleveland Clinic.

A small percentage of patients do not respond to therapy and may need to have a surgeon resurface the underside of the knee cap.

Iliotibial Band Syndrome

Another common knee problem when walking uphill is iliotibial (IT) band syndrome. The IT band starts at your hip, travels down your leg and crosses your knee cap. It's made of thick fibrous tissue. Knee pain when bending the knee repeatedly while walking, especially uphill, can irritate the iliotbial band, according to Cedars-Sinai.

"The forward and backward motion of running or walking uphill causes friction where the IT band meets the knee, which causes increased pain and inflammation," Dr. Okubadejo says.

That inflammation causes knee swelling and lateral pain across the knee cap that you feel more intensely when going uphill. The pain is often so bad that you'll have to stop exercising.

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Initial treatment for IT band syndrome is similar to other soft tissue injuries — rest, ice and anti-inflammatories. Physical therapy is often prescribed to stretch tight muscles, strengthen weak muscles and address altered biomechanics that contributed to your condition.

Your doctor might also inject steroid medication into the affected area. In rare cases, conservative treatment doesn't work and you may need surgery.

6 Leg Exercises and Stretches for Knee Pain Walking Uphill

If knee pain is derailing your walking workouts or your knee gives way when walking, here are a few moves you can do to stretch and strengthen the muscles in your legs and help prevent knee pain.

1. Biking

Riding a stationary bike or mobile bike is an excellent way to condition your knees and the supporting muscles. Biking builds strength and endurance in your quadriceps and hamstrings, thereby strengthening your knees.

Begin to bike two to three months before you plan to begin hiking. Try riding at least 20 minutes a day, three to five days a week to condition your legs and prevent hiker's knee.

2. Leg Extension

Leg extensions specifically target the quadriceps muscles on the front of your thighs. You can perform this exercise with body weight only or with added resistance from an exercise band or a leg extension machine.

  1. Sit at a machine, bend your knees and place your ankles under the roller pads.
  2. Grasp the handles or the side of the seat to hold your torso immobile.
  3. Press your shins against the pads to lift your legs to horizontal.
  4. Squeeze your quadriceps at the top of the movement and then return to the starting position.
  5. Perform 1 to 3 sets of 10 reps.

3. Wall Sit

Wall sits work your quadriceps in an isometric contraction. This exercise will improve your muscular endurance, which will really benefit your knees on long hikes.

  1. Lean your back against a wall with your heels two to three feet away from the wall.
  2. Slowly slide your back and butt down the wall until your knees reach a 90-degree bend.
  3. Adjust your feet so that your ankles are directly below your knees.
  4. Hold this position for 10 to 60 seconds and then relax.
  5. Repeat 5 times.

Tip

Each time you practice wall squats, try to hold the position longer than the previous time until you're able to maintain the squat for 5 minutes.

4. Hamstring Stretch

Keeping your hamstrings flexible will keep your knees healthy and help prevent pain.

  1. Sit at the edge of a chair with your left leg bent and your right leg extended with your heel on the floor and your toes pointing up. Take a deep breath in.
  2. As you exhale, keep your back straight and slowly bend forward at the waist until you feel a stretch in the back of your right leg.
  3. Hold the stretch for 30 seconds, then repeat the movement with your left leg.
  4. Repeat the stretch twice on each leg.

5. Calf Stretch

Stretch your calves on a daily basis to prevent any unnecessary tightness that may lead to knee pain.

  1. Stand facing a wall and place your hands flat against the wall.
  2. Step backward with your left leg and forward with your right.
  3. Keeping your left knee straight, bend your right knee and lean into the wall until you feel a stretch in your left calf muscle.
  4. Hold this position for 30 seconds and then repeat the stretch with your right leg.
  5. Complete this stretch 2 times with each leg.

6. Iliotibial Band Stretch

If you get knee or IT band pain hiking downhill, try this stretch. When done before activity, only hold for a short time. When performed afterward, hold for 30 to 60 seconds on each side.

  1. Sit in a chair with your knees bent and feet flat on the floor.
  2. Cross your right leg over your left leg and then clasp your hands around your right knee.
  3. Gently pull your knee toward your left shoulder until you feel a stretch.
  4. Hold here for 30 seconds and then lower your foot back to the floor.
  5. Perform the stretch with your left leg.
  6. Repeat the stretch twice with each leg.

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