Are you one of the many individuals who has experienced knee pain hiking downhill? You start off on a great day of hiking, especially in the warmer weather of SoCal, only to be stopped in your tracks because of the nagging knee pain that won’t let up. For whatever reason, going uphill doesn’t bother you. But as soon as you start going downhill, the knee pain is there. Sound familiar? Why exactly does this happen and what can be done to prevent it from happening again? This post will address all of your concerns surrounding your knee pain when hiking downhill.
TAKE ME STRAIGHT TO THE EXERCISES TO FIX MY KNEE PAIN!
**This is not medical advice. Please consult your medical provider for more information.
What is Happening Around the Knee When Walking Downhill?
Are you someone who deals with knee pain specifically when walking downhill? This is a common occurrence and complaint to hear in the physical therapy clinic.
When you walk, there are many muscles and muscle groups that are working. The ones we will be focusing on are the glutes, quads, and hamstrings. The gluteals are your large posterior hip muscles, aka your bum. The quads are in the front of your thigh and the hamstrings are in the back of the thigh.
The glutes help to extend, abduct, and externally rotate the leg, as well as help stabilize the pelvis when you are walking. The quads are the main knee extensors. The hamstrings are the main knee flexors.
These muscles all work together when you walk. Some will work more if you are going uphill vs downhill. Your muscles work, or activate, in different ways. They can either work by shortening (concentric) or lengthening (eccentric).
Concentric vs Eccentric Contraction
For the purpose of this post, we will be focusing on the quadriceps (quads). When walking uphill, the quads work concentrically. This means the muscle shortens when it contracts. When walking downhill, the quads work eccentrically. This means the muscle lengthens when it contracts.
When hiking downhill, there is a lot more force going through the knee joint. Your quad has to work really hard to slow down your body’s momentum going down the hill. Your quad muscles need to be strong to control this movement. On top of that, your quad must be strong eccentrically to be able to control your downhill walking or hiking. Lets take a closer look at this phenomenon at work…
Sit down in a chair and extend your knee out straight. Count slowly to 3 as your extend your knee out. Your knee should be straight by the time you reach your count of 3. This is your quad muscle contracting concentrically.
Now slowly count to 3 as you bend your knee back to the starting position. Your knee should be bent at a 90 degree angle by the time you reach your count of 3. This is your quad muscle contracting eccentrically. Was one of them harder? Most people will say controlling their knee while it bends is harder. Now imagine if you had extra weight on your ankle as you slowly lower it down. This would make it even more challenging!
As you hike downhill, your body weight is going through your knee joint and your quads need to be strong enough to control all of that force! If your quads are generally weak or if they are specifically weak with eccentric control, you are going to feel that nagging pain in your knee.
A Common Misconception
When you think about strengthening your quads, you should work on strengthening them with multiple types of exercises focusing on both concentric and eccentric movements. Going to the gym and busting out a ton of reps on the knee extension machine just isn’t enough.
If you are dealing with knee pain hiking downhill, try to best simulate the motion with your exercises. You should be incorporating wall sits, eccentric squats or pause squats, and lunges. Remember that functional fitness not only helps reduce pain, but also allows you to train for whatever life throws at you.
Other Causes of Knee Pain Hiking Downhill
Weakness or Poor Mechanics
We have discussed how weakness of the quads can lead to knee pain. Weakness in areas above and below the knee is also important to look at.
If the muscles of your foot are not strong or you have weak ankles, you will have a much more difficult time with stabilizing your ankle. This can lead to rolling your ankle, developing foot pain, or lead to increased force through the knee.
Weakness in the hip/glute muscles may also lead to knee pain. These muscles are important for controlling the motion of the femur – the large thigh bone. If you do not have adequate control of your femur, it can lead to poor mechanics and increased knee pain.
If you are looking to improve your strength and mechanics to address your knee pain, check out these posts:
- Knee Pain Walking Down Stairs? This Can Help!
- Physical Therapy Exercises for Knee Pain: How to Reduce Arthritic Pain
- How to Strengthen Knees for Function and Performance
- Knee Pain When Walking? How to Walk with Pain Free Knees
- Why Strength Training for Runners is Important
Patella Alignment and Tracking
Your patella (kneecap) sits in a small groove. As your knee bends and straightens, your patella moves slightly within that groove. If the patella moves too much or moves in the wrong direction, it can lead to instability.
Tight muscles and stiff soft tissue around the knee can lead to poor tracking of the patella. It can be pulled to the left or right too much. Your kneecap may be resting in a bad position to start off or it may be moving too much or too little in directions that lead to poor tracking. This may be reason for knee pain when walking downhill. It is important to reach out to a physical therapist to determine if this could be an issue you are dealing with.
Is Your Back Masking Itself as Knee Pain?
Occasionally, knee pain may be coming from your back. This is something known as radiating pain. In this instance, if you try to work on the knee, your symptoms will not go away because you are not addressing the root cause. A physical therapist can help determine the true source of your pain. To learn more about radiating pain and sciatica, try looking into these posts:
- Pain From Your Back Down Your Leg? Sciatica Treatment Explained!
- How to Get Rid of the Pain from Piriformis Syndrome
- Sciatica Symptoms? Try This and Feel Better
Is It Okay to Keep Hiking?
As long as your knee pain is not hindering you from doing your daily activities or causing excruciating pain while you are walking, it is okay to keep hiking. Depending on the severity of symptoms, a physical therapist may suggest taking time off, activity modification, or bracing. Advice can vary from reducing the length of your hike, using trekking poles for better stability, or choosing a hike with less hills for a period of time.
The biggest thing is that we keep you doing what you love doing a much as possible and within reason to make sure further injury is not occurring. While rest can sometimes be good for recovery (and maybe sometimes needed), staying moving and active is an even better option.
Things to Help Reduce Pain When Hiking
Trekking or walking poles not only help with balance and stability, but they help with distributing stress. When safety is of concern with lots of uneven terrain, walking poles can be of great help!
Knee braces can be helpful, but there is a fine line between using them when needed and beginning to rely on them. Short term use of a brace may be helpful. Long term use can lead to a sense of reliance on the brace. It can also masks symptoms of injury and prolong recovery.
It is important to use a brace as needed, but to make sure you are effectively training your muscles to help control your movement. In the long run, this will help reduce the risk of injury.
Lastly, check on your feet! Sometimes knee pain can be coming from the foot or ankle. If orthotics are right for you, they may certainly help either your foot or knee pain when hiking downhill. On top of that, make sure you have the right footwear for hiking!
Strengthening to Prevent Knee Pain
As stated earlier, eccentrics are what you should be focusing on. While the glutes will definitely help you out, focusing on eccentric quad strength is just as important. Give these exercises a try to help strengthen important muscle groups for hiking!
Sidelying Clam Iso
Lie on your side with a resistance band just above your knees. Keeping your feet together, lift your knee towards the ceiling and hold this position for 30-60 seconds.
You want to feel this on the side of your hip. This targets the glutes. You do not want to feel this in your back. Perform 3 sets and turn on your other side to repeat.
Eccentric squat
This exercise will focus on the eccentric portion of the movement.
Start by standing with your feet hip width apart of slightly wider. Slowly squat to a comfortable depth. Your movement should last over a period of 3-5 seconds. The slower the movement, the harder the exercise.
Briefly pause the movement once you get to the depth your want, then explode standing up. This motion is quick, taking around a second to stand up.
You can make this exercise my challenging by adding a resistance band above your knees or by adding weight (barbell, dumbbell, or kettlebell).
Perform 3 sets of 8-10 reps.
Quadruped Fire Hydrant
To perform this exercise correctly, start on your hands and knees. Move your left knee at a 45° angle behind you, not directly to your right side. Try to externally rotate your left leg like you are trying to drop your foot to a lower level than your knee.
Common faults involve arching, lifting, or rotating the back. Try to keep your low back still, only moving from your hip joint. If you feel the muscles working in your butt, you’re doing it right. You should not feel this exercise in your low back if you are doing it correctly.
Hold this position for 30 seconds. Repeat for 3 sets on each side.
Sissy Squat
Kneel down onto a soft surface. Keep your shins and feet pushing down into the ground. Lift your arms up in front of you.
Then, keeping your core engaged, lower your body backwards. Only go as far as comfortable to you. You might only start off with a small movement before progressing your range. The goal is to lean back as far as you can go keeping a straight line from your shoulders down to your knees.
Perform 2-3 sets of 8-10 reps.
Eccentric Step Down
You can use a step, curb, stair, or anything elevated and stable for this exercise.
Standing on one leg, slowly bend your knee on the stance side and tap the heel of your other leg to the surface below you. Send your hips backwards to counterbalance yourself.
This is a quad exercise, but you will also use your glutes. If you don’t use your hips enough, you might feel more knee pain or you could lose your balance and fall forward.
If this is too challenging starting off, hold onto something like a railing, wall, or stick to give you better support and stability.
Perform 3 sets of 10-12 reps on each side.
TL;DR
This post reviews the mechanics of the muscles of the knee when hiking downhill to help explain why you may be experiencing knee pain. It also reviews what to do to help treat and prevent your knee pain hiking downhill. Training eccentric quad work is paramount to help with anything going downhill or down stairs.
Tera Sandona is a licensed Doctor of Physical Therapy (DPT) and the founder of PT Complete. She helps high-achieving women break out of cycles of chronic pain, stress, and burnout through her Regulate and Rebuild Method, a sequenced approach that addresses the nervous system first and builds strength second. Her work focuses on helping women finally understand their bodies, rebuild strength, and create lasting resilience that fits real life.
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