Fix Your Downhill Knees

A couple of weeks ago our family hiked from up high in the Olympic National Park to the town below—4230 vertical feet over 8 miles (or 9.5 if you want to take the GPS’ word for it). We always do a couple challenging family “thru-hikes” each summer: point to point hikes that add some other element of sticking with the challenging walk over time. A one-day kid version if you will.

 

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This was no easy trail (and in many spots, it wasn’t a trail at all); most steps required mindful foot placement because it was so rugged. But, our two families made it. This was the first time I’ve ever done so many steep downhill miles without any flat or uphill breaking up the bulk of the walking. Two days later, delayed onset of muscle soreness (DOMS) was pinging me in three areas on each leg: glute medius, lateral quad, and soleus.

 

Why these muscles?

Going uphill is hard. Leg muscles have to do a lot of work to lift the weight of the body up, which requires the heart and lungs move more. Lowering the body doesn’t take as many heart and lung motions. You’re being pulled down the mountain, which is easier in one way but harder in another. Declines—especially steep ones—require the body “put on the brakes” to keep the body from tumbling down. The areas I felt a couple days after my downhill trek were where the body’s “downhill brakes” are located.

Let me draw it out for you in a super clear way that couldn’t possibly be misinterpreted.

1. The SOLEUS muscle is the deepest calf muscle and it connects the heel to shin. As you take your downhill step, the soleus lengthens (green arrows) even though it’s working in the direction of staying short (red arrows). When muscles work in the opposite direction of their net movement, it’s called an eccentric contraction.
2. The QUADS on the front of the thigh also get longer (green arrows) as the leg moves forward to lower the body, but they're working opposite to that motion, which is what slows things down.
3. The front view makes it easier to see that the GLUTE MEDIUS (one of the lateral hip muscles) is doing the same thing as the other two: getting longer as it lowers the other side of the pelvis, but controlling that motion eccentrically.

There are many ways to get downhill that don’t use the parts noted above. When ankles, knees, hips, and waist are stiff, gait patterns get creative. Those with stiff parts can still log many miles a day, and even multiple hikes a week; these creative patterns just take their toll over time.

 

Why can knees hurt when walking downhill (or down stairs, for that matter)?

1. Your knees are working harder than they have to

The first thing I have folks check on their downhill gait is “are you using your knees and hips or just your knees?”

The lowering of the hip when you’re going downhill not only keeps the knee from having to do all the work to get that foot to the ground below, it also gives you the opportunity to keep your mass from bombing down the hill.

If you list and shift the hip (see picture 3 below) what you’re doing is creating a “slalom” for your center of mass—moving it side to side as it goes down—slowing you naturally, so you don't have to ride the quad brakes so hard.

The Pelvic List exercise is key to downhill gait because this is where you can train the glute medius to work specifically while walking (i.e. on a single, standing leg). Watch the video below from the Walking Well program for more explanation.

Work on the pelvic list and stepping down off a block to get your soleus and glute medius prepared to take the workload off your quads. This is also a move to practice while you hike. Even if you haven’t built up a lot of practice, you can always bring this move out to change your gait on the trail.

 

2. Your kneecap (patella) isn’t tracking in the “patellar groove”

Going downhill works your quads and thus tenses them. The patella is embedded in the quadriceps’ tendon, which means tense quads press the patella deeper into the knee joint than when you’re not walking downhill.

Our knees have space for the kneecap, but the kneecap can get pulled out of alignment (usually it’s pulled laterally) based on your all-time movement habits and patterns. Going downhill when the kneecap is adjacent to its groove increases the pressure in the knee. P.S This can also be why kneeling upon or deeply bending a knee hurts.

My kneecaps have a tendency to get pulled laterally so I'm diligent about doing our patella-centering leg lifts. These look pretty similar to general "kneehab" leg lifts only I've adjusted the form specifically to target the more medial quads to balance out the net pull on the kneecap. You can find this exercise in Move Your DNA, Walking Well, and a variety of our virtual studio classes. Unfortunately this isn't a quick adjustment you can make on the trail, but I do do them while I'm out backpacking, so they definitely travel well.

Hope this takes some of the mystery out of why downhill/down-steps walking often makes for achy knees. The good news: it's most often a situation you can do something about.

This isn't the first piece I've written on walking or hiking hills. Check out Save Your Knees: A Hiking Tutorial.