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

Walking makes you feel great, but knee pain when walking uphill (or downhill) can leave you ready to permanently park your walking shoes. Typical knee issues that cause pain while walking on an incline are challenging but treatable.

In the meantime, limit your walking to flat ground and make sure to stretch before and after you exercise. However, if your knee pain doesn't go away when you stop walking uphill, the pain gets worse, or your knee gives out, be sure to see a doctor or physical therapist.

Here are five common problems that can make your knees hurt when you’re walking on an incline, plus eight exercises and stretches that can help.

You May Have Patellar Tendinitis

"Knee pain while walking uphill could be due to patellar tendinitis," says Gbolahan Okubadejo, MD, a New York City area spinal and orthopedic surgeon. This is when the tendon in your kneecap (the 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.

Fix It

"Leg-strengthening exercises and rehabilitation can help strengthen the knee joint and reduce pain," Dr. Okubadejo says. "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

Fix It

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

You Might Have Arthritis in Your Knee

"Arthritis can make walking uphill tricky and painful," Okubadejo says. "Arthritis is when your knee's cartilage breakdown continues, and the space between the bones in the patella, femur, and tibia diminishes, and damage develops." This damage can actually change the shape of the joint and force bones out of their normal position, causing knee pain, he says.

Fix It

Along with the treatment options outlined 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), medications, and elevating the knee can all help reduce knee pain," Okubadejo says.

It May Be Patellofemoral Pain Syndrome

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

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

While the 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.

Fix It

Treating patellofemoral pain requires a visit to your doctor or a 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.

After the pain subsides, you'll work on a variety of exercises prescribed by your physical therapist. Among them are moves that specifically strengthen the quadriceps (the four muscles in your thigh that help stabilize the kneecap), as well as hip abductors and external rotators of the hip.

Iliotibial Band Syndrome

"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," Okubadejo says. That inflammation causes knee swelling and lateral pain across the kneecap that you feel more intensely when going uphill. The pain is often so bad that you have to stop exercising.

Fix It

Your doctor may refer you to a physical therapist to help you stretch tight muscles and strengthen weak muscles. They can also review how you move when you are working out and suggest improvements, such as changing the height of your bicycle seat or adjusting your running form.

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

8 Leg Exercises and Stretches for Knee Pain Walking Uphill

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

1. Biking

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

If you take a break from walking because of knee pain, plan to bike two to three months before you get back to the trails. 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 target the quadricep muscles on the front of your thighs. You can perform this exercise using a leg extension machine or sitting in a chair. When you’re ready, add resistance by using the settings on the leg extension machine or, if you are in a chair, by wearing ankle weights.

To do leg extensions using a machine, follow these steps:

1. Sit at a leg extension 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 and lift your legs so they are horizontal.
4. Squeeze your quadriceps at the top of the movement, then return to the starting position.
5. Perform one to three sets of 10 reps.

3. Glute Bridge

Glute bridges help strengthen your glutes, which are part of the muscles in your butt. Building these muscles helps take the load off your knees and strengthens your core for power movements like walking and running.

1. Lie on your back, with your knees bent and feet flat on the floor hip-width apart. Your feet should be close enough to your hips that if you reach one hand at a time toward each heel, you can just touch it with your fingertips. Relax your arms alongside your body. Think of your shoulders as glued to the floor to help keep your spine neutral.
2. Squeeze your glutes and core muscles, then press your heels into the floor, pushing your hips up toward the ceiling until you form a diagonal line from your knees to hips to chest. Resist the urge to arch your lower back as you raise your hips. Focus on keeping your spine in a neutral position throughout.
3. Hold this position for a few seconds with your glutes engaged.
4. Slowly lower your hips back down to the floor and reset in the starting position for a second before lifting back up.

4. Banded Clamshell

Banded clamshells can help strengthen your hip abductors (which help move your legs to the side for movements like getting out of bed) and external rotators (which rotate the femur in the hip joint).

1. Slide your legs through a resistance band and bring it just above your knees.
2. Lie on one side, resting your head on your bottom arm so that your neck is in a neutral position.
3. Bend your knees at 90 degrees. Keep your hips and knees evenly stacked on top of each other.
4. Engage your abs and slowly lift the top knee upward as high as you can without rotating your hips backward. Keep your feet together for the whole movement, opening up your knees like a clamshell. Resist the urge to make the movement easier by pushing your feet together.
5. Slowly lower your top knee to return to the starting position.
6. Do 10 to 15 reps, then switch sides. Repeat for two or three sets.

5. Wall Sit

Wall sits work your quadriceps in an isometric contraction. This exercise improves muscular endurance, which will benefit your knees on long walks. 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 five minutes.

1. Lean your back against a wall, with your heels 2 to 3 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 five times.

6. 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.

7. 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, then repeat the stretch with your right leg.
5. Complete this stretch two times with each leg.

8. Iliotibial Band Stretch

If you get knee or IT band pain walking downhill, try this stretch. When doing this stretch before an activity, hold it for only a short time. After exercising, hold this stretch for 30 to 60 seconds on each side.

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

The Takeaway

• Common causes of knee pain when walking on an incline are patellar tendinitis, chondromalacia, arthritis, patellofemoral pain syndrome, and iliotibial band syndrome.
• A doctor can diagnose the source of your knee pain and recommend treatment, which may include icing and resting your joint, physical therapy, surgery, or medications such as anti-inflammatories or corticosteroids.
• Work out the muscles that support your knees, including your quadriceps, hamstrings, and glutes, with regular exercises such as riding a bike, leg extensions, glute bridges, and wall sits.
• Stretching your leg muscles helps reduce knee pain, so include hamstring, calf, and IT band stretches in your regular workout routine.