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Why Do I Feel Pain in Knee When Walking Downhill?

Hands down, hiking is one of the best ways to enjoy life – it’s amazing exercise, it allows you to disconnect, the scenery is unbeatable and most importantly, it gets you outside. Nothing beats a dirt trail surrounded by trees, mountains, wildflowers, rocks, and all the amazing views your senses can handle. While it’s easy to enjoy every second on the trail, some hikers may find downhill hiking less than enjoyable. So what does it give? What causes even the most agile and fit hikers to experience knee pain when walking downhill?

Mechanics Of Downhill Walking

Walking downhill requires the muscles at the front of the thighs—the quadriceps—to contract eccentrically, meaning they work as the fibers lengthen. Consider the standard dumbbell biceps curl: During a 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 they are straight again, your biceps contract eccentrically as they lengthen to help you control the weight rather than letting gravity pull the barbell to the floor.

What Else Can Cause Knee Pain?

  • Bursitis. A bursa is a sac that holds a small amount of fluid that is under the skin above the joint. It helps prevent friction when the joint moves. Falls from overuse or repetitive bending and kneeling can irritate the bursa at the top of the patella. This leads to pain and swelling. Pain physicians in Dallas refer to this condition as prepatellar bursitis. You may also hear it called “preacher’s knee.”

  • Dislocated kneecap. This means your kneecap is moving out of position, causing knee pain and swelling. Your doctor may call this a “patellar dislocation.”

  • IT (iliotibial) band syndrome. The iliotibial (IT) band is a piece of tough tissue that runs from your hip down to the outside of your knee. If you overdo it with activity, it can become inflamed over time. This causes pain on the outside of the knee. It is common among downhill runners.

  • Meniscal tear. Sometimes a knee injury can cause the cartilage to tear. These rough edges can get stuck in the joints, causing pain and swelling. Many times people will feel like they are “catching” in the joint when they are active.

  • Osteoarthritis. This is a “wear and tear” type of arthritis. It is the leading cause of knee pain after 50 years. This condition causes the knee joint to hurt or swell when you are active. Joints affected by osteoarthritis may also feel stiff at the start of the day.

  • Patellofemoral pain syndrome. Muscle imbalances, tension, and leg alignment problems usually cause this condition. It causes knee pain and occasional “buckling”, meaning your knee suddenly cannot support your weight. It’s not because of an injury. It is more common in women than in men.

Ways To Prevent Knee Pain When Hiking Downhill

You don’t have to let an angry runner’s knee dictate what you can do on a hiking trail! Here are some tips to make this hike pain-free.

1. Use Hiking Sticks

Hiking poles or trekking poles can instill strong opinions in tourists. However, whether you love them or avoid them, you should definitely consider them if your knees hurt from going downhill. A good set of hiking poles helps prevent knee hyperextension when riding downhill on a trail. This also helps in treating sharp stabbing pain in the knee.

Hiking poles also help shift some of the weight from the legs to the upper body and core. This takes some of the pressure off your knees and helps distribute some of the work over your whole body when climbing these mountains.

2. Strengthen The Surrounding Muscles

Your knees will start talking to you when your butt doesn’t! Make sure your weekly training program includes plenty of moves to support your knee, including extra work (check out our moves below or join us for EC Fit, an 8-week program for better hikes all around). And also Pain Management in Dallas helps with knee pain treatments in fort worth when hiking.

Stronger glutes and stronger hips can help tremendously in relieving knee pain but don’t underestimate stability work. A yoga class with several balancing poses can help you build leg stability. Hikers with weak or unbalanced leg muscles run a much higher risk of knee pain or injury on the descent. Balancing work can offset this risk and bonus – you can also work on your zen.

3. Knee Bracket

External support such as a tape or knee brace can be great, especially if recommended by a pain doctor in Dallas. If you’re wearing a knee brace because of a recent injury, or if the brace doesn’t address what may be a bigger problem, also seek medical attention.

Getting medical help to manage knee pain from a bigger problem or a little extra time to heal a knee injury will make the hike that much more enjoyable when you’re in the best possible shape to be there.

4. Small Steps

Small quick steps are a win here. Going downhill is a big no-no. It increases the pressure and load on the knees, risks hyperextension, and speaks of a sense of imbalance! Small steps that keep moving make downhill hiking a lot more fun. Even if it means going a little slower than you’d like, a slow pain-free hike down is better than a fast descent that hurts right then or later that day.

You want your torso to not fall forward or backward; an easy way to monitor this is to keep your shoulders over your ribcage and your ribcage over your hips. This will also help you keep your balance as you transition from one foot to the other.

Think about keeping your leg strong and wide under you. Stable, grounded feet help you adjust to uneven terrain. Try to avoid shifting into the balls of your feet, where you’ll put a serious strain on your strongest knees… or you’ll roll.

4 Moves To Protect Your Knees When Hiking Downhill

Here are some of my favorite poses to gear up for those big downhill goals!

1. Tree Pose

A yoga-inspired tree pose will build your balance and the ligaments and tendons that make for a happy foot and leg. Best for strengthening your core, glutes, back, and legs.


  • Start barefoot, and make sure you’ve got a wall, kitchen counter, or chair back nearby if you think your balance needs assistance.

  • Stand tall with your feet together, shoulders rolled back, and ribcage over your hips.

  • Start by coming to the ball of your right foot, testing out putting all your weight into your left foot.

  • Turn your right toes and right knee out to the right.

  • Lift your right foot to rest against your left calf, or you can use your right hand to place your right foot up high against your left thigh. Avoid the left knee–we’re here to avoid shooting knee pain, and putting pressure directly on the knee with your foot isn’t the best idea.

  • Root your left foot into the earth, and bring your palms to prayer position at your heart, or lift them overhead like tree branches for more balance work.

  • Keep your right hip opening and hip points even.

  • Stay here for a few breaths, and then do it all on the second side.


Think of open hips, open heart, and strong roots keeping you from falling over! Don’t be afraid of using a wall for help when you need it.

2. Warrior 3

This yoga pose works your balance, breathing, legs, core, and back. Best for strengthening the stabilizing muscles in your feet, ankles, upper body, and legs.


  • Start barefoot with a wall, chair, or sofa arm nearby for help, but make sure you have lots of room to expand in this area.

  • Begin by coming up to the balls of your right foot to start easing balance into your left side.

  • Root your left foot strongly into the ground, making sure not to lock your knee out at any point.

  • Lift your right foot off the ground, flex your foot, and bring your chest towards the floor, stopping parallel with your hips.

  • You can choose different variations of Warrior 3 by where you put your hands:

  • One hand on a balancing surface

  • Both palms at the heart center, in the prayer position

  • Palms next to your hips, facing down, in “airplane arms.”

  • Most advanced: hands come out to stretch in front of you, palms facing each other

  • Stay here (and remember to breathe) for 20 to 30 seconds, then switch sides.


  • Strong feet, strong legs, and a strong core will make this exercise shine.

  • When your leg is up, make sure your toes face the ground, not away.

3. Standing Knee Adduction

This seemingly simple move zeroes in on areas known for causing sharp knee pain. Best for strengthening inner thighs, hips, outer glutes, and lower abs. Add a mini-band for maximum burn, but this will get the job done easily without one just using body weight.


  • Start standing with feet around hip distance apart, keeping the edges of your feet as wide as the edges of your shoulders.

  • Bend slightly at your waist, counterbalancing with your glutes behind you.

  • Bend your knees slightly so that you aren’t locking out your knees.

  • Using your inner thigh and outer glute, pull your right knee towards your center line gently, and then return it back to neutral.

  • Do this 5 times on the right, then 5 times on the left, and then 5 times with both.

  • Repeat 3-5 times.


  • Add a mini-band for increased resistance.

  • Be careful that you feel this in your glutes and thighs, and not your knee!

4. Clamshell

This versatile exercise challenges every glute it finds. Best for strengthening the glutes, obliques, and thighs, and addressing muscle imbalances between each side. This also helps with pain in the knee.


  • Take it to the floor lying on your right side, with your right elbow underneath your right shoulder. Knees should be bent in front of you, with feet in line with your hips.

  • Take time to press your forearm strongly into the ground, to keep from collapsing into the shoulder.

  • Keep your feet flexed.

  • Open your left knee towards the sky, keeping your feet together.

  • Close your left knee back to meet the right.

  • Do this 10 times, then roll over to the other side.

  • 10 rounds on each side. Repeat 3-6 times.

Do not hesitate to contact us if you would like to schedule an appointment.

Dr. Rao K. Ali M.D.

Dr. Rao Ali, a board-certified pain management physician, leads the clinic, which specializes in nonsurgical treatment. The physician has experience in the emergency room as well as training in pain management and rehabilitation. As a personal physician, he works with each patient to develop a treatment plan that will minimize or eliminate their pain. Providing expert diagnosis and treatment of a wide range of conditions, Pain Management In Dallas, PA provides a comprehensive range of services. These services include neck pain, back pain, hip and knee pain, fibromyalgia, neuropathy, complex regional pain syndrome, headaches, migraines, and many others.