How Should You Descend Stairs If You Have Knee Pain?

The question of how to descend stairs without aggravating existing knee pain came up in a reader question to the Ask Well blog on the New York Times website.

Several suggestions followed.

One: Strengthen your quadriceps or thighs. An exercise to do so (the straight-leg raise) was described.

Well, if your knees tolerate well quad-strengthening exercises, great. If not, you may be buying yourself a ticket to the land of Even Worse Knee Pain.

But let’s say you want to do something to get stronger, and walking isn’t enough to prepare you for the dreaded stair challenge. My thought: do unloaded squats. Find a machine (or build a DIY setup in your Mom’s garage as I did, using bungee cords and a mountain-climbing harness :)), and do lots of easy repetitions of a squat, at an easy load. Functionally, I think that’s closer to a stair-step motion than a straight-leg raise anyway.

Two: Avoid prolonged sitting.

While this strikes me as a fine idea, it’s good advice generally for just about anyone, whether they have bad knees or not. So I’m a bit less impressed by this recommendation.

Three: Descend stairs backwards. (That sound you just heard was thousands of knee pain sufferers tumbling down a flight of stairs.)

Needless to say, if you crack your crown doing this, don’t come looking for me. I’m skeptical that people with weak knees and a probably degraded sense of balance should be trying to navigate stairways in reverse.

The rationale for this advice, by the way: “Descending stairs backwards reduces loads across the knee joint,” according to orthopedic surgeon Kevin J. Bozic. A 2010 study showed that, when subjects went down stairs backward, the forces generated migrated toward the hip rather than knee.

So theoretically this approach may make sense, though in practice, I’m not so sure.

Finally: What would my suggestion have been on this matter, had I been polled?

That’s easy: Don’t.

In other words, to avoid pain while descending stairs, don’t descend stairs (or descend stairs as infrequently as possible).

Think of it this way: If you went to a doctor and said, “Doc, my knees hurt whenever I play soccer,” his perfectly reasonable response might be, “Listen, you might have to give up soccer for a while, until your knees get stronger.” So why should that sort of advice be considered strange when you simply substitute “stairs” for “soccer”?

This isn’t about avoiding stairs forever. Or even avoiding all stairs. There will inevitably be some stairs to descend, and once your knees are stronger, you can go up and down stairs all you want. In the meantime, you may have to alter your lifestyle a bit, such as by moving your second-floor bedroom onto the first floor, or taking a pass on going to the football game and sitting in the bleacher seats that are a 56-row climb to the top of the stadium.