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

Experiencing knee pain when walking uphill (or downhill) can leave you feeling ready to ditch the trails for good. While typical knee issues that cause pain while walking on an incline are challenging, they’re often treatable.

As you explore what may be to blame for your knee pain, limit your walking to flat ground, and stretch before and after you exercise. If your knee pain doesn’t go away when you stop walking uphill, the pain gets worse, or your knee gives out, consult your doctor or physical therapist.

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 condition occurs when the tendon in the kneecap (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.

How to Fix It

“Leg-strengthening exercises and rehabilitation can help strengthen the knee joint and reduce pain,” says Dr. Okubadejo. “Seeing an orthopedic surgeon or knee specialist to discuss your options is another way to relieve knee pain and improve your quality of life.”

Chondromalacia

How to Fix It

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

Knee Arthritis 

“Arthritis can make walking uphill tricky and painful,” says Okubadejo. “Arthritis [presents] when your knee’s cartilage breakdown continues, and the space between the patella, femur, and tibia [bones] 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.

How to Fix It

“Maintaining [a healthy] weight, injections such as corticosteroids, surgery, medications, and elevating the knee can all help reduce knee pain [from arthritis],” says Okubadejo.

Patellofemoral Pain Syndrome

“When we run, the tibia and femur move, which puts pressure on the kneecap,” says Okubadejo. “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 of the knee joint, which causes the patella to rub against the femur.

While symptoms of PFPS occur at your knee, the problem may originate at your ankle or hip. Muscle imbalances and foot arch position can also contribute to kneecap alignment issues.

How to Fix It

Treating PFPS requires a visit to your doctor or a physical therapist. For the first few days, your doctor may advise you to rest your knee from aggravating activities, ice it for 15 to 20 minutes every few hours, and take an anti-inflammatory medication such as ibuprofen.

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

In addition to physical therapy, you may need orthotics, shoe inserts that help stabilize your feet and ankles while walking.

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,” says Okubadejo. That inflammation causes knee swelling and lateral pain across the kneecap that feels more intense when moving uphill. The severity of this pain often causes people to stop exercising.

How to 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’re exercising and suggest improvements, such as changing the height of your bicycle seat or adjusting your running form.

Your doctor may also inject a steroid medication into the affected area. In rare cases where 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 your knee gives way when walking, there are a few ways you can 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, particularly your quadriceps and hamstrings.

If you take a break from walking because of knee pain, try biking for two to three months before you return to the trails. Ride at least 20 minutes a day, three to five days a week, to condition your legs and prevent conditions like PFPS.

2. Leg Extensions

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’re in a chair, by wearing ankle weights.

How to Do It

1. Sit at a leg extension machine, bend your knees, and place your ankles under the roller pads.
2. Grasp the handles or the sides of the seat to hold your torso immobile.
3. Press your shins against the pads, and lift your legs so they’re 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 Bridges

Glute bridges help strengthen your gluteal muscles along your backside. Building these muscles helps take the load off your knees and strengthens your core for power movements like walking and running.

How to Do It

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 straight line with your knees, hips, and chest. Resist the urge to arch your lower back as you raise your hips.
3. Hold this position for a few seconds with your glutes engaged.
4. Slowly lower your hips back down to the floor, returning to the starting position for a second before lifting up again.
5. Perform one to three sets of 10 to 15 reps.

4. Banded Clamshells

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).

How to Do It

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 to 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, opening 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. Complete 10 to 15 reps, then switch sides. Perform two to three sets on each side.

5. Wall Sits

Wall sits work your quadriceps in an isometric contraction, improving muscular endurance that will benefit your knees on long walks. Each time you practice wall sits, try to hold the position longer than the previous time, until you’re able to maintain the position for five minutes.

How to Do It

1. Lean your back against a wall, with your heels two to three feet away from the wall.
2. Slowly slide your back 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, then relax.
5. Repeat five times.

6. Hamstring Stretch

Keeping your hamstrings flexible can help keep your knees healthy and help prevent pain.

How to Do It

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 inhale.
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 stretch 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.

How to Do It

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 twice with each leg.

8. IT Band Stretch

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

How to Do It

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, PFPS, and IT 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.
• Regularly exercise the muscles that support your knees, including your quadriceps, hamstrings, and glutes, with bike riding, 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 as well.