Knee pain going downhill

What it is

Going downhill, the quadriceps work eccentrically: lengthening under load to control the descent rather than shortening to produce it. Eccentric loads are far higher than concentric ones, and the forces at the knee during descent are several times body weight per step.

When the quadriceps fatigue, control is lost and the joint takes the shock instead. This is why the pain characteristically arrives partway down a long descent, and why the day after a hill walk is worse than the walk itself.

What it feels like

• Fine or nearly fine going up, and painful coming down
• Pain around or behind the kneecap rather than deep in the joint
• Building through a descent rather than starting at the top
• Much worse on steep or long descents, and on stairs
• Aching and stiff for a day or two afterwards

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Eccentric quadriceps weakness

Controlling a descent is a different capacity from producing an ascent, and it is trained by different work. Most walking, cycling and gym work is concentric, so the eccentric capacity is untrained.

Quadriceps fatigue partway down

The muscle has a finite eccentric endurance. Once it is gone, each step lands with less control and more impact through the joint - which is why the pain has a distance threshold rather than starting immediately.

Hip abductor weakness

Descending on one leg at a time requires the pelvis to stay level and the knee to stay in line. Weak glute medius lets the knee drift inward on every step, which loads the kneecap unevenly.

Poor kneecap tracking

The patella has to glide in its groove under high load. Weak vastus medialis, tight lateral structures and a rotating femur all pull it off line, and the pressure concentrates on a smaller area.

Stiff ankles

Restricted dorsiflexion limits how much the ankle can absorb, so more of the shock is passed up to the knee. It is a common and easily missed upstream contributor.

Load carried on the back

A heavy pack multiplies every one of these forces. Descent with a loaded pack is the classic setting for this pain to appear for the first time.

Training only on the flat or uphill

Gym leg work, cycling and uphill walking build concentric strength. Descending capacity is only built by descending, and almost nobody trains it deliberately.

Existing knee osteoarthritis

A joint with reduced cartilage tolerance reaches its limit sooner, and downhill is where the highest loads occur.

Worn or unsupportive footwear

Poor grip and worn cushioning both increase the impact and the braking effort required on a descent.

Who tends to get it

• Hikers, particularly with a pack, and particularly on multi-day trips
• Runners doing downhill or trail routes
• Anyone whose training is entirely flat or uphill
• People with existing knee osteoarthritis or a history of knee pain
• Anyone returning to hill walking after a long break

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineKnee Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Knee swelling, locking or giving way on a descent needs assessment before the next trip

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Eccentric training produces noticeable change within six to eight weeks and the improvement on real descents is usually clear. Trekking poles produce an immediate reduction in knee load and are worth using rather than resisting. This is a capacity problem rather than a joint problem in most people, which means it responds well - but the capacity has to be built with the specific type of work, since general leg strength does not transfer to it well.

Prevalence basis: Wilderness and sports medicine surveys

Others the same routine covers

These share the Knee Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.