We tend not to think too much about walking downstairs when we can do it painlessly. When every step is a sore one, it becomes a far more complex task. Dave Duffy explains why.
Mechanically speaking, walking downstairs is really a matter of the load you’re putting through your knee and your ability to control it. In particular, pain when you’re bending your knee, as you do when walking downstairs, is often a problem with the patellofemoral joint – the point at which the back of your kneecap and thighbone meet the front of your knee.
It’s easiest to explain what happens when you’re walking downstairs or downhill by first considering what’s going on when you’re simply sitting or standing.
Standing: When you’re standing straight, your kneecap isn’t fully engaged with the knee joint. It sits slight proud, or proximal, of the joint. As a result, the load (that is, the force passing through the back of the kneecap) is low.
Sitting: Sit down, and your kneecap shifts. Now it engages with the knee joint, sitting in a groove at the front of the knee. Even though you’re sitting down, load is now passing through the kneecap. Some people will say their knees hurt when they’ve been driving for a while or when they’ve been sat on a plane or at the cinema. It’s all a result of the increased load passing through the patellofemoral joint.
Walking downstairs: When you start going downstairs, you shift to a position where not only is your kneecap engaged in the joint (because you’re bending your knee with every step) but you’re also putting weight into the back of the knee. That combination means your knee is operating at highest load.
There’s nothing necessarily problematical with a high load. Most knees cope with high loads all the time, whether you’re bending to lift heavy objects or swiftly shifting from sprint to stop on a bent knee – as you might in a game of squash.
But where there’s already damage to the kneecap or the groove in which it sits, high load activities are where you’ll feel the greatest pain. And that’s probably why your knee hurts when you walk downstairs or downhill.
How do you treat patellofemoral joint pain?
One relatively simple but effective way to protect the joint is to strengthen the muscles at the front of the leg – the quads. The stronger they are, the more they help support the knee. It’s important to note that strengthening the quads won’t reverse damaged already caused, but it can help protect the knee from further damage by managing the load going through it.
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Knee Cap Problems
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