If your knees feel fine on the climb and start to ache halfway down, you are not imagining it. Descents load the knee in a different way from climbing, and most training plans never prepare you for it.
This guide explains what happens in the knee on the way down, the strength work our physical therapist and our mountain training coach prescribe for it, what helps on the trail itself, and the signs that mean you should see a doctor rather than push on.
This is general information, not a diagnosis. If your knee pain is sharp, new or getting worse, have it assessed by a doctor or physical therapist before your next big hike.
Why Downhill Hiking Hurts Your Knees
On a descent, your quadriceps work as brakes. They contract while they lengthen (an eccentric contraction) to control every step down. That is harder on the muscle and on the joint than climbing.
Lab studies put numbers on it. Kuster and colleagues compared level and downhill walking on a 19% slope and found much higher knee joint moments going down. In a follow-up analysis of the same walkers, peak force in the knee joint averaged 3.9 times body weight on level ground and 8 times body weight downhill, mostly from the muscles pulling across the joint.
Peak force in the knee joint, in multiples of body weight
Fatigue makes it worse. In a 2023 Innsbruck study, prolonged eccentric work in simulated downhill walking disturbed the sensorimotor control people need for precise foot placement. Tired legs land less accurately, which is why the last hour of a descent is where many slips and knee tweaks happen.
Common Causes of Knee Pain on Descents
Patellofemoral Pain (Hiker’s Knee)
A dull ache around or behind the kneecap that gets worse on stairs and descents. A clinical review in athletes lists overuse, weak hip muscles, poor core endurance and tight muscles among the risk factors, which is why strength work is the first-line treatment.
Iliotibial Band Syndrome
A burning or sharp pain on the outside of the knee, often after a set distance. The Cleveland Clinic describes it as an overuse injury where the IT band rubs or presses on the outside of the knee. Long descents with repeated knee bending are a classic trigger.
Meniscus Problems
The menisci are the C-shaped cartilage pads between your thighbone and shinbone. A tear can cause pain, swelling, catching or a knee that locks. Unlike the two overuse problems above, this usually needs a medical assessment.
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Build Knees That Can Handle the Descent
Our knee strengthening guide was built with physical therapist Dr. Antigone Vesci, and her main point is that hiking knees need endurance more than maximum strength.
Dr. Antigone Vesci
PT, DPT, The Edge Performance Therapy“Strength is how much weight your muscles can lift once; endurance is how many times they can keep lifting it. Strength helps your performance on the trail, but endurance is what keeps you from getting hurt along the way.”
Her plan uses 3 sets of 12 to 20 repetitions, two to three times a week: lunges or step-ups, banded side steps, bridges with knee fall-outs, planks, single-leg squats to a chair and dead bugs. Expect six to eight weeks before you notice a real difference on the trail.
Train the Way Down, Not Just the Way Up
Jakob Ulcnik, co-founder of the training app Train to Mountain, told us in our mountaineering training interview that this is the part almost everyone skips:
Jakob Ulcnik
Co-founder, Train to Mountain“Stair machines and incline treadmills are useful, but it’s the descent that wrecks your quads, and almost nobody trains for it.”
From our mountaineering training interview
These are the starting points his plans prescribe for descent strength:
| Exercise | Start | Later |
|---|---|---|
| Eccentric step-down from a 8 to 16 in20 to 40 cm box, lowering the other foot as slowly as you can | 3 sets of 10 per leg, body weight, 4-second lowering | 4 sets of 10 per leg with 12% of your body weight |
| Walking down a long staircase | 3 rounds of 2 minutes of controlled descent | 5 rounds of 3 minutes with 15% of your body weight on your back |
Source: Train to Mountain’s training plans, as given to OutdoorAdept by Jakob Ulcnik. Full table in our mountaineering training interview.
If a staircase is all you have, take the lift up and walk down. That is descent training.
On the Trail: What Helps Your Knees Going Down
Use Trekking Poles
This is the best-supported fix. In a study by Schwameder and colleagues (Journal of Sports Sciences, 1999), walking down a 25-degree slope with poles reduced knee joint forces by 12 to 25%, partly through the arms and partly because people leaned slightly forward. Lengthen your poles a little for the descent; our trekking pole height calculator gives flat, uphill and downhill lengths, and our guide on how to use trekking poles covers technique.
Shorten Your Stride and Keep Your Weight Over Your Feet
Leaning back to fight gravity puts more load on the knee and makes slips more likely. Keep your weight over your feet, bend your knees slightly and take shorter steps. On steep ground, zigzag rather than going straight down.
Slow Down When Your Legs Get Tired
Because fatigue reduces control, the end of a long descent is the moment to slow down and take a break, not to hurry to the car park.
Choose Footwear That Fits, with Enough Cushioning for You
For people with knee osteoarthritis, a double-blind trial found that cushioned shoes reduced knee pain over three months compared with identical shoes without the cushioning. For healthy knees the evidence is less clear, and our guide to sole thickness explains the trade-offs. Our physical therapist Dr. Ashley Katzenback puts footwear in its place:
Dr. Ashley Katzenback
PT, DPT, CMTPT, Cape Concierge Physical Therapy“The biggest misconception about shin splints is that people think they can fix them with footwear. Footwear is a tool. Strengthening is the actual fix.”
From our shin splints guide
She said it about shins, and the same logic applies to knees: the shoe can help, the training does the work.
Pack Lighter
Everything in your pack is carried down every step too. Our backpack weight calculator gives a target pack weight for your body weight and trip.
After the Hike: Recovering from a Sore Knee
Sports medicine has moved on from RICE. The PEACE and LOVE approach (British Journal of Sports Medicine) is the current standard for soft-tissue injuries:
- First days (PEACE): protect the knee for 1 to 3 days, elevate it, avoid anti-inflammatories that may slow healing, use compression, and learn about the injury rather than relying on passive treatments.
- After that (LOVE): load it gradually and let pain guide you, stay optimistic, keep blood flowing with pain-free cardio such as cycling or swimming, and exercise to restore strength and mobility.
If you tweak a knee on the trail, that means easy days and controlled movement, not weeks of complete rest.
When to See a Doctor
Most post-hike knee soreness settles in a day or two. These signs do not:
- The knee swells noticeably, especially within hours of a twist or fall
- You heard or felt a pop
- The knee gives way, locks or catches
- You cannot put full weight on it
- The knee looks deformed, or is red, hot and feverish
- Pain keeps getting worse despite rest and easier activity
Orthopedic surgeon Dr. Aman Dhawan of Penn State Health gave one quick sign in a Penn State Health Q&A: “Swelling inside the knee, if the knee starts looking like, you know, a soccer ball or a basketball and there seems to be a lot of fluid on there, that’s a very quick indicator or a very prime indicator that something is amiss, and usually it’s something structural within the knee. It doesn’t necessarily mean that you need surgery, but does mean that you should get this looked at by a physician.”
Before the appointment, write down when the pain started, what makes it worse, and what you have tried. It saves time and leads to a better assessment.
FAQ
Why Do My Knees Hurt Going Downhill but Not Uphill?
Going down, your quadriceps work as brakes while they lengthen, and the knee carries far more load. In one study, peak knee joint force averaged 3.9 times body weight on level ground and 8 times body weight walking downhill.
Do Trekking Poles Really Help Your Knees?
Yes. In a study of downhill walking on a 25-degree slope, poles reduced knee joint forces by 12 to 25%, partly by taking load through the arms and partly by changing posture.
Should I Hike with Knee Pain?
Mild soreness after a long descent that fades in a day or two is common. Swelling, a pop, a knee that gives way, or pain that keeps getting worse are reasons to stop and get it checked.
What Exercises Help Knee Pain When Hiking Downhill?
Exercises that train the quads to brake under control: slow step-downs, lunges or step-ups, single-leg squats to a chair, plus glute and core work. Our physical therapist recommends higher repetitions for endurance.
