Why does walking up and down hills cause me so much pain?

Living in San Francisco, many of us walk to work, do not have cars, and live in very hilly areas. Because many of us do not have a choice to avoid hill walking so we trudge up them, perhaps in pain. A common question we get asked as physical therapists is why it hurts to walk up or down hills.

Two common injuries we see in the clinic are knee pain and low back pain. Walking on hills can affect both depending on what the pathology is.

Walking up hills

Although it seems more difficult on your legs, our bodies are designed to endure them easier IF we use the right muscles. Our gluteals (buttocks) are the powerhouse in our legs and walking up hill requires good control with our core (abdominals) and gluts to protect our back and knees. However, if our gluts and core are weak excessive strain through the knee and low back may occur.

Walking up hills also require sufficient calf flexibility in the ankle. If you don’t have this or are walking in a shoe with poor support or a heel, excess compression may occur in the front of the knee (patellofemoral joint) or the low back (lumbar spine).

Walking down hills

Walking down hills, believe it or not requires a more difficult type of muscular contraction (eccentric) from a smaller muscle group (quads). The quads and core muscles must work as a unit to slowly descend down hills and if either of these are week, the knee will have more compression or shearing forces affecting the patellofemoral joint or meniscus. If the core is not stabilizing the low back, increased compression through the low back may occur.

The Solution?

  • strengthen your gluts
  • strengthen your core
  • strengthen your quads
  • stretch your calves
  • wear supportive shoes (no heels).


See past video of these exercises in action on our Facebook page.

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