Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 94: Why Going Down Stairs Is Harder After Knee Replacement (And How to Improve It Safely)

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Episode 94: Why Going Down Stairs Is Harder After Knee Replacement (And How to Improve It Safely) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  Instead of lifting your body, your muscles are
• 0:02
  controlling your descent. This is called eccentric
• 0:05
  muscle activity where your quadriceps are lengthening
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  while they contract, acting like a brake to control
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  how quickly your knee bends as you lower yourself.
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  Are you ready to get back to what you love after
• 0:18
  knee replacement? The Total Knee Success podcast
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  is your trusted guide with practical tips, evidence
• 0:25
  -based strategies, and no fluff. It's not personal
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  medical advice, just solid education to help
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  you manage pain, regain mobility, and get back
• 0:34
  to living the life you love. Let's dive in. Welcome
• 0:39
  back to the Total Knee Success podcast. I'm Michelle.
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  A few weeks after his knee replacement, David
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  stood at the top of his staircase looking down.
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  Going up had started to feel manageable, but
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  going down felt completely different. He held
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  the railing tightly, unsure how much he could
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  trust his new knee, and each step felt like a
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  test of strength, balance, and confidence. That
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  moment is common for people early in the healing
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  process. By the end of this episode, you'll understand
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  why going downstairs is usually harder than going
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  up after knee replacement, what is happening
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  in your body during that movement, and examples
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  of approaches that may be used in rehabilitation
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  settings to help build the strength and control
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  needed over time. We will also discuss how readiness
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  for stair practice is often assessed and why
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  guidance from your physical therapist or surgeon
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  is important before beginning. This information
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  is provided for general educational purposes
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  only and is not intended as medical advice or
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  a substitute for individualized evaluation, diagnosis
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  or treatment by a qualified healthcare professional.
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  Let's start with a simple observation. Going
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  upstairs and going downstairs are not the same
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  task. When you go upstairs, your muscles are
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  working to lift your body against gravity. This
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  is called concentric muscle activity, where your
• 1:58
  quadriceps, the muscles at the front of your
• 2:00
  thigh, contract to straighten your knee and help
• 2:03
  push you upward. Going downstairs is different.
• 2:06
  Instead of lifting your body, your muscles are
• 2:08
  controlling your descent. This is called eccentric
• 2:12
  muscle activity, where your quadriceps are lengthening
• 2:14
  while they contract. acting like a brake to control
• 2:18
  how quickly your knee bends as you lower yourself.
• 2:21
  That braking function is one of the main reasons
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  going downstairs feels harder. After a knee replacement,
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  quadriceps strength is often reduced. This can
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  be related to the surgery itself, as well as
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  swelling, pain, and a phenomenon called arthrogenic
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  muscle inhibition, where the nervous system may
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  temporarily limit how strong muscles can contract
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  around the joint. Even if your knee feels stable
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  when walking on flat ground, going downstairs
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  requires a higher level of control. The quadriceps
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  must absorb body weight, control knee bending,
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  and help keep movement smooth and steady. If
• 2:56
  that control is not fully restored yet, you may
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  notice compensatory strategies. You might lean
• 3:01
  more on the handrail, step down with your operated
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  leg first, or turn your body slightly sideways.
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  These are commonly observed strategies used to
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  maintain safety. Progression is typically guided
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  by a qualified healthcare professional to help
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  ensure it is appropriate for your specific situation.
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  Let's talk about the mechanics of going downstairs.
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  When you step down, your leading foot reaches
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  the lower step while your trailing leg remains
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  on the higher step. As you shift your weight
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  forwards, your knee bends and your quadriceps
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  control that bending to prevent a rapid drop.
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  This requires a combination of strength, balance,
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  coordination, and confidence. Your knee also
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  experiences higher forces during stair descent,
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  compared with walking on flat ground. Research
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  has shown that joint forces can increase significantly
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  during stair activities, meaning your muscles
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  must be prepared to handle that added load. This
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  is one of the reasons stair descent often requires
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  more preparation and conditioning during your
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  healing process. It doesn't mean stairs are inherently
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  unsafe, but it does mean they demand more from
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  your body. Balance is another important factor.
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  When you go downstairs, your center of mass moves
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  forward and downward, and your body must continuously
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  adjust to maintain stability. If your balance
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  feels uncertain, your brain may interpret that
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  as a risk and respond by increasing muscle tension
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  or limiting movement, which can make the movement
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  feel stiff or awkward. Fear can also influence
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  movement, even if your knee is physically capable.
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  Concern about falling may change how you move.
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  You may hesitate, move more slowly, or avoid
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  fully loading your operated leg. This is a protective
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  response, but it can also affect how the movement
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  is performed over time. So, now we have several
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  overlapping factors, reduced quadricep strength,
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  decreased eccentric control, balance challenges,
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  higher joint forces, and sometimes fear. Together,
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  these help explain why going downstairs often
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  lags behind other activities during rehab. Now,
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  let's talk about how this may be addressed in
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  rehab settings. and how readiness for stair practice
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  is often evaluated. Before getting into specific
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  examples, keep in mind that these are general
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  approaches commonly used during the healing process.
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  And your situation is unique and your surgeon
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  or your physical therapist typically guide your
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  specific plan. And it's especially important
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  to confirm with your physical therapist or surgeon
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  that stair practice is appropriate for you before
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  attempting it independently. There are a few
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  general signs clinicians may consider when evaluating
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  readiness. They can include your ability to stand
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  and walk on flat ground with good control, your
• 5:33
  ability to shift your weight onto your operated
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  leg without significant pain or instability,
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  and your ability to perform basic movements such
• 5:40
  as sitting to standing with reasonable control.
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  Some individuals may also demonstrate a small
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  step down or controlled lowering movement in
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  a supervised setting before progressing to a
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  full set of stairs. These are examples instead
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  of requirements, and decisions are truly individualized.
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  In many rehab programs, clinicians emphasize
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  gradual progression over time. Early after surgery,
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  many people use a step two pattern. When going
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  up the stairs, stepping up with the non -operated
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  leg first and then bringing the operated leg.
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  And then when stepping down, lowering yourself
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  with the non -operated leg by stepping first
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  with your operated leg down. This reduces the
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  demand on your replaced knee and often is used
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  initially. It's common and appropriate. for a
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  starting point in many cases. As strength and
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  control improve, some individuals may work toward
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  a step over pattern, where each foot alternates
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  naturally on each step, which is the normal walking
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  pattern that we generally use when we don't have
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  knee pain. This transition is typically guided
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  and progresses at a pace that's appropriate for
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  you. Before practicing full stair descent, clinicians
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  often focus on building the necessary components.
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  One of the most important components is quadricep
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  strength. In rehab settings, clinicians may use
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  exercises such as sit to stand, mini squats,
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  and little step -down variations to help develop
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  the strength needed for stair descent. Performing
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  graduated stepping up is a common progression,
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  starting with a two -inch, then progressing to
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  a four-, six-, and eight -inch step. As performance
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  improves, it's common. A physical therapist can
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  demonstrate how to perform the step exercises
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  safely. Another important component is eccentric
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  control, which involves practicing movements
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  where muscles control a lowering motion. Graduated
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  stepping down can be progressed in a similar
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  fashion to stepping up that we just talked about.
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  Technique is important for stepping down, and
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  having a therapist advise you on your movement
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  quality is invaluable. Also, clinicians may incorporate
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  controlled lowering into a chair over several
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  seconds, which can resemble the demands of stair
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  descent. Balanced training is also commonly included.
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  Exercises such as supported single leg standing,
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  weight shifting, or controlled movements with
• 7:56
  assistance may be used to help improve your stability.
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  And these are typically performed with appropriate
• 8:01
  support and supervision, especially early in
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  the healing process. When you begin practicing
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  on the stairs themselves, clinicians often recommend
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  a safe setup. And this might include using a
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  handrail, having additional support available.
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  and choosing a staircase with good lighting and
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  non -slip surfaces. Hopefully in the clinic you
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  have good lighting and non -slip surfaces. A
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  step two pattern may still be used initially
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  with attention to placing your foot fully on
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  the step and moving in a controlled manner. Progression
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  is typically gradual. In clinical practice, variables
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  such as the number of steps, the level of support,
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  or movement pattern may be adjusted over time
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  rather than changed all at once. And your response
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  to the activity is also considered. You might
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  experience mild soreness after a stepping activity
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  because it's challenging for the knee. But what's
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  appropriate can vary, and your therapist can
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  help you interpret these responses, especially
• 8:53
  if symptoms such as persistent pain, swelling,
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  or stiffness occur. And there are also situations
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  where stair descent may remain more challenging.
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  Significant quadriceps weakness, limited knee
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  bend, balance impairments, or other joint issues
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  can all affect your ability. In these cases,
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  working with your therapist can help you guide
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  a more individualized approach. Changes can continue
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  over time, and you might notice that stairs remain
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  difficult a few months after surgery, but strength,
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  control, and confidence can continue to improve
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  beyond the early healing period. Research on
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  functional progress after knee replacement suggests
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  that activities requiring higher levels of control,
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  such as stair descent, what we're talking about,
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  often take longer to return, and this reflects
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  the complexity of the task. If stairs are an
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  important part of your daily life, then discussing
• 9:43
  that with your healthcare team, if you're having
• 9:45
  trouble with it, can help guide rehab priorities.
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  And for those who don't regularly encounter stairs,
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  rehab goals may focus more on other functional
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  activities first. Function varies based on individual
• 9:57
  needs and environments, though the ability to
• 10:00
  climb stairs is related to higher function overall.
• 10:04
  If you want some more practical strategies and
• 10:07
  education geared to where you are in your process,
• 10:10
  check out the link in the show notes to join
• 10:11
  the Total Knee Success Insider Newsletter. I
• 10:14
  break things down in simple, actionable ways
• 10:17
  to help you keep moving forward from where you
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  are in the healing process. Also in the show
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  notes, you'll find a helpful resource if walking
• 10:24
  still feels awkward or uneven after surgery.
• 10:27
  My book, Walking Like Yourself Again After Knee
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  Replacement, goes deeper into why walking can
• 10:32
  feel frustrating even weeks or months after surgery,
• 10:35
  and what factors can influence improvement. It's
• 10:38
  based on clinical experience and current evidence,
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  and it's designed to help you better understand
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  what you're feeling and how people rebuild smoother,
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  more confident walking over time. Going down
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  the stairs after knee replacement is often harder
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  than going up because it requires controlled
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  lowering, strong quadriceps function, balance,
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  and coordination. These elements take time to
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  rebuild. Readiness for stair practice is typically
• 11:01
  determined with guidance from your PT or surgeon.
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  Approaches used in rehab often focus on safety,
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  support, controlled movement, and gradual progression.
• 11:12
  Your experience may vary and progress can continue
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  over time with appropriate guidance. In episode
• 11:17
  95, we'll discuss how to get in and out of a
• 11:19
  low car more easily, why it can feel so awkward,
• 11:23
  and practical techniques to make the process
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  safer and more comfortable. Thanks for joining
• 11:28
  me. I'm Michelle, and this has been the Total
• 11:30
  Knee Success podcast. This podcast is for educational
• 11:37
  purposes only. Discover more at TotalKneeSuccess
• 11:40
  .com. And be sure to subscribe and share, because
• 11:44
  every step forward takes you closer to living
• 11:46
  the life you love.