Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 115: Curbs and Stairs After Knee Replacement (How to Handle Going Up, Coming Down, and Real-World Steps)

Transcript

Episode 115: Curbs and Stairs After Knee Replacement (How to Handle Going Up, Coming Down, and Real-World Steps) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Coming down requires it to help control the lowering
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  while your other foot reaches the next step.
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  In my experience, alternating feet going up can
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  feel secure well before alternating feet going
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  down. You can use different patterns in the two
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  directions. Are you ready to get back to what
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  you love after knee replacement? The Total Knee
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  Success podcast is your trusted guide with practical
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  tips, evidence -based strategies, and no fluff.
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  It's not personal medical advice, just solid
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  education to help you manage pain, regain mobility
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  and get back to living the life you love. Let's
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  dive in. Welcome back to the Total Knee Success
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  podcast. I'm Michelle. Walking across a flat
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  floor may be getting easier and you're walking
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  more like yourself. Then you reach the curb outside
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  of restaurant or the steps at your daughter's
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  house. Stepping up or down takes a little more
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  thought about where to put your feet and how
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  to use your support. This is part three of our
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  four -part walking series. Episode 113 covered
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  walkers and episode 114 covered canes. Today
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  we'll bring those skills to curbs and stairs.
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  By the end of this episode, you'll have a better
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  idea of how to manage a curb with a walker or
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  cane, which leg leads going up and coming down
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  stairs with a rail and a cane, and how step two
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  and step over patterns differ. We'll also look
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  at what changes when you need less support. Level
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  walking moves your body forward while your legs
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  support you. Going upstairs adds a lift against
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  gravity. In physics, work means applying force
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  over a distance. Your leg muscles must lift your
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  body through the height of each step. For the
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  same body weight, a higher step requires more
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  work than a lower one. Your quadriceps, the muscles
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  at the front of your thigh, help straighten your
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  knee as you lift onto the next step. Muscles
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  around your hip and ankles help, too. In a study
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  of people six months after a single knee replacement,
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  greater quadriceps strength in their surgical
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  leg was associated with faster stair climbing
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  performance. Participants also relied more on
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  their other leg and the hip on their surgical
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  side. Coming down requires your supporting leg
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  to control the lowering while your knee bends.
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  Your quadriceps produce force while lengthening,
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  acting like breaks. Alternating feet coming down
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  places more demand on your surgical knee and
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  thigh than lowering one step at a time with the
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  stronger leg controlling the descent. A study
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  that directly measured forces through knee replacements
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  in five people found higher average peak joint
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  loads coming downstairs than going up or walking
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  on level ground. This study measured joint loading.
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  It did not establish when someone is ready to
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  alternate their feet. That helps explain why
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  stairs can remain a challenge after level walking
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  feels easier. On a flat floor, your surgical
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  leg can support you as you move forward. On stairs,
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  that leg needs to lift your body or control its
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  lowering while your knee bends. Strength, knee
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  motion, balance, and coordination all contribute.
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  So the two activities can improve at different
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  rates. Now let's put those differences into the
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  curb and stair patterns. The instructions I'm
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  describing are general examples for someone who's
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  allowed to put their full weight through their
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  surgical leg. Use the sequence and support you
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  were taught. Restrictions on weight -bearing,
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  another painful joint, or surgery on both knees
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  can change the setup. Let's start with a single
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  curb and a walker. A curb is one step between
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  two levels, often with no rail. It may be near
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  traffic, sloped toward the street, or have an
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  uneven edge. You may have more time and room
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  at a curb cut, which is the sloped opening in
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  the sidewalk. Choose the crossing that fits your
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  walking. A standard or front -wheeled walker
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  may provide support for a single curb. Going
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  up, walk close to the curb and establish your
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  balance. Before you place the walker, look at
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  where the wheels or feet will land. Set it on
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  the higher surface with all four contact points
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  supported before you put weight through it. Use
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  your walker for support as you step up with your
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  stronger leg first, then bring your surgical
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  leg up. Coming down, approach the edge with your
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  body facing the curb and your feet inside the
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  walker. Look at where its wheels or feet will
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  land and set it on the lower surface with all
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  four contact points supported before you put
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  weight through it. Use your walker for support
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  as you step down into the walker space with your
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  surgical leg and then your non -surgical leg.
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  Walker first in either direction, stronger leg
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  first going up, surgical leg first coming down.
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  Before starting the step, give yourself time
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  to feel steady with both feet planted and your
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  walker securely positioned. Your walker needs
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  enough level space to sit securely. A tall step,
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  narrow landing, or sloping surface can change
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  whether this method is suitable. A four -wheeled
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  rollator moves differently, so use the method
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  you were taught for that device. If lifting the
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  walker leaves you unsteady, ask your therapist
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  to check whether that curb and walker technique
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  fits your balance. Practice a curb height step
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  with the equipment you'll actually use before
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  trying it in a busy parking lot. That lets you
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  focus on the movement before you add traffic,
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  other people, or an unfamiliar surface. Now let's
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  use a cane for that curb. For both going up and
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  coming down a curb, you generally hold your cane
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  in the hand opposite your surgical leg. If your
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  right knee was replaced, hold the cane in your
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  left hand. If your left knee was replaced, you're
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  probably holding the cane in your right hand.
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  A cane helps with balance and provides limited
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  support. Your leg still needs to support your
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  body weight as you step. With your cane on the
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  lower surface to help steady you, step onto the
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  curb with your stronger leg first, then bring
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  your surgical leg and your cane up to that level,
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  using the technique that you were taught. Coming
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  down, place the cane on the lower surface first.
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  Step down with your surgical leg using the cane
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  to help steady yourself, and then bring your
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  stronger leg down. Practice the curb sequence
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  at physical therapy or in a safe place with the
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  support you need. The reminder is stronger leg
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  first going up, cane and surgical leg first coming
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  down. What about a curb without a walking aid?
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  On a curb you may still choose stronger leg first
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  going up and surgical leg first coming down while
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  using a step two pattern. Using less support
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  depends on whether you can lift and lower your
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  body steadily and keep your balance on that surface.
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  Now, let's move from a single curb to a flight
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  of stairs. If you need to bring your walker up
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  or down the stairs, work with your physical therapist
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  on how to do that. Your walker, staircase, and
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  support needs determine the method. That needs
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  hands -on instruction, so we'll leave the walker
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  -stair technique out of this podcast. We'll start
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  with a common early pattern called Step 2. Both
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  feet come onto the same step before you move
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  to the next one. A quick reminder, this podcast
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  is for educational purposes only. Follow the
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  instructions your surgeon and physical therapist
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  gave you for your own situation. Now let's go
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  up with a rail and cane using the Step 2 pattern.
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  Hold the rail with one hand and the cane with
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  your other hand. On level ground, the usual cane
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  position is opposite your surgical leg. On stairs,
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  the location of the rail may change which hand
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  you use for the cane. Your stair sequence may
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  therefore feel different from your walking sequence.
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  Use the rail and cane for the support you need
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  as you step up with your stronger non -operative
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  leg first. Then bring your cane and surgical
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  leg up together onto that same step. Stronger
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  leg first, then cane and surgical leg together.
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  Pause with both feet supported before repeating
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  the sequence. This gives your stronger leg more
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  of the work of lifting your body. The rail and
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  cane give you support while your surgical leg
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  regains strength and control. Now let's come
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  down with the same step two pattern. Hold the
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  rail with one hand and the cane with the other.
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  Place the cane on the step below you first, then
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  lower your surgical leg onto the step using the
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  rail and cane for support. Then bring your stronger
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  leg down to join it. Cane, surgical leg, stronger
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  leg. This keeps your stronger leg on the upper
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  step while you begin lowering your body. Once
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  both feet are on the same step, establish your
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  balance before repeating the sequence. Each step
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  needs enough room for your feet and the cane.
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  If you're using a rail without a cane, the same
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  common leg order applies. Stronger leg first
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  going up, surgical leg first coming down. Your
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  individual instructions determine how much support
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  you use. Now, when might you begin alternating
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  feet? The step over pattern is also called reciprocal
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  stair climbing. Each foot goes to the next step,
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  passing the foot that's already supported. Your
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  feet take turns leading instead of meeting on
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  every step. Readiness depends on your movement
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  and your surgical instructions. Going up with
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  alternating feet requires your surgical leg to
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  help lift your body. Coming down requires it
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  to help control the lowering while your other
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  foot reaches the next step. In my experience,
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  alternating feet going up can feel secure well
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  before alternating feet going down. You can use
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  different patterns in the two directions. For
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  alternating feet, hold the rail with one hand,
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  and the cane with the other. Your cane moves
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  with the foot opposite the hand holding it. This
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  applies whichever knee was replaced. If your
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  cane is in your left hand, it moves with your
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  right foot. If it's in your right hand, it moves
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  with your left foot. Advance your hand along
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  the railing so you have support as you step,
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  especially when your surgical leg is lifting
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  or lowering your body. Practice this pattern
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  with your therapist so the cane and rail provide
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  support where you need it. They may have some
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  cues specifically for you to feel good about
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  the movement. For example, going up, your stronger
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  foot may go onto the first step. Your surgical
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  foot then goes onto the second step, and your
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  stronger foot goes onto the third. When your
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  surgical foot is on the higher step, that leg
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  helps lift your body as your other foot passes
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  it. Coming down, one foot reaches the step below,
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  and your other foot passes it to the next lower
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  step. Your leg on the upper step bends to control
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  the lowering. When your surgical leg is on that
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  upper step, it needs to control your body as
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  your other foot reaches down. What about stairs
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  without a cane? On stairs you can use a step
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  two or step over pattern without a cane when
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  you have enough strength, balance, and control
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  for the task. Keep using the rail for support.
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  Walking without a cane and climbing stairs without
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  a rail are separate decisions. Knee stiffness,
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  pain, swelling, and muscles that aren't activating
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  as well after surgery can all affect your control.
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  If you pull hard on the rail, swing your body
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  sideways, or lower yourself with a quick drop,
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  a step two pattern may give you more control.
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  on that staircase. A study about a year after
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  knee replacement found differences in knee movement
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  and muscle activity during stair descent compared
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  with people without a knee replacement. A separate
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  2025 study of people one year after both knees
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  had been replaced found that quadricep strength
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  helped distinguish who could use the stairs independently.
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  The authors suggested that coordination and other
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  joints may also contribute. Neither study establishes
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  a universal date or knee bend measurement for
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  alternating feet. The 2026 Physical Therapy Guideline
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  supports progressive strengthening and movement
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  training after knee replacement. And your therapist
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  can watch the part of the task that feels difficult
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  and help you work on strength and coordination
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  together. Sit to stand, step -ups and controlled
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  step -downs may be included in that work. Exercise
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  selection, step height and support depend on
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  your movement and surgical instructions. The
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  steps at therapy may be lower than your daughter's
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  staircase or a tall porch step. A lower step
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  gives you a shorter distance to lift or lower
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  your body. The height, depth, and rail position
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  can make one staircase feel different from another.
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  A deep tread may give your foot plenty of room
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  while a narrow tread takes more careful placement.
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  Place your foot securely on the available tread
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  and take time to locate the next surface. Shadows,
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  poor lighting, and some glasses can make an edge
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  harder to judge. A well -lit staircase with a
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  secure rail gives you a more dependable setting
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  for the task. If a rail is loose, have it repaired
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  before relying on it. Keep the steps dry and
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  free from objects that reduce the space available
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  for your foot. The length of the staircase can
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  also change how it feels. You may manage a few
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  alternating steps at therapy, then feel less
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  controlled farther along a staircase at home.
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  Fatigue, pain, or increased swelling can change
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  how you move. A step two pattern remains an option
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  when you need more control. You may alternate
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  unfamiliar staircases when you're feeling steady
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  and then take one step at a time on a taller
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  or unfamiliar flight. Choose the pattern that
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  fits the task and how you are moving. If you
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  rely on the rail, keep that hand available. A
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  laundry basket can block your view of the steps
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  and occupy both hands. Having someone move it,
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  using another arrangement, or making separate
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  trips with a suitable small item can help you
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  keep your support available. Contact your healthcare
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  team promptly for a new inability to bear weight,
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  repeated knee buckling, fall with injury, or
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  a major change in your ability to walk. And as
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  always, seek emergency care for chest pain, sudden
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  or unexplained shortness of breath, or fainting.
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  Walking up and down stairs after a knee replacement
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  can be a real milestone. Great job. Remember,
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  going up means lifting your body. Coming down
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  means controlling the lowering. Use the leg sequence
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  and support that fit you. And let the way you
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  move guide your practice. One step at a time
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  remains a useful choice as your strength and
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  control develop. You can get my free walking
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  guide for ideas to help you walk and feel more
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  like yourself after knee replacement. It's easy
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  to get the free download and the link is in the
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  show notes. If you'd like more education on how
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  strength, motion, balance and coordination influence
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  your walking, my book Walking Like Yourself Again
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  After Knee Replacement goes deeper into those
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  connections. The link is also in the show notes.
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  In episode 116, we'll finish this walking series
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  with hills, grass, gravel, sloped driveways,
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  and uneven sidewalks. Thanks for joining me.
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  I'm Michelle, and this has been the Total Knee
• 14:39
  Success podcast. This podcast is for educational
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  purposes only. Discover more at TotalKneeSuccess
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  .com. And be sure to subscribe and share, because
• 14:53
  every step forward takes you closer to living
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  the life you love.