Going Down Stairs After Knee Replacement: Why It Is Harder – Episode 94
Stair descent demands controlled quadriceps strength, balance, coordination, and confidence, which often develop later than level walking or climbing stairs.
By Michelle, PT, DPT, The Total Knee Success Podcast
Going down stairs after knee replacement can feel surprisingly difficult, even when walking and climbing stairs have started to improve. The difference is not simply confidence or caution. Descending requires your operated leg to control your body as gravity pulls you toward the next step.
Prefer to listen? Play Episode 94 below for the complete discussion.
Have you recently had a total knee replacement, or are you preparing for surgery and wondering what recovery will really be like? Welcome to the Total Knee Success Podcast, your resource for total knee replacement recovery and life after surgery. Hosted by Michelle Losurdo, a trusted doctor of physical therapy and board-certified orthopedic clinical specialist, this show is designed for anyone considering, preparing for, or recovering from knee replacement surgery.
In about the time it takes to put a cold pack on your knee, each episode shares practical total knee surgery tips, evidence-based guidance, and clear strategies to help you manage pain, improve mobility, and thrive through the healing process. You’ll learn about post-operative knee rehab exercises, approaches to knee replacement physical therapy, and real-world tools for building confidence, improving sleep, maintaining a healthy diet, and regaining natural movement. From time to time, you’ll also hear patient perspectives and success stories that encourage you along the way.
Michelle also highlights the mindset and motivation strategies that make a lasting difference in recovery—helping you stay positive, focused, and resilient. And if you’re a family member, friend, or caregiver supporting someone through a knee replacement, you’ll find valuable insights here, too.
Please remember: Michelle is not your personal therapist and does not know you. This podcast provides general education and opinion only. Always consult your healthcare provider before making changes to your recovery plan. This podcast is not related to her clinical or teaching roles.
If you’re ready to feel stronger and more confident on your journey—or if you’re supporting someone you care about—this is the total knee replacement podcast that will help you succeed—one step at a time
Episode 94 explains why going down stairs is often more difficult than going up after knee replacement. Michelle discusses the role of quadriceps strength, eccentric control, balance, and coordination in stair descent, and outlines examples of approaches used in rehabilitation settings. The episode also highlights general considerations related to readiness for stair practice and emphasizes the importance of guidance from a physical therapist or surgeon.
Read the Episode 94 article and resources
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Why Going Down Stairs Is Harder Than Going Up
Climbing and descending stairs use the quadriceps, the large muscles at the front of your thigh, in different ways.
When you climb a step, your quadriceps shorten as they contract to straighten your knee and lift your body. This is called a concentric contraction.
When you descend, those muscles must remain active while gradually lengthening. This is called an eccentric contraction. Your quadriceps act like a brake, slowing your body as your knee bends and your foot moves toward the lower step.
That braking action requires substantial strength and control. After knee replacement, quadriceps function may be reduced by pain, swelling, surgical stress, and arthrogenic muscle inhibition. Arthrogenic muscle inhibition occurs when the nervous system temporarily limits how strongly the muscles surrounding a joint can contract.
A knee may therefore feel dependable during level walking but less trustworthy when controlling a step downward.
Stair Descent Requires More Than Strength
Going down stairs combines several physical demands at once.
Your operated leg must support your weight while the knee bends. Your balance system must manage a forward and downward movement of your body. Your brain must coordinate foot placement, speed, and use of the railing while judging the height of the next step.
Concern about falling can also affect the movement. A person may hesitate, stiffen the knee, lean heavily on the railing, or rotate slightly sideways. These are common protective strategies rather than proof that someone is failing.
Stair activities also place greater forces through the knee than level walking. That does not make stairs inherently unsafe, but it helps explain why descending can remain difficult after other daily activities feel more manageable.
How Clinicians Assess Readiness for Stair Practice
There is no single test that determines when someone should begin practicing stair descent. A physical therapist may consider whether the person can:
- Walk on level ground with reasonable control
- Shift weight onto the operated leg without substantial instability
- Rise from a chair with controlled movement
- Perform a small supervised lowering movement
- Use a railing or walking aid safely
These are examples, not universal requirements. Surgical precautions, strength, balance, pain, swelling, and the home environment can all influence the decision.
Early on, many people use a step-to pattern. The non-operated leg steps down first, followed by the operated leg onto the same step. This reduces the demand placed on the replaced knee.
An alternating pattern, with one foot on each step, generally requires more eccentric quadriceps control and may come later.
Building the Control Needed for Stair Descent
Rehabilitation often addresses the separate abilities that stair descent requires before combining them on a full staircase.
Quadriceps Strength
Sit-to-stand movements, supported mini squats, and selected step exercises may be used to strengthen the quadriceps. The exact exercise, depth, resistance, and timing depend on the individual plan.
Controlled Lowering
Slow lowering movements can help develop eccentric control. A clinician might use a controlled descent toward a chair or a small step-down exercise to observe how well the knee manages bending under load.
The goal is usually smooth control rather than speed or a large number of repetitions.
Balance and Weight Acceptance
Supported weight shifting and balance activities may help a person become more comfortable placing weight through the operated leg. Stable support is especially important when balance remains uncertain.
Stair-Specific Practice
When stair practice is appropriate, the setup can include a sturdy railing, good lighting, non-slip surfaces, and additional supervision. Progression may involve changing one variable at a time, such as the number of steps, the amount of hand support, or the stepping pattern.
Persistent pain, increasing swelling, instability, or a sensation that the knee may give way deserves professional evaluation rather than simply more repetition.
Why Progress Can Take Longer Than Expected
Stair descent is a higher-level activity. Limited knee bend, quadriceps weakness, balance changes, discomfort, and problems in the opposite knee, hip, ankle, or back can all influence performance.
Some people continue to notice difficulty several months after surgery. Improvement may continue as strength, coordination, and confidence develop, but timelines vary considerably. Someone who uses stairs daily may also have different functional priorities than someone who lives on one level.
A Related Resource for Awkward or Uneven Walking
This page contains affiliate links. As an Amazon Associate I earn from qualifying purchases.
When walking still feels awkward, uneven, or tiring, understanding the factors that influence gait can be useful. Walking Like Yourself Again After Knee Replacement offers a concise, evidence-informed explanation.
View the Walking Book on Amazon
Frequently Asked Questions
Is it common for going down stairs to lag behind going up?
Yes. Descending requires the quadriceps to control knee bending while supporting body weight, which is often more demanding than pushing upward.
Should I keep using a step-to pattern?
A step-to pattern is commonly used while strength or control is limited. A physical therapist can help determine when an alternating pattern is appropriate.
What if my knee feels unstable on stairs?
Instability, giving way, or worsening symptoms should be discussed with a surgeon or physical therapist. These symptoms may require assessment before stair practice progresses.
Conclusion
Going down stairs after knee replacement is difficult because your quadriceps must act as a controlled brake while your balance system manages a forward and downward shift. Strength, knee motion, coordination, confidence, and the surrounding environment all contribute.
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Educational disclaimer: This article provides general education and does not replace individualized medical advice, diagnosis, or treatment. Consult your surgeon, physical therapist, or another qualified healthcare professional before beginning or changing stair practice or exercise. Seek appropriate medical guidance for concerning pain, increasing swelling, redness, drainage, loss of function, or other unexpected symptoms.
References
- Bade MJ, Stevens-Lapsley JE. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. J Orthop Sports Phys Ther. 2011;41(12):932-941. doi:10.2519/jospt.2011.3734.
- Mizner RL, Snyder-Mackler L. Altered loading during walking and stair climbing after total knee arthroplasty. J Orthop Res. 2005;23(5):1083-1090. doi:10.1016/j.orthres.2005.03.017.
- Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther. 1998;78(3):248-258.
- Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty. J Bone Joint Surg Am. 2012;94(21):2017-2024. doi:10.2106/JBJS.K.01219.
- McClelland JA, Webster KE, Feller JA. Gait analysis of patients following total knee replacement: a systematic review. Knee. 2007;14(4):253-263. doi:10.1016/j.knee.2007.04.008.
- Total Knee Success Podcast, Episode 94 source transcript.