How should individuals with osteoarthritis (OA) use stairs to manage their condition?

Managing Stairs with Osteoarthritis

Individuals with osteoarthritis should use specific stair-climbing techniques that reduce joint loading, including maintaining proper posture with slight forward trunk lean, using handrails for support, and incorporating a step-by-step approach rather than alternating feet when pain is significant.

Exercise and Stair Management Recommendations

General Approach to Stairs

• Individuals with osteoarthritis should approach stairs with caution, as stair climbing is often one of the first activities affected by knee osteoarthritis 1
• Use handrails for support when ascending and descending stairs to reduce load on affected joints 2
• Consider a "step-by-step" approach (bringing both feet onto the same step before proceeding) when experiencing significant pain rather than alternating feet 2
• Maintain proper posture with a slight forward trunk lean (approximately 6 degrees more than healthy individuals) to reduce quadriceps demand during stair climbing 3

Technique Modifications

• For knee OA, a slight forward trunk lean can reduce the net quadriceps moment by up to 35%, which may decrease pain during stair climbing 3
• Use appropriate and comfortable shoes with good support when navigating stairs 2
• Take smaller steps and maintain a controlled pace rather than rushing up or down stairs 4
• Consider leading with the less affected leg when ascending stairs ("up with the good") and leading with the affected leg when descending ("down with the bad") 2

Exercise Recommendations to Improve Stair Function

Strengthening Exercises

• Incorporate strengthening exercises for both legs, including quadriceps and hip girdle muscles, to improve stair climbing ability 2
• Focus on isometric (sustained) strengthening exercises to build joint stability needed for stair navigation 2
• Include exercises that target the hip abductors and external rotators to improve frontal plane stability during stair climbing 5

Balance Training

• Balance exercises are conditionally recommended for patients with knee and/or hip OA to improve stability during challenging activities like stair climbing 2
• Practice single-leg balance exercises to improve stability and confidence when transferring weight between steps 2

Aerobic and Functional Training

• Regular aerobic exercise (walking, cycling, aquatic exercise) is strongly recommended to maintain overall function and mobility 2
• Incorporate functional training that mimics stair climbing movements, such as step-ups, to build specific strength and endurance 2
• Start with small step heights and gradually progress as strength and confidence improve 2

Assistive Devices and Home Modifications

Assistive Devices

• Consider using a walking stick (held on the side opposite to the affected joint) when navigating stairs 2
• Walking frames or wheeled walkers may provide additional stability for those with more severe OA 2

Home Modifications

• Install handrails on both sides of staircases when possible 2
• Consider stair lifts or relocating essential living spaces to avoid stairs if mobility is severely limited 2
• Ensure adequate lighting on staircases to improve visibility and reduce fall risk 2

Pain Management During Stair Use

• There is no uniformly accepted pain threshold at which patients should avoid stairs; use shared decision-making with healthcare providers to determine appropriate activity levels 2
• If pain increases significantly during or after stair use and persists for more than 1-2 hours, modify technique or reduce stair frequency 2
• Consider timing pain medication approximately 30 minutes before activities involving stairs when appropriate 2

Weight Management

• Weight loss is strongly recommended for patients with knee and/or hip OA who are overweight or obese 2
• Even modest weight loss (5% of body weight) can significantly reduce joint loading during stair climbing 2
• Combine weight loss efforts with exercise programs for enhanced effectiveness in improving stair climbing ability 2

Common Pitfalls and Caveats

• Avoiding stairs completely may lead to deconditioning and further functional decline; instead, modify technique and build strength 2
• Pain during stair climbing should not be ignored but used as a guide to modify activity appropriately 2
• Stair climbing ability may be a useful functional marker for evaluating osteoarthritis status and quadriceps function, potentially indicating disease progression before significant pain is reported 3
• Relief of knee pain (such as through medication) may improve level walking but might be insufficient to enhance stair-stepping function, requiring additional interventions focused specifically on stair climbing ability 4