What are the guidelines for arthritis patients using stairs?

Guidelines for Arthritis Patients Using Stairs

Stair climbing is explicitly recommended as a functional exercise for arthritis patients to improve functionality, and should be incorporated into regular activity with proper technique modifications rather than avoided. 1

Core Recommendation for Stair Use

• Stair climbing is specifically listed as a functional exercise that improves functionality in arthritis patients, alongside sitting and standing exercises 1
• Exercise programs should focus on improving functionality through cross-training, with functional exercises including stair climbing as a key component 1
• The 2019 American College of Rheumatology/Arthritis Foundation guidelines strongly recommend exercise for all patients with knee, hip, and/or hand osteoarthritis, which encompasses functional activities like stair use 1

Proper Stair Climbing Technique

• Use handrails for support when ascending and descending stairs to reduce load on affected joints 2
• Lead with the less affected leg when ascending stairs and lead with the affected leg when descending 2
• Consider a "step-by-step" approach (placing both feet on each step before advancing) rather than alternating feet when experiencing significant pain 2
• Wear appropriate and comfortable shoes with good support when navigating stairs 2

Exercise Prescription to Support Stair Function

• Begin with repeated short bouts of low-intensity exercise daily, progressively increasing duration 1
• Exercise affected joints using a pain-free range of motion for flexibility training 1
• Incorporate strengthening exercises for quadriceps and hip girdle muscles (particularly gluteus medius) to improve stair climbing ability, performing 2-3 days per week starting with as few as 2-3 repetitions and working up to 10-12 repetitions 1, 2
• Include isometric strengthening exercises to build joint stability needed for stair navigation 2
• Practice single-leg balance exercises to improve stability and confidence when transferring weight between steps 2
• Incorporate functional training that mimics stair climbing movements, such as step-ups, starting with small step heights and gradually progressing 2

Pain Management During Stair Use

• Use shared decision-making to determine appropriate activity levels, as there is no uniformly accepted pain threshold at which patients should avoid stairs 1, 2
• Discontinue or modify exercise if joint swelling or pain lasts for more than one hour after stair climbing 1
• Consider timing pain medication approximately 30 minutes before activities involving stairs when appropriate 2
• Modify technique or reduce stair frequency if pain increases significantly during or after use and persists for more than 1-2 hours 2

Critical Contraindications and Timing

• Avoid exercising joints during active flare-ups 1
• Avoid vigorous, repetitive exercises that use unstable joints 1
• Avoid morning stair climbing if rheumatoid arthritis-related stiffness is present 1
• Stop if experiencing unusual or persistent fatigue, increased weakness, or decreased range of motion 1

Supporting Interventions

• Weight loss is strongly recommended for overweight or obese patients with knee and/or hip osteoarthritis, as even modest weight loss significantly reduces joint loading during stair climbing 2
• Consider using a walking stick or assistive device when navigating stairs if needed 2
• Install handrails on both sides of staircases when possible 2
• Referral to physical or occupational therapy is beneficial for appropriate instruction in stair climbing technique and exercise progression 1

Common Pitfalls to Avoid

• Avoiding stairs completely leads 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
• Research shows that stronger lower limb muscles and less knee pain are consistently associated with greater stair-climbing ability, reinforcing the importance of progressive strengthening rather than avoidance 3
• Recent evidence suggests that while very frequent stair climbing (>150 steps/day) may increase knee OA risk in genetically predisposed individuals, moderate stair use as part of a balanced exercise program remains beneficial 4