Does climbing stairs cause osteoarthritis (degenerative joint disease) of the knees?

Climbing Stairs Does Not Cause Knee Osteoarthritis

Based on strong evidence from systematic review, climbing stairs or ladders does not increase the risk of developing knee osteoarthritis in women, and there is no established causal relationship for the general population. 1

Evidence Quality and Strength

The highest quality systematic review examining occupational activities and osteoarthritis risk found:

• Strong evidence for NO increased risk of knee OA in women related to climbing stairs or ladders 1
• When examining both men and women together, climbing stairs/ladders showed strong evidence for no increased risk across multiple studies 1
• This conclusion is based on synthesis of 12 separate studies examining stair/ladder climbing as an occupational exposure 1

Important Distinction: Causation vs. Difficulty

A critical pitfall is confusing two separate issues:

• Climbing stairs does NOT cause knee OA (the question at hand) 1
• People who already HAVE knee OA experience difficulty climbing stairs - this is a symptom, not a cause 2

The relationship works in only one direction: existing knee OA makes stair climbing difficult and painful, but stair climbing itself does not create the disease 2.

Contradictory Recent Evidence Requires Context

One 2024 UK Biobank study found a positive association between frequent stair climbing (>150 steps/day) and knee OA risk 3. However, this finding:

• Contradicts the strong evidence from the comprehensive 2020 systematic review of multiple occupational studies 1
• May reflect reverse causation (people with early undiagnosed OA modify their stair climbing patterns)
• Represents observational data that cannot establish causation 3
• Should not override the systematic review evidence which synthesized 12 studies specifically examining this question 1

Activities That DO Increase Knee OA Risk

In contrast to stair climbing, these occupational activities have strong evidence for INCREASING knee OA risk:

• Combined kneeling, squatting, and bending activities - strong evidence across men and women 1, 4
• Heavy physical demands in occupational settings - strong evidence for knee OA 1, 4
• Notably, when kneeling and squatting are examined individually (not combined), they show no increased risk 1

Clinical Implications

For patient counseling:

• Reassure patients that routine stair climbing in daily life does not cause knee osteoarthritis 1
• Stair climbing can actually be therapeutic for existing knee OA when combined with appropriate interventions 5
• Focus prevention efforts on avoiding prolonged occupational kneeling, squatting, and bending in combination, especially with heavy loads 1, 6

For patients with existing knee OA:

• Difficulty climbing stairs reflects disease severity, not disease causation 2
• Stronger lower limb muscles and less knee pain are consistently associated with better stair-climbing ability 2
• Stair climbing training with interferential electrotherapy improves physical activity in knee OA patients 5