Stair climbing is often one of the first major mobility goals after a total knee replacement, representing a significant step toward regaining independence. While the activity may feel challenging initially, it is a safe and necessary part of the recovery process that helps rebuild strength and confidence in the new joint. The techniques used immediately after surgery are temporary, focusing on safety and minimizing strain on the operated leg. Any technique described here or elsewhere must always be cleared and personalized by your physical therapist (PT) before you attempt it at home.
Preparing for Stair Climbing
Physical therapists introduce stair training once a patient can safely bear full weight on the operated leg and has achieved sufficient knee flexion. This readiness is usually assessed within a few days of surgery, often before hospital discharge, to ensure the patient can safely navigate their home environment. Before starting, ensure the staircase is well-lit and free of any tripping hazards, such as loose rugs or clutter.
A firm, secure handrail provides stability and balance during this early phase of recovery. If a railing is only available on one side, use a cane or crutch in the opposite hand for a second point of support. Non-slip, supportive footwear, like athletic shoes or special non-slip socks, should be worn to maximize grip on the steps.
Technique for Going Up Stairs
The guiding principle for ascending stairs after knee replacement is “Up with the good.” This means the unoperated leg initiates the movement onto the next step. This technique allows the stronger leg to perform the work of lifting the body weight, protecting the operated knee from excessive force.
To begin, stand close to the bottom step, holding the railing with one hand and your assistive device in the other hand, or use both railings if available. The unoperated leg steps up first, planting the foot firmly and completely on the next step. Once the good leg is securely on the step, it extends to bear the majority of the body’s weight.
Next, the operated leg is brought up to meet the unoperated leg on the same step, followed by the assistive device. Both feet momentarily rest on the same stair before the sequence is repeated. This methodical, step-by-step process reduces the amount of knee flexion required and ensures maximum control and stability during the ascent.
Technique for Going Down Stairs
Descending the stairs requires a reverse technique, following the principle, “Down with the bad.” This means the operated leg moves first to the step below. Going down demands an eccentric contraction from the quadriceps muscle, a motion that is more demanding than lifting the body up.
Start by placing the assistive device, such as a cane or crutch, down to the step below you, followed by the operated leg. The operated leg and the assistive device move simultaneously to share and stabilize the load as you slowly lower your body. The unoperated leg remains on the upper step and slowly bends to control the lowering motion, absorbing the force and preventing a rapid drop.
Finally, the unoperated leg is brought down to meet the operated leg and the assistive device on the lower step. Maintain a firm grip on the handrail throughout the descent, focusing on slow, controlled movement. The ability to control this eccentric loading motion is a major focus in physical therapy, as it is one of the last functional milestones patients regain.
Refining Your Technique and Safety
The initial single-step method is a temporary strategy to ensure safety and prevent excessive strain on the new joint. As strength, balance, and confidence improve, your physical therapist will likely clear you to transition to a more natural, alternating step pattern. This progression typically occurs once the quadriceps muscles have significantly regained their strength and eccentric control.
Even when moving to an alternating step pattern, continue using the handrail for an extended period. Avoid carrying any heavy or bulky objects in your hands while navigating the stairs. Additionally, keep your knee tracking straight over your foot during the step, as twisting or rotating the knee while bearing weight can introduce unnecessary stress on the joint.