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Reference is freely downloadable at the following site:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047219/

J Phys Ther Sci. 2014 May; 26(5): 629–631.

Published online 2014 May 29. doi:  10.1589/jpts.26.629

PMCID: PMC4047219

Biomechanical Analysis of Stair Descent in Patients with Knee Osteoarthritis

Tatsuya Igawa, PT, PhD1,* and Junji Katsuhira, PhD1

1) Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Japan

*Corresponding author. Tatsuya Igawa, Department of Rehabilitation, International University of Health and Welfare Mita Hospital: 1-4-3 Minato-ku, Tokyo 108-8329, Japan. (E-mail: [email protected])

Author information ► Article notes ► Copyright and License information ►

Received 2013 Jun 6; Accepted 2013 Jul 3.

Copyright 2014©by the Society of Physical Therapy Science

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License

This article has been cited by other articles attempting to investigate the lower extremity joint kinematics and kinetics of patients with the knee osteoarthritis (knee OA) during stair descent and clarify the biomechanical factors related to their difficulty in stair descent. [Subjects and Methods] Eight healthy elderly persons and four knee OA patients participated in this study. A 3-D motion analysis system and force plates were employed to measure lower extremity joint angles, ranges of motion, joint moments, joint powers, and ratios of contribution for the joint powers while descending stairs. [Results] Knee joint flexion angle, extension moment, and negative power during the early stance phase in the knee OA group were smaller than those in the healthy subjects group. However, no significant changes in these parameters in the ankle joint were observed between the two subject groups. [Conclusion] Knee OA patients could not use the knee joint to absorb impact during the early stance phase of stair descent. Hence, they might compensate for the roles played by the intact knee joint by mainly using ipsilateral ankle kinematics and kinetics.

Dennis

Dennis Mazur

Dear Mansour,

I don't think there is a direct relationship between osteoarthritis and stair climbing in normal healthy people with normal body weight. However, descending stairs for especially overweight and physically unfit people may put extra pressure on joints. Also other main reasons may include defects in calcium metabolism/absorption and vitamin D deficiency. I have been climbing stairs all my life and my current average is 55 floors (~715 steps) per day for the pass year, and I have no problem whatsoever.

best wishes, Refik

I think that there is no direct communication

Please let me know if this reference is useful to you:

Am J Phys Med Rehabil. 2017 Mar 18. doi: 10.1097/PHM.0000000000000736. [Epub ahead of print]

Effect of Land-Based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Fernandopulle S1, Perry M, Manlapaz D, Jayakaran P.

Author information

1

From the Centre for Health, Activity and, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin (SF, DM, PJ); Wellington Hospital, Capital and Coast District Health Board, Wellington (SF); and Centre for Health, Activity and, Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington (MP), New Zealand.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the effects of land-based generic physical activity interventions on pain, physical function, and physical performance in individuals with hip/knee osteoarthritis, when compared with a control group that received no intervention, minimal intervention, or usual care.

METHODS:

A systematic search for randomized controlled trials on 11 electronic databases (from their inception up until April 30, 2016) identified 27 relevant articles. According to the compendium of physical activities, interventions were categorized into: recreational activities (tai chi/Baduajin-6 articles), walking (9 articles), and conditioning exercise (12 articles).

RESULTS:

Meta-analysis for recreational activity (n = 3) demonstrated significant mean difference (MD) of -9.56 (95% confidence interval [CI], -13.95 to -5.17) for physical function (Western Ontario and McMaster Universities Arthritis Index) at 3 mos from randomization. Pooled estimate for walking intervention was not significant for pain intensity and physical performance but was significant for physical function (n = 2) with a MD of -10.38 (95% CI, -12.27 to -8.48) at 6 mos. Meta-analysis for conditioning exercise was significant for physical function (n = 3) with a MD of -3.74 (95% CI, -5.70 to -1.78) and physical performance (6-minute walk test) with a MD of 42.72 m (95% CI, 27.78, 57.66) at 6 mos. The timed stair-climbing test (n = 2) demonstrated a significant effect at 18 mos with a MD of -0.49 secs (95% CI, -0.75 to -0.23).

CONCLUSION:

Very limited evidence to support recreational activity and walking intervention was found for knee osteoarthritis, in the short-term on pain and physical function, respectively.

Dennis

Dennis Mazur

Stairs aren't a problem in healthy knees. 

The reasons why patients are advised to avoid them when OA shows up is that stairs are stress raisers, especially descending them. The point is that OA knees regardless the severity,  are often unstable and in these conditions stairs may  induce shear stresses on the cartilage and speed up the degenerative process. 

Hope this helps 

Thank you all for your valuable answers.

Combination of stairs and weight or better loading and repetition of it is discussed as having some effect of knee joint degeneration. It is calculated that when someone is walking on plain ground he puts about 5 times the body weight or load in every step into the joint. When stairs are used or walking up or down hill the person is loading the knee up to 7 or 10 times the body weight or load according to the speed used. So repetition (circle of loading) - weight (and load) - and inclination of the ground has possibly effect of degenerative knee disease

YES there is direct relation as climbing stairs increase force reaction on the joint and increase the load on cartilage

What exactly is your question ? Do you Want to know if it causes osteoarthritis or if it damages further the already pathologic joint. 

Dear Geert

I'm sorry if my question was not clear for you.

My main question was about if stair climbing has a direct relationship to cause knee osteoarthritis. However, I also wanted to know if stair climbing can lead to more damage to the knee joint in people who already have knee osteoarthritis whether in earlier or late stage.

I hope it's more clear now!

Stair climbing increases loads on the knee joints. And if we take into consideration the mechanical factor for appearing and progression of degenerative joint disease, it is clear that damage to joint cartilage increases with stair climbing. So reduced loads are beneficial for knee arthrosis. There some anecdotal data that if people start using a cane at initial stages of degenerative joint disease, this simple method may reduce the need for TKA or THA with about 40%. Such a statement would not be liked by orthopedic surgeons at all. But it is true.

there is a mechanical association....

however it becomes relevant when there is a predisposing  factor like altered bio mechanics / .....

Theoreticly yes, practicaly no. There is mechanic association with the uneven backbone. This is a one part of issue. The second one are microvascular disorders, wich lead to  cartilage dehydration. and then to others disorders in cartilage. I would like to differentiate osteoarthritis (autoimmune inflamation) and osteoarthrosis (chronic distrophy).

It depends on where the specific area in the knee is that is arthritic but stair climbing does add stress to the joint. Pain when climbing stairs is often a sign of a patella tracking problem. This is easy to fix with the right stretches and exercises so get this checked. You may be able to fix it before the knee cap becomes too degenerated to heal.

Climbing the stairs is movement with weight and it is with relation with knee pain, I make prescription of exercises on ergocycle so the all weight is on tuber ishiadicum, and muscles can be stretches.

I think their correlation is logical in the positive direction, but the cause-effect relationship has not been fully established. Besides, there are other factors like obesity, weak bone density, etc which could predispose someone to having knee osteoarthritis.

Going on stairs is always with weight of joint. It is not a form of prescription of exercises, because is bad for cartilage compared with bad effect on muscles power on quadriceps.

In high economy countries it is instaling, in other no one care for it

So, what do you say to athletes and gym-goers that like to use the stair-master or the treadmill with incline as exercises for the legs or cardio? Will all of them develop osteoarthritis due to degenerative cartilage? I think most degeneration will occur with aging regardless of injury which, of course, makes things worse and speed up the process. We use those exercises to increase the strength of the muscles that surround the joints hoping that strong muscles will help protect the joints. In people who have developed instability due to degeneration, putting more stress on the joint during climbing is simply not a very good idea because increase stress in the already unstable joint will undoubtedly cause more pain and damage especially in the presence of weak and unconditioned surrounding musculature. Those people will benefit from using ergonomic stationary bicycle to help their mobility and strengthen the surrounding muscles that help protect the knee.

Pain can be both the symptom of the degenerative joint due to cartilage loss and can also be the modulator of the diseased joint. As a consequence of the degenerative process in the joint, pain is created to send signals that the joint is no longer healthy. The pain produced by the diseased joint will have big implication in the disease process going forward. Depending on the amount of pain experienced during movements, it will undoubtedly influence the amount of physical activity and the kind activities that can be tolerated. Although the level and intensity of pain may be subjective and vary among individuals, the threshold that an individual will bear the pain will determine the timing when the physical activity will be altered. Once the physical activities are altered from normalcy, both physical and structural changes will occur in and surrounding the joint. The surrounding muscles may not be used as required in usual manner to do activities to compensate for the pain which will result in atrophy and weakness. As a result of the surrounding muscle atrophy and weakness, structural change in the joint will most likely occur due to less or no protection from the muscles on the weight that is being transferred and loaded onto the joint. This event will cause more damage to the joint and is the beginning of the vicious cycle of worsening condition in the degenerative joint. From this analysis, it is clear and of paramount important to exercise the joint and the surrounding muscles that control the joint. Water therapy can be started first if weight bearing is too painful. Stationary bicycle is both practical and safe to increase the joint mobility and muscle strength. Physiotherapy specialist should be consulted if there's any question or doubt regarding the correct and proper exercises to adjust to certain comorbid conditions on individual basis .

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jor.20751

I think there is logic suitable for many patients with knee osteoarthritis , but not for all of them.