Injury & Prevention : Healthy Knees

Although walking is less strenuous on the joints than other forms of exercise, it can still contribute to joint problems, especially when walking for longer distances. Furthermore as walking uses certain joints excessively, it can focus the strain of exercise in just a few particular areas, such as the knees.

To avoid joint problems it is important to incrementally increase your level of exercise. If you are attempting to achieve 10,000 steps per day, try to gradually increase your steps in small amounts until you reach that goal.

You should also consider your walking technique. We rarely think about walking in terms of technique, but there are some methods of walking that are more efficient and less strenuous than others.

For example one bad habit when walking is called overpronation. When we walk the sole of our foot rolls against the ground slightly to absorb the impact of our foot against the floor and balance our weight. Overpronation is the habit of rolling the sole of your foot too much when you walk, rather than pushing off the ground for the next step, which causes your weight to be resting on just one side of your foot. Overpronation bends the foot, the calf and the knee and can lead to pain and tiredness in these areas.

One tell-tale sign of overpronation is the wear of your shoes; if your shoes are worn down on the inner side, you may overpronate. You can correct this habit by paying more attention to your stride as you walk, but also consider buying corrective shoes to help adjust your technique. Shoes with straight or semi-curved lasts can help combat this habit, whilst specific arch supports or motion-control shoes are also useful.

Stretching can also help relax the muscles, which can reduce the tendency to over pronate during walking.

Underpronation, also known as supination, is the opposite; the foot doesn’t roll enough to absorb the impact, concentrating the impact of collision against the outer areas of the foot, which also stresses the joints in the legs and the feet. If you underpronate, your shoes should also be unevenly worn, but on the outer edge.

For underpronators, shoes with curved lasts will help correct your bad habit. You should also favor lighter and more flexible material for your shoes as these allow for more motion, making it easier to pronate correctly.

If you still find that you have aches and pains in your legs, ankles and feet following a walking session, consider the ground you walk upon. Harder, uneven or slippery surface are more difficult to walk over and may cause excess strain. Therefore, if possible, try to avoid surfaces like concrete or asphalt and instead try and walk over grassy or earthy areas, which absorb the impact of your feet better. The local park is a great place to walk. Likewise avoid walking over sand or snow which requires more effort.

Shoes should be replaced on a semi-frequent basis. The protective aspects of shoes will be degraded through prolonged walking, especially the inner support, increasing the risk of injury and other problems. A good ballpark is that shoes should be replaced between every 300 – 500 miles. If you have a hard time calculating how this number equates to steps or distance, it equates to around 6 months of time for someone walking approximately 10,000 steps per day.

It can be useful to purchase multiple pairs of walking shoes to rotate between in case one pair gets damaged and can no longer be used (or for any reason is no longer usable).

Stretching & Warm Up

Even though walking is perceived as a milder form of exercise than running or most sports, it can still be useful to stretch and warm up before you have a walking session. Nonetheless, successful stretching and warming up reduces injury and muscle fatigue and can increase performance during a particular session. Warming up increases the blood flow to your muscles – this prepares them for a greater level of activity.

Common warm-up stretches for walking include:

Calf Stretches: Stand upright, grasping a chair or a piece of furniture to keep you steady. Take a step back with your left leg, keeping the heel of your foot on the floor. Bend your right knee, leaning your body towards the furniture. As you place your weight forward you should feel the stretch in your left leg. Hold this pose for several moments, repeating the movement with the legs in the opposite positions.

Hamstring & Ankle: Sit on the edge of a chair. Move your right leg forward on the floor, ensuring the heel still touches the floor. Flex your right foot, ensuring that your keep your toes pointing directly as the sky. Learn your torso and upper body forward, until a stretch is felt in the thigh. Hold this posture for a moment before repeating with the legs in the alternate position.

Groin Stretch: Stand upright with your legs slightly further than shoulder length apart grasping a chair or piece of furniture in front of you. Pivot your feet so that your left foot is pointing forward whilst you right foot is pointing at a 45 degree angle. Lunge with the right foot, ensuring that the knee doesn’t surpass the feet. Repeat the feet in the other positions.

Leg Swings: Stand upright, grasping a chair or piece of furniture to the side of your body. Grasp it with your nearest hand. Move your left leg forward, then to the side of your body, then behind, taping the floor with your toes at each point. Repeat with the alternate leg.

Cooling Down

It’s just as important to cool down as it is to warm up! Cooling down allows your heartbeat and muscles to acclimatize to a lower level of activity, which can take several minutes after an intense bout of exercise. If your body changes for intense exercise to sedentary levels of activity too quickly, it can actually stress the body – which is why athletes will often perform a gentle jog after finishing their exercise.

To cool down, simply gradually slow your walking over the period of several moments, allowing your heartbeat to decline steadily.

Using Weights

Many people try and use hand or ankle weights to add resistance to their walking routine. This is not recommended. Generally speaking it is incredibly difficult to add enough weight to build up muscle. However, this is not the reason why it is discouraged by the walking community – the strain weights place upon the ankle as well as the pressure on tendons, ligaments and blood pressure may result in injury.

Furthermore, people who wear weights tend to walker slower, removing any calorie burn effect that the extra weight might produce. Instead of adding weights, if you want to make your walk more intense, try walking with a faster pace. Alternatively, introduce weights into your lifestyle in a formal and controlled way in the gym. Resistance training with carefully considered repetitions will build up muscle strength and mass with more consistency and ease than slapping a few weights around your ankles and wrists.

Walking & Posture

When walking it is important to maintain proper posture. Your head should be upright and centered rather than leaning forwards, backwards or towards either of your shoulders. Likewise your chin should stay parallel to the ground, with a raised or sagged chin putting excess strain on the neck.

If you suspect that you do not keep your head upright or your chin parallel to the ground, try balancing a flat object on your head such as a book or folder. If the object stays balanced without any support your head is in the correct position – if not, your posture could use improvement. Of course the objective isn’t to go outside balancing objects on your head, it is simply to get a sense of how a good posture should feel.

Your shoulders should also be relaxed. As a result of stress or merely chronic bad habits many people raise and tense their shoulders whilst walking. This can contribute to pain and stiffness in the shoulders, but also prevent a natural walking rhythm, making walking harder.

Conversely the chest should be lifted and expanded. You don’t have to walk around like a puffin, but your chest should be raised as this helps straighten the back. If you have a hard time envisioning what a raised chest should feel like, imagine that you are being pulled upwards by a rope from the center of your ribcage – this should be your walking posture, all of the time!

However, correct posture concerns more than just the upper body – whilst walking you should also gently tense your abdominal muscles. This helps keep the lower spine straight. Of course you won’t be able to breathe or walk easily if you strongly contract your abdominal muscles, so don’t over-do it.

Additionally, your buttocks should also be directly below your hips. If you are leaning forward and not properly supporting your back, your buttocks will stick out from the rest of your body.

Also, whilst walking you need to ensure you arms have a natural and fluid swing in response to your movement. If your elbows are tensed or if you are holding your arms in towards your torso you will inhibit this motion, so ensure you attempt to relax and allow your body to move how it wants to.

Finally, also consider your walking stride. The length of your stride should vary according to your weight, the flexibility of your hips and the stiffness of the muscles in your leg. It is a good idea to experiment with different walking strides and get a sense of what feels most natural and efficient.

Common Walking Injuries and Solutions

We have talked a lot about preventing injuries, but no matter how careful you are, at some point you are likely to experience some type of walking injury. Therefore it can be useful to understand, distinguish and appreciate the different common injuries that occur so you can learn to recover from them sooner.

Plantar Fasciitis

The plantar fasciitis is the tissue at the base of your foot which connects your heel and ball of your feet. The main use of this tissue is to absorb and disperse the impact and shock of walking and running. If your technique is poor or you over-exert yourself your plantar fasciitis can become torn and stretched, resulting in tenderness and soreness at the base of the foot. Tears in the plantar fasciitis are particularly common from running on the pavement and hard concrete which do not absorb or disperse any of the shock of impact themselves.

To help cope and prevent plantar fasciitis injuries pay attention to any stiffness or tenderness at the base of the foot. When feeling tender, stretch that area by sitting down, extending the leg and pulling the toes and ball of the foot until you feel a stretch in the arch of the foot. Repeat this several times for both feet until the tissue has loosened.


Bunions are caused when the joints in the toes become skewed and do not connect to each other cleanly. This causes swelling and inflammation in the area, eventually forming a bunion. Some people are more likely to form bunions than others, especially people who have arthritis, or especially flat feet.

If you are susceptible to bunions, invest in a wide pair of shoes. Wider pairs of shoes can allow you to fit pads and protective gear inside the shoes reducing pressure on the bunion and also lowering friction. Bunions are complicated to treat and they may require therapy or surgery to realign the joints into the correct position.

Achilles Tendonitis

Essentially pain in your calf and your heel, Achilles tendinitis is simply caused by over-exertion, especially if there is not a suitable period of warming up and stretching before exercise. It can also be caused if the foot flexes too much whilst moving due to sharp inclines or uneven ground.

Reducing the length of your walking distance, improving your warm-up periods and running on even, flat ground are all good choices for combating Achilles tendonitis.

If the pain is severe, consider stopping your exercise regime until the condition has improved and using ice packs to help battle inflammation. When the condition has improved, return to your previous intensity and distance of walking or exercise gradually, allowing your muscle to re-adjust.

Lower Back Pain

Lower back pain is caused by poor walking technique. It is unlikely to result purely from walking, but walking may exacerbate the back pain caused by chronic poor posture, being overweight or previous back injury.

Keeping your spine upright and tightening your abs whilst you walk are the best solutions to lower back pain. You can try to straighten your back by raising your arms vertically above your head and pushing upwards.

Shin Splints

Whilst you are standing upright your shins bear a great weight load compared to other positions and this is especially true for running and walking. Shin splints are caused by the muscles in the calf and surrounding areas being too weak to suddenly deal with a greater level of activity caused by walking and running.

Lowering your level of activity can help shin splints improve whilst anti-inflammatory and pain relief medication can deal with other symptoms. Also consider specific exercises to strengthen and tone your calves, such as calf raises or squats.

Using runners tape can also help with shin splints. Any good sports store or online store should stock runners tape. Simply apply the tape to your shins or how instructed on the packaging.


Bursitis is soreness and inflammation around the hips. For most of the joints in our body, fluid-filled sacs help cushion and absorb impact in the joint sockets, preventing wear and tear of the bones. Injury is often caused by these sacs bursting or being destroyed but in the case of bursitis, the fluid-filled sacs become inflamed and swell. Bursitis is caused by excessive stress, usually caused by a rapid increase in activity and effort.

To help deal with bursitis you should vary your exercise regime with forms of exercise where your weight isn’t being rested on the legs, such as swimming or cycling. You can also consider lowering your overall level of activity.

Bursitis can also be prevented by gradually increasing your level of activity rather than sudden and large increases. Likewise when overcoming bursitis gradually return to your former level of activity otherwise you might experience a relapse in symptoms.

Ingrown Toenails

Ingrown toenails occur when the toenails themselves bend and grow into the surrounding flesh. Ingrown toenails can be incredibly painful and even cause the toenail to be ripped away from the toe. Not only is this excruciating, but toenails don’t always grow back, leading to permanent damage to your foot!

Ingrown toenails are predominantly caused by shoes that are too small, especially width-wise. As a result, buying roomier shoes can help solve the condition. Likewise keeping your toenails neatly trimmed and preventing them from growing too long also helps.


Neuroma is recognized by the pain it caused in the ball of the foot and the toes. Neuroma is actually caused by the nerves in the foot growing and thickening altering the sensations in the foot – it can also produce numbness or an unpleasant tingling.

Neuroma is by far more common in women than in men, although the exact reason is not known. However it has been hypothesized that this gender-difference may be caused due to the structure of the female foot and the tendency for women to wear punishing and poorly fitting shoes, such as high heels.

Neuroma can be improved by wearing shoes that fit better and balance the weight evenly across the foot. However it’s important to immediately consult a doctor if you suspect you are suffering from Neuroma as the condition can progress rapidly.

About the author

Dr. Arthur

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