Your hips and calves do the extra workStrong evidence
In 10 young adults walking up a 9 degree slope (about 16%), muscle activity rose most in the hips: the study reports increases of 345 to 635% in the buttock and hamstring muscles, 165 to 366% in the thigh muscles and 136 to 175% in the calves, compared with flat walking. Walking down the same slope, only the thigh muscles worked harder. Uphill, most of the extra support comes from the hips; downhill, from the knees.
Sources 4, 3, 20
The Achilles tendonEmerging evidence
Your calf muscles pull on the Achilles tendon, and they worked much harder uphill, so the tendon takes more load (our reading). In a study of 6 men, the Achilles tendon stretched substantially with each step on the flat and on a 10% incline, and the calf muscle worked at longer lengths as the slope rose.
If you have Achilles or calf pain, build the slope slowly and use the rule our pain guides use: pain up to 5 out of 10 during exercise is acceptable if it has settled by the next morning. In a trial in Achilles tendinopathy, carrying on activity within a rule like this did no harm.
Sources 4, 21, 22
Knees going upEmerging evidence
In 12 adults with obesity, walking slowly (about 1.7 mph) up a 6 degree slope (about 10.5%) gave a similar moderate effort to walking briskly on the flat (about 3.4 mph), with knee loads about 19 to 26% lower. In a second study of 19 adults with and without obesity, the same slow uphill walk cut the early force through the knee joint by 23 to 35%, and walking more slowly on the flat lowers knee loads too. At 3 mph, slopes of 10% or more lowered a measure linked with inner-knee load in 15 young men and 12 older men.
These are small lab studies in healthy or heavier adults, not trials in people with knee pain. And your knee bends more with each step as the slope steepens, while the thigh muscles work harder, so if you have pain around the kneecap you may not find uphill walking easier: keep slopes gentle, let your symptoms guide you, and see our runner's knee guide.
Sources 5, 6, 23, 24, 25, 7, 4
Knees going downStrong evidence
Downhill is the hard part for knees: on a 19% ramp, knee moments and power were much higher than on the flat, and the force through the knee joint reached about 8 times body weight against 3.9 on the flat. Take descents slowly with short steps, and use poles on real hills. On a treadmill you never walk downhill.
Sources 26, 8, 4
The "12% is best for knees" claimMixed evidence
A 1996 study of 6 people suggested that a slope just over 12% might ease kneecap discomfort or strain on the anterior cruciate ligament in knee rehabilitation. That was the authors' suggestion, not a finding, and the same study found the knee bent more as the slope rose.
Source 7
ShinsMixed evidence
In older adults, the muscle at the front of the shin worked harder as the slope rose, while in a study of younger adults it was the only leg muscle measured that didn't. If your shins ache, see our shin splints guide.
Sources 14, 3
Back and spinal stenosisMixed evidence
In 22 adults, walking on a 10% incline changed how much the upper body turned but not how the pelvis moved. People with lumbar spinal stenosis, a narrowing in the lower spine that causes leg symptoms on walking, walked longer on an inclined treadmill than on the flat, which is the basis of a diagnostic treadmill test. A walking programme that built up to hills and stairs helped stop low back pain coming back in the WalkBack trial, but no trial has tested incline walking for back pain.
Sources 27, 28, 29, 30