Planning to hike from Pico do Arieiro to Pico Ruivo? Here’s how to protect your knees—and what to do if they start hurting

Robbie Braz

2025

Pico do Arieiro to Pico Ruivo: A Physiotherapist’s Guide to Madeira’s Hardest Hike

Planning to hike from Pico do Arieiro to Pico Ruivo? Here’s how to protect your knees—and what to do if they start hurting

Hiking from Pico do Arieiro to Pico Ruivo is one of the most iconic trails in Madeira.

It’s stunning—but it’s also one of the hikes where people most often end up with knee pain or lower back discomfort, especially after the long descents.

If you’re planning to do it (or just finished it and feel sore), here’s what’s going on—and what to do next.


Why this hike hits your knees (and sometimes your back)

The biggest challenge isn’t the climb—it’s the descent.

Walking downhill on uneven stone steps puts your quads under eccentric load (they’re constantly “braking” your movement). Over time, that creates fatigue and stress around the knee joint.

At the same time:

  • A backpack shifts your center of gravity
  • You naturally lean forward
  • Your lower back works harder to stabilize

If your muscles fatigue, the load starts going into joints instead.


What you can do during the hike

A few small adjustments can make a big difference:

  • Use trekking poles → reduces load on knees and improves balance
  • Take shorter steps → lowers joint impact
  • Keep a slight bend in your knees → better shock absorption
  • Stay upright → avoid collapsing forward on descents
  • Engage glutes + core → spreads the load more evenly
  • Adjust your backpack → keep weight close to your body
  • Stay hydrated → fatigue increases injury risk


Just finished the hike and feeling it?

It’s very common to feel:

  • Knee stiffness
  • Tight quads
  • Lower back discomfort

This usually peaks 24–48 hours after the hike.

Light movement helps—but if pain is building or affecting your trip, it’s better to deal with it early.


What to do next (this is where most people get stuck)

If you’re in Madeira and:

  • your knee hurts when going downstairs
  • your back feels tight or “locked”
  • you’re unsure if it’s just soreness or something more

 the best next step is a quick assessment.

That way you know:

  • if it’s safe to keep hiking
  • what to avoid
  • how to recover faster


Recover properly without interrupting your trip


Instead of waiting for it to get worse, you can:


Injured during your trip? Start here

If something doesn’t feel right after your hike, don’t ignore it.

 Start here:

  • Get assessed
  • Get treatment
  • Recover comfortably during your stay

(You can book directly online or message us—we’ll guide you on the best next step.)

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Madeira, a stunning archipelago off the coast of Portugal, is often hailed as one of the best destinations for those seeking recovery and rejuvenation. With its mild, temperate climate, stunning landscapes, and rich natural resources, Madeira offers the ideal environment for those suffering from injuries or seeking to enhance their overall well-being. For people from Nordic countries and those dealing with joint arthritis, the island’s climate and surroundings can have a profound impact on healing and improving quality of life. 1. A Mild and Consistent Climate for Recovery Madeira is renowned for its mild climate, with temperatures typically ranging from 16°C (60°F) in winter to 25°C (77°F) in summer. This consistent, moderate weather has a remarkable effect on people suffering from joint pain, arthritis, and other chronic conditions. 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