Why does my knee hurt when going down stairs?

Why is going down stairs harder than going up?

When walking downstairs, the thigh muscles work while lengthening to control the body as it lowers. The knee bends under load, which increases the pressure between the kneecap and the thigh bone. Any irritation in that joint, or in the knee joint generally, is more likely to be felt during this movement.

Similar activities that load the front of the knee include squatting, kneeling, sitting for long periods with the knees bent and running downhill.

What is patellofemoral pain?

Patellofemoral pain is a dull ache around or behind the kneecap. It is common in teenagers, young adults and runners, but it can affect people of any age. It is usually related to load on the knee exceeding what the tissues can currently tolerate, for example after a sudden increase in activity.

Weakness of the hip and thigh muscles, reduced flexibility and changes in training are common contributors. The knee usually looks normal, without major swelling.

Could it be osteoarthritis?

In people aged 45 or over, knee pain on stairs is often associated with osteoarthritis. UK guidance describes a clinical diagnosis based on activity-related joint pain with either no morning stiffness or stiffness lasting no longer than 30 minutes 3. Osteoarthritis can affect the joint behind the kneecap as well as the main knee joint.

Osteoarthritis guidance recommends exercise, education and weight management where relevant as core treatments, whatever the severity shown on X-ray 3.

What treatments help patellofemoral pain?

An international consensus statement on patellofemoral pain recommends exercise therapy, particularly combined hip and knee strengthening, to reduce pain and improve function. It also supports foot orthoses and patellar taping for short-term pain relief, and combined interventions 1.

A clinical practice guideline for physical therapists also recommends hip and knee strengthening exercises and supports short-term use of taping and orthoses alongside exercise 2. Education on load management helps people adjust activity without stopping it completely.

What practical changes help on stairs?

Holding the handrail, taking stairs one step at a time with the stronger leg going first on the way up and the painful leg going first on the way down, and slowing the descent reduce load on the painful knee. Footwear with good cushioning may help.

Temporarily reducing activities such as deep squats or downhill running, then gradually reintroducing them as strength improves, allows symptoms to settle.

Which exercises are commonly used?

Common exercises include side-lying leg raises and clam exercises for the hip muscles, bridging, wall sits or partial squats within comfort, step-ups and controlled step-downs, and leg press exercises. Exercises progress in resistance and depth over several weeks.

Some discomfort during exercise is acceptable if it settles within 24 hours. A physiotherapist can tailor the programme to the specific cause of pain.

When is imaging needed for knee pain on stairs?

Most knee pain on stairs can be diagnosed from symptoms and examination without imaging. For patellofemoral pain, X-rays or MRI are not usually needed. For osteoarthritis in people aged 45 or over with typical symptoms, a clinical diagnosis is often sufficient.

Imaging may be considered when symptoms are atypical, follow an injury, include locking or giving way, do not improve with treatment, or when surgery is being considered.

When should knee pain be checked by a doctor?

Seek assessment for knee pain following an injury, significant swelling, a knee that locks or gives way, redness and warmth with fever, inability to bear weight, or night pain that does not ease.

In children and teenagers, knee pain can sometimes come from the hip, so persistent pain with a limp should be assessed.

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