Knee Pain Going Down Stairs

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Find out about the common causes of knee pain going down stairs and how to treat them

Knee pain going down stairs, and as you go back up, is a common problem and can make life really tricky.

It is not surprising so many people complain of pain when you consider that the force going through the kneecap is 3.5x body weight when you come down the stairs.

That means for a person weighing 120lbs, as they come down, a force of 420lbs goes through the kneecap which has a contact surface area of only 12cm2.

Here we look at the common causes of knee pain coming down stairs and steps, how to reduce pain and improve function and share top tips on the best way to get up and down stairs if you suffer from knee pain.

Causes of Knee Pain Going Down Stairs

In most cases knee pain going down stairs usually indicates a problem with the knee cap (patella) and how it moves. The kneecap is a small bone, shaped like an upside down triangle which sits in the patella groove at the front of the knee and glides up and down as the knee moves.

Huge forces go through it with every day activities. As a result, the back of the patella is lined with the thickest layer of cartilage in the whole body as it is designed to withstand massive compressive forces.

Anything that interferes with how the patella moves, or that affects the cartilage lining the knee cap will magnify these huge forces and lead to knee pain going down stairs.

Let's take a look at the four most common causes of knee pain going down stairs:

1. Runners Knee

Runners Knee, also known as Anterior Knee Pain or Patellofemoral Pain Syndrome, is the most common cause of knee pain going down stairs.

Runners Knee is the most common cause of knee pain going down stairs.

What is it: Runners Knee is a condition where there is a problem in the way the patella moves up and down

Causes: Muscle tightness/weakness, flat feet, abnormal anatomy

Symptoms: General ache and knee cap pain, grinding, mild swelling

Aggravating Activities: Repeated activities, stairs, prolonged inactivity

Who Does it Affect: Can affect anyone, at any age, whether they are active or not. Accounts for approximately 25% of all knee injuries seen in sports injury clinics

Learn More: in the Runners Knee section

2. Chondromalacia Patella

What is it: Chondromalacia is a conditions where there is damage to the cartilage on the back of the kneecap

Knee pain going downstairs is often caused by a problem with the cartilage on the back of the kneecap

Symptoms: Achy knee cap pain, swelling, clicking/grinding

Aggravating Activities: Getting up from sitting, sports, pressure through the kneecap, stairs

Who Does it Affect: Most common in young, healthy people. More common in women.

Learn More: in the Chondromalacia Patella section

3. Knee Osteoarthritis

What is it: In osteoarthritis, there are degenerative changes aka wear and tear in the knee bones and cartilage of the knee

Symptoms: Morning stiffness, pain, swelling, clicking/grinding, reduced knee movements

Aggravating Activities: Worse after prolonged rest, activity, cold weather, stairs

Who Does It Affect: Most common over the age of 50

Learn More: in the Arthritis section

4. Pes Anserine Bursitis

What is it: With Pes Anserine bursitis, the problem is not with the kneecap directly, but inflammation of the nearby pes anserine bursa, a small fluid filled sac that reduces friction between knee tendons and bone

Pes Anserine Bursitis often causes knee pain on stairs

Symptoms: Pain and swelling approximately 2-3 inches below the knee joint on the inner side of the knee

Aggravating Activities: Stairs (going up tends to be worse than coming down), sleeping on your side (due to pressure on the bursa), hamstring stretches

Who Does It Affect: Most common in overweight women, runners and swimmers (particularly breaststroke)

Learn More: In the Pes Anserine Bursitis section

5. Quads Strain

What is it: A quads strain is when one or more of the quadriceps muscles on the front of the thigh are partially or fully torn

Symptoms: Thigh pain, swelling and bruising, impaired function, quads weakness

Aggravating Activities: Knee pain going down stairs, jumping, kicking

Who Does It Affect: Mostly athletes, particularly during middle age

Learn More: In the Pulled Quads section

Forces Through The Knee Cap

Squatting places forces around 7-8x bodyweight through the kneecap

People often don't realise quite how much the force through the knee varies in different situations. Let's have a quick look at the forces that go through the kneecap with different activities.

Walking: 0.5x body weight
Climbing Up Stairs: 2.5x body weight
Going Down Stairs: 3.5x body weight
Squatting: 7-8x body weight

It really highlights why some activities cause so much pain in the knees!

What Can Help?

If you are suffering from knee pain going up and downstairs that just affects one knee, here's a top tip! It means going up one step at a time i.e. one foot moves up, then the other joins it on the same step and so on. It is a little slower than alternating feet with each step but it can make a real difference.

Going Upstairs: Step up first with your good leg, then follow onto the same step with your bad leg. Repeat all the way up

Coming Downstairs: Step down first with your bad leg, then follow onto the same step with your good leg. Repeat all the way down.

A simple way to remember it is "Good leg up to heaven, bad leg down to hell!"

Following this order on the stairs requires less knee movement and places less force through the affected knee. You'll be surprised how much difference it makes!

Holding on to a bannister/rail can also really help as it helps reduce the weight going through the knee.

You can learn more and find specific treatment ideas for whatever is causing your knee pain on stairs by using the links above for each condition.

Want To Know More?

Of course, lots of knee problems will feel worse on the stairs, but these are the four problems where knee pain on stairs is one of the most prominent features.

If none of these are sounding like your problem, visit the knee pain diagnosis section, for help working out was is causing your pain, and to learn what you can do about it.

  1. Knee Pain Guide
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  3. Symptoms
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  5. Knee Pain On Stairs

Page Last Updated: 06/02/2020
Next Review Due: 06/02/2022

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