Knee pain on stairs: why it happens and when to see a physio

Stairs ask a lot of your knee. Each step up or down loads the joint at the front of the knee, behind the kneecap, with several times your body weight. That is why stairs are often the first place a problem becomes noticeable, long before walking on flat ground hurts.

The most common reasons

• Pain around or behind the kneecap (often called patellofemoral pain). Very common in active people, teenagers and people who have recently increased their walking, running or gym work.
• Knee osteoarthritis. Gradual wear of the joint surfaces, more common after the age of 45, often with stiffness in the morning or after sitting.
• Weak or tired muscles around the hip and thigh. When the quadriceps and hip muscles do not share the load well, the kneecap takes more of it.
• Tendon irritation just above or below the kneecap, usually after a sudden jump in activity.

Coming down stairs is often worse than going up. Going down asks your thigh muscles to work as brakes while they lengthen, which puts more load through the front of the knee.

What usually helps

1. 01

   Adjust the load, do not stop moving

   Use the handrail, take stairs one at a time for a while, and reduce the activity that set it off rather than resting completely. Gentle movement keeps the joint healthy.

2. 02

   Strengthen the thigh and hip

   Most knee pain on stairs improves with a progressive strengthening plan for the quadriceps and the hip muscles. It works best when it is matched to what your knee can tolerate today and built up week by week.

3. 03

   Check how you move

   How your hip, knee and foot line up on a step matters. A physio watches you on a step, a squat and a single-leg stand to see where the load is going.

4. 04

   Manage your total activity

   Pain that settles within 24 hours after activity is usually acceptable while you rebuild. Pain that lingers into the next day is a sign to ease back a little.

This article is general information, not a diagnosis. If your knee pain is new, severe or not improving, have it assessed.