If you’ve ever noticed that your knee feels perfectly fine walking on flat ground but suddenly starts hurting when you go downstairs, you’re definitely not alone. It’s one of the most common complaints we hear in the clinic.
Many people assume they’ve “worn out” their knee or that arthritis is to blame, but the truth is that pain when going downstairs can have several different causes. Understanding what’s causing your symptoms is the first step towards
getting the right treatment.
Let’s look at some of the most common reasons your knee might be hurting.
Why Does Going Down Stairs Hurt More?
Walking downstairs places significantly more force through the knee than walking on level ground.
Every step requires your quadriceps (the muscles at the front of your thigh) to slowly control your body weight as you lower yourself. This is known as an eccentric contraction, and it places increased compressive forces through the knee joint (1).
If one of the structures around the knee is irritated or overloaded, these extra forces often make going downstairs one of the first activities to become painful.
1. Patellofemoral Pain Syndrome (Runner’s Knee)
This is probably the most common cause of pain going downstairs.
The pain is usually felt:
● Around or behind the kneecap
● During stairs, squatting or prolonged sitting
● After running or jumping (2,3)
Rather than the kneecap “tracking badly” as was once thought, we now know that patellofemoral pain is often caused by the joint becoming overloaded. This can happen when the muscles around the hip and knee aren’t absorbing force efficiently (2).
How physiotherapy helps
Treatment usually focuses on:
● Strengthening the quadriceps
● Improving hip and glute strength
● Improving movement control
● Gradually increasing load tolerance
Research consistently shows exercise therapy is the most effective treatment for patellofemoral pain (2,8).
2. Knee Osteoarthritis
Although arthritis is often blamed for knee pain, it isn’t always the culprit.
People with knee osteoarthritis often notice:
● Pain first thing in the morning
● Stiffness after sitting
● Pain walking downstairs
● Difficulty standing up from chairs
● Swelling after activity (4)
Going downstairs increases compression through the knee joint, which can make arthritic joints more sensitive.
How physiotherapy helps
Contrary to popular belief, exercise is one of the best treatments for knee osteoarthritis.
Strengthening the muscles around the knee helps absorb more force, reducing stress on the joint and improving everyday function (4,5).
3. Patellar Tendinopathy (Jumper’s Knee)
Pain just below the kneecap may indicate irritation of the patellar tendon.
It’s particularly common in:
● Runners
● Footballers
● Volleyball players
● Basketball players (6,7)
Early on, the tendon may only hurt during stairs or jumping before progressing to everyday activities.
How physiotherapy helps
Treatment focuses on:
● Isometric exercises for pain relief
● Heavy slow resistance training
● Progressive tendon loading
● Returning gradually to sport
Simply resting rarely solves the problem. Progressive loading remains the cornerstone of rehabilitation (6,7).
4. Meniscus Injuries
The meniscus acts like a shock absorber inside the knee.
Small tears can sometimes cause:
● Pain on stairs
● Catching sensations
● Clicking
● Swelling
● Difficulty fully bending or straightening the knee (1,9,10)
Not every meniscus tear requires surgery.
How physiotherapy helps
Many people recover extremely well with:
● Strength training
● Balance exercises
● Movement retraining
● Activity modification
Only certain tears require surgical intervention, and conservative physiotherapy is often recommended as first-line treatment (1,9,10).
Could It Just Be Tight Muscles?
Sometimes.
Tight quadriceps, calves or hamstrings can contribute to altered movement patterns, but they are rarely the sole cause of persistent knee pain.
Stretching can help improve flexibility, but on its own it usually won’t solve the underlying issue. In most cases, strengthening is far more important (2,4,6).
When Should You See a Physiotherapist?
It’s worth getting assessed if:
● The pain has lasted more than a couple of weeks.
● It’s stopping you exercising.
● Your knee repeatedly swells.
● It feels unstable or gives way.
● You can’t fully bend or straighten it.
● The pain is gradually getting worse.
The earlier you identify the cause, the easier it usually is to treat.
What Does Physiotherapy Involve?
Every knee is different, but treatment commonly includes:
● Identifying the exact source of pain
● Strength testing
● Assessing walking, squatting and stair mechanics
● Progressive strengthening
● Improving balance and movement control
● Advice on modifying activity while symptoms settle
The aim isn’t simply to reduce pain, it’s to improve the knee’s ability to cope with everyday demands.
Final Thoughts
Pain going downstairs doesn’t automatically mean you’ve “damaged” your knee or that you’ll need surgery.
In many cases, it’s simply a sign that one or more structures around the knee are struggling to cope with the loads being placed upon them.
With the right diagnosis, a progressive strengthening programme and a gradual return to activity, most people make an excellent recovery.
If stairs have become something you dread, don’t ignore it. A physiotherapy assessment can identify exactly what’s causing the problem and help you get back to moving confidently again.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating all types of knee pain. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog Written By: Emre Oz (Head of Integrated MSK & Sports Medicine Operations at Crouch Physio/Specialist MSK Physiotherapist).
References
1. Spang RC III, Nasr MC, Mohamadi A, et al. Rehabilitation following meniscal repair: A systematic review. BMJ Open Sport & Exercise Medicine. 2018;4:e000212.
2. Lack S, Neal B, De Oliveira Silva D, Barton C. How to manage patellofemoral pain: Understanding the multifactorial nature and treatment options. Physical Therapy in Sport. 2018;32:155–166.
3. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. American Family Physician. 2019;99(2):88–94.
4. Sharma L. Osteoarthritis of the Knee. New England Journal of Medicine. 2021;384:51–59.
5. Tore NG, Oskay D, Haznedaroglu S. The quality of physiotherapy and rehabilitation program and the effect of telerehabilitation on patients with knee osteoarthritis. Clinical Rheumatology. 2023;42:903–915.
6. Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(11):887–898.
7. Figueroa D, Figueroa F, Calvo R. Patellar Tendinopathy: Diagnosis and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2016;24:e184–e192.
8.Petersen, Wolf, et al. “Patellofemoral pain syndrome.” Knee surgery, sports traumatology, arthroscopy 22.10 (2014): 2264-2274.
9. Chirichella PS, Jow S, Iacono S, et al. Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PM&R. 2019;11:292–308.
10. Mameri ES, Dasari SP, Fortier LM, et al. Review of Meniscus Anatomy and Biomechanics. Current Reviews in Musculoskeletal Medicine. 2022;15:323–335.
