Why knee pain down stairs affects 1 in 5 people

Knee pain down stairs is a very common issue – it’s experienced by 22.7% of people in any given year!

But it doesn’t have to be this way… This common problem has some common (and very effective) solutions.

Given that there’s more stairs everywhere as cities become more congested and building get taller, it’s worth planning ahead and making sure you don’t have another episode of knee pain down stairs.

Is it harder to walk up or down stairs?

As funny as it seems, going downstairs is a bigger challenge.

It requires more effort and is prone to causing pain if any aspect of the movement is compromised (like a stiff or sore ankle joint).

Why is it harder to go downstairs than up?

Walking downstairs requires more ankle flexibility, more quads strength and more stability that going upstairs.

A deficit in any one of these areas can lead to pain down stairs.

Adding to this difficulty is gravity (dang “gravity” again!) – it’s pulling you down the stairs with a constant force so there’s always pressure on the body.

Compare that to walking upstairs and you can decrease the force required by just walking slower.

Why does my knee hurt when coming down stairs?

Along with the deficits mentioned above, any pre-existing issue with the joint cartilage behind your patella can also cause pain down stairs as its put under pressure.

Walking downstairs, compared to upstairs, exerts a lot more pressure on the patellar cartilage behind the knee cap.

There’s cartilage on the back of the knee cap as well as on the groove in the femur/thigh bone that it moves through.

If either cartilage surface has softening, irritation or patchy coverage, the excessive pressure can cause pain and (occasionally) swelling.


At what age do stairs become difficult?

Age itself is not an issue…but it comes with a few challenges.

As we age, it becomes more difficult to retain muscle and strength.

There are also age-related changes in the ability of joint cartilage to regenerate and repair, making cartilage defects more common.

Joint stiffness and loss of range also become more prevalent, and a stiff ankle joint makes it harder to avoid pain down stairs.

Why do I have trouble walking down stairs?

Given the age-related changes above, there’s an interaction between them that can make it difficult to negotiate stairs.

Less strength makes it harder to control the body and knee position, making you more prone to patellofemoral (kneecap) overload.

The changes in cartilage surface make it easier to provoke a pain response.

Combine those two factors with a stiff ankle, which lifts the heel up as you descend stairs and causes a sudden spike in knee loading, and you’ve got the perfect recipe for knee pain down stairs.

Most of those factors can be improved or mitigated so it’s not all doom and gloom – we’re just painting the picture of why you knee suddenly causes pain down stairs.

How do I know if I have arthritis in my knee?

Arthritis gets a bad rap – it’s this mean condition of wear-and-tear that punishes the older generation without remedy or cure.

The truth of the matter is that it’s a bit of a medical mystery.

We know it’s more common with age, but age alone won’t cause it.

We know that it doesn’t like overactivity, but constantly active folks and runners have some of the healthiest cartilage in older age.

Probably the best way to conceptualise it at the moment is that it’s an area of your cartilage that’s become sensitive and is irritated by abnormal loading patterns.

Fix and control the loading and it becomes less sensitive. And just like an area of chafing (skin rubbing) or blisters, it gradually becomes less sensitive and not as easily provoked.


What is the proper way to walk down stairs?

This might surprise you but there is no “proper” way to walk down stairs.

Sure, most of us just walk down forwards and one step after another. But if you’re lacking strength, if your ankles are very stiff or if you currently have patellofemoral pain, you may prefer and benefit from walking down stairs sideways or always leading with the same leg.

If you try to walk “normally” you’ll get pain down stairs and make things worse. So the insistence on descending normally might actually prolong your recovery.

Remember that the brain and body are wonderfully intuitive – if they’re changing the way you move, they probably have good reason.

How do you walk down stairs with knee pain?

As we mentioned above, you can always lead with your sore leg. If you have left knee pain, you can lower that leg first onto every step so the knee never needs to bend and won’t become sore.

Another “alternative” method of descending is to walk slightly sideways. To lower your body to the next step, the pelvis can tilt and take away some of the knee bend required.

Long story short, try different methods and if it reduces the pain, it’s probably a good temporary alternative.

Why is knee pain worse going down stairs?

Walking down stairs increases the pressure underneath the (patella) kneecap as well as through the tendon connecting the patella to the tibia (shin).

When the cartilage or tendon is injured or sensitive, the increase in pressure causes pain down stairs.

Does this mean that my knee is damaged?

Not necessarily.

Pain can occur from uninjured structures if there has been a recent increase in abnormal or excessive loading on that area.

If the knee is also swelling in response to pressure throughout the day, there is a greater chance that there may be an underlying area of damage or degeneration.

But even despite physical changes in the cartilage, that doesn’t mean that you’re stuck with pain for the rest of your life.

Most knees over the age of 35 years have some degeneration but don’t experience pain.


How do you stop patellofemoral pain?

The trick to fixing knee pain down stairs is to find the underlying cause.

You can directly address the pain with McConnell taping or anti-inflammatory medication but these options only provides pain relief without a long term solution.

The underlying cause may be strength, range of motion or movement patterns – find the factors contributing your pain and address it directly.

Most treatments for patellofemoral pain won’t provide an immediate change but you should notice less pain down stairs within a few weeks.

Is chondromalacia patella serious?

Chondromalacia Patella is a softening of the cartilage behind the knee cap.

It’s typically diagnosed via MRI after a prolonged and stubborn episode of patellofemoral pain.

It’s not too serious on its own but it can be a warning sign worth paying attention to.

Ignoring it and pushing on with the same loading patterns can lead to progression of the softening into cartilage damage, although the progression is quite slow and takes a number of years or decades.

How long does it take for chondromalacia patella to heal?

The duration of the time relates to the severity of the irritation and the age of the person.

More severe irritations can take longer to settle and older people typically take longer to recover.

What is the pain behind my knee?

Pain behind the knee can come from a few different causes.

You might have a meniscal tear in the knee that doesn’t like being compressed.

It might be a Baker’s Cyst, a collection of fluid that stretches the back of the knee joint.

It might even be an irritated nerve causing Sciatica.

Each of these issues has a specific pattern of pain and unique causes – a quick trip to your trusty health professional should get to the bottom of it.

Why does the back of my knee hurt when I walk down stairs?

For each of the problems above, they cause pain down stairs for different reasons.

Meniscal tears and Baker’s Cysts cause pain due to compression – more knee bend squashes it. If you can descend with less knee bend (using one of the methods mentioned above), it’ll take the pressure of it.

If it’s a spinal nerve irritation or Sciatica, it’s more related to bending your trunk forward as you walk down stairs.

This stretches the nerves and irritates them, causing pain behind the knee.


Why did this injury start? I don’t remember doing anything to it.

Knee cap related issues, from either the college or the tendon, can occur due to a period of excessive loading directly on the area such as an initial return to the gym or a hiking trip.

The knee can also be subject to abnormal loading if the muscles that stabilise the leg, located in the hip and ankle, are able to control the position of the knee.

This is often due to a secondary injury causing a limp, excessive muscle fatigue or irritation of the nerve supplying these muscles, such as sciatica.

Can Sciatica cause knee pain?

Sciatica can definitely refer pain to the back of the knee. But it’s often not localised just to the knee.

With Sciatica, you’ll also feel pain up into the hamstrings or down to the calf.

How can I fix this injury?

There are two approaches to fixing pain down stairs.

One approach is to treat the knee directly, with techniques such as knee taping.

The other approach works on the underlying cause of the issue, which may involve movement control exercises or supportive orthotics.

How long does this injury take to get better?

The duration of the recovery is directly related to the underlying cause of the injury.

If this came about after a single day of increased activity, the injury will pass once the localised muscle fatigue recovers.

(Side note: muscle patterns aren’t hardwired in the brain. So if your muscles have been working abnormally for a period of time, there’s a chance that the brain will continue with the abnormal muscle pattern even after the underlying cause is fixed. This is where corrective exercises can be crucial)

If this injury has come about due to prolonged abnormal loading on the knee, from causes like a loss of leg strength or excessive body weight, then the cause can take longer to address and the knee takes longer to recover.

Will knee pain go away on its own?

No, and yes.

If the cause of the knee pain was transient and not related to any internal causes, it can settle without any intervention. An example would be a health runner who just pushed their long run distance too far too quickly. They stirred it up but it’ll recover well, given a short period of controlled activity.

On the other hand, knee pain down stairs that’s related to cartilage damage or underlying weakness will continue unless the cause of the pain is addressed.

How can I relieve knee joint pain?

As we mentioned above, the cause of the pain needs to be addressed to successfully treat the condition and relieve knee pain.

Quick, but temporary, fixes include medication and taping along with activity modification (a fancy way of saying “just avoid anything that causes the pain”).

Long term fixes include strength work, better footwear and mobility exercises.


When should you see a doctor about knee pain?

Knee pain down stairs is fairly common and the overwhelming majority of cases don’t need any medical intervention.

The triggers for making a booking with your doctor are:

  • Persistent pain that’s not responding to treatment
  • Worsening pain over a period of time
  • Pain that significantly impacts on your function (eg. you must avoid stairs)
  • Knee pain that coincides with other health issues (eg. you lose significant weight or feel generally unwell)

How do I know if my knee pain is serious?

Again, most cases of knee pain down stairs have simple causes.

However there are some more serious causes that happen very rarely, including bone fractures and inflammatory conditions.

These typically become clearer as the condition fails to respond to regular treatment or behaves unexpectedly.

If you’re ever concerned, make a booking with your doctor or Physiotherapist. They can screen for serious causes and get you back on the right path sooner.