Knee pain going down stairs: common causes and what helps

Why stairs single out the knee

Going down stairs asks a lot of the knee. Each step loads the joint with several times your body weight, and the thigh muscles have to control that load while the knee bends under it. The kneecap is pressed against the thigh bone at the same time. Walking on the flat rarely stresses the knee this way, which is why stairs, hills and getting out of a low chair are often the first things to feel sore when something in the knee is irritated.

Pain on stairs is a symptom, not a diagnosis. The pattern of the pain — where it is, whether going down hurts more than going up, and whether the knee swells, clicks, locks or gives way — helps point towards the cause.

Common causes

Patellofemoral pain. This is the most common reason for pain at the front of the knee, around or behind the kneecap, that is worse going down stairs, squatting or sitting with the knee bent for long periods. It is usually related to how load is shared across the joint rather than to damage, and often follows a change in activity, a period of inactivity, or weakness in the hip and thigh muscles. Our patellofemoral pain page explains it in more detail.

Meniscus tear. The menisci are two crescents of cartilage that cushion the knee. A tear can happen with a twist on a planted foot, or gradually with age as the cartilage becomes less resilient. Pain is often on the inner or outer joint line, and the knee may swell, click, catch or feel as if it will lock. Many degenerative tears are managed well without surgery. See meniscus tear.

Knee osteoarthritis. Over time the joint surfaces can change, and the knee may feel stiff in the morning, ache after activity and hurt on stairs. Osteoarthritis is common and does not mean the knee is "worn out": exercise, weight management and load advice are the mainstay of care, and many people stay active for years. See knee osteoarthritis.

Other possibilities include patellar tendinopathy (pain just below the kneecap, common in jumping sports), iliotibial band syndrome (outer knee, common in runners) and pain referred from the hip or lower back.

What may help at home

• Adjust load, do not stop moving. Cut back on the activities that flare the knee for a week or two, but keep walking, cycling or swimming if they feel comfortable. Complete rest tends to weaken the leg and can make the knee more sensitive.
• Use the handrail and lead with the stronger leg. Going down, step first with the painful leg so the stronger leg controls the descent. Taking stairs one at a time for a while is sensible.
• Strengthen the thigh and hip. Simple exercises such as sit-to-stand from a chair, step-ups on a low step and side-lying leg raises may help the knee cope with load. Start with a level that is comfortable and build up gradually.
• Check your footwear. Worn or unsupportive shoes can change how the knee is loaded. Where foot posture seems to be contributing, a 3D foot scan can show whether custom orthotics may help.
• Ice and over-the-counter options. A cold pack for 10–15 minutes after activity can ease a sore knee. Ask a pharmacist about over-the-counter pain relief if you need it.

Many people notice improvement within a few weeks of consistent changes. If the knee is not settling, an assessment can clarify why.

What an assessment involves

At your first appointment, one of our physiotherapists or our chiropractor will take a history and examine the knee: how it moves, where it is tender, whether there is swelling, and how your hip, foot and balance affect it. Most knee problems are diagnosed by examination. Where a scan would change the plan — for example a suspected significant meniscus tear that locks the knee — we can arrange X-ray or MRI through our imaging partner, often with same- or next-day appointments subject to availability.

Treatment is usually a progressive exercise programme alongside hands-on techniques, taping or, where appropriate, focused shockwave for long-standing tendon pain. We will explain what we find and agree a plan that fits your activity and goals. Outcomes vary from person to person, and fees are on our fees page.

When to seek urgent help

• Call us for a same-day assessment if the knee pain followed a fall, twist or sports injury, if the knee is locked or gives way, or if it is hot, swollen and painful without a clear cause. We can examine you and arrange fast-track imaging where needed.
• Go straight to A&E for more severe symptoms, such as an obvious deformity, inability to put any weight on the leg, or a deep wound.
• Call 999 for life-threatening signs, such as a calf that is suddenly swollen, hot and painful with chest pain or breathlessness.

When to book

If knee pain on stairs has lasted more than two to three weeks, keeps coming back, or is stopping you from exercising, working or sleeping, an initial assessment at our Bloomsbury clinic is a sensible next step. We will examine the knee, explain what we find and agree a plan with you.