If your knee hurts when you walk up or down stairs, you are not alone. This is one of the most common knee complaints we see in physiotherapy, and it can affect people of all ages.
Pain on stairs often points to a problem around the kneecap (patella), particularly a condition called patellofemoral pain syndrome (PFPS). The good news is that most cases improve with the right rehabilitation and do not require surgery.
What causes knee pain on stairs?
The most common cause of pain when going up and down stairs is patellofemoral pain syndrome, sometimes called runner’s knee or kneecap pain.
This condition occurs when the joint between the kneecap and the thigh bone becomes irritated. Activities such as climbing stairs, squatting, lunging, or getting up from the a chair increase the load through this joint, which is why they often trigger symptoms.
People usually feel pain:
- Around or behind the kneecap
- At the front of the knee
- When walking downstairs (often more than upstairs)
- During squats or lunges
- After sitting for a long time with the knee bent
Why does it often hurt more going downstairs?
This is one of the questions people ask most frequently.
Walking downstairs places greater forces through the patellofemoral joint than walking on level ground. The quadriceps muscles at the front of the thigh work harder to control the movement as you lower your body weight, which can increase pressure around the kneecap.
That is why many people with patellofemoral pain notice that descending stairs is more painful than climbing them.
What is patellofemoral pain syndrome?
Patellofemoral pain syndrome is a condition involving irritation of the structures around the kneecap.
Despite the name, it does not necessarily mean that the kneecap is “out of place”. More often, it is related to how the knee is moving and how well the surrounding muscles are supporting the joint.
Factors that can contribute include:
- Weakness in the quadriceps muscles
- Reduced hip strength
- Changes in activity levels
- Running or exercise overload
- Poor movement control during squatting or stairs
- Previous knee injuries
Is it arthritis?
Not always.
Many people assume knee pain on stairs means they have arthritis, but patellofemoral pain syndrome is different from osteoarthritis.
Patellofemoral pain is common in younger and middle-aged adults, particularly those who are active, although it can occur at any age.
Osteoarthritis may also cause pain on stairs, especially if there is stiffness, swelling, or pain that is more widespread through the knee joint. A physiotherapy assessment can help determine the most likely cause of your symptoms.
Should I stop exercising?
Usually, no.
Completely avoiding activity can lead to increased weakness and reduced knee capacity over time. Instead, the goal is to modify activity temporarily while improving strength and movement.
For example, you may need to reduce the depth of squats, temporarily decrease running volume, or avoid repeatedly using stairs while symptoms are settling.
The aim is to keep the knee moving without continually aggravating it.
How physiotherapy can help
A physiotherapist will assess:
- Knee movement
- Hip and thigh strength
- Walking and stair mechanics
- Balance and control
- Training or activity levels
Treatment is usually focused on addressing the underlying factors contributing to the pain.
Rehabilitation may include:
- Quadriceps strengthening
- Hip strengthening exercises
- Balance and control exercises
- Gradual loading of the knee
- Technique modification for stairs, squats, and exercise
- Advice modification to sport or activity
The exercises are usually progressed gradually as the knee becomes stronger and less irritable.
Are there other treatment options?
Exercise rehabilitation is the foundation of treatment for patellofemoral pain syndrome, but some people benefit from additional physiotherapy treatments depending on their symptoms.
This may include dry needling, hands-on treatment, taping, or other techniques to help reduce pain and improve movement while you work through a strengthening program.
How long does recovery take?
Recovery varies from person to person.
Some people notice improvement within a few weeks, while others may require several months of consistent rehabilitation, particularly if symptoms have been present for a long time.
The key is usually not just reducing pain, but improving the knee’s ability to tolerate activities such as stairs, walking, exercise, and sport.
When should you seek treatment?
It is worth booking an assessment if:
- Knee pain has lasted more than two weeks
- Stairs are becoming increasingly difficult
- You have stopped exercising because of your knee
- The knee feels unstable
- Pain is affecting work, sport, or daily activities
Early treatment often leads to a quicker and easier recovery.
Get help for knee pain in Canberra
If you are experiencing knee pain going up stairs, knee pain going down stairs, or knee pain around the kneecap, physiotherapy can help identify the cause and develop a personalised rehabilitation plan.
Shirley has a particular interest in treating patellofemoral pain syndrome, knee pain, and rehabilitation for people who want to return to walking, exercise, sport, and everyday activities.
If stairs have become something you dread, book an appointment with Shirley at Back In Strength Physiotherapy & Pilates in Deakin, Canberra, and let us help you get back to moving comfortable and confidently.
