Knee pain going down stairs — causes and what helps

Knee pain when going down stairs most often results from overload of the patellofemoral joint, and in people over 45 also from knee osteoarthritis. When you go down, the quadriceps muscle brakes the movement, and the pressure of the kneecap on the thigh bone is several times higher than when walking on the flat. Exercises that strengthen the thigh and hip and a temporary change in how you go down stairs help.

Below we describe the most common causes, symptoms that require a visit to a doctor, a way of going down stairs that takes the load off the knee, 5 exercises with dosage and how a physiotherapist works with the knee.

Contents

Why does the knee hurt when going down stairs?

When you go down stairs, the quadriceps muscle works eccentrically, i.e. it brakes the bending of the knee under body weight. The kneecap is then pressed firmly against the thigh bone, which is why an irritated patellofemoral joint hurts precisely on the stairs, in a squat and after sitting for a long time. In older people, similar pain is caused by cartilage degeneration, and in athletes by overload of the patellar tendon.

The most common causes:

• patellofemoral pain – pain “under” or around the kneecap, common in runners, teenagers and people who have quickly increased their activity;
• knee osteoarthritis – pain when bearing weight, brief morning stiffness, sometimes creaking;
• jumper’s knee, i.e. overload of the patellar tendon, described in our post jumper’s knee – symptoms and treatment;
• meniscus injury – pain after twisting the knee, sometimes with locking.

Finding the cause requires an examination, because each of them needs a different dosage of load.

How to go down stairs so it hurts less?

With a painful knee, go down one step at a time, holding the handrail: first put the painful leg down, then bring the healthy one next to it. Going up, the order is reversed – the healthy leg goes up first. This way, when going down, the stronger leg bends and brakes your body weight, which reduces pressure on the painful kneecap.

It also helps to go down more slowly, avoid carrying heavy bags on the stairs and, for longer distances, use the lift until the pain eases. The idea is not to give up stairs for good, but to temporarily reduce the load, which is then gradually increased along with the exercises.

Which exercises are safe with knee pain?

With knee pain and no warning signs, exercises that strengthen the quadriceps and glute muscles are usually safe, done within a range in which pain does not exceed 3 on a 0–10 scale. Research on patellofemoral pain shows that combining knee and hip exercises works better than either on its own. Here are 5 general exercises.

1. Thigh tightening with a towel roll. Sitting with your legs straight, put a rolled-up towel under your knee and press down on it, tightening your thigh. 10 contractions of 5 seconds, 2 sets, twice a day.
2. Glute bridge. Lying on your back with knees bent, lift your hips, squeezing your buttocks. 10 repetitions, 2 sets, once a day.
3. Side-lying leg raise. Lying on your side, lift the straight upper leg by approx. 30 cm, toes pointing forward. 12 repetitions, 2 sets on each side.
4. Sit-to-stand. Sit on a high chair and stand up without using your hands, making sure your knees do not drift inwards. 8–10 repetitions, 2 sets.
5. Low step-up. Step up with the painful leg onto a step approx. 10 cm high and slowly step down. 8–10 repetitions, 2 sets, holding the handrail.

If pain gets worse or radiates, stop the exercise and consult a physiotherapist.

How does a physiotherapist help with knee pain?

The physiotherapist examines the knee, hip and foot, assesses the alignment of the knee during a squat and going down stairs, and checks muscle strength. On this basis they put together an exercise programme with gradually increasing load. As a support, they may use manual therapy, kinesio taping of the kneecap or TECAR therapy. In Rydułtowy a consultation costs PLN 180 and TECAR therapy PLN 150.

The physiotherapist decides on the number of visits and type of treatment individually after the consultation. In advanced osteoarthritis, when conservative treatment is not enough, a doctor may consider surgery – we describe rehabilitation afterwards in our post rehabilitation after knee replacement.

TECAR therapyfor pain and overload of the tissues around the knee, once contraindications have been ruled out150 PLN Manual therapy + kinesio tapingmobilisations and taping to offload the kneecap190 PLN

Prices valid from 08.2026.

What to avoid with knee pain on the stairs?

The most common mistakes are avoiding movement altogether, which weakens the thigh muscles, and the opposite – training “through the pain” with deep squats, lunges and downhill running. Sitting for long periods with your knees sharply bent does not help either, nor does relying solely on passive treatments or a brace. The key is a gradual, regular increase in load, ideally under the supervision of a physiotherapist.

We describe other causes of joint pain in our guide joint pain and injuries – shoulder, elbow, knee, foot.

Summary

Knee pain when going down stairs is most often due to overload of the patellofemoral joint or osteoarthritis. Going down “painful leg first”, 5 simple thigh and hip exercises and a gradually increased load help. Swelling after an injury, a locking knee and calf pain need a doctor first.

Frequently asked questions

Does knee pain when going down stairs mean osteoarthritis?

Not always. In younger and active people it is more often patellofemoral pain, which does not mean cartilage damage. Osteoarthritis is more likely after the age of 45, especially with brief morning stiffness. The diagnosis is made by a doctor on the basis of an examination, and an X-ray is not always needed for this.

Does a knee brace help with pain on the stairs?

A knee brace or sleeve may reduce pain during activity for some people, but it does not replace exercise. Worn all the time, it can weaken your sense of control over the joint. It is worth discussing the type of brace and how long to use it with a physiotherapist or orthopaedic doctor who knows the cause of the pain.

Can I run with knee pain?

Often yes, but with less volume, on flat ground and without running downhill. Pain while running should not exceed 3 on a 0–10 scale and should not get worse the next day. If it does, it is worth temporarily replacing running with cycling or swimming and getting your training plan checked.

Does being overweight affect knee pain?

Yes, a higher body weight increases the load on the knees with every step, and even more so when going down stairs. In osteoarthritis, weight loss is one of the recommended parts of treatment alongside exercise. Even moderate weight loss can reduce symptoms, and a weight-loss plan is best agreed with a doctor or dietitian.

Do I need a referral to see a physiotherapist with knee pain?

A referral is usually not required for a private visit at the clinic in Rydułtowy. The clinic has no contract with the NFZ (the Polish public health fund), and a physiotherapy consultation costs PLN 180. If you have knee X-ray, ultrasound or MRI results or a report from an orthopaedic doctor, bring them to your first visit.

Can a physiotherapist come to my home?

Yes, the clinic provides home physiotherapy within 15 km of Rydułtowy, including in Rybnik, Wodzisław Śląski, Radlin and Pszów. A visit costs approx. PLN 200 for up to 5 km, then PLN 2 per kilometre beyond that, and the exact price is agreed when booking. It is a good option for people whose pain makes it hard to manage stairs.

Sources

• Crossley K.M. et al., 2016 Patellofemoral pain consensus statement, British Journal of Sports Medicine, 2016.
• Willy R.W. et al., Patellofemoral Pain: Clinical Practice Guidelines, JOSPT, 2019.
• NICE, Osteoarthritis in over 16s: diagnosis and management (NG226), 2022.