Why Stairs Hurt Your Knees

Plenty of people can walk on flat ground without pain but wince on every step of the staircase. That isn't random. Stairs ask a lot more of the knee.

Why stairs are harder

When you climb, one leg lifts your whole body weight up against gravity. Going down, the thigh muscle works as a brake while the knee bends under load. Studies of knee forces suggest stairs put several times your body weight through the joint, and the kneecap gets pressed hard against the thigh bone as the knee bends.

So stairs are a good test of your knee's capacity. If it's irritated or the muscles around it are weak, stairs are where you notice it first.

Common causes of stair pain

• Pain at the front of the knee or around the kneecap: often patellofemoral pain. It's common in teenagers, runners and people who have recently increased activity. It's usually worse going down stairs and after sitting for a long time.
• Knee osteoarthritis: aching, stiffness, swelling, often in people over 50. Knee osteoarthritis pain is often felt on both up and down stairs.
• Meniscus problems: sharp pain on twisting, catching or locking. See meniscus tear.
• Tendon problems just below the kneecap, common in jumping sports.

Quick tips that help straight away

• Up with the good, down with the bad. Lead with the stronger leg going up, and with the painful leg going down. Use the rail.
• Take them one at a time on bad days.
• Keep the knee in line with your second toe. Avoid letting it collapse inwards.
• Spread it out. Do several short trips instead of one heavy load.

Fixing it longer term

Stair pain usually improves when the muscles that control the knee get stronger:

1. Quadriceps (front of thigh): sit-to-stands, step-ups, wall squats within a comfortable range
2. Hip muscles: side-lying leg lifts and bridges, which stop the knee caving in
3. Calves: calf raises, which help absorb load
4. Step-downs: slow, controlled lowering from a small step, which trains the exact movement that hurts

Start low, go slow, and progress the step height over weeks.

When to see a physio

If stairs have hurt for more than a few weeks, the knee swells, locks or gives way, or you're avoiding stairs altogether, it's time for an assessment.