If your knee hurts when going down stairs, you are not alone. “Stair pain” is one of the most common knee complaints people search for online, and it is one of the most common reasons people finally seek a physical therapy evaluation. The frustrating part is that stairs are not optional. You might be able to avoid running, deep squats, or long walks for a while, but you still have to go down the stairs at home, at work, or in a parking garage. When each step feels like a sharp jab, a burning pressure, or a deep ache, daily life becomes a constant negotiation with your knee.
In this blog, we will break down why the knee often hurts more when going down stairs than when going up, what that pain is commonly related to, and what you can do next. You will learn how the kneecap, the quadriceps, the hip, the ankle, and even the foot can influence what you feel at the knee. We will also cover red flags that mean you should stop guessing and seek a professional evaluation.
This article is educational and general. It does not replace a medical exam. If you have a significant traumatic injury, major swelling, a locked knee, fever, severe night pain, calf swelling, or sudden inability to bear weight, seek medical care promptly.
Why going down stairs is harder on the knee than going up
Most people assume stairs should be “even,” but the body experiences stairs differently depending on the direction. Going up stairs asks your muscles to generate force to lift your body. Going down stairs asks your muscles to absorb force and control your body weight as you lower. That “absorbing and controlling” piece is where many knees get irritated.
When you step down, your quadriceps act like brakes. They contract while lengthening, called an eccentric contraction. Eccentric work is powerful, but it can also be demanding when the muscle is weak, inhibited, or fatigued. On top of that, descending stairs increases compressive forces at the patellofemoral joint, which is the contact between the kneecap (patella) and the groove it moves in on the thigh bone (femur). If that joint is sensitive, or if the forces are not well distributed, you may feel pain at the front of the knee, around the kneecap, or behind it.
Stair descent also exposes movement strategy. A small shift in hip control, ankle mobility, or foot mechanics can change the position of the knee on every step. Over hundreds of steps per day, those small changes matter.
Where the pain is matters
One of the first things we ask is, “Where do you feel it?” Location does not give a diagnosis by itself, but it helps narrow the most likely sources.
Pain around or behind the kneecap often points toward patellofemoral pain, quadriceps capacity issues, or mechanics that increase compressive stress at the front of the knee.
Pain at the inside or outside joint line can be related to the meniscus, cartilage surfaces, or joint irritation. Joint line symptoms are more concerning when paired with swelling, catching, or true locking.
Pain just below the kneecap may be patellar tendon related, often seen with jumping sports, rapid increases in training, or repeated stair work.
Pain above the kneecap can be quadriceps tendon irritation, which may show up with heavy loading or higher intensity training.
Pain in the back of the knee can be related to swelling, hamstring tendon irritation, or other causes that need a more specific evaluation.
The most common reasons your knee hurts going down stairs
Patellofemoral pain, the classic “stairs hurt” diagnosis
Patellofemoral pain is one of the most common reasons for pain on stairs. People often describe it as pain “under the kneecap” or “around the kneecap.” It can feel sharp with stair descent, deep squats, or downhill walking. It can also show up as an ache after sitting for a long time and then standing up, sometimes called “movie theater sign.”
Patellofemoral pain is rarely about a single structure being “bad.” It is more commonly about load and tolerance. The joint is experiencing more stress than it can comfortably handle at this moment, often due to a combination of strength, mobility, and movement factors. Clinical practice guidelines for patellofemoral pain emphasize exercise as the primary treatment, specifically a combination of hip and quadriceps strengthening to reduce pain and improve function over time. The evidence base consistently supports strengthening, load management, and progressive return to activity rather than rest alone.
Quadriceps weakness or poor eccentric control
Even without a specific label, weakness matters. If your quadriceps are not strong enough or not coordinating well, your knee can feel like it “drops” on the way down. People describe shakiness, instability, or a need to pull themselves down using the handrail. The knee may also drift forward or inward, increasing irritation at the patellofemoral joint or stressing tendons.
Quadriceps weakness is common after any swelling or injury, because the quadriceps can become inhibited when the knee is irritated. It is also common after periods of inactivity, after pregnancy, after long stretches of sedentary work, or after returning to sport too quickly. The key is that the knee does not just need “more exercise.” It needs the right dose and progression.
Hip weakness and knee valgus, the knee collapsing inward
Knee pain does not always mean the knee is the main problem. The hip is the control center for the femur. If the hip muscles that stabilize and rotate the thigh are weak or not firing well, the knee may collapse inward during stair descent. This pattern is often called valgus, and it can increase stress on the patellofemoral joint and surrounding tissues.
Research has supported hip strengthening as an effective component of patellofemoral pain rehabilitation, improving pain and function. In the clinic, we frequently see stair pain reduce as hip control improves, even if the person came in convinced they had “bad knees.”
Ankle stiffness and limited dorsiflexion
Your ankle needs to bend forward as you descend stairs. That motion is dorsiflexion. If your ankle is stiff, your body steals motion elsewhere, often by driving the knee forward aggressively or allowing the foot to collapse inward. Both strategies can increase stress at the knee. Limited dorsiflexion can come from prior ankle sprains, calf tightness, Achilles stiffness, or simply mobility changes that develop over time.
A quick clue is whether you can keep your heel down during a squat. If your heel lifts early or you feel stuck at the ankle, your knee may be compensating for your ankle.
Foot mechanics and load distribution
The foot is your foundation. If the foot collapses excessively (often seen with a flatter foot) or remains rigid and does not adapt well, the alignment of the leg changes up the chain. A foot that collapses can increase internal rotation of the tibia and femur, and that can alter kneecap tracking and increase patellofemoral stress. A rigid foot that does not absorb load well can increase impact and force the knee to take more shock.
This is not about having a “good” or “bad” foot type. It is about how your foot behaves during walking, stairs, and single leg tasks, and how well your hip and ankle control that behavior.
Meniscus or joint surface irritation
A meniscus irritation can contribute to stair pain, particularly when pain is sharp at the joint line, swelling appears after activity, or there is catching or locking. However, it is important to know that meniscus changes are common on MRI even in people without pain. That means imaging is only one piece of the puzzle.
A physical therapy exam looks at how your symptoms behave with movement, how your knee loads, your strength and mobility, and your functional patterns. If the exam suggests a need for imaging or a physician referral, we help guide the next step.
Tendon overload
Patellar tendon or quadriceps tendon pain can show up strongly on stairs because the tendon is repeatedly loaded as you decelerate. Tendon pain is often linked to changes in training load, like a sudden increase in jumping, running, hills, or even stair climbing at work. Tendons respond well to progressive loading, but they do not like sudden spikes or random intensity.
The key is choosing strengthening exercises that match your stage, and building load tolerance in a structured way.
Common mistakes people make when trying to fix stair knee pain
Pushing through sharp pain, hoping it will “toughen up”
Pain is not always tissue damage, but sharp pain that consistently worsens is a sign you are exceeding current tolerance. Many people make it worse by pushing through high pain levels day after day.
Resting completely and losing capacity
The other extreme is doing nothing. Complete rest often leads to stiffness, weakness, and decreased confidence. The goal is usually modified movement and progressive strengthening, not shutdown.
Chasing random exercises without a plan
Many people try five different exercises from five different videos. The problem is not effort. The problem is lack of diagnosis, lack of dosing, and lack of progression. The right exercise with the wrong load can still flare symptoms.
Ignoring mobility and movement mechanics
Strength is important, but so is alignment, control, and mobility. If the ankle is stiff, or the hip is not controlling the femur, strengthening alone may feel like it helps temporarily but does not change the pattern.
What you can do now, practical steps
Step 1: Identify your triggers and modify load
If stairs spike your pain, use a handrail, take stairs more slowly, and limit repeated flights for a short period. Modifying does not mean you are fragile. It means you are respecting tissue tolerance while building capacity.
Step 2: Focus on “quieting” irritation
Swelling and irritation increase pain sensitivity. Managing swelling, avoiding repeated high pain activities, and spacing out intense lower body days often helps reduce symptoms.
Step 3: Begin targeted strengthening and control
Most stair pain responds best to a combination of quadriceps and hip strengthening, progressed carefully. This is supported by clinical practice guidelines and multiple studies. The program needs to match your pain response and your current capacity.
Step 4: Address ankle and hip mobility if they limit mechanics
Improving dorsiflexion and hip mobility can reduce compensations. Mobility is not the whole answer, but it can be a key constraint.
What a physical therapist evaluates that the internet cannot
A PT evaluation identifies the driver of your symptoms. We look at knee range of motion, swelling, joint irritability, patellar mobility, hip strength, calf strength, ankle mobility, balance, single leg control, and stair mechanics. We also ask about training load, footwear, sleep, stress, and recovery because your knee responds to the whole system.
Most importantly, we build a plan that is specific to you. Two people can have knee pain on stairs for completely different reasons. The evaluation helps avoid wasted time and repeated flare ups.
When to seek professional evaluation sooner
Seek help if:
- Your symptoms are worsening over 2 to 3 weeks
- You have swelling that does not resolve
- Your knee gives way or feels unstable
- You experience catching or true locking
- You cannot fully straighten the knee
- Pain limits daily activities like walking, standing, or sleep
- You are changing your gait to avoid pain
- These are signs you need a structured plan and possibly further medical input.
Frequently asked questions
Is it arthritis if stairs hurt?
Not always. Arthritis can cause stair pain, but patellofemoral pain, tendon irritation, and mechanics issues can cause similar symptoms. The pattern of stiffness, swelling, and response to activity helps clarify. Imaging can help, but function and clinical exam matter.
Should I get an MRI?
Not immediately for most cases. Many people improve with a structured rehab plan. Imaging is more helpful if there are red flags, significant swelling, true locking, or failure to improve with appropriate care. Your PT can help determine if imaging is appropriate.
Should I avoid stairs completely?
Usually no. The goal is often modified exposure while improving capacity. Complete avoidance can make the knee less tolerant. We want stairs to be possible, not feared.
Exercises that commonly help, with clear intent
Below are examples of exercise categories that physical therapists commonly use for stair related knee pain. The best choices depend on your irritability, your movement quality, and your goals, so use these as education rather than a one size fits all prescription.
Quadriceps capacity, knee friendly strength building
A common starting point is a sit to stand from a chair. The goal is controlled movement without the knees collapsing inward. If sit to stands are easy, we often progress to a higher demand pattern like a slow step down from a small step, focusing on control on the way down. For patellofemoral pain, we frequently start with a range that is tolerable and slowly build depth and resistance. The key is that your pain during exercise stays mild and returns to baseline within 24 hours.
Hip strength and control, keeping the knee aligned
Exercises like side steps with a band, hip bridges, and single leg balance progressions are common because they improve the hip’s ability to control the thigh. When the hip controls the femur better, the knee often feels less “pinched” or overloaded on stairs. A helpful cue during step downs is to keep the knee tracking in line with the second and third toes, and to keep the pelvis level rather than dropping to one side.
Calf and ankle mobility, improving the mechanics of descent
A simple calf stretch can help if tightness limits dorsiflexion, but many people need active mobility. An example is a knee to wall dorsiflexion drill where you gently move your knee toward the wall while keeping the heel down. Strength matters too, especially eccentric calf control, because the calf contributes to shock absorption and control during downhill movement and stairs.
A simple two week approach many people tolerate
Week 1: reduce repeated painful stairs when possible, use the handrail, and begin low to moderate intensity strengthening every other day with a focus on good form.
Week 2: add one progression, either a slightly lower chair for sit to stands or a slightly higher step for step downs, while keeping swelling and pain response in check.
If you are not improving by week 2, or if symptoms are worsening, that is a good sign to be evaluated.
A real world example
A common story is the recreational hiker or busy parent who notices stair pain first, then begins avoiding stairs, then loses strength, then the pain becomes more consistent. After evaluation, we might find limited ankle dorsiflexion on the painful side, weak hip control, and a quadriceps strength deficit compared to the other leg. When we improve ankle mobility, build hip control, and restore quadriceps capacity with a structured plan, stair pain often decreases over the following weeks and confidence returns.
The key takeaway
Stair knee pain is rarely something you have to accept as your new normal. In many cases it is a load and mechanics problem that responds very well to a progressive plan built around your specific deficits and your goals.
Research and resources
Patellofemoral Pain Clinical Practice Guideline, Journal of Orthopaedic and Sports Physical Therapy, 2019
https://www.jospt.org/doi/10.2519/jospt.2019.0302
American Family Physician summary of APTA guideline recommendations for patellofemoral pain, 2020
https://www.aafp.org/pubs/afp/issues/2020/1001/p442.html
Systematic review: Effectiveness of hip muscle strengthening in patellofemoral pain syndrome, 2015
https://pmc.ncbi.nlm.nih.gov/articles/PMC4518569
Quadriceps focused versus hip focused exercises for patellofemoral pain, British Journal of Sports Medicine, 2023