Knee Pain Going Down Stairs: What It Means and What to Do

We talk about stairs a lot in my office. When a patient tells me their knee hurts going down the stairs, the most common thing I see is a more severe problem behind the kneecap, often arthritis there. Here’s why going down is the hard part, what it usually means, and when it’s time to come in.

Why going down hurts more than going up

Your thigh muscle, the quadriceps, works on the stairs both ways, but differently:

• Going up, and pushing off, the quad shortens as it lifts you. That’s called a concentric contraction.
• Going down, the quad has to lengthen while it works, acting as a brake to lower your body weight. That’s an eccentric contraction.

The braking contraction on the way down pulls the kneecap the hardest against the thigh bone. If the cartilage behind your kneecap is worn, or your kneecap doesn’t sit well in its groove, that’s exactly when you feel it.

What knee pain on stairs usually means

The most common causes I see:

• Arthritis behind the kneecap. This is called patellofemoral arthritis: significant wear of the cartilage between the kneecap and the thigh bone.
• A kneecap that doesn’t track well. When the kneecap slides partly out of its groove (subluxation), going down stairs puts even more stress on it.
• General knee arthritis. Arthritis in the rest of the knee can cause pain going up and down stairs as well.

An exam and X-rays tell us which one it is, and how severe it is.

The real danger: a fall

Pain behind the kneecap does more than hurt. It can turn off the quad. When your thigh muscle shuts off, even for a moment, the knee gives way. On a flat floor that’s unsettling. On stairs, it can mean a fall, and that’s what I want to avoid most.

Staying safe on stairs in the meantime

Treatment options

There are a lot of options, and they all have a place:

• Physical therapy
• A brace
• Medication and ice
• Injections: cortisone, gel, or PRP

Here’s the honest part. When the arthritis is severe, these treatments push the problem down the line. They can make you more comfortable for a while, but they don’t fix it. For severe arthritis, the long-term treatment is a knee replacement. That’s the only thing that fixes it.

When to come in

When you come in, we review your X-rays together and make the decision based on your quality of life. If the arthritis is severe and the knee is affecting your life in a big way, including pain on the stairs, that may be a reason for a replacement. If it isn’t there yet, we start with the other options.

For the rest of what I look for, see signs you need a knee replacement and bone-on-bone knee. If your knee also wakes you up, read knee pain at night.