Why Do My Knees Hurt Going Down Stairs? A Physiotherapist Explains
- theziblingsalipoon
- 6 days ago
- 8 min read
Your knees feel completely fine walking around.
Going upstairs isn’t too bad.
You can exercise, walk the dog and get through most of your day without thinking about them.
Then you walk down a flight of stairs and suddenly there it is: an ache around the kneecap, a sharp sensation at the front of the knee, or that familiar discomfort that appears with every step down.
Knee pain when going downstairs is an extremely common complaint, and one we regularly see in physiotherapy.
It can also be confusing. If your knee can tolerate walking, why does something as ordinary as walking downstairs suddenly hurt?
The answer usually comes down to load.
Walking downstairs places different demands on the knee than walking on flat ground or even walking upstairs. Your muscles need to control your body weight as you lower yourself onto the next step, and this creates considerably more demand through the knee joint and surrounding muscles.
The good news is that pain during stairs doesn’t automatically mean your knee is damaged, worn out or that you need to stop using it.
For many people, the solution is actually the opposite: gradually improving the knee’s ability to tolerate load.
Why Going Downstairs Is So Demanding On Your Knees
Walking downstairs might look simple, but biomechanically there is quite a lot happening.
As you step down, the leg remaining on the higher step has to control your body as your centre of mass lowers towards the next step.
Your quadriceps, the large muscles at the front of your thigh work eccentrically during this movement.
An eccentric muscle contraction occurs when a muscle produces force while lengthening.
Rather than simply allowing gravity to drop you onto the next step, your quadriceps act like a braking system. They control how quickly your knee bends and how smoothly your body lowers.
The knee therefore isn’t simply moving through flexion.
It’s controlling your body weight through that range.
If the muscles surrounding the knee don’t currently have enough capacity for that demand, going downstairs can expose it very quickly.
Why The Kneecap Is Often Involved
One of the most common sources of pain at the front of the knee is the patellofemoral joint.
This is the joint formed between your kneecap, or patella, and the femur underneath it.
As your knee bends and straightens, the patella moves within a groove at the end of the femur.
The quadriceps tendon attaches above the kneecap, while the patellar tendon continues from the kneecap towards the shin. Together, this system allows the quadriceps to transfer force across the knee.
As knee flexion increases, forces through the patellofemoral joint also change.
Activities involving deeper knee bending under load, such as stairs, squatting, lunging and getting up from a low chair can therefore be more provocative for someone whose knee is currently sensitive.
This is one reason patellofemoral pain frequently appears when going downstairs.
What Is Patellofemoral Pain?
Patellofemoral pain is commonly experienced as pain:
around the kneecap
underneath the kneecap
at the front of the knee
during stairs
during squatting or lunging
after sitting with the knee bent for a long period
during or after running
It is sometimes described as “runner’s knee”, although you certainly don’t need to be a runner to experience it.
Importantly, patellofemoral pain doesn’t necessarily mean the joint is damaged.
Pain is influenced by many factors, including how much load the knee has recently been exposed to compared with how much load it currently has the capacity to tolerate.
A sudden increase in running, walking, hills, gym training or stairs may be enough to irritate a previously comfortable knee.
The issue may therefore be less about something being “wrong” with the knee and more about the relationship between load and capacity.
Your Quadriceps Matter More Than You Might Realise
Because the quadriceps act as the braking system while you descend stairs, strength through this muscle group is incredibly important.
If the quadriceps don’t have enough strength or endurance to control your body weight effectively, other structures may experience greater demand.
This is why rehabilitation for knee pain commonly includes progressive quadriceps strengthening.
Depending on the individual, exercises might include:
sit-to-stands
squats
step-ups
controlled step-downs
split squats
reformer footwork
leg press variations
The goal isn’t simply to make the quadriceps “activate”.
It is to progressively increase how much force they can tolerate and produce.
That distinction matters.
But Knee Pain Isn’t Always Just About The Knee
The knee sits between the hip and the ankle.
What happens at both joints influences how force travels through the knee.
This means an effective assessment shouldn’t only look at the painful area.
Hip Strength
Your gluteal muscles help control the position of your pelvis and femur during single-leg tasks.
When you’re descending stairs, you’re essentially performing repeated single-leg loading.
If the hip lacks strength or control, the thigh may move differently under load, changing how force is distributed through the knee.
This doesn’t mean every person with knee pain has “weak glutes”.
It simply means hip capacity is one of several factors worth assessing.
Ankle Mobility
Your ankle also needs sufficient dorsiflexion, the movement that allows the shin to travel forward over the foot as you descend a step.
If ankle mobility is limited, the body has to find movement elsewhere.
You may:
turn the foot outward
allow the heel to lift
rotate through the hip
change the position of the knee
lean the trunk differently
Again, these aren’t automatically bad movements.
They’re adaptations.
But understanding why they occur can help determine what needs to be addressed.
What About Arthritis?
For older adults especially, knee pain is often immediately blamed on arthritis.
You may have had an X-ray showing osteoarthritis and been told that the joint is experiencing “wear and tear”.
That language can make movement feel frightening.
Osteoarthritis involves changes within the joint, but these changes don’t mean the knee should no longer be loaded.
In fact, exercise and strengthening are among the most strongly recommended conservative strategies for managing knee osteoarthritis.
The presence of changes on imaging also doesn’t perfectly predict pain.
Some people have significant osteoarthritis visible on imaging and relatively little pain.
Others experience substantial symptoms despite relatively minor imaging findings.
This is why we treat the person and their function not simply the scan.
Should You Avoid Stairs If Your Knees Hurt?
Temporarily reducing a provocative activity can sometimes be useful, particularly during an acute flare.
But permanently avoiding stairs usually isn’t the goal.
Every time you avoid a movement completely, your body receives less exposure to that particular demand.
Over time, your capacity to perform it may reduce further.
The better long-term strategy is usually to find an appropriate starting point and gradually rebuild tolerance.
For example, instead of immediately performing repeated full-height step-downs, rehabilitation might begin with:
a smaller step
hand support
reduced repetitions
slower controlled lowering
partial range
assisted lower-limb strengthening
As capacity improves, the demand progresses.
Eventually, normal stairs become the exercise rather than the problem.
Why Rest Isn’t Usually The Complete Solution
When something hurts, resting it makes intuitive sense.
And during an acute flare, temporarily reducing aggravating activity can absolutely be appropriate.
But if every episode of knee pain results in weeks of complete rest, a frustrating cycle can develop.
The knee hurts.
You stop loading it.
Strength and capacity decrease. You return to activity.
The same activity now represents an even greater relative load.
The knee becomes irritated again.
You rest again.
Good rehabilitation interrupts this cycle by maintaining as much appropriate activity as possible while gradually increasing tissue capacity.
Do Knee Braces, Taping Or Supports Help?
Sometimes.
Taping, braces and sleeves may temporarily improve comfort for certain people.
If they allow you to remain active and participate in rehabilitation, they can be useful tools.
But they generally shouldn’t become the entire treatment strategy.
The long-term goal is to improve your own physical capacity rather than becoming dependent on an external support for every activity.
What About Stretching?
Stretching is another common recommendation for knee pain.
If restricted mobility is genuinely contributing to your presentation, targeted mobility work may form part of treatment.
But stretching everything around the knee isn’t automatically the answer.
A knee that hurts while descending stairs often needs greater load tolerance, not simply more flexibility.
This is why endless quadriceps, hamstring and calf stretching may feel temporarily relieving without changing what happens when you return to stairs.
How Clinical Pilates Can Help With Knee Pain
Clinical Pilates gives us an excellent environment for progressively rebuilding lower-limb capacity.
At Body Form, our approach is informed by physiotherapy rather than simply selecting generic “knee-friendly” exercises.
Depending on your assessment, your programme may target:
quadriceps strength
glute strength
calf strength
hip control
ankle mobility
balance
single-leg stability
movement confidence
progressive tolerance to knee flexion
The Reformer is particularly useful because spring resistance allows us to modify load precisely.
Someone who isn’t ready for full bodyweight squatting may begin with supported
Reformer footwork.
As strength improves, we can progress towards more demanding positions including standing work, lunges, step-downs and loaded strength exercises.
The goal is always progression.
We don’t want to spend months protecting the knee from everything that challenges it.
We want to progressively build a knee that can handle those challenges.
Why We Combine Pilates And Strength Training
For knee rehabilitation, strength matters.
Clinical Pilates provides an excellent foundation for developing movement control, coordination and progressive resistance.
However, as clients improve, they often need greater external load to continue developing strength.
This is why Body Form integrates Pilates equipment with strength-based training.
Depending on the individual, later-stage rehabilitation may include:
heavier resistance
dumbbells
weighted squats
split squats
step-ups
calf strengthening
single-leg loading
The exercise method is secondary.
The important question is whether the programme is progressively preparing your body for what you actually want to do.
If your goal is surfing, running, hiking, playing with your grandchildren or simply getting downstairs comfortably, your rehabilitation ultimately needs to prepare you for those demands.
When Should Knee Pain Be Assessed?
Not every sore knee requires an urgent physiotherapy appointment.
However, an assessment is worthwhile if:
pain is persistent or progressively worsening
there is significant swelling
the knee repeatedly gives way
you experience locking or catching
pain began following a significant injury
you’re unable to comfortably bear weight
symptoms are preventing you from exercising or completing normal daily activities
you’ve tried reducing activity but symptoms repeatedly return
A physiotherapy assessment can help identify what is contributing to your symptoms and, importantly, what you can safely continue doing while you recover.
Practical Takeaways
Knee pain when going downstairs is extremely common.
Descending stairs requires your quadriceps to control your body weight as your knee bends, creating a significant loading demand.
Pain around the kneecap is commonly associated with the patellofemoral joint, but pain does not automatically mean structural damage.
Hip strength, ankle mobility, quadriceps capacity and overall activity levels can all influence knee loading.
Complete avoidance of stairs is rarely the best long-term solution.
Progressive strengthening is one of the most important strategies for improving knee capacity.
Stretching, taping and braces can sometimes help symptoms but shouldn’t replace progressive rehabilitation.
Osteoarthritis does not mean you should stop loading your knees.
Your rehabilitation should ultimately prepare you for the activities you want to return to.
Build Stronger Knees At Body Form
If knee pain is making stairs, squatting, walking or exercise uncomfortable, you don’t necessarily need to stop moving.
You may simply need a better plan for how you load your knee.
At Body Form, our physiotherapists can assess your knee, identify the factors contributing to your symptoms and develop a progressive programme combining Clinical Pilates and strength training.
Our goal isn’t simply to make your knee feel better temporarily.
It’s to build the strength, capacity and confidence you need to keep doing the things you enjoy.
Body Form is located in Mona Vale on Sydney’s Northern Beaches, with physiotherapy,
Clinical Pilates, strength classes, semi-private sessions and individual rehabilitation available.
Contact our team to book a physiotherapy assessment or find out which starting option would suit you best.
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