Guide
Why Does My Knee Hurt Going Down Stairs? Causes and What Helps
If your knee hurts going down stairs, the most common reason is irritation of the joint behind your kneecap, called patellofemoral pain or "runner's knee." Stair descent puts some of the highest everyday loads on that joint, so it is often the first activity to hurt. In older adults, wear of the cartilage under the kneecap (patellofemoral arthritis) is another frequent cause, and both usually improve with targeted hip and thigh strengthening rather than surgery.
This guide explains why stairs, and going down them in particular, provoke knee pain, which conditions are most often behind it, what the research says actually helps, and when to see a doctor. It is general information, not a substitute for an examination by your own doctor or physical therapist.
Why does going down stairs hurt more than going up?
Your kneecap (patella) sits in a groove at the end of your thighbone called the trochlea, and slides up and down in it every time you bend and straighten your knee (AAOS OrthoInfo). The pressure between the back of the kneecap and that groove rises as the knee bends under load.
Going down a step, you lower your whole body weight onto a bent knee while your thigh muscles (quadriceps) work to brake the movement. A biomechanics study in Gait & Posture notes that, among activities of daily living, the highest loads on the kneecap occur during stair descent (Bonifácio et al., 2018). A study of women with patellofemoral pain found they had higher patellofemoral joint reaction force and stress during stair descent than pain-free women, and that a measure of inward knee loading was moderately linked to how much pain they reported (Waiteman et al., Clinical Biomechanics, 2018).
The stairs themselves matter too. In a small laboratory study of 12 younger and 12 older adults, slick and uneven steps changed knee mechanics in ways that raised stress on the kneecap joint during parts of each step, and the authors suggested older adults may be more exposed to that stress (Hunt et al., Biomechanics, 2024).
What conditions cause knee pain on stairs?
Patellofemoral pain syndrome (runner's knee)
This is the most likely culprit, especially if the pain is a dull ache around or behind the kneecap. The American Physical Therapy Association's clinical practice guideline describes patellofemoral pain as pain around or behind the kneecap that often worsens with loading activities such as squatting, prolonged sitting, going up or down stairs, jumping or running, and notes it can recur and persist for years (Willy et al., JOSPT, 2019).
It is common. A systematic review and meta-analysis of 23 studies reported an annual prevalence of 22.7% in the general population and 28.9% in adolescents (Smith et al., PLoS One, 2018). AAOS notes it is especially common in females and young adults who play sports, but it also affects non-athletes (AAOS).
According to AAOS, contributing factors include overuse or a sudden increase in activity, poor tracking of the kneecap in its groove, and weakness or imbalance in the quadriceps and in the hip muscles that rotate the thigh outward and move it away from the body. Typical signs are pain on stairs, squatting, running or jumping; pain after sitting a long time with bent knees (the "moviegoer's sign"); and popping or crackling when climbing stairs or standing up.
Patellofemoral arthritis
When the cartilage on the underside of the kneecap and in the trochlear groove wears down, the result is patellofemoral arthritis. AAOS says it causes pain at the front of the knee and can make it difficult to kneel, squat, and climb and descend stairs. Pain is typically brought on by stairs, sitting with the knees bent, rising from a chair, and kneeling or squatting, and there may be a crackling sensation called crepitus (AAOS: Patellofemoral Arthritis).
A 2025 study of 66 people with MRI-confirmed cartilage damage behind the kneecap and pain on stairs found that how the knee moved during stair descent was associated with worse pain, function and cartilage damage, with different patterns in men and women (Hammond et al., BMJ Open, 2025). It was a cross-sectional study, so it shows links rather than cause and effect.
Other causes worth knowing
- General knee osteoarthritis affecting the inner or outer compartments of the knee can also make stairs painful, usually alongside stiffness and pain with walking.
- Meniscus tears can cause pain, swelling, catching or locking, and a feeling that the knee gives way (AAOS: Meniscus Tears). See our guide on meniscus tear recovery time.
- After knee replacement, stairs can remain hard for a while. In a 36-patient pilot study, stair descent was the most challenging task tested, with only half of patients scoring optimally six months after surgery (Harper et al., JAAOS, 2026).
What helps knee pain when going down stairs?
Strengthen the hips and thighs
Exercise therapy is the best-supported treatment for patellofemoral pain. A 2018 international consensus statement, voted on by a panel of 41 patellofemoral pain experts, recommended exercise therapy, especially combining hip-focused and knee-focused exercises, to improve pain and function (Collins et al., Br J Sports Med, 2018). AAOS likewise advises strengthening and stretching the quadriceps and strengthening the hip muscles, because they work together to keep the kneecap stable, and may add core exercises.
For knee osteoarthritis, the 2019 American College of Rheumatology and Arthritis Foundation guideline strongly recommends exercise and, for people who are overweight, weight loss (Kolasinski et al., 2019 ACR/AF guideline). Our guide to the best exercises for knee arthritis covers what that looks like in practice.
Adjust your load for a while
AAOS suggests temporarily cutting back on activities that make the knee hurt, switching to lower-impact options such as a stationary bike, elliptical or swimming, and losing weight if you are overweight to reduce pressure on the knee. Increasing training gradually and warming up are also part of its prevention advice.
Consider foot orthoses, braces and short-term pain relief
The 2018 consensus statement supported foot orthoses and combined interventions for patellofemoral pain, but rated the evidence for patellar taping or bracing as uncertain, and did not recommend mobilizations of the knee or lower back on their own or electrophysical treatments (Collins et al., 2018). For patellofemoral arthritis specifically, the ACR guideline gives a conditional recommendation for patellofemoral bracing (ACR/AF 2019).
AAOS lists rest, ice (20 minutes at a time, never directly on skin), light compression and elevation, plus anti-inflammatory medicines such as ibuprofen or naproxen, as short-term home measures. Check with a doctor or pharmacist before taking NSAIDs regularly.
Is surgery ever needed?
Rarely. AAOS says surgery for patellofemoral pain is very rarely needed and is reserved for severe cases that do not respond to nonsurgical treatment, and that most cases of patellofemoral arthritis are also treated without surgery.
What can I do on the stairs themselves?
These are practical habits rather than treatments, and none of them has been tested in a large trial:
- Use the handrail to take some weight off the painful knee.
- Take one step at a time, bringing both feet onto each step before moving to the next, until symptoms settle.
- Take your time on wet, slick or uneven steps, which the laboratory research above links to higher kneecap stress.
- Wear supportive shoes suited to your activity, as AAOS recommends for prevention.
When should I see a doctor about knee pain on stairs?
AAOS advises contacting your doctor if the pain persists or it becomes harder to move your knee. Get checked promptly if your knee locks or catches, gives way, swells significantly, cannot bear weight, or if the pain followed a fall or a twisting injury. A doctor can usually diagnose patellofemoral pain with a physical exam, and may order an X-ray to rule out bone problems, or an MRI if symptoms do not improve with physical therapy and home exercise (AAOS).
Related research on KneePainNews
- Pool-based jump training eased kneecap pain in teens more than standard exercises
- Adding hands-on manual therapy to exercise may ease knee arthritis pain in the short term
- A hands-on knee mobilization technique was no better than a sham for arthritis pain
Frequently asked questions
- Why does my knee hurt going down stairs but not up?
- Going down, your thigh muscles brake your body weight on a bent knee, and research notes the highest everyday loads on the kneecap joint occur during stair descent. That makes descent the first activity to hurt when the joint behind the kneecap is irritated.
- Is knee pain on stairs a sign of arthritis?
- It can be, especially in older adults. AAOS says patellofemoral arthritis makes it difficult to climb and descend stairs. In younger and active people the more common cause is patellofemoral pain syndrome, which does not involve arthritis.
- What exercises help knee pain on stairs?
- A 2018 international consensus statement recommended exercise therapy for patellofemoral pain, especially combining hip-focused and knee-focused strengthening. AAOS also advises strengthening the quadriceps and hip muscles. A physical therapist can tailor a program to you.
- Does a knee brace help with stair pain?
- The evidence is mixed. The 2018 patellofemoral pain consensus rated taping and bracing as uncertain, while the 2019 ACR/Arthritis Foundation guideline conditionally recommends patellofemoral bracing for arthritis behind the kneecap.
- Should I avoid stairs if my knee hurts?
- AAOS suggests cutting back temporarily on activities that cause pain and switching to lower-impact exercise, but the long-term goal is to build strength so everyday activities like stairs become comfortable again. Using the handrail can help in the meantime.
- When should I see a doctor for knee pain on stairs?
- See a doctor if the pain persists or it becomes harder to move your knee, or promptly if the knee locks, gives way, swells a lot, cannot bear weight, or the pain followed an injury.
Sudden severe pain, swelling, or can't bear weight? Seek medical care promptly. In an emergency call 911.