Clinic notes · Knees

Knee pain going down stairs: why it happens and what actually helps

By the Calm Joints physio team · Updated September 29, 2026 · 7 min read

Illustration of a person walking down a staircase

Knee pain on the way down stairs is most often linked to pain around the kneecap (patellofemoral pain) or knee osteoarthritis. The best-supported fix is not rest. It's a strengthening program for the hips and knees, which international experts recommend for reducing pain in the short and long term.^[1]

Why does going down stairs hurt more than going up?

Walking down stairs asks your thigh muscles (the quadriceps) to work as brakes. They lengthen under load to lower your body weight one step at a time, while the kneecap presses into the groove at the front of your thigh bone. If that area is irritated, or the muscles around the hip and knee have lost strength, the downstairs step is often the first place you notice it.

The American Academy of Orthopaedic Surgeons lists pain with activities that repeatedly bend the knee, like climbing stairs, squatting and running, as a hallmark of patellofemoral pain syndrome. Another is pain at the front of the knee after sitting a long time with your knees bent.^[3]

What are the most common causes?

Patellofemoral pain (pain around the kneecap)

This is common in active people and young adults, but it also shows up in people who aren't athletes. It's often triggered by a sudden jump in activity, like more days of exercise, longer sessions or more hills and stairs.^[3]

Knee osteoarthritis

For many adults over 45, stair pain goes hand in hand with stiffness in the morning or after sitting. The encouraging part is that exercise is a core, first-line treatment in major international guidelines for knee osteoarthritis.^[4]^[5]

What does the research say helps?

The international patellofemoral pain consensus statement made clear recommendations.^[1]

Exercise therapy is recommended to reduce pain in the short, medium and long term, and to improve function in the medium and long term.
Combining hip and knee exercises works better than knee exercises alone, and the panel said this combination should be used in preference.
Some passive treatments, such as knee and lower-back mobilisations and electrical machines, were not recommended.

For knee osteoarthritis, a Cochrane review of 54 studies found high-quality evidence that land-based exercise reduces pain. In pain-score terms, that's about 12 points on a 100-point scale right after treatment, an effect the authors called comparable to anti-inflammatory drugs, with benefits lasting two to six months after formal treatment ended. Programs delivered one-on-one tended to beat group or unsupervised home programs.^[2]

Physio tip: Lead with your good leg going up and your sore leg going down ("up with the good, down with the bad") while you build strength. Use the handrail. It's a short-term tool, not a crutch for life.

Try this today: 4 exercises

Do these slowly, 3 to 4 days a week. Mild discomfort during exercise is common. Stop if pain turns sharp, or if the knee is more sore the next morning than it was before you started.

Side-lying leg raise (hip strength): Lie on your side with your bottom knee bent. Keep your top leg straight and lift it about 30 cm, leading with the heel, then lower over 3 seconds. Do 2 sets of 10–12 on each side.
Glute bridge: Lie on your back with your knees bent and feet flat. Squeeze your buttocks and lift your hips until your body forms a line from shoulders to knees, then hold 2 seconds. Do 2 sets of 10–12.
Wall sit (shallow): Slide your back down a wall only as far as feels comfortable, even just a few centimetres. Hold 15–30 seconds, 3 to 5 times. Go deeper over the weeks.
Slow step-down: Stand on the bottom stair holding the rail. Slowly lower the heel of your other foot toward the floor over 3 seconds, then come back up. Keep your knee pointing over your toes. Do 2 sets of 8.

When should you see a physio?

See a physiotherapist if stair pain has lasted more than a few weeks, keeps you from doing things you care about, or keeps coming back. A physio can work out whether it's coming from the kneecap, the joint or somewhere else (hips and ankles are often part of the story), then build a program that progresses safely.

Get urgent medical help if your knee is very painful, you can't move it or put weight on it, it's badly swollen or has changed shape, it locks or gives way, or it's red and hot and you have a fever. That last one can be a sign of infection.^[6]

Want a plan built for your joints?

Book a virtual visit with a registered Calm Joints physiotherapist. We'll assess how you move, find what's driving the pain, and give you a program you can do at home.

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Frequently asked questions

Is it bad to use stairs if my knee hurts?

Usually not. Staying active is recommended, and research supports strengthening rather than avoiding movement. Use a rail, take one step at a time and build strength with exercise. If you can't put weight on the knee or it's badly swollen, get checked first.

What exercise is best for knee pain on stairs?

Research on patellofemoral pain recommends combining hip and knee strengthening over knee exercises alone. Bridges, side-lying leg raises, shallow wall sits and slow step-downs are common starting points.

How long does it take to feel better?

It varies. In the knee osteoarthritis research, benefits from exercise programs were measured over weeks to months, with effects lasting two to six months after treatment. Consistency matters more than intensity.

Can a virtual physio help with knee pain?

Yes. Research suggests real-time video physiotherapy is comparable to in-person care for improving function and pain in many musculoskeletal conditions. A physio can watch you move on camera and coach your exercises live.

Should I wear a knee brace?

Braces and taping were assessed in the patellofemoral pain consensus, and exercise was the core recommendation. A physio can tell you whether a brace makes sense for your knee.

Sources

Keep reading

This article is for general education and isn't personal medical advice. If you have pain that worries you, talk to a registered physiotherapist or your doctor. In an emergency, call 911.