Knee Arthritis and Stairs: Why They Hurt and What to Change

By Emma Glynn - The Hip & Knee Physio

If you have knee arthritis and stairs have become a problem, you have probably noticed a very specific pattern. Flat walking may be manageable, but stairs feel different. Going down may feel worse than going up. You may start using the handrail more, avoiding certain places, or planning your day around how many stairs you need to face.

That is not you being dramatic. Stairs ask more from the knee than easy flat walking. They require strength, control, confidence and enough joint tolerance to manage repeated loading.

Knee arthritis and stairs can become difficult when the demand of the task is higher than the knee’s current capacity.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist in Camberwell. I work exclusively with hip and knee conditions, and stairs are one of the most useful real-life tasks I assess in people with knee osteoarthritis.

For a broader overview of knee OA, you can visit my knee osteoarthritis page.

Why knee arthritis and stairs can be difficult

Stairs are not just “walking, but higher”. They require the knee to control your body weight through a larger range of movement. The quadriceps have to work hard, especially when lowering you down a step.

This is one reason people often say going downstairs is worse than going upstairs. Downstairs requires controlled lowering. If the knee is painful, swollen, weak or reactive, that controlled lowering can feel threatening.

Stairs often expose the difference between what your knee can tolerate on flat ground and what it can tolerate under higher load.

Common reasons stairs become painful include:

• Quadriceps weakness

• Hip and gluteal weakness

• Reduced confidence loading the affected leg

• Swelling or stiffness limiting knee bend

• Patellofemoral joint sensitivity

• Pain inhibition reducing muscle control

• Doing too many stairs during a flare

• Rushing or descending without enough support

This does not mean stairs are damaging the knee every time they hurt. It means the task currently exceeds what the knee is happy to manage.

Why going downstairs often feels worse

Going upstairs is demanding, but going downstairs can be even more provocative because the knee has to act like a brake. The quadriceps control the descent while the knee bends under load.

If your quadriceps are underperforming, the knee may feel sore, wobbly or unreliable. If the joint is swollen, the muscles around the knee can also switch off a little, which makes control harder.

Downstairs pain often tells me the knee needs better strength and control, not simply more rest.

You may notice:

• Pain at the front of the knee

• Pain around the inside of the knee

• A feeling of weakness or giving way

• More reliance on the handrail

• Turning sideways to descend

• Taking one step at a time

• Avoiding stairs late in the day

These are useful clues. They help guide where rehab should start.

Knee arthritis and stairs during a flare

During a flare, stairs can become dramatically harder. The same staircase you usually manage may suddenly feel sharp, stiff or unreliable. That does not necessarily mean the arthritis has suddenly worsened structurally.

A flare usually means the knee is more irritable. It may be swollen, sensitised, overloaded or simply not recovering well from recent activity.

During a knee arthritis flare, stairs often need temporary modification rather than permanent avoidance.

Useful short-term modifications include:

• Using the handrail

• Taking one step at a time

• Going slower

• Reducing unnecessary stair trips

• Leading with the less painful leg when going up

• Leading with the more painful leg when going down

• Using lifts or ramps temporarily where practical

• Breaking up stair-heavy activities across the day

The old phrase is “up with the good, down with the bad”. It is not elegant, but it is memorable. During a flare, it can reduce load enough to keep you moving without poking the bear quite so hard.

If your knee often flares after busy days, this article on knee arthritis flare patterns may help.

Stairs are not automatically bad for knee arthritis

It is easy to think that if stairs hurt, they must be damaging the knee. That is not always true. Pain is a warning signal, not a direct damage meter.

Stairs are a normal part of life. The goal is usually not to avoid them forever. The goal is to work out what dose your knee can currently tolerate and how to rebuild the strength and confidence to manage them better.

Stairs are not the enemy, but the dose and timing need to match your knee.

For example, your knee may tolerate:

• One flight of stairs slowly

• Stairs earlier in the day but not after a long walk

• Going up better than going down

• Stairs with a handrail

• Low steps better than high steps

• Stairs when the knee is not swollen

These details matter. They help separate a task that is unsafe from a task that simply needs modification.

What helps knee arthritis and stairs feel more manageable

The right strategy depends on why stairs are difficult. For some people, the issue is strength. For others, it is swelling, fear, poor pacing, or trying to do too much during a flare.

The most useful plan usually combines short-term stair modifications with longer-term strength and load tolerance work.

Helpful options may include:

• Strengthening the quadriceps

• Strengthening the glutes and calves

• Practising step-ups at a lower height first

• Training controlled step-downs when ready

• Using sit-to-stand exercises to build basic capacity

• Reducing stair volume during flare periods

• Improving walking and hill tolerance gradually

• Using a handrail without seeing it as a failure

Exercise is one of the best-supported non-surgical treatments for knee OA, and current guidelines recommend tailored exercise and physical activity as core care (Australian Commission on Safety and Quality in Health Care, 2024; Kolasinski et al., 2020). The key is choosing the right starting point.

If you want a broader exercise guide, this article on knee arthritis exercises explains what helps and what may need modifying.

Exercises that often prepare the knee for stairs

A stair plan does not always start on stairs. If stairs are too painful, we may begin with exercises that build the same ingredients in a more tolerable way.

A good stair program builds strength first, then gradually exposes the knee to the task it needs to perform.

Depending on your starting point, useful exercises may include:

• Sit-to-stand from a higher chair: This builds basic quadriceps and hip strength.

• Wall sits: These can load the quadriceps without repeated bending.

• Seated knee extensions: These can target quadriceps strength in a controlled range.

• Low step-ups: These introduce stair-specific loading at a manageable height.

• Supported step-downs: These train controlled lowering when the knee is ready.

• Calf raises: These support walking and stair propulsion.

• Glute bridges or hip abduction exercises: These can improve hip contribution and lower limb control.

The exact exercise is less important than the dose. Too many step-downs too soon can flare a sensitive knee. Not enough challenge may fail to build capacity. Annoying, yes.

But that is where the clinical reasoning lives.

How much stair pain is acceptable?

A little discomfort on stairs can be acceptable for some people with knee OA, especially if it settles quickly and does not make the knee worse later. But pain that changes your walking, increases swelling, or lingers into the next day suggests the dose needs adjusting.

Your knee’s 24-hour response is often more useful than the pain score on one step.

Consider reducing stair load if:

• Pain sharpens as you continue

• You start limping

• The knee swells afterwards

• Symptoms are clearly worse the next morning

• You need to avoid normal walking after stairs

• You feel unsafe or unstable

That does not mean you have failed. It means the current stair dose is too high for now.

When stairs suggest you need assessment

Stairs are a useful daily test. If they are becoming harder, more painful or more limiting, it is worth understanding why.

It is worth getting assessed when stairs start changing how you move through your day.

You may benefit from assessment if:

• You avoid stairs whenever possible

• Going downstairs feels unsafe

• You rely heavily on the handrail

• Your knee swells after stairs

• You have sharp pain with every step

• Your knee gives way

• You cannot build stair tolerance despite exercise

• You are unsure whether the pain is arthritis, kneecap pain, meniscus pain or something else

If your symptoms are broader than stairs, this article on knee arthritis symptoms may help you compare the pattern.

What I assess in clinic

When I assess knee arthritis and stairs, I look at the knee, but I also look at the whole task. The problem may not be only the joint. It may be strength, swelling, confidence, hip control, foot position, step height, pacing or training history.

A stair assessment should explain why stairs are difficult, not just confirm that they hurt.

Assessment may include:

• Knee range of motion

• Swelling and warmth

• Quadriceps and hip strength

• Sit-to-stand capacity

• Step-up and step-down control

• Walking pattern

• Pain behaviour over 24 hours

• Current activity and exercise load

From there, the plan can be specific. Some people need strength. Some need flare management. Some need a graded stair progression. Some need medical review if the presentation does not fit straightforward knee OA.

What to do next

If knee arthritis and stairs are becoming a regular problem, the answer is not necessarily to avoid stairs forever. It is to understand what the knee can currently tolerate and rebuild from there.

The goal is to make stairs more manageable by improving strength, control and load tolerance over time.

You may benefit from an in-person assessment if:

• Stairs are one of your main triggers

• You are avoiding places because of stairs

• Your knee swells after stair-heavy days

• You want to keep walking, travelling, hiking or exercising

• You have been told you have knee OA but do not have a plan

• You are unsure which exercises are safe

If you are based in Melbourne’s inner east, including Camberwell, Hawthorn, Kew, Canterbury, Surrey Hills, Glen Iris or nearby, you can book an in-person knee assessment with me at The Hip and Knee Physio.

Emma

References

Australian Commission on Safety and Quality in Health Care. (2024). Osteoarthritis of the knee clinical care standard. ACSQHC. https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard

Bennell, K. L., & Hinman, R. S. (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport, 14(1), 4–9. https://doi.org/10.1016/j.jsams.2010.08.002

Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2015(1), CD004376. https://doi.org/10.1002/14651858.CD004376.pub3

Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2), 149–162. https://doi.org/10.1002/acr.24131

National Institute for Health and Care Excellence. (2022). Osteoarthritis in over 16s: Diagnosis and management (NICE guideline NG226). NICE. https://www.nice.org.uk/guidance/ng226

Medical disclaimer

This blog is general educational information only and is not a substitute for individual medical advice, diagnosis or treatment. If you have severe or worsening knee pain, a hot or rapidly swollen joint, fever, recent trauma, inability to weight-bear, significant locking, repeated giving way, new neurological symptoms, calf swelling, shortness of breath, or symptoms that concern you, please seek medical review promptly.