Knee pain going downstairs? Here’s why and what can help
- Emma Glynn
- Sep 30
- 3 min read
By Emma Glynn - The Hip & Knee Physio
TL;DR: Going down stairs puts bigger load on the kneecap + quads. That can sting if tissues are irritated or under-conditioned. Adjust the dose (steps, speed, handrail), add a few strength exercises, and most knees cope much better.
General information only; not personal medical advice.
Why down hurts more than up
When you go down stairs, your quads work eccentrically (braking). That increases pressure at the patellofemoral joint and can poke irritable structures:
Patellofemoral pain (kneecap area, front of knee)
Fat-pad irritation (pain under/around the kneecap, worse with hyper-straightening)
Meniscal grumble (inner or outer joint-line ache)
OA sensitivity (stiff, achy starts, settles with sensible movement)
None of that screams “give up stairs forever.” It says, “match the load to what I can handle today.”
Quick self-checks (and when to get help)
Green lights: ache ≤4/10 that settles within 24–48 hours after stairs.
See a clinician sooner if: locking/catching, repeated giving-way, hot/red swelling, night pain, or if ache keeps ratcheting up despite easier stairs.
A 7-day “stairs without swearing” plan
Day 1–2 — Calm it down
Use the handrail, go slower down, point the knee over the 2nd toe.
Reduce total stairs by ~30–50% (yes, really).
If it throbs later that day or the next morning → you still did too much. Trim further.
Day 3–4 — Control before capacity
Keep the easier dose. Add 2–3 strength exercises (below).
Aim for “comfortably challenging,” not heroic.
Day 5–7 — Add tiny bits back
Increase total stairs ~10–15% for the week (not per day).
Still use the rail if needed; the goal is smooth before hard.
Three strength exercises
Sit-to-stand (tempo): 3 seconds down, 1 up. 2–3 sets of 6–8 reps.
Supported step-downs (low step): Tap the heel down lightly, keep knee over mid-foot. 2–3 x 6–8/leg.
Wall sit (comfortable depth): 15–30 sec holds × 3–4 reps.
If symptoms spike during or 24–48h after, reduce depth/reps/sets.
Technique tweaks that help immediately
Rail is not cheating. Off-load to nail control first; we’ll peel it away later.
Softer landings. Think “quiet feet” and smooth knees.
Hip strategy. Lightly hinge from the hips so the knee doesn’t shoot forward over the toes.
Shoes, surfaces & little comforts
Grippy, supportive shoes beat worn-out flats.
Avoid long runs of steep, uneven steps while settling irritation.
Heat can help stiffness; ice can soothe irritability. Neither fixes the cause; they’re comfort tools.
Do I need a scan?
Usually no to start. Good assessment → targeted load and strength → review progress. Imaging is helpful when the result would change the plan, or if red flags are present.
What happens in the first session here
History & goals → movement assessment → starter plan you can do today (2–3 exercises matched to tolerance) → a simple progression for 2–4 weeks.
Ready for stairs that don’t bite?
Prefer to talk? Call (03) 9978 9833
👉 Take my Knee Quiz if you’re unsure whether your symptoms need attention.
FAQs
Should I avoid stairs completely?
Not usually. We reduce the dose (fewer flights, slower cadence, rail support) so symptoms settle while you rebuild capacity.
Will a brace help?
Sometimes, as a short-term comfort tool. It doesn’t replace strength/control and isn’t a forever fix.
How long until I notice change?
Varies. Many feel smoother control within 1–2 weeks when dosing is right; strength capacity builds over several weeks.
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Disclaimer
The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.
Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.
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