• Dr. Brandon

Why do I have knee pain while going up and down stairs?


Knee pain when going up and down stairs is an all too common complaint (especially when going down stairs) and while it can strike at any age, it tends to be worse in active people in their 30's, 40's, and 50's. So, why would someone have knee pain mainly going up and down stairs? The answer depends on a couple of different things. Before we dive into the why, we first need to understand several things about the knee.


So, why is the knee prone to this kind of pain? The knee relies on other areas of the body, mainly the ankle and the hip to give it stability. Since the knee is a very mobile joint while the ankle is a stable joint, any loss of mobility at the ankle places extra stress on the knee. Signs that you may not have enough mobility in the ankle include stiffness in the ankle, heels coming off the ground in squats or lunges, or calf muscles that feel tight. A simple test to see if you have enough mobility at the ankle is to kneel close to a wall with one leg in front. Place your fist against the wall and bring your toes to your fist. Push your leading knee towards the wall. If your heel stays on the ground, then you have enough mobility or dorsiflexion. If your heel pops up, then working on your ankle mobility might begin to ease knee problems by taking some of the stress off the knee.


The second is that there is some weakness to the hip muscles that control the knee, mainly the glutes, which causes the knees to go towards each other or bow in when going up and down stairs and sometimes causes your gait to scissor or have your toes point out (like a duck) when walking. The third thing that sometimes causes runner’s knee is an issue either in the spine that forces the knee to take more of the load when running, walking, or when lunging or squatting.


So, what is actually happening in the knee?

Our knees are divided up into 2 joints with a third joint very close by. When talking about knee pain on stairs, we can be dealing with an injury to the joint between the kneecap or patella and the femur or thigh bone or an issue between the main weight bearing joint between the thigh bone (femur) and the shin bone (tibia) where the meniscus may be involved. First I’ll break down what may be happening with the kneecap. The kneecap slides up and down in a groove at the bottom of your thigh bone. It slides up when you straighten your knee and down when you bend your knee. It also has some wiggle room on either side of it. When there is too much wiggle room i.e. the joint is too loose, or when there are kneecap tracking problems, that is usually what causes a condition called patellofemoral pain syndrome and is also known as runner’s knee. So, what causes those tracking problems? We find that many of the people who come to Body Mechanix Physiotherapy for this kind of knee pain have a combination of things going on. First the kneecap is “stuck” too far to the side (usually towards the outside) and is pushing up against the groove in the femur often causing a pinching feeling on the outside of the knee while also causing a dull ache on the inside of the knee. When pain is coming from the kneecap and its tracking, it will also sometimes cause swelling below the kneecap as the bursa becomes irritated. This sometimes results also in knee bursitis as well.


What about if the source of the pain is happening from the other part of the knee?

Many of the same causes of runner’s knee or patellofemoral pain syndrome can lead to knee pain at the joint line where the meniscus is. In this case, often an injury in the past caused somebody to start limiting their activity. This often starts a downward cycle of taking time to rest it, starting to exercise again, the knee still hurts which causes the person to rest some more. Sometimes they’ve gone to their physician who advises them to rest some more or give up their sport or exercise to find something more gentle. Often this creates more weakness around the knee while helping to add a few pounds here and there and before you know it, the knee is now dealing with an extra 20 pounds while not having the strength to support the load. This causes pain through the pinching of the meniscus and cartilage between the two bones while they rub due to the loss of lubricant between the joint surfaces which leads to more knee irritation.

Another cause of this kind of pain is an awkward step or landing on the knee which causes damage to the inside of the joint. This damage often is able to heal a good amount(even though you can still have pain). Often the best start for this kind of pain is to begin moving the knee gently fairly soon after the injury to stimulate healing.


How to diagnose my knee pain

Finding the true cause of knee pain can be tricky. Often the pain isn’t in just one point (like you can put your finger on the pain). More often than not, it is a combination of causes which can be as varied as coming from the low back, kneecap tracking issues, muscle strains around the knee, to arthritis (read the post 5 things you can do today to ease “bone on bone” knees). Here are 3 keys to narrowing down where your knee pain is coming from.


Key Number 1: Does the pain come and go? Is it worse after sitting down or worse when bending over? This kind of pain may be coming from your low back. Believe it or not, pain that comes and goes is actually one of the things that I’m happy to hear my patients tell me. This means that there is something that is happening throughout the day that is provoking the knee pain and often means that any damage found on an xray or MRI may not be as relevant to helping you feel better (mainly because the x-ray or MRI picture doesn’t change when you’re having a bad day or a good day)


Key Number 2: Does weather, being sick, or stress affect your knee (or other joints), this is also good news because this means that what you are dealing with is mainly a sensitive nervous system (even if you’ve been told you have “bone on bone” knees). How can I say that? Possible danger is just one of the things our nerves report on. But…they also are affected by things such as temperature, pressure, blood flow, and stress (all of which can make them very sensitive to the slightest movement). The good news is that this sort of pain is also very treatable and able to be overcome.


Key Number 3: Do your knees bow together when getting up or down from a chair, going up and down stairs, or when walking? Chances are, your muscles are not supporting your knees allowing the extra stress to go to either of the joints in the knee causing irritation and pain.


If this article describes your story and you are looking for some help with something like knee, back or neck pain, we offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.

Here are just a few of the things you will learn in one of our free consultation:

  • What is the underlying cause of your pain? (hopefully nothing too serious!)

  • Roughly, how long will it take to fix the problem?

  • What to do to help – which doesn’t include painkillers, resting or surgery etc.

  • What other, natural, drug free methods are there to speed up recovery alongside treatment?

Our consultations are great for anyone that may be “unsure” if physio is right for them, and they give you the opportunity to ask questions and see for yourself if we can help you.

If you’d like one of our limited free consultation sessions, please click here to request your Total Body Diagnostic or CALL us on 850-765-2779 to make a no-obligation enquiry.

About the author

Brandon Alkire, DPT, CSCS, FMS, Cert. DN

Doctor of Physical Therapy and Strength Coach

Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for over 18 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town.

He's the author of 4 pain relief guides for neck, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.

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