Knee pain when climbing stairs: what it can mean

Knee pain on the stairs most often comes from the front of the knee, where the kneecap glides over the thigh bone. The usual causes are kneecap pain (patellofemoral pain), wear in the joint (osteoarthritis) and, less often, a torn meniscus. Most cases improve with exercise and changes to activity.

Why stairs are hard on knees

Each step asks the knee to bend under your full body weight. The kneecap is pressed into a groove at the end of the thigh bone, and the thigh muscle (quadriceps) works hard to lift you up or to lower you down with control. Any problem at the front of the knee, or weakness in the muscles that steady it, tends to show up first on stairs, when squatting or when getting up from a low chair.

Kneecap pain (patellofemoral pain)

This is the most common cause in younger, active people, and it is sometimes called “runner’s knee”. It can also happen in people who do not play sport.

How it usually feels:

• a dull ache at the front of the knee, around or behind the kneecap
• worse on stairs, when running, jumping or squatting
• worse after sitting a long time with the knees bent, such as on a long drive or a flight
• sometimes a crackling sound when climbing stairs or standing up

It often starts after a sudden increase in activity, such as more running or a new gym routine. Weak thigh and hip muscles, and the way the kneecap tracks in its groove, also play a part.

Treatment is usually simple. Rest from the activities that hurt, switch for a while to lower-impact exercise such as a static bike or swimming, and use ice for short spells. A physiotherapy programme to strengthen the thigh and hip muscles is the main treatment. Most people improve without surgery.

Osteoarthritis of the knee

In people over about 50, wear of the joint cartilage is a common cause. The smooth lining at the ends of the bones thins, and the joint becomes painful and stiff.

Typical signs:

• pain that builds up slowly over months or years
• stiffness, often worse in the morning or after rest
• swelling after a busy day
• creaking or grinding as the knee moves
• difficulty with stairs, walking far and getting up from the floor

Arthritis can affect the kneecap joint alone, which makes stairs and squatting especially hard. First treatment includes exercise, weight loss if needed, painkillers or anti-inflammatory medicine, and pacing activity. Injections help some people. When these no longer control the pain, an operation such as a knee replacement may be discussed.

A torn meniscus

The menisci are two rubbery, C-shaped cushions between the thigh bone and the shin bone. A tear can happen with a twist in younger people, or with very little force in an older knee where the meniscus has worn.

Signs that point to a meniscus tear:

• pain along the inside or outside edge of the joint
• swelling and stiffness
• catching or locking, where the knee gets stuck
• a feeling that the knee might give way
• not being able to bend or straighten it fully

Many meniscus tears settle without an operation. If the knee keeps locking, or symptoms continue despite treatment, keyhole surgery (knee arthroscopy) may be suggested to repair or trim the tear.

Other causes

Pain below the kneecap can come from the patellar tendon, especially in people who jump. In teenagers, pain and a bump below the kneecap can be a growth-related problem. Pain that is hot and red, or a knee that swells up for no clear reason, needs a doctor to look for infection or gout.

What you can try at home

• Cut back on what makes it hurt for a few weeks, but keep moving.
• Use the handrail. Lead with the stronger leg going up and the sore leg going down.
• Use ice wrapped in a cloth for up to 20 minutes at a time.
• Try anti-inflammatory tablets or gel if they are safe for you.
• Start gentle strengthening for the thigh and hip muscles.

How a doctor finds the cause

The doctor asks where it hurts and what makes it worse, then examines the knee, the kneecap and the way you walk and squat. An X-ray shows arthritis and the bones. An MRI scan is used when a meniscus or ligament injury is suspected, or when pain does not settle with treatment.

When to see a doctor

See a doctor if the pain lasts more than a few weeks, keeps you off the stairs, or wakes you at night. Go sooner if the knee locks, gives way, swells quickly, or you cannot put weight on it. A hot, red, swollen knee with a fever needs to be seen the same day.

The knee specialist page explains what a visit involves, and the meniscus tear page covers that injury in more detail.