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What causes knee pain going down stairs?
There are many reasons why you can get knee pain going downstairs. As you step down, your knee bends and your body weight will be solely on one leg. Therefore, the force of your full weight can overload any irritated structures on the front of your knee.
As the knee bends to lower you down the step, it must shift forwards over your foot. This increases the pressure in the knee and at the front of the knee through the patellofemoral joint (kneecap) in particular.
If your knee hurts when going downstairs, you should seek the advice of a medical professional such as a physical therapist or sports doctor to have a thorough assessment, a diagnosis and a plan to improve the problem.
Here are the most common reasons why your knee hurts going downstairs.
Patellofemoral joint pain – Front of Knee Pain Going Downstairs
Chondromalacia patella, Patella Alta and Osteoarthritis of the patella (kneecap) are all causes of patellofemoral joint pain.
The patellofemoral joint is the joint between the knee cap and the thigh bone, the patella and the femur. As the knee bends, the contact between these bones increases.
Chondromalacia patella is a painful condition of degeneration of the cartilage of the patella and can be a part of patellofemoral arthritis.
Patella Alta is a condition where the location of the patella is too high, and therefore the surfaces do not move with each other efficiently. Therefore, increased wear and tear can lead to Chondromalacia patella and knee arthritis.
Related Article: Patellofemoral Pain Syndrome
Patella Tendinopathy – Front of Knee Pain Going Downstairs
Patellar Tendinopathy or tendonitis is the overload or degeneration of a tendon which can make it weaker, painful and feel stiff and thickened.
Patella tendonitis affects the patella tendon, the second part of the quadriceps tendon located below the kneecap and attaches to the tibial tuberosity. Patella tendinopathy will often feel more painful when the quadriceps muscle is loaded, and the tendon is under strain and can worsen while the muscle and tendon lengthening.
Therefore, causing knee pain going downstairs, as the quadriceps is working to slow the knee bend, placing the tendon under strain. As the knee is bending, the quadriceps and patella tendon are lengthening.
Fat pad impingement – Front of Knee Pain Going Downstairs
The Hoffa’s fat pad is located under the patella tendon at the front of the knee.
As the knee bends, pressure can be put on this structure, which usually is not an issue. However, if the fat pad is irritated, it is often swollen or enlarged. In this case, the fat pad can get pinched with knee movements.
In particular, on full straightening of the knee and if the knee is bent far. So the knee may hurt going downstairs.
Read more about Hoffa’s Fat Pad Impingement and Hyperextension Brace, which is useful for recovery of this condition.
Meniscus – Inner Knee Pain Going Downstairs
The meniscus is a thick fibrocartilage structure that sits between the femur and the tibia, attached by ligaments. It helps increase the knee joint’s stability and absorb impact.
If there is an irritation to the meniscus or damage, such as a tear, it will feel painful when pressure is placed on it.
Bending the knee can add additional pressure to the meniscus, so an irritated or injured meniscus can cause pain in the knee going downstairs.
Usually, this will be experienced either on the inside or the outside of the knee as the meniscus is made of two halves, medial and lateral.
Read more about Lateral Meniscus Tear and treatments or Medial Meniscus Tear, Meniscus Tear Exercises.
IT Band Syndrome – Outer Knee Pain Going Down Stairs
The Iliotibial Band (IT Band) attaches from the Tensor Fascia Lata and Gluteus Maximus to the outer aspect of the knee.
If the IT Band becomes overloaded, it can cause increased compression against structures on the other knee leading to inflammation and pain.
The IT band applies more compression to these structures when standing on one leg and when the knee is bent 10-15º.
As a result, IT Band Syndrome is one of the primary causes of outer knee pain going downstairs.
Related Article: IT Band Syndrome: Causes and Treatment
Osgood-Schlatter or Sinding-Larsen Johansson with children
These two conditions are mostly only seen in children as they affect soft bones, which is the case before the skeleton fully matures and hardens. Both are conditions of inflammation of the bone at the attachment of a tendon.
Osgood-Schlatter’s Disease affects the attachment of the patella tendon to the tibial tuberosity at the front of the shin bone, and Sinding-Larsen Johansson affects the inferior pole of the patella when the patella tendon originates from.
Any stress in the form of traction from a working muscle or loaded tendon can cause pain on these points. Therefore, the individual will often report that their knee hurts going downstairs.
Physiotherapy with James McCormack
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments weekly.