What Causes Knee Pain When Going Up and Down Stairs?

According to researchers, climbing two more minutes of stairs each day would be enough to offset the one to two pounds that the average American gains each year. That's helpful advice and relatively easy to implement—unless knee pain gets in the way. What causes knee pain when going up and down stairs? And what can you do about it?

Chondromalacia can cause knee pain to worsen on stairs. In fact, this condition may cause knee pain only on stairs. Osteoarthritis and ITBS are other possible explanations. Fortunately, patients can relieve pain by resting the knee, strengthening the surrounding muscles, and bracing the knee.

What Causes Knee Joint Pain?

Most cases of knee pain are related to injury, aging, or chronic stress on the joint. Some of the most common knee injuries are sprains and strains, which involve damage to the ligaments. Acute trauma can also cause cartilage tears and fractures.

If you've suffered an acute knee injury, you likely have some sense of what happened. You also probably have symptoms beyond knee pain walking up and down stairs.

Maybe, though, you can't recall an injury. And maybe your knee pain is isolated to specific circumstances. 

Perhaps you experience knee pain above the kneecap when walking up stairs. Maybe you only have knee pain walking up stairs and not down. On the other hand, maybe you feel a stabbing pain in the knee when walking down stairs.

What can cause this kind of knee pain without injury? And what can cause knee pain specifically on the stairs?

Knee pain not associated with injury usually involves damage related to aging or overuse. When knee pain occurs with bending, squatting, and climbing stairs, this damage is usually centered on the kneecap. 

Pain in the kneecap region is referred to as anterior knee pain, or pain in the front of the knee.

However, "anterior knee pain" is a description, not a diagnosis. So you're still left wondering, "What is causing my knee pain?"

What Causes Knee Pain When Going Up and Down Stairs?

Two of the most common causes of anterior knee pain are chondromalacia and osteoarthritis. IT band syndrome is another possibility.

Chondromalacia

Chondromalacia, or chondromalacia patellae, refers to a condition in which the cartilage behind the kneecap softens and breaks down. In a normal knee, this cartilage provides a tough and slippery cushion between the bones of the knee joint. When the cartilage is damaged, these bones rub together causing further deterioration and pain.

The defining symptom of chondromalacia is a dull ache focused in the kneecap region. You might also experience a grinding sensation when you move your knee.

 

Activities that put pressure on the kneecap can make these symptoms worse. Patients with chondromalacia frequently experience worsening symptoms when they:

• Climb or descend stairs
• Run downhill
• Do knee bends or squats
• Sit for long periods of time
• Stand up from a seated position

Diagnosing and Treating Chondromalacia

Chondromalacia is treatable, and it usually responds to conservative treatment. However, its proper diagnosis requires the expertise of a medical professional. 

Your doctor will use your description of your symptoms and a physical exam to begin evaluating your condition. He or she may also order additional tests. Blood tests and x-rays, for example, can rule out other types of inflammation, like arthritis. Meanwhile, an MRI can confirm a chondromalacia diagnosis. In severe cases, your doctor might suggest arthroscopic surgery to confirm the diagnosis and begin treatment.

In the vast majority of cases, though, chondromalacia responds well to conservative, nonsurgical treatment.

Rest is an important component of chondromalacia treatment. Your doctor will advise you to take a break from your regular exercise routine.

At the same time, he or she may suggest gentle exercises to strengthen the muscles around your knee. Depending on your doctor's recommendations, you might perform these exercises at home or with a physical therapist.

Your doctor or physical therapist may also recommend taping or bracing your knee. These measures can help your kneecap maintain its proper alignment. 

As you work to strengthen your knee, you may also use ice and medication to reduce inflammation. Follow your doctor's advice when taking over-the-counter or prescription pain relievers. Also consider icing your knee for 15-20 minutes a few times each day, especially after doing therapy exercises.

Osteoarthritis

Like chondromalacia, osteoarthritis involves the breakdown of cartilage and resulting knee joint inflammation. With osteoarthritis, though, the damage and inflammation go beyond the cartilage, affecting the bones and connective tissues as well. Furthermore, osteoarthritis is a degenerative condition. This means that it becomes progressively worse over time.

Symptoms of osteoarthritis include:

• Pain
• Stiffness
• Tenderness to touch
• Reduced range of motion
• Cracking, grating, or popping sensations or sounds
• Signs of inflammation, like swelling, redness, and warmth

The symptoms of osteoarthritis do worsen over time. Even in the short term, though, you might notice that certain activities or circumstances produce more severe symptoms.

For example, you might notice that your symptoms are worse when you walk for a long period of time or when you climb stairs. You might notice, too, that your pain level remains elevated even after these activities.

On the other hand, you might experience increased pain and stiffness after long periods of inactivity as well. 

If you suspect osteoarthritis, you might wonder then, "Is there anything I can do to relieve the pain?" Actually, there is. Osteoarthritis cannot be cured, but its symptoms can be managed. As with other knee conditions, treatment requires a proper diagnosis.

Diagnosing and Treating Osteoarthritis

Your doctor will assess your condition using your description of your symptoms and a physical exam. Blood tests and x-rays can confirm an osteoarthritis diagnosis. Your doctor may also use MRI imaging to view the inside of your knee joint. In some cases, a primary care doctor or orthopedic doctor might refer you to a rheumatologist for additional testing.

If your doctor diagnoses osteoarthritis, he or she will help you manage your symptoms and slow the progression of the disease.

Treatments for osteoarthritis include conservative and surgical measures. Most patients find significant relief from conservative treatments.

Conservative treatment for osteoarthritis almost always involves increasing your activity level. Doing so safely may mean modifying your current exercise program. It may also mean beginning a new physical therapy regimen to strengthen the muscles around the knee. Finally, if you're overweight, your doctor might advise increased activity to promote weight loss and reduce stress on the knees.

As you work to increase your activity, devices like braces, canes, and crutches can provide support. Over-the-counter and prescription medications can also reduce inflammation and relieve pain. For some patients, cortisone shots provide a good option for longer-term relief. Still, long-term use of any medications involves risks, and you should discuss these with your doctor.

Most patients experience noticeable relief from conservative measures. Again, though, osteoarthritis is a degenerative condition. Eventually, conservative measures may not provide the relief you need. If and when you reach this point, your doctor can suggest surgical options, including knee replacement.

Illiotibial Band Syndrome

The iliotibial (IT) band is a tough band of fibers that runs from your hip to the top of your shinbone. Its path is lateral. This means that it runs from the outside of your hip and down the outside of your thigh before entering from the outer side of your knee. 

The IT band is responsible for extending, rotating, and stabilizing your leg from your hip to your knee. 

With overuse, the IT band can become tight and inflamed. This condition is called IT band syndrome.

Symptoms of IT band syndrome, or ITBS, include:

• Pain on the outside of the knee
• Snapping or popping sounds and sensations
• Swelling, especially on the side of the knee or below the knee where the IT band attaches to the shinbone

Activities that worsen IT band syndrome include running, bending, and climbing. Without treatment, ITBS—and its symptoms—can worsen. As your condition progresses, you might notice pain radiating from your knee up your thigh and into your hip.

Diagnosing and Treating IT Band Syndrome

As always, your doctor's efforts to diagnose the cause of your knee pain will begin with a description of your symptoms. Your doctor will then conduct a physical exam to pinpoint the location of pain and swelling. He or she will also look for muscle imbalances and even subtle differences in the lengths of your legs.

Because ITBS involves the soft tissues, x-rays aren't usually helpful. In some cases, your doctor might order an MRI to view the inflammation and rule out other conditions. Usually, though, a physical exam is sufficient to diagnose ITBS.

Treating ITBS begins with conservative measures. Since ITBS is an overuse injury, rest is one of the most important components of treatment. You'll need to rest your IT band from activities, like running and bending, that aggravate it.

While avoiding problematic activities, you'll also add therapeutic measures to your daily routine. These include stretching exercises and massage. Your doctor might suggest that you try performing IT band stretches at home. If your condition is severe or at-home measures don't provide relief, he or she might also prescribe physical therapy. 

As you work to stretch and strengthen your leg muscles, medication and icing can reduce inflammation. If you're working with a physical therapist, ultrasound and electrical stimulation provide additional treatment options.

Finally, your doctor or therapist may suggest shoe orthotics to correct leg imbalances or improve your gait.

The vast majority of patients fully recover from ITBS with conservative measures. If your condition doesn't respond to conservative treatment, your doctor might suggest surgery. Options include arthroscopy and surgical release of the IT band.

How to Walk Up and Down Stairs Without Knee Pain

If you're suffering from knee pain when going up and down stairs, it's important to diagnose and treat the underlying condition. 

At the same time, simply changing the way you walk up and down stairs can bring some relief. These changes can also help you prevent future overuse injuries.

The following guidelines can help you climb and descend steps without pain.

First, be sure to engage your whole foot with each step. Avoid stepping with just your toes when climbing or descending stairs.

Focusing your weight on your toes activates your thigh muscles. These muscles, in turn, increase pressure on the kneecap and push it into the thigh bone. We've seen, of course, that it is precisely this contact and pressure that causes knee pain when going up and down stairs.

Engaging your whole foot means planting its entire surface on the step before reaching for the next one. It also means shifting your weight to your outer heel to activate your glutes.

Second, keep your feet and knees aligned. When you step, your knee should be directly above your foot. If it angles in, this could indicate a muscle imbalance. These imbalances and misalignments can also cause or worsen pain and inflammation.

Third, pay attention to your posture. When climbing stairs, lean slightly forward. By leading with your body, you further reduce the pressure on your knees.

Finally, if you continue to struggle with knee pain going down stairs, you can experiment—carefully—with going backward. Studies show that descending the stairs backward shifts pressure from your knees to your hips. Patients with osteoarthritis of the knee may find significant relief from this method.

Of course, it's important to back down the steps carefully. Hold the handrail. Go slowly. And if possible, have someone nearby for support, especially on unfamiliar stairs.

It's the Climb: Taking Steps to De-escalate Knee Pain on the Stairs

Experiencing knee pain on the stairs—and sometimes only on stairs—can be frustrating. This is especially true when you can't pinpoint an injury that explains your pain.

If you haven't suffered an acute injury, what causes knee pain when going up and down stairs? Conditions like chondromalacia, osteoarthritis, and ITBS are common culprits.

Fortunately, chondromalacia and ITBS are treatable. While osteoarthritis is degenerative, conservative and surgical measures can control symptoms.

Finally, changing the way you navigate stairs can also relieve pain and prevent re-injury.

As you manage pain in your knees or elsewhere, count on PowerRebound's blogs for the best advice.