Why Your Knee Hurts When Going Down Stairs (And How to Fix It)

If you feel knee pain when going down stairs, you’re not alone. This is one of the most common complaints we see in physical therapy.

Many people notice their knee feels fine when walking on flat ground, but the moment they descend stairs, hills, or slopes, the pain appears. The good news is that in most cases, this type of knee pain is very treatable with the right strengthening program.

Below we’ll explain why stairs hurt more than walking, the most common causes, and three exercises that can help relieve knee pain.

Why Does My Knee Hurt More Going Down Stairs?

Going down stairs places much higher stress on the knee joint than walking on flat ground.

When descending stairs, your knee must slowly control your body weight as it bends. This creates increased pressure between the kneecap (patella) and the thigh bone (femur).

If the muscles that control the knee aren’t working efficiently, that pressure increases and can lead to pain.

This type of discomfort is often related to patellofemoral pain, also called anterior knee pain.

Common symptoms include:

• Pain going down stairs
• Pain walking downhill
• Pain after sitting for long periods
• Pain with squatting or lunging
• Aching in the front of the knee

Common Causes of Knee Pain on Stairs

Patellofemoral Pain (Patellar Tracking Issues)
The kneecap sits in a groove at the end of the thigh bone. As the knee bends and straightens, the kneecap should glide smoothly within this groove.

If the muscles around the hip and thigh are weak or not coordinating well, the kneecap can track slightly off-center, creating irritation and pain.

This is often referred to as patellar tracking pain.

Quadriceps Weakness
The quadriceps muscle plays a huge role in controlling knee bending when going down stairs.

If the quads are weak, the knee joint absorbs more stress instead of the muscles doing the work.

Hip Weakness
Many people are surprised to learn that hip strength has a major influence on knee pain.
Weak hip muscles allow the thigh to rotate inward when stepping down. This movement can increase pressure on the kneecap and contribute to anterior knee pain.

3 Exercises That Help Reduce Knee Pain

​Strengthening the muscles that support the knee can significantly reduce symptoms.
Here are three exercises we commonly recommend.

1. Supported Squats

Stand facing a counter or sturdy surface and hold it lightly for balance.
Slowly bend your knees and hips into a squat while keeping your chest upright.

Lower only to a comfortable depth and return to standing.

Goal:
2–3 sets of 10–12 repetitions

This exercise helps strengthen the quadriceps and glutes, which support the knee during daily movements.

2. Step-Down Exercise

Stand on a step or stair with one foot.

Slowly lower your opposite heel toward the floor while keeping control of the knee on the step.

Focus on keeping the knee aligned over the middle of your foot.

Goal:
2–3 sets of 8–10 repetitions per leg
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This exercise directly trains the muscles used when descending stairs.

3. Side-Lying Leg Raises

Lie on your side with your bottom knee bent and your top leg straight.

Lift the top leg upward while keeping it slightly behind your body.

Slowly lower it back down.

Goal:
2–3 sets of 12–15 repetitions

This exercise strengthens the hip muscles that stabilize the knee during walking and stair use.

When Should You See a Physical Therapist?

While mild knee pain can improve with strengthening exercises, it may be helpful to see a physical therapist if:

• Pain has lasted more than a few weeks
• Stairs remain painful despite rest
• Your knee feels unstable or weak
• Pain is limiting exercise or sports

A physical therapist can evaluate movement patterns, strength, and joint mechanics to determine exactly what is causing your symptoms.

Often, a few targeted exercises and adjustments to movement patterns can make a significant difference quickly.

The Bottom Line

Pain when going down stairs is commonly caused by patellofemoral pain, quadriceps weakness, or hip weakness.

The encouraging news is that most knee pain improves quickly with the right strengthening program.

If you’re experiencing knee pain going down stairs, patellar tracking pain, or anterior knee pain, physical therapy can help identify the cause and get you back to moving comfortably.
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If you're in the Danville or San Ramon area, San Ramon Valley Physical Therapy can help evaluate your knee and guide you through the right treatment plan.