Knee Pain on Stairs: What It Means and How to Fix the Cause

Stairs are where many people first notice their knees. Going up, there is an ache at the front of the knee. Going down, it is sharper, or the knee feels unsteady. Nairobi offices, flats and footbridges mean most of us climb a lot of stairs, so this is one of the most common things we hear at our Westlands studio.

The good news: most stair-related knee pain is not damage. It is a sign that the knee is taking more load than it should, usually because of what the hips and feet are doing.

Why stairs hurt when walking on flat ground does not

Climbing a step puts roughly three times your body weight through the knee. Coming down is harder still, because the muscles at the front of the thigh have to control you as you lower. Any small problem in how the knee tracks or how the load is shared gets magnified on stairs.

Pain at the front of the knee, around or behind the kneecap

This is the most common pattern, sometimes called runner's knee or patellofemoral pain. The kneecap is being pressed or pulled off its ideal track. It often comes with an ache after sitting for a long time with bent knees, such as in a matatu, at the cinema, or at your desk.

Pain just below the kneecap

Often the tendon that connects the kneecap to the shin is irritated, especially in people who jump, run or have recently increased training.

Pain on the inside or outside of the knee

Can come from the tissues around the joint, a tight band down the outside of the thigh, or the way the knee drifts inward when you step.

See a doctor first if

• The knee is hot, red or very swollen
• It locks, catches or gives way
• You cannot put weight on it, or the pain started with a twist, fall or a "pop"
• You have fever, or the pain wakes you at night and does not ease

We are a corrective exercise studio, not a clinic, and we refer to a doctor if we see these signs.

The real causes: above and below the knee

The knee is a hinge between two mobile joints. When either of them does not do its job, the knee pays.

• Weak hips and glutes. When the muscles on the side of the hip are weak, the thigh rolls inward as you step up, and the kneecap is pulled off track. Watch your knee in a mirror as you climb a step: if it drifts toward the other knee, this is likely part of your story.
• Stiff ankles. If the ankle cannot bend forward enough, the knee has to make up the difference on every step down.
• Flat feet or collapsing arches. When the arch drops, the shin rotates inward and so does the knee. A foot pressure mat assessment shows this clearly.
• Tight thighs. Tight quadriceps and a tight band down the outside of the thigh increase pressure behind the kneecap.
• Doing too much too soon. A new running plan, hiking Ngong Hills every weekend, or a jump in gym training.

If your knee caves in when you climb a step, the knee is rarely the problem. It is where the problem shows up.

Three things you can start this week

• Side-lying leg raise. Lie on your side, bottom knee bent, top leg straight. Lift the top leg slightly behind you, toes pointing forward, and lower slowly. 2 sets of 12 each side. You should feel it in the side of your hip, not the front.
• Slow step-down. Stand on the bottom stair, holding the rail. Slowly lower one heel to the floor, keeping the knee in line with your second toe, then rise. 2 sets of 8. Stay pain-free: if it hurts, use a lower step.
• Calf and ankle stretch. Hands on a wall, one foot back, heel down, knee straight, then bent. 30 seconds each, twice a day.

Take the stairs one at a time with the rail while it is sore, leading with the stronger leg going up and the sore leg going down.

How we help knee pain at Wellness Solutions Africa

We start with a postural assessment to see how your hips, knees and feet move together, and add the foot pressure mat when feet look involved. Most clients with knee pain on stairs then follow either our Pain Relief pathway or, when feet and walking are the driver, our Strong Feet & Movement pathway.

The work happens through a monthly membership, so a coach progresses your exercises week by week until stairs stop being a problem, and then keeps you strong.

Start with our free 60-second posture screen, or book an assessment in Westlands, Nairobi.

This article is general information, not medical advice. If you have any of the warning signs above, see a doctor first.