Why do I get knee pain going up and down stairs?

Every week I see a number of people who come to see me with knee pain going up and down stairs. Knee pain is common and because it can be quite sharp it can be quite worrying. People often are worried something is damaged and the pain can often stop you in your tracks.

What can cause pain at the front of the knee?

If someone presents with pain at the front of the knee it could be a number of possible things…. the most common problem arises from pain from your knee cap (patellofemoral joint). Personally, I think patello-femoral pain accounts for a large proportion of knee pain and it is tricky to treat. The most likely problem stems from overloading the knee cap but occassionally there may be some instability.

The other things that could cause pain at the front of the knee could be patella tendon, fat pad, joint line pain (OA of the knee), perhaps if there was an impact injury there maybe a hairline fracture or even one most exclude bone tumours.

But as I mentioned knee cap pain is really common and how you can differntiate is that knee cap pain is often painful when you are climbing stairs, getting out of a chair or getting off the floor, often it can also be sore running or after sitting for long periods such as driving. The knee doesn’t often swell up but it can.

Why does the knee get painful?

Simply put, the knee cap takes the load of the knee when moving with weight through it. What that means is on movements when we are moving our bodies say out of a chair or up stairs we are pushing up through our knees. If the muscles that help with doing this action are not strong enough then the result is that the knee and knee cap will take the strain.

Most of the time, the quadriceps are not strong enough to cope with the demands that you are expecting the knee to do, be it getting up the stairs or running or even weight lifting 100kg squat bar. The problem that happens is that once the knee cap produces pain, it then can be painful with all the above activities.

Why is my knee pain not improving with rest?

I put the knee cap in a ‘stubborn injury’ category, this I think is because of two things, firstly, if we are honest with ourselves the symptoms may have been there for a long while but not enough to stop us so that by the time it comes to getting help the problem is really ingrained. Secondly, because the knees are always being used it’s very hard to give it the relative rest. Finally, building the strength often needs to work in positions that can cause pain so it’s sometimes hard to progress.

What can help reduce my knee pain?

Some of the best things you can do to reduce the pain are icing, stretching, rollering or massage. Taping does help and getting your physio to show you how to tape can also be useful.

How long will it take for my knee pain to get better?

Time is of the essence with patello-femoral pain. This is because we need to come off the things that are aggravating it (or reduce them if it’s running, for example, take it easier, don’t run so far), strengthen up without aggravating the symptoms. I believe that the trick is to find quads exercises that do not aggravtate your pain, that means that when you exercise there is no pain during/ after or the next day. Then keep building on those. This can take a good few weeks until you start to feel the strength gains.

What are my options if my knee pain doesn’t get better?

If things are not getting better:

1. Check you are doing enough of the right exercises.
2. Check that there is no pain from the programme you are given.
3. Get an x-ray or MRI to check that the diagnosis is correct so that you know you are on the right track.
4. Try taping or a knee support but make sure this is a temporary solution.
5. Make sure you are stretching your legs and perhaps even massaging the quads.
6. Make sure you are strengthening your gluteals and core to help take the pressure of the knees.
7. Finally, you can look at your shoes and make sure they support your feet and are cushoined enough.

If you have given rehab a good shot and looked at all the above then it could be worth seeing if an orthopaedic surgeon can offer you injections or even sometimes they may go in and clean up the back of the knee cap if there is evidence of fraying.

Good exercises for the knee include:

1. Wall Squat

1. knee extensions

If you don’t find your symptoms improve with the above exercises, it’s worth getting a specific programme for you… Remember we’re not all the same and sometimes we need a helping hand!