Why Do I Have Knee Pain While Going Up and Down Stairs?
This question was asked by one of our new clients who is suffering with knee pain:
“Dr. Andalon, I’ve suffered with an on-off type of knee pain now for more than a year. What I can’t put my finger on is when it started or why, and more confusing is that my knee pain gets worse as the days goes on, especially after I exercise. For a while now, I have noticed that going up and down stairs causes me considerable knee pain. At times I have to carefully go down the stairs slightly sideways - like I’m a contestant in a beauty pageant trying not to fall. I’ve always been an active person and have always taken the stairs at work. But now, I am forced to use the elevator; something I thought I would never have to do - at least not at my age. Do you know what I could be doing wrong or know why I have knee pain while going up and down stairs?”
– Christine, 42. Encinitas,CA.
What’s happening here is likely to be a simple case of the muscles around Christine’s knee joint being “weak” and others being “tight”. The muscles just aren’t strong enough, and others aren’t flexible enough to be able to last through the activities that she wants her body to do and where she wants to go. A big culprit could be improper movement habits while Christine is performing her exercises at the gym. Certain joints aren’t moving like they are supposed to (ankles and hips), and therefore her knees are taking up most of the force. Think of it like this… whether you try to squat onto the toilet, couch, chair, bench, squat machine at the gym or go up and down stairs, you have to have adequate ankle and hip mobility in order for your knee not to significantly go past your toes. I am not saying your knees can’t go past your toes when you squat, but if movement is initiated at your knees first versus your hips, then you are causing an abnormal shear force in your knee joint that, with time will cause major problems. You also need to have good muscle strength and flexibility in your quadriceps, hamstrings, calf, and hip muscles, along with core stability. This is especially important when lunging or squatting so your knee tracks appropriately, and you can avoid developing osteoarthritis in your knee joint. And if a muscle, any muscle, is weak or a joint is damaged in some way, it’s not going to be able to support you through the long day ahead, especially during certain activities that place the knee joint in its most vulnerable position. When you attempt to squat to a certain depth or when you go up and down the stairs, you’re placing a lot of force on the knee joint – and when irritated and/or injured, it will not be able to support your bodyweight and will give you pain. And when they do this, joints, such as your knees, are left to fight their own battles! And that’s not good. Particularly if you’re aged 40+… as that’s the period where cartilage damage really begins (arthritis), and the surfaces of your knee start to rub together. Without muscles to support these knee joints (or just really tired, weak, and stiff ones), you’re much more likely to suffer knee pain or aches. If this problem isn’t corrected, you may develop something called chondromalacia patellae.
What is Chondromalacia Patellae?
Big name, big trouble – a very common problem: chondromalacia patellae is the medical name for one of the most common knee problems we treat in the clinic. Chondromalacia patella is the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella). Pain results when the kneecap and the thigh bone (femur) rub together. Dull, aching pain and/or a feeling of grinding when the knee is flexed may occur.
What Causes Chondromalacia Patellae?
The most common causes include:
Excessive use of the knees: This can result from running, jumping, or any activity that requires heavy use of the knees. Chondromalacia is often called "runner's knee" for this reason. It occurs in people of any age and is common in young, active athletes.
A kneecap that is out of alignment: If the kneecap is not in the proper position, the cartilage will not be able to protect it from rubbing. Some people are born with a misalignment of the knee that can cause this issue.
Weak muscles in the thighs, hips or calves: The leg muscles help support the knee and keep it in place. If they are not strong enough, the knee may not track appropriately. Even a slight misalignment can gradually wear down the cartilage and cause pain over time.
A knee injury: An accident, fall, or blow to the knee can throw the kneecap out of proper alignment, damage the cartilage, or both.
Symptoms
Symptoms of chondromalacia include:
Dull, aching pain that is felt in or around, on the side, behind, or below the kneecap, especially when climbing stairs, during intense activity, or staying in one position for a length of time (sitting)
A feeling of grinding (crepitus) is felt when the cartilage is worn down, or the kneecap isn’t sliding in its groove. This is typically felt when the knee is flexed during exercise or during heavy use of the legs. This can happen while:
Doing knee bends
Going up or down stairs
Walking downhill
Standing up after sitting for a while
Activities that Might Cause Pain Include:
Running or walking down hills or stairs
Walking on uneven ground
Hiking
Snowboarding or skiing
Tennis, soccer, basketball, or any other sport that requires quick agility movements
Climbing stairs
Straightening the knee while it is bearing weight
Many times, if you stop doing the activities mentioned, the pain may go away. Although the pain may go away for some with walking, it’s only because the knees do not have to move as much. As soon as you squat, kneel, or sit with your knees bent greater than 90 degrees, it may instantly cause your pain to return with this condition. This is why the knees often hurt when a person is going up or down the stairs. This deeper movement means that the kneecap is forced to slide up and down over the femur more than usual… and if your cartilage is beginning to wear out, watch out! Add in heavy use of the knees with running, jumping, or high-intensity workout routines, and it's easy to see why this problem is common in active people and fitness enthusiasts, and why it can occur at any age.
Who is at risk for chondromalacia patella?
Many people are surprised to find their cartilage is damaged because they've never hurt their knees in the past. Unfortunately, chondromalacia can be brought on by more than an accident or injury. People who are at risk for developing chondromalacia patella include:
Those who are overweight
People who have had an injury, fracture, or dislocation related to the kneecap
Runners, soccer, basketball, tennis players, weightlifters and exercise enthusiasts, cyclists, and other people who exercise often
Teenagers and healthy young adults, more often females
Treatments for Knee Pain
People who have symptoms or knee pain of chondromalacia should seek out early treatment to prevent further damage and alleviate pain. If chondromalacia isn't treated, it may lead to patellofemoral arthritis. This occurs when the cartilage becomes worn away by harm. The most important thing to understand is that when the cartilage is lost, it cannot grow back. If you or somebody you know is currently dealing with frustrating knee pain, below are four easy things you can begin right away to help:
1). Do Lighter Exercises
Low-impact exercise such as swimming, Pilates, cycling, and at times walking on level surfaces are good choices to keep the muscles strong without worrying about knee pain. Make sure you stick to exercises that are comfortable. This may help prevent further damage. If knee pain is caused by performing any of these activities, we recommend you avoid these activities and follow tip #2.
2.) Physical therapy
Consult a physical therapist who works with individuals to perform exercises and stretches.
3.) Working toward a healthy weight.
Being obese can be detrimental to your knees. Losing weight may alleviate pressure on the knee joint. It’s important to keep in mind that losing weight is not a race – whether you need to lose 20, 50, or even 100 pounds – and that the benefits of losing weight and being physically active go far beyond how you look in the mirror. It’s a lifelong process to become a healthier you – for yourself and your family. As always, check with your doctor before beginning any weight loss program.
4) Ask about injection options.
Some people with knee arthritis ask their doctor about platelet-rich plasma (PRP) injections, which are made from your own blood, spun down in a centrifuge. Research on PRP for knee pain is still developing, so it's a conversation to have with your doctor, and it works best alongside the right exercise, not instead of it.
< PRP Injections: Why Physical Therapy Plays A Key Role In Your Success > So, the answer to Christine’s knee problem? Well, it’s likely to be a simple case of strengthening knee muscles (and hip and lower back ones too) to make them stronger, stretching other muscles that are stiff and tight, and improving the mobility of neighboring joints. But here’s something people often get wrong: simply resting every day will do very little to strengthen muscles – if anything, it’ll make weak muscles worse and mean you’re more likely to suffer more pain, not less. The answer is not found in more exercising; it’s in doing the right exercises to strengthen and stretch the right muscles, which means your knee will be strong enough to go up and down stairs again, meaning you can resume your active activities and exercise routine to keep your heart and lungs healthy, and do it with less knee pain at the end of a day.
What To Next:
If you live in or near North County San Diego, start with a Discovery Visit: one 60-minute session with a women's health specialist at our Encinitas studio, and you walk out with a plan built for the body you have now.
No referral needed. No pressure — just answers and a plan.
