Knee pain on stairs, and what it usually means

Pain on stairs is one of the most common reasons people first come to a knee clinic. It is also one of the most informative, because which direction hurts narrows things down considerably.

Down hurts more than up

• Going downstairs loads the front of the knee far more than going up. Pain clearly worse on the way down often points to the kneecap and the surface behind it.
• Pain going up, especially with a sense of weakness, points more often to the thigh muscle and the quadriceps mechanism.

The usual causes, in rough order

• Kneecap tracking problems, common in younger and more active people, and often manageable without surgery.
• Early wear behind the kneecap, which can be present long before the rest of the joint is affected.
• Meniscal problems, which more often produce catching, locking, or a sense that the knee is not trustworthy.
• Referred pain from the hip, missed often enough to be worth ruling out every time.

What is worth noting before you see anyone

• Which direction hurts, at what point in the step, and whether there is swelling afterwards. That description is genuinely useful in clinic.
• Avoid testing it repeatedly on stairs to see whether it still hurts. It will.

When imaging is worth it

• If the pain has lasted more than a few weeks, if there is swelling, or if the knee catches or gives way, examination and usually a standing X-ray are reasonable. An MRI is not the first step for most people and is often ordered too early.