Knee · Oakville Pain Clinic Blog
Why Does My Knee Hurt Going Down Stairs? A Pain Doctor's Guide
Going-downstairs knee pain is rarely random. Here are the four conditions we see most often in our Oakville pain clinic — and what to do about each.
“My knee is fine going up the stairs, but going down it kills me.” If that's you, you're describing one of the most common patient complaints we hear in our Oakville pain clinic. It's rarely random — going-downstairs knee pain points to a small handful of specific underlying problems. Here are the four we see most.
Why descending stairs hurts more
Going down stairs loads your knee very differently than going up. On the way down, you're absorbing your bodyweight on a single flexed knee with each step — the load on the kneecap and on the cartilage behind it can be 3 to 5 times your bodyweight. That's why even a mild knee problem becomes obvious going down stairs long before it shows up walking on flat ground.
1. Knee osteoarthritis (especially patellofemoral)
The most common cause of going-downstairs knee pain in adults over 40 is knee osteoarthritis, particularly patellofemoral osteoarthritis — wear behind the kneecap. The kneecap rides through a groove on the front of the thighbone, and that interface gets heavily loaded with knee flexion. Sound familiar?
Other clues: morning stiffness that loosens with movement, intermittent swelling, sometimes a clicking or grinding sensation. An X-ray usually confirms it. The AAOS overview of knee arthritis is a good background read.
What helps: physiotherapy and quad strengthening first; weight management if applicable; an injection (PRP, hyaluronic acid, or cortisone) for symptoms that interfere with daily life. We cover this on our PRP for Knee Osteoarthritis page.
2. Patellofemoral pain syndrome (“runner's knee”)
In younger adults, women, and active people, going-downstairs knee pain is often patellofemoral pain syndrome (PFPS) — sometimes called “runner's knee.” This is a problem of the kneecap tracking poorly through its groove, often driven by weak hip and glute stabilizers, tight quadriceps, or overuse. Imaging is usually normal.
What helps: almost always physiotherapy — focused on hip stabilizer strengthening, quad balance, and movement retraining. Most cases resolve with a structured program. PRP isn't first-line for PFPS in young patients with normal imaging.
3. Patellar tendinopathy (“jumper's knee”)
If the pain is specifically right below your kneecap (you can usually point to it), and you're active in jumping or running sports, suspect patellar tendinopathy. The patellar tendon connects your kneecap to your shinbone, and chronic overload causes microscopic damage that doesn't heal well — tendons have poor blood supply.
What helps: structured eccentric loading physiotherapy is first-line. For chronic cases that haven't responded, PRP under ultrasound guidance is well-evidenced. We cover this on our PRP for Achilles & Patellar Tendinopathy page.
4. Meniscus injury (degenerative or traumatic)
The meniscus is a C-shaped cartilage that cushions and stabilizes the knee. Tears can be traumatic (from a twist, often in sports) or degenerative (from years of wear, common after age 40). Both can cause descending-stairs pain, sometimes with catching or locking.
What helps: degenerative meniscus tears in older patients usually don't need surgery — physiotherapy produces equivalent outcomes. Acute traumatic tears in younger patients sometimes do. PRP is used selectively for chronic post-injury knee pain. An MRI is usually needed to clarify what you're dealing with.
When to see a pain physician
See a doctor if your knee pain:
- Has been present for more than 4–6 weeks despite rest
- Is associated with significant swelling, locking, giving way, or inability to bear weight
- Started with a specific injury (twist, fall, sports incident)
- Wakes you up at night
- Is interfering with work, sleep or daily activities
At Oakville Pain Clinic we assess and treat all four of the above — from initial diagnosis through to PRP, exosome therapy and coordination with physiotherapy. Self-referrals welcome — call 647-910-5359 or book online.
Common Questions
Frequently Asked Questions
Is going-downstairs knee pain serious?
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Not necessarily — but it shouldn't be ignored if it persists more than a few weeks. The most common causes (knee osteoarthritis, patellofemoral pain syndrome, patellar tendinopathy, meniscus injury) all respond best to early treatment. Get assessed if pain has lasted more than 4–6 weeks, if there's swelling, locking or giving way, or if it's interfering with daily life.
Why does going down stairs hurt more than going up?
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Descending stairs loads the kneecap and the cartilage behind it with up to 3–5 times your bodyweight on each step, while going up loads the muscles more than the joint surfaces. That's why a knee problem affecting cartilage or kneecap tracking will show up dramatically going down stairs long before you notice it walking on flat ground.
Is PRP appropriate for going-downstairs knee pain?
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It depends on the underlying cause. PRP has strong evidence for knee osteoarthritis (a common cause in adults over 40) and for chronic patellar tendinopathy (jumper's knee). It's not first-line for patellofemoral pain syndrome in younger patients with normal imaging — physiotherapy is. We assess each patient and only recommend PRP when the diagnosis supports it.
Do I need an MRI?
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Not always. Many causes of going-downstairs knee pain can be diagnosed through history, physical examination and X-ray. MRI is typically reserved for cases where there's suspicion of a meniscus or ligament tear, when symptoms aren't responding to treatment, or when surgical evaluation is being considered.
Related Services
Treatments mentioned in this article
Have a specific condition you want to discuss?
Self-refer at any time — our team contacts you within 24 hours to schedule your consultation at Oakville Pain Clinic.