Why do my knees hurt going downstairs, and can exercise help?
Lots of clients come to me with this issue: going upstairs is fine, but coming down is another story.
Perhaps you grip the handrail, turn sideways or take one step at a time. These adjustments can help you manage the stairs, but you might also want to feel stronger and more confident coming down.
So why can going down feel so different from going up?
Gravity plays a part, thank you Newton, but the key difference is what your muscles have to do: lift your body upwards or control its movement downwards.
Your thighs are acting like brakes
When you climb stairs, your leg muscles work to lift you onto the next step.
Coming down, the supporting leg has to control your body as you lower towards the step below. Your quadriceps (the muscles at the front of your thigh) work while lengthening to help control that descent. This is called eccentric muscle action. Think of them as brakes controlling your speed.
That describes the movement, but it doesn’t fully explain the pain. The useful questions are what might be contributing to your symptoms, and how you can gradually build your ability to manage the movement.
Does knee pain on stairs tell you what’s wrong?
Not by itself.
Pain around or behind the kneecap, often called patellofemoral pain, can be aggravated by stairs. Osteoarthritis and other knee problems can also make stairs uncomfortable. The location, onset and behaviour of your symptoms matter, so pain on stairs isn’t enough to diagnose the cause.
It also isn’t enough to conclude that knee pain means that your knees are simply “worn out” or that you should stop using them. That doesn’t mean you should just push through the pain and live with it. It means finding an appropriate way to keep moving, with advice where needed.
Exercise can be helpful for common knee conditions, although the type and amount need to suit you.
Can strengthening your legs help reduce knee pain?
Research supports strengthening exercises as a way to improve pain and everyday function in people with common knee conditions.
For people with patellofemoral pain, a systematic review and meta-analysis of 14 trials found that strengthening both the hip and knee muscles improved pain and activity, with better results than knee strengthening alone.[3]
For knee osteoarthritis, a large 2025 systematic review and network meta-analysis found moderate-certainty evidence that strengthening probably improves physical function at around 12 weeks compared with control groups. Physical function means how well you can manage everyday activities.[4]
These findings support strengthening as an option. They don’t mean that weakness is necessarily the cause of your pain, or that everyone needs the same exercises.
Research has found that people with pain around the kneecap often have reduced thigh strength, including when the muscles work to control lowering [1]. Small studies have also found differences in how smoothly they control a step down [2]. These findings don’t tell us whether the changes caused the pain or developed in response to it, but they give us a reason to include controlled lowering when building leg strength.
That’s where exercises such as slowly sitting into a chair or practising an appropriately supported step-down can fit: they let you practise this part of the movement at a manageable level.
How to start building leg strength?
You don’t have to begin by repeatedly practising the most uncomfortable staircase in your house.
Sit-to-stands and squats are practical ways to work your thigh and hip muscles while practising lowering and lifting your body; useful foundations for everyday tasks such as getting out of a chair or negotiating stairs.
A starting point might be standing up from a higher chair, using your hands for support or practising a smaller range squat. As your ability improves, you can gradually adjust the support, depth, repetitions or resistance.
You don’t have to reach a particular squat depth to make the exercise worthwhile. The aim is to find an appropriate challenge that you can practise consistently and build on.
In my YouTube video, I demonstrate five exercise progressions to help you find that starting point and gradually develop strength, control and confidence with movement. They’re options to explore, rather than a requirement to complete all five or reach the hardest variation.
Build confidence alongside strength
When a movement has been uncomfortable, it’s understandable to feel hesitant about it.
My approach is to help you understand what you’re practising and why, and find a level where you feel able to begin.
Progress might mean controlling a movement more smoothly, using a little less support or feeling more confident about trying it again. It doesn’t have to mean immediately using a deeper bend or a heavier weight.
Pay attention to how your knee responds during exercise and afterwards. If symptoms are increasing, reduce the challenge and seek advice rather than repeatedly pushing through. If you have a diagnosed condition or recent surgery, follow your healthcare professional’s guidance.
When should you get your knee checked?
See a GP or physiotherapist if your knee pain isn’t improving within a few weeks or is limiting everyday activities.
Seek urgent advice through NHS 111 if you cannot bear weight or move the knee, it is badly swollen or has changed shape, or you have a fever with redness or heat around the knee.
You don’t need to work out on your own whether pain is something to adapt your exercise around or something that needs assessment.
Want to see what an appropriate starting point could look like? Watch the five exercise progressions.
Want to feel stronger and more confident on stairs, and beyond?
Maybe reading this has made you think:
“I’ve started taking the stairs one step at a time.”
“I don’t feel confident lowering myself onto my right leg.”
Or perhaps you’ve noticed other everyday movements becoming more difficult: getting out of a low chair, walking downhill or getting up from the floor.
It’s easy to gradually work around these things without really noticing how much you’ve changed what you do.
You don’t have to wait until they limit you further before getting some support.
That’s where Coach Caroline comes in.
I work with active adults over 50 to build the strength, mobility, balance and confidence they need to keep doing the things they enjoy, now and for years to come.
We look at where you are now, what you want to feel more capable doing, and what you need to work on to get there. Your programme is built specifically for you, with coaching and support to help you find an appropriate starting point and progress as your ability grows.
If you'd like some help figuring out where to start, get in touch.
Find out more about Coach Caroline or Arrange a Free Call References
[1] Local neuromuscular characteristics associated with patellofemoral pain: A systematic review and meta-analysis https://www.sciencedirect.com/science/article/abs/pii/S0268003321002394
[2] Anderson and Herrington (2003), A comparison of eccentric isokinetic torque production and velocity of knee flexion angle during step down in patellofemoral pain syndrome patients and unaffected subjects. DOI: 10.1016/S0268-0033(03)00054-8. https://www.sciencedirect.com/science/article/abs/pii/S0268003303000548
[3] Nascimento et al. (2018). Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. DOI: https://www.jospt.org/doi/10.2519/jospt.2018.7365
[4] Yan et al. (2025). Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ. DOI: https://www.bmj.com/content/391/bmj-2025-085242
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