If your knee aches on the stairs, when you kneel or when you squat, the cause is usually one of three things: irritation around the kneecap (patellofemoral pain), arthritis in the joint, or a sore tendon below the kneecap. The first-line care with the strongest backing is exercise that strengthens both the hips and the thighs, started early and kept up. A few warning signs, covered below, mean you should be examined first.
What causes knee pain when climbing stairs?
Stairs bend the knee under load, which is why they expose several different problems. Where the ache sits, and what else you notice, points to the likely one. A clinician still has to confirm it.
| What you notice | Likely cause | Where to read more |
|---|---|---|
| Dull ache in the front of the knee or around the kneecap, worse on stairs (often going down), squatting, or after sitting a long time | Patellofemoral pain | This guide |
| Stiffness after rest, a grating feeling when you stand, walk or climb stairs, an older or previously injured knee | Knee osteoarthritis | Knee osteoarthritis treatment |
| One tender spot just below the kneecap, pain that builds with jumping or lunging | Patellar tendinopathy | Jumper's knee |
Patellofemoral pain. AAOS OrthoInfo describes a dull, aching pain in the front of the knee that usually begins gradually and shows up with activities that repeatedly bend the knee, such as climbing stairs, running, jumping or squatting. It can also bring pain after long sitting with the knees bent, and popping or crackling on stairs. Cleveland Clinic adds that pain is especially common going down stairs. The 2019 JOSPT guideline tells clinicians to diagnose it from pain around the kneecap that squatting, stair climbing or prolonged sitting reproduces, after other causes are excluded.
Osteoarthritis. Mayo Clinic lists a grating sensation when you stand up, walk or climb stairs, along with stiffness after rest and loss of flexibility.
Patellar tendinopathy. A 2015 JOSPT review names two hallmarks: pain at the lower tip of the kneecap, and pain that rises with demand on the thigh muscles, notably in jumping and landing.
One more point from the 2019 guideline: hip problems can send pain to the knee, and hip osteoarthritis has been reported to present mainly as knee pain. If the knee exam comes up clean, see our guide to hip arthritis treatment.
When is knee pain on stairs a reason to be seen first?
Get examined before you start any home program if the knee locks, gives way, swells after an injury, turns hot and swollen, or hurts after a fall or hard blow. Stair pain is often the overuse kind, but these signs point to a different problem that needs a different plan.
- Catching, locking or giving way. AAOS lists catching or locking and the sensation of the knee giving way among the symptoms of a meniscus tear, with stiffness and swelling building over two to three days.
- Swelling after an injury. For an ACL tear, AAOS says you might hear a pop and feel the knee give out, and the knee swells within 24 hours.
- A hot, swollen, painful knee, especially with a fever. MedlinePlus says septic arthritis (a joint infection) usually brings fever, swelling in one joint and intense pain that worsens with movement. Cleveland Clinic says a swollen joint with a fever should be seen right away.
- A fall or hard blow. The 2019 guideline tells clinicians to screen for fracture after acute knee injury with the Ottawa or Pittsburgh knee rules, so an injury like this belongs in an exam room.
- No improvement. Mayo Clinic says to call your healthcare professional if knee pain does not improve within a few days or it gets harder to move the knee.
What is the first-line care for patellofemoral pain?
Exercise comes first. The 2019 JOSPT guideline gives its strongest grade (A) to exercise that combines hip-targeted and knee-targeted work, to reduce pain and improve function in the short, medium and long term. The hip work targets the muscles at the back and side of the hip; the knee work can be squats or resisted knee extension. Hip work may come first early on, and the combination is preferred over knee-only training.
The reviews agree, with caveats:
- A 2018 meta-analysis of 14 trials (673 people) found hip and knee strengthening beat knee strengthening alone for pain and activity. The authors noted the gains came without a measured change in strength, so the exact mechanism is unclear.
- A 2022 meta-analysis of 65 trials found knee exercise beat sham, placebo or wait-and-see care in the short term, and hip-and-knee exercise beat knee exercise alone at three months. It concluded no treatment has been adequately tested beyond that point.
- The 2018 international consensus (41 experts voting on the evidence) also supports exercise, "especially the combination of hip-focused and knee-focused exercises."
- A Cochrane review from 2015 called its evidence very low quality but consistent in favor of exercise, with some very low quality evidence favoring hip plus knee work. It is a snapshot now, and the newer reviews above are stronger.
A starter set. The American Physical Therapy Association's home program uses five moves, listed here with its general dosing. Your physical therapist tailors it.
- Clamshells (side-lying, knees bent, lift the top knee)
- Bridging (on your back, lift the hips)
- Hip abduction (side-lying, lift the top leg)
- Straight leg raise
- Short arc quad raise (over a rolled towel)
Choose PT suggests one to three sets of 10 to 15 repetitions, one to two times a day, up to four days a week, and stopping an exercise if it increases your pain. If symptoms have not improved in two to three weeks, it advises seeing a physical therapist. The Mayo Clinic adds that over-the-counter pain relievers should not be taken for more than two to three weeks.
Do taping, braces and shoe inserts help?
Taping and prefabricated foot orthoses (shoe inserts) have short-term support when paired with exercise. Knee sleeves and braces do not. Here is how the two main sources rate each.
| Option | 2019 JOSPT guideline | 2018 international consensus |
|---|---|---|
| Patellar taping | May use tailored taping with exercise for short-term pain relief (4 weeks); grade B | Uncertain |
| Knee braces, sleeves, straps | Should not prescribe; grade B | Uncertain (listed with taping) |
| Foot orthoses | Prefabricated inserts for people with greater-than-normal foot pronation, for up to 6 weeks, with exercise; grade A | Supports use |
"Tailored" taping means a clinician adjusts the tape to cut pain during a task such as a step-down. The guideline adds that taping may not help in the longer term or on top of more intensive physical therapy. On inserts, it finds insufficient evidence that custom ones beat prefabricated ones. A 2022 review found foot orthoses beat control on global rating of change at short term follow-up. Both sources are several years old, so ask a physical therapist what current practice looks like.
How do you take stairs while the knee settles?
Cut back on repetitive stair climbing, kneeling and squatting for a while, and swap in low-impact work. Mayo says to avoid things that increase the pain, such as climbing stairs repetitively, kneeling or squatting. AAOS says to stop the activities that hurt until the pain goes away and suggests a stationary bike, elliptical or swimming in the meantime. HSS says to minimize stair climbing, at least temporarily, while the knee quiets down.
You cannot always avoid stairs, so here is what we can and cannot say. We did not find a trial that tests stair technique for knee pain, so treat the habits below as practical suggestions.
- Take stairs slowly. A small 2002 study (10 people with patellofemoral pain, 10 without) found those with pain climbed more slowly and put less force through the kneecap joint, which kept the stress on it at normal levels.
- Prefer dry, even, well-lit stairs. A 2024 study of 12 younger and 12 older adults found older adults had higher kneecap-joint stress going up stairs, and slick and uneven stairs changed the stress pattern.
- Use the handrail for balance. We found no study that measures how much it unloads the knee.
- Let a physical therapist watch you take stairs. Choose PT says therapists watch how you walk, use stairs, squat and balance, then target the weak areas they find.
Where do studio services fit?
For patellofemoral pain, the main guideline advises against laser and electrical therapies, so treat studio services as optional extras beside your exercise program. The 2019 guideline says clinicians should not use biophysical agents, including electrical stimulation and therapeutic laser, for patellofemoral pain (grade B), and the 2018 consensus does not recommend electrophysical agents. Those findings are about patellofemoral pain; they do not settle every knee problem.
OutRecover's pages describe Class IV laser as a clinician-guided laser used for back, knee and shoulder discomfort, PEMF as a mat that sends gentle electromagnetic pulses, and red light as a full-body bed. If your knee pain is arthritis, our osteoarthritis guide covers what the guidelines and trials say about each, and the studio's joint health research summary lists its own sources.
One studio service lines up with a specific line in the guideline. For people whose knee extension hurts too much to train, the 2019 guideline says clinicians may use blood flow restriction plus high-repetition knee exercise, while monitoring for adverse events. That is its weakest grade (F, expert opinion), and the 2018 consensus called blood flow restriction uncertain. The studio's KAATSU session is light training with bands, and the research is on the blood flow restriction page. It is not for people with a history of deep vein thrombosis.
Two packages fit best, in this order:
- OutRelief lists shoulder, hip and knee pain and arthritis pain and stiffness among who it is for. It combines PEMF, Class IV laser and red light, plus an IV and molecular hydrogen, which this guide did not review.
- OutMove is a shorter program for stiff, achy joints, with the same three light and magnetic services.
If you have had knee surgery, clear anything new with your surgeon first.
What should you do this week?
Check for warning signs first, then start the exercise and give it two to three weeks.
- Check the warning signs above. If any fits, book an exam before anything else.
- If none does, see a physical therapist or sports medicine doctor, or start the five exercises and note what changes in two to three weeks.
- Decide on taping or inserts with that clinician, as a short-term add-on to the exercise.
- If you want a studio add-on, call the studio or take the recovery quiz, and judge it against a goal you set first, such as climbing a flight without a rest.
Sources
- Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health. Journal of Orthopaedic & Sports Physical Therapy, 2019. https://www.orthodiv.org/wp-content/uploads/2021/08/WillyetalCPGforPFPjospt.2019.pdf (abstract: https://pubmed.ncbi.nlm.nih.gov/31475628)
- Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain. British Journal of Sports Medicine, 2018. https://pubmed.ncbi.nlm.nih.gov/29925502
- Neal BS, Bartholomew C, Barton CJ, Morrissey D, Lack SD. Six treatments have positive effects at 3 months for people with patellofemoral pain: a systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 2022. https://pubmed.ncbi.nlm.nih.gov/36070427
- Nascimento LR, Teixeira-Salmela LF, Souza RB, Resende RA. Hip and knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy, 2018. https://pubmed.ncbi.nlm.nih.gov/29034800
- van der Heijden RA, Lankhorst NE, van Linschoten R, et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews, 2015. https://pubmed.ncbi.nlm.nih.gov/25603546
- American Academy of Orthopaedic Surgeons. Patellofemoral pain syndrome. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/
- American Academy of Orthopaedic Surgeons. Meniscus tears. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/
- American Academy of Orthopaedic Surgeons. Anterior cruciate ligament (ACL) injuries. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/
- MedlinePlus. Septic arthritis. National Library of Medicine. https://medlineplus.gov/ency/article/000430.htm
- Cleveland Clinic. Joint effusion (swollen joint): symptoms, causes, and treatment. https://my.clevelandclinic.org/health/symptoms/21908-joint-effusion
- Cleveland Clinic. Patellofemoral pain syndrome (PFPS): symptoms and treatment. https://my.clevelandclinic.org/health/diseases/17914-patellofemoral-pain-syndrome-pfps
- Mayo Clinic. Patellofemoral pain syndrome: symptoms and causes; diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792 and https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/diagnosis-treatment/drc-20350797
- Mayo Clinic Orthopedics and Sports Medicine. Knee arthritis, overview. https://sportsmedicine.mayoclinic.org/condition/kneearthritis
- Hospital for Special Surgery. Knee pain due to patellofemoral disorders and treatments. https://www.hss.edu/health-library/conditions-and-treatments/list/patellofemoral-disorders
- American Physical Therapy Association. 5 exercises to reduce knee pain. Choose PT, reviewed 2024. https://www.choosept.com/health-tips/Five-exercises-reduce-knee-pain
- American Physical Therapy Association. Physical therapy guide to knee pain. Choose PT. https://www.choosept.com/guide/physical-therapy-guide-knee-pain
- Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. Journal of Orthopaedic & Sports Physical Therapy, 2015. https://pubmed.ncbi.nlm.nih.gov/26390269
- Brechter JH, Powers CM. Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait & Posture, 2002. https://pubmed.ncbi.nlm.nih.gov/12297253
- Hunt, Holcomb, Fitzpatrick, et al. Effects of aging on patellofemoral joint stress during stair negotiation on challenging surfaces. Biomechanics, 2024. https://pubmed.ncbi.nlm.nih.gov/39364279
