Knee Pain When Going Down Stairs (Exercises And Stretches)

Do you experience knee pain when going down stairs?

This blog post will cover the best exercises and stretches to help address this issue.

What knee structures could be hurting as you walk down stairs?

As shown from the list below, there are multiple structures in the knee that can cause pain as you walk down stairs.

a) Front of the Knee: Patellofemoral Joint, Patella Tendon, Distal Thigh (Quadricep) Muscle, Anterior Portion of Meniscus

b) Inner Side of the Knee: Medial Joint Line, Medial Hamstring Tendon, Medial Collateral Ligament (MCL), Pes Anserine Bursitis, Medial Plica

c) Outer Side of the Knee: Lateral Joint Line, Lateral Collateral Ligament (LCL), ITB Friction Syndrome, Lateral Plica

d) Back of the Knee: Distal Hamstring Tendons, Upper Calf Muscles, Posterior Portion of Meniscus, Baker’s Cyst, Popliteus

As each specific knee issue will benefit from a specific treatment, I will not be able to go through each individual issue on this blog post.

However – That being said, the suggestions presented on this blog post can be applicable and beneficial to injuries to all of the above structures.

Why do people have knee pain whilst going downstairs?

As you step down from a stair, the knee moves forwards relative to the position of the foot.

The body weight then is transferred to the front of the foot.

This position tends to place more load onto the knee which can stress the structures of the knee.

If the knee does not have the capacity to tolerate this amount of load, this may lead to an injury whilst going down stairs.

This issue is amplified if there is:

• A degree of rotation in the knee
• Increased body weight
• Past injuries to the knee
• Weakness

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How to fix Knee Pain when going down stairs

STEP 1: Avoid Walking Down Stairs
STEP 2: Reduce Inflammation
STEP 3: Apply a Knee Support
STEP 4: VMO Exercises
STEP 5: Ideal Alignment of Knee
STEP 6: Ankle Dorsiflexion
STEP 7: Midfoot Stiffness
STEP 8: Foot Stability
STEP 9: Hip Stability
STEP 10: Strengthen Tibialis Anterior
STEP 11: Strengthen Calf
STEP 12: Knees Over Toes Exercises
STEP 13: Lose Weight

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STEP 1: Avoid Walking Down stairs

If the act of walking down stairs aggravates your knee pain, you may need to consider avoiding using them for a short period of time.

(Obviously – You can’t avoid using stairs forever. In the initial stages of your rehabilitation, it is better to minimize the chance of aggravating the symptoms in the knee).

As your knee condition improves, you will need to perform exercises which focus on improving your ability to walk down stairs without pain.

Note: You may also need to avoid/reduce exposure to any position, movement and/or activity that increases your knee pain.

Quick Tips

If you have to walk down stairs, consider the following:

• Hold onto the hand rails to reduce the load on the knee.
• Step down with your painful leg first.
• Take your time.

STEP 2: Reduce Inflammation

A significant amount of inflammation in the knee can make it too painful to perform the suggested exercises on this blog post.

Here are some simple ways to reduce inflammation:

a) Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the painful areas of the knee.

Do this 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.

(Note: Please consult your Primary Care Provider before taking any medication.)

c) Cold Therapy

Apply an ice pack to the painful area of the knee for at least 10-15 minutes.

Do this 3-5 times per day.

(Note: Do not apply the ice pack directly to the skin as it may cause an irritation.)

d) Try Natural Products

It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.

(To be honest – I am not 100% how effective this is! … But it might be worth a shot.)

e) Cortisone Injection

The cortisone injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.

Talk to your Primary Care Provider to see if the cortisone injection is appropriate for your shoulder injury.

STEP 3: Apply Knee Support

In the early stages of rehabilitation, you may benefit from providing external support to the knee.

Here are 3 ways you can achieve this:

1. Knee Tape

Applying tape to the knee can help reduce the amount of knee pain experienced when walking down stairs.

See Video by Rock Tape

Instructions:

• Bend your knee to 90 degrees of flexion.
• Outline the border of the knee cap.
• Starting from the top of the knee, apply 2x intersecting tape bordering the knee cap at 30 % stretch towards the bottom of the knee.
• Apply decompression tape horizontally across the patella tendon at 80% stretch.

2. Knee Brace

Wearing a knee brace can help provide support to the muscles and joint.

It can also keep the knee structures warm which may help with reducing pain.

(Note: Make sure that you use a brace that fits the size/shape of your knee appropriately. Poorly fitted knee braces will not support your knee adequately.)

3. Crutches

Using crutches will help take some of your body weight off your knee.

STEP 4: VMO exercises

The Vastus Medialis Oblique (VMO) is an important muscle which helps stabilize the knee as you walk down stairs.

It is located on the inner side of the thigh.

a) VMO Activation

It is important that you can ACTIVATE and FEEL the VMO muscle engage.

Aim to feel the VMO activation in all of the exercises suggested in this section of the blog post.

Instructions:

• Lie down on the floor.
• Place a rolled up towel underneath your ankle.
• Keep your leg straight.
• Push your knee downwards as hard as you can comfortably tolerate.
• Aim to feel a firm contraction in the VMO muscle.
• You can place your hand on top of the inner thigh muscle (above the knee cap) and feel the for the contraction.
• Hold for 5 seconds.
• Repeat 20 times.

b) Straight Leg Raise

Instructions:

• Lie down on the floor.
• Push your knee downwards.
• Keep your knee completely locked straight throughout this exercise.
• Pivot your leg outwards.
• Aim to feel a firm contraction in the VMO muscle.
• Lift your leg slightly.
• Perform 20 repetitions.
• Progression: Add an ankle weight.

Note: It is important that you keep the leg completely locked straight throughout this exercise. If you can not keep your leg straight, it is likely that you’ll need to persist with the previous exercise first to build more strength in the VMO muscle.

c) Terminal Knee Extension

Instructions:

• Lie down on the floor.
• Place a rolled up towel underneath your knee.
• Pivot your leg outwards.
• Push your knee down onto the rolled up towel.
• Whilst keeping the downward pressure onto the towel, lift your foot off the floor.
• Aim to feel a firm contraction in the VMO muscle.
• Hold for 5 seconds.
• Repeat 20 times.
• Progression: Add an ankle weight.

Looking for more VMO exercises to strengthen the knee?

See Post: VMO Exercises

STEP 5: Understand the Ideal alignment of the leg

The ideal alignment of the leg involves the hip/knee/foot being in line with one another.

The aim should be to preserve this alignment whilst walking down stairs.

This helps distribute the load on the knee more evenly throughout the knee structures.

(Note: You do not need to maintain 100% perfect alignment of the leg to have function in the knee, but in my opinion , this is something that should be aimed for.)

Keep this idea of the ideal alignment of the leg when performing the exercises on this blog post.

(The following steps from 6-11 will help preserve this ideal alignment.)

STEP 6: Improve Ankle Dorsiflexion

Ankle Dorsiflexion is the movement of the ankle where it bends backwards.

An adequate amount of ankle dorsiflexion is essential when walking down stairs to help preserve the ideal hip/knee/foot alignment.

Limited ankle dorsiflexion whilst walking down stairs may result in the knee collapsing inwards which places a rotational stress on the knee. (See above)

This knee position may place more pressure on certain structures of the knee leading to pain whilst walking down stairs.

Ankle Dorsiflexion Test

Do you have stiff ankles?

Try out this quick test to see how much range of motion you have in your ankle.

Instructions:

• Face a wall.
• Keep the front of your knee in contact with the wall throughout this test.
• Move your foot away from the wall.
• Aim to get the front of your toes as far away from the wall whilst keeping the knee in contact with the wall.
• Keep feet flat on floor. Do not allow your heels to lift off the floor.
• Do not allow your ankle/foot to roll inwards.
• Measure the distance between the tip of your big toe and the wall.

My recommendation: Aim to get the tip of the big toe approximately >4 inches from the wall.

If you have tight ankle, here are a few ways to improve your ankle dorsiflexion:

a) Calf Release

Instructions:

• Sit down on the floor with both legs straightened in front of you.
• Place a foam roller underneath the calf muscle that you would like to release.
• Place the weight of the other leg on top of the leg that is on the foam roller.
• Keep the bottom leg completely relaxed throughout this exercise.
• Apply a firm downward pressure with the leg at the top.
• Rock your leg from side to side.
• Make sure to cover the entire length of the calf muscle.
• Continue for 2 minutes.

b) Calf Stretch

Instructions:

• Stand on the edge of a step.
• Keep the leg at the back completely straight.
• Slowly lower the heel of the back leg.
• Do not let the foot arch to collapse.
• Aim to feel a stretch in your calf muscle.
• Hold this stretch for at least 30 seconds.

c) Dorsiflexion with Band

Instructions:

• Attach a resistance band to a stationary object at floor height.
• Loop the other end of the resistance band around your ankle.
  • Make sure the band is below the bumps on side of the ankle.
• Move away from the anchor point as to increase tension in the band.
• Assume the lunge position with your ankle on a bench. (See above)
• Lunge forward.
• Do not allow for your foot arch to collapse.
• Repeat 30 times.

Do you have stiff ankles? Check out my complete guide on how to reclaim the full movement of your ankles:

See Post: How To Increase Ankle Dorsiflexion

STEP 7: Improve Midfoot stiffness

Stiffness in the middle region of the foot may hinder the ability for the foot to splay out as you walk downstairs.

Without the natural splaying of the foot, this will usually lead to the knee collapsing inwards as you walk down stairs.

This will cause the knee to lose the ideal knee alignment which may place excess pressure on certain structures in the knee.

The following exercise will help loosen up the joints.

a) Midfoot Mobilization

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Hold the midfoot with one hand.
• Using your other hand, place your thumb under the base of the big toe and the other fingers on top of the base of the pinky toe. (See image)
• Whilst anchoring the midfoot still, proceed to rotate the forefoot away from you.
• Perform 30 repetitions.

STEP 8: Foot stability

The knee position is strongly influenced by the control of the foot.

Poor control of the foot whilst walking down stairs will likely lead to the knee moving out the ideal alignment of the leg.

Here are some great exercises for the foot:

a) Maintain the Foot Tripod

When performing exercises for the knee, it is important that you “Maintain the foot tripod”.

This involves loading the foot equally between the 3 points as shown above.

Your feet serve as the foundation to your whole body.

If your feet are not stable, the knee will not be stable.

b) Maintain the Neutral Arch of the Foot

Maintaining a more neutral position of your foot will encourage the knee to be in a better alignment.

Here is a great exercise for it:

Instructions:

• Stand with your feet facing forwards and shoulder width apart.
• Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
  • Drag the base of your big toe backwards towards the heel.
• Keep the base of the big toe in contact with the ground to prevent this area from lifting.
• Gently push the tip of your big toe down onto the ground.
• Aim to feel a strong contraction of the muscles underneath your foot.
• Hold this for 5 seconds.
• Repeat 20 times.

c) Single Leg Balance

The goal with this exercise is to keep your foot as still as possible.

Instructions:

• Stand on one leg.
• Aim to keep your foot as still as possible.
• Hold for 30 seconds.

Note: If you are having issues with keeping the foot still when balancing on one foot, you will need to lightly hold onto something for balance.

step 9: Hip Stability

If you have weak hips, this can result in the poor control of the knee alignment as you walk downstairs.

a) Gluteus Medius Strengthening Exercise

Instruction:

• Stand side ways next to a wall.
• Lift your knee up to hip height and place the side of that leg against a wall.
• Bend your planted leg to ~10 degrees.
• Push the lifted leg into the wall.
• Aim to feel a muscular contraction on the side of both hips.
• Hold this position for 5-10 seconds.
• Repeat 10 times.
• Repeat on the other side.
• Progression: Perform the exercises with the knee in a more bent position.

If you would like to see more exercises to help stabilize your hip, check out this blog post:

See Post: Gluteus Medius Strengthening Exercises

step 10: Strengthen The Tibialis Anterior

The Tibialis Anterior is a muscle that is located at the front/side of the shin and attaches to the inner side of the foot.

Strengthening the Tibialis Anterior can help control and stabilize the knee as you walk down stairs.

Here are a few exercises to help strengthen this muscle:

a) Seated Foot Raises

Instructions:

• Sit down on the edge of a chair.
• Have both feet flat on the floor.
• Lift the front part of your foot.
• Hold for 3-5 seconds.
• Aim to feel a contraction in your shin.
• Perform 20 repetitions.

b) Standing Against Wall

Instructions:

• Stand up right.
• Lean your back onto a wall.
• Have your feet away from the wall.
• Lift the front part of your foot.
• Hold for 3-5 seconds.
• Aim to feel a contraction in your shin.
• Perform 20 repetitions.
• Progression: Place your feet further away from the wall.

c) Resistance Band

Instructions:

• Tie a resistance band on a stationary object.
• Loop the other end of the resistance band around the forefoot.
• Sit down on the floor.
• Move away from the anchor point to increase tension in the resistance band.
• Move your foot towards you.
• Aim to feel a contraction in the shin.
• Perform 20 repetitions.
• Progression: Increase tension on the resistance band.

STEP 11: Strengthen The Calf (with knee slightly bent)

It is important to strengthen the calf muscle with knee in slightly bent position.

This is to mimic the same position your leg adopts as you walk down stairs.

Instructions:

• Stand up right.
• Hold onto something for balance.
• Stand on one leg.
• Bend your knee slightly forwards.
• Maintain this knee position throughout this exercise.
• Lift your heels up/down off the floor.
• Hold for 3 seconds at the top of movement.
• Perform 20 repetitions.
• Progression:
  • Use less arm support.
  • Bend the knee more forwards.

STEP 12: Knees Over Toes Exercises

When walking down stairs, the knee naturally translates forwards relative to the foot.

This is referred to the “knees over toes” position and naturally places more stress/load/demand on the knee.

The exercises suggested in this section are aimed at strengthening the knee in this “knees over toes” position.

Make sure that there is NO knee pain whilst you are performing the exercises.

If the exercises are too difficult, apply more support using your hands to offload the pressure on the knees.

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Progression:

Note: All of these exercises can be progressed by the following methods:

• Use less support from your hands.
• Move your knee further into range.
• Perform the exercise slower.
• Hold onto a weight.

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a) Wall Lunge

Instructions:

• Place your foot onto a step.
• Have both of your hands supported onto a wall that is in front of you.
• For the leg that is on the step, keep the knee in line with your foot throughout this exercise.
• Place as much of your body weight onto the leg that is at the front.
• Lunge forwards.
• Allow your knee to move forwards over your toes as much as you can comfortably tolerate.
• Provide as much support from your hands as required.
• Perform 20 repetitions.

b) Knees Over Toes Squat

Instructions:

• Keep the feet shoulder-width apart.
• Place your heels onto a small step.
  • (This will place more pressure on your forefoot and toes.)
• Make sure to keep your knees in line with your feet at all times.
• Slowly bend your knees forwards.
• Only squat to a depth that you are comfortable with.
• Perform 10 repetitions.
• Note: If required – you can off load some of your body weight off your knees by holding onto a table for support.

c) Toe Tap

Instructions:

• Stand up right.
• Hold onto a stationary object for support.
• Stand on one leg.
• For the leg that is on the ground, keep the knee in line with your toes throughout this exercise.
• Using your other foot, reach and gently tap your toe on the ground as far forwards as possible.
  • As you perform this movement, the knee on the floor should move forwards relative to the foot.
• Return to the starting position.
• Perform 20 repetitions.

d) Step Down

Instructions:

• Stand on top of a step.
• Hold onto a hand rail for support.
• For the leg that is on the step, keep the knee in line with your toes throughout this exercise.
• Using your other foot, slowly reach your foot down towards the step below.
• Only lower the foot to a level that you are comfortable with.
• Return to starting position.
• Perform 20 repetitions.

step 13: Reduce Body Weight

Carrying excess weight on your body will place more stress on the knee as you walk down stairs.

If you are over weight, reducing body weight can help reduce the stress on your knees.

Please seek professional guidance if you are not sure how to achieve this.

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Conclusion

The act of walking down stairs can place excess pressure on the structures of the knee.

There are multiple structures in the knee that can potentially be injured.

Follow the 13 steps as mentioned on this blog post to increase your ability to walk down stairs without pain.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before attempting any exercise. For more information: Medical Disclaimer.