Why does the area around my kneecap hurt when I go down stairs?

Why downstairs is harder than upstairs

Going down a step, the front thigh muscle lengthens while it brakes your body weight on a bent knee. That pulls the kneecap firmly into its groove, and the force rises the more the knee bends. If the joint is sensitised, this is often the first everyday activity to hurt, before walking on the flat or even climbing up.

People often notice it on the stairs at home, at a mall car park, on stadium steps after a match, or walking down the slopes at the end of a desert outing.

What usually lies behind it

In most people it is patellofemoral pain: an overload of the kneecap joint rather than a tear. Typical triggers are a recent rise in running, hiking or gym leg work, weak quadriceps or hip muscles, and returning to activity after a long break. Previous kneecap dislocation, a tight outer thigh and flat, rolling feet can add to it.

Pain that is sharp and on the inner or outer joint line, rather than around the kneecap, raises the possibility of a meniscus problem instead.

Making stairs easier now

• Use the handrail and take the stairs one step at a time, leading down with the sore leg while the pain settles
• Use lifts or ramps for a few weeks if stairs flare the knee badly
• Strengthen the thigh and hip muscles with step-ups on a low step, bridges and side leg raises
• Practise slow, controlled step-downs from a low step, keeping the knee in line with your second toe
• Reduce squatting, lunging and downhill walking until the stairs become more comfortable

When to see a knee surgeon

See a specialist if the pain is not improving after six to eight weeks of sensible changes, if the knee swells, catches or gives way, or if you had a definite injury such as a twist or fall. At Aman Hospital in Doha, the assessment focuses on how the kneecap tracks, muscle control on a step-down, and ruling out cartilage or meniscus damage.