Knee Pain When Walking, Running or Using Stairs: What Could Be Going On?

Knee pain can show up in surprisingly specific situations. You may feel fine while sitting or standing, but notice discomfort when walking downhill, running, climbing stairs, getting up from a chair or increasing your activity level.

The reason is not always obvious. Knee pain during movement can be related to the kneecap, tendons, muscles, meniscus, joint irritation or the way your hip, knee and ankle work together.

At Zone 4 Physiotherapy & Wellness Centre, we often see people whose knee symptoms are affecting everyday movement, exercise or their ability to stay active. Understanding when the pain occurs and what makes it better or worse can provide useful information during an assessment.

This article explains some common reasons your knee may hurt when walking, running or using stairs, what different symptoms may suggest, and when it may be worth having your knee assessed.

Why Does Knee Pain Show Up During Walking, Running or Stairs?

Your knee does not experience the same demands during every activity.

Walking on level ground generally requires less knee bending and muscular effort than running, squatting or climbing stairs. When you use stairs, your knee bends further while the muscles around your hip and thigh work to control your body weight.

Running adds another challenge. Each step involves repeated loading, and changes in training volume, speed, terrain or recovery can affect how well your knee tolerates that load.

This is why someone may have little discomfort during normal walking but experience pain while running or climbing stairs.

The location of your pain, how it started and which movements trigger it can all provide clues, but symptoms alone cannot reliably diagnose the underlying cause.

Common Causes of Knee Pain During Activity

Several conditions can cause similar knee symptoms. Some of the more common possibilities include:

Patellofemoral Pain

Patellofemoral pain is commonly felt around or behind the kneecap. It can become noticeable during activities that require repeated knee bending, including:

• climbing or descending stairs
• running
• squatting
• kneeling
• getting up from a chair
• sitting for a long time with the knee bent

It is sometimes called runner’s knee, although you do not have to be a runner to experience it.

Changes in activity, training load, muscle strength and movement patterns may all play a role. HealthLink BC notes that patellofemoral pain can be associated with overuse, weak thigh muscles or problems with kneecap movement. HealthLinkBC

Tendon Related Knee Pain

The tendons around the knee help transfer force between muscles and bones.

Repeated running, jumping or a sudden increase in activity can sometimes make a tendon more sensitive to load. Tendon-related discomfort may be more noticeable during exercise and may settle when activity is reduced.

Where the pain is located can vary depending on which tendon is involved.

Meniscus Related Symptoms

The menisci are structures inside the knee that help distribute load through the joint.

Meniscus problems can occur following a twisting injury, but changes to the meniscus can also develop gradually.

Possible symptoms can include pain along the inside or outside of the knee, stiffness, swelling or catching sensations.

Importantly, symptoms vary considerably between people. An assessment considers your symptoms and function rather than relying on one symptom alone.

Knee Osteoarthritis

Knee osteoarthritis involves changes within the joint that become more common with age.

Some people notice stiffness after sitting or resting, discomfort during longer walks or increased symptoms when using stairs.

Having osteoarthritis does not automatically mean you should stop being active. Appropriate movement and strengthening are often important parts of managing symptoms and maintaining function.

Muscle Strength and Movement Control

Sometimes the knee itself is only part of the picture.

Your quadriceps, hamstrings, gluteal muscles and other muscles around the hip and leg help control how forces move through the knee.

Reduced strength or changes in movement control may become more noticeable when the physical demand increases, such as during running, hiking, squatting or climbing stairs.

This is one reason a physiotherapy assessment may look beyond the painful area and assess the hip, ankle, strength and overall movement pattern as well.

Why Does My Knee Hurt When Going Up or Down Stairs?

Stairs require more knee flexion and muscular control than level walking.

When going upstairs, your quadriceps and hip muscles help lift your body onto the next step. When going downstairs, those muscles must control your body as you lower yourself.

For some people, the increased demand around the kneecap can make existing sensitivity more noticeable.

Pain around the front of the knee during stairs is commonly associated with patellofemoral pain, although it is not the only possible explanation.

If stairs repeatedly trigger your symptoms, it is useful to note whether the pain is worse going up, down or both, and whether you experience swelling, clicking, catching or instability.

Those details can help guide an assessment.

What About Knee Pain When Running?

Running involves repeated loading, so knee symptoms may appear when the amount of activity exceeds what the tissues are currently prepared to tolerate.

For example, symptoms may begin after:

• increasing weekly running distance
• adding hills
• increasing running speed
• returning after time away from training
• changing running surfaces
• adding other demanding activities at the same time

This does not necessarily mean running has damaged your knee.

Instead, it may indicate that something about your current training load, strength, movement or recovery needs to be assessed.

For runners and other active individuals, rehabilitation may include progressive strengthening and a gradual return to activity rather than simply avoiding movement.

Could Your Hip, Ankle or Foot Be Contributing?

Knee pain is not always assessed in isolation.

The hip, knee, ankle and foot work together during walking and running. Changes in strength, mobility or control elsewhere in the lower limb can influence how movement is distributed.

For example, a physiotherapist may assess:

• hip strength and control
• knee mobility
• ankle mobility
• balance
• walking or running mechanics
• tolerance to squatting and stepping
• strength differences between sides

Foot mechanics may also be relevant for some people.

When appropriate, an assessment may consider whether custom orthotics could form part of a broader management plan, particularly when foot mechanics or footwear are relevant to the person’s symptoms.

Should You Keep Exercising With Knee Pain?

It depends on the cause, severity and behaviour of your symptoms.

Not every episode of knee discomfort means you need to stop moving completely. In some situations, temporarily modifying the activity may be more useful than avoiding it altogether.

For example, this could involve reducing running distance, changing exercise intensity or temporarily avoiding a movement that repeatedly aggravates symptoms.

The important point is that exercise should be appropriate for your individual situation.

A generic list of “best knee exercises” cannot account for differences in injury history, strength, mobility, symptoms and diagnosis.

When Should You Get Knee Pain Assessed?

Consider having your knee assessed when pain:

• keeps returning during walking, running or stairs
• is getting progressively worse
• limits your normal activities
• affects your ability to exercise or participate in sport
• persists despite modifying the activity
• is associated with recurring swelling or instability

Certain symptoms deserve more prompt medical attention.

HealthLink BC recommends seeking medical assessment for symptoms including severe pain, significant swelling following an injury, inability to bear weight, inability to fully straighten the knee, instability or a knee that locks in one position. HealthLinkBC

What Can a Physiotherapy Assessment Look At?

A physiotherapy assessment is not simply about finding the painful spot.

Depending on your symptoms, your physiotherapist may assess your knee mobility, strength, balance and movement during activities that reproduce your symptoms.

They may also look at your hip and ankle because these areas can influence lower-limb movement.

At Zone 4, treatment recommendations are based on your assessment, symptoms and goals rather than using the same approach for every person.

Depending on what is found, your rehabilitation plan may include progressive strengthening, mobility work, movement education, activity modification and other appropriate physiotherapy techniques.

For people who want to return to sport, hiking or higher-level activity, kinesiology and active rehabilitation may also support the transition toward rebuilding strength, movement capacity and confidence.

Knee Pain and Staying Active in North Vancouver

Living in North Vancouver often means plenty of opportunities to walk, run, hike and spend time outdoors.

If knee pain is making stairs, neighbourhood walks, running or other activities uncomfortable, identifying what is contributing to your symptoms can help you make more informed decisions about activity and recovery.

At Zone 4 Physiotherapy & Wellness Centre, our team provides Physiotherapy in North Vancouver for people dealing with knee pain, sports injuries and other musculoskeletal concerns.

The goal is not simply to focus on where it hurts. An assessment can help determine how strength, mobility, movement and activity demands may be contributing to the problem.

Frequently Asked Questions

Why does my knee hurt on stairs but not when walking?

Stairs require greater knee bending and muscular effort than level walking. This can make symptoms around the kneecap or other sensitive structures more noticeable even when normal walking feels comfortable.

Does knee pain on stairs mean I have arthritis?

No. Osteoarthritis is one possible cause, but patellofemoral pain, tendon problems, meniscus-related symptoms and other factors can also cause pain during stairs. An assessment is needed to determine what may be contributing in your individual case.

Why does my knee hurt when I start running more?

A sudden increase in running distance, intensity, hills or overall training load can increase the demands placed on the knee. Strength, recovery, previous injuries and movement patterns may also be relevant.

Can weak muscles contribute to knee pain?

Reduced strength around the hip, thigh and lower leg can influence how the knee manages load during activities such as stairs, running and squatting. Strength is therefore commonly considered during assessment and rehabilitation.

Should I stop running if my knee hurts?

Not necessarily. The appropriate response depends on your symptoms and their cause. Some people may benefit from temporarily reducing or modifying their running while gradually rebuilding capacity. Persistent or worsening pain should be assessed.

Get Your Knee Pain Assessed

Knee pain during walking, running or using stairs can have several possible causes, and similar symptoms can occur with different conditions.

Rather than trying to diagnose the problem based on one movement or symptom, a proper assessment can help identify factors that may be contributing to your pain and determine an appropriate plan.

If knee pain is interfering with your daily activities, running, hiking or exercise, the Zone 4 team can assess your movement, strength and symptoms and help you plan the next steps in your recovery.