Why Do I Have Knee Pain When Going Up Stairs?

Knee pain when going upstairs can be caused by many things, but two of the most common are chondromalacia patella and arthritis. These two conditions can take a seemingly benign task like stair climbing and turn it into a challenging endeavor. Fortunately, increasing your knowledge of each issue can help you treat the condition and reduce your pain.

Sportswoman with hurt leg sitting on ground

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Chondromalacia Patella

Chondromalacia patella occurs when the smooth, slippery cartilage tissue that lines the back of your knee cap (patella) begins to soften and break down. As your knee bends and straightens, the patella normally slides up and down in a groove at the bottom of your upper leg bone (called the femoral groove). In people with chondromalacia patella, increased amounts of rubbing and friction occur as a result of this cartilage breakdown and can irritate your joint.

Symptoms

One of the hallmark signs of chondromalacia patella is a dull, achy pain that is centered in the area behind the knee cap. This condition can also lead to soreness and aches in the areas below or on the inside or outside of your patella as well.

As mentioned before, soreness while going up the stairs is one of the primary complaints by people who are experiencing this issue. In addition, however, activities like squatting, walking downhill, running, and standing up after a longer period of sitting can also be more difficult or painful with chondromalacia patella.

Causes and Risk Factors

Several different risk factors can make you more likely to develop chondromalacia patella in your knee. Individuals who are overweight are at greater risk due to the increased amount of stress placed on the joint. Females and people with a previous injury—such as a fracture or dislocation—to their knee cap are also more susceptible.

Often informally called “runner’s knee," chondromalacia patella is also more frequently seen in individuals who participate in endurance sports like running or biking. In this situation, muscular imbalances that cause the knee cap to track improperly in the femoral groove may lead to repetitive rubbing and irritation. 

Arthritis

As the breakdown of the knee’s cartilage progresses, the space between the bones in the knee (the tibia, the fibula, and the patella) diminishes and damage to one or several of them can develop. This is referred to as arthritis. While there are many different varieties of this condition, by far the most prevalent is osteoarthritis.

Symptoms

Both chondromalacia patella and arthritis can make activities like climbing the stairs, walking, and squatting quite painful. Several other symptoms can help you distinguish between the two conditions, however. Osteoarthritis is typically seen in middle and older aged individuals. In addition, osteoarthritis usually causes knee stiffness and swelling (particularly in the morning and after long periods of sitting down). This can make it difficult to bend or straighten the knee and cause the first few steps of the day to be sore and challenging.

Causes and Risk Factors

There are multiple different factors that can put you at a greater risk of developing arthritis. Like chondromalacia patella, females and individuals who are overweight more frequently experience this condition. People with a previous injury to their knee or whose career or chosen sport places repetitive stresses on the joint are also at risk. In addition, there seems to be a genetic component to this condition which makes you more likely to develop it if your family members also have issues with arthritis.

Diagnosis

When diagnosing osteoarthritis, an X-Ray is typically used to visualize the space between the bones at the knee joint and any damage that may have occurred to the bone itself. If the doctor suspects another form of this condition (like rheumatoid or psoriatic arthritis) is to blame, a blood draw may also be necessary to confirm their diagnosis.

In the case of chondromalacia patella, the damage to the cartilage itself is not able to be visualized on an X-Ray. As such, an MRI is usually necessary to properly diagnose this condition. In addition, a thorough doctor’s examination and review of your symptoms are beneficial when diagnosing either of the two issues.

Treatment

Both chondromalacia patella and arthritis are diagnoses that can be well-managed with conservative measures initially, especially when the symptoms are mild to moderate in intensity. The suggestions below may be useful in relieving the pain you feel when ascending stairs.

Chondromalacia Patella

Because chondromalacia patella is commonly seen in people who participate in repetitive activities like running, rest can play a big role in reducing the pain associated with this condition. Icing your knee and using over-the-counter or prescription pain medication can also help calm down a flare-up in your joint.

To prevent future issues, physical therapy may be necessary to help build up strength and flexibility in your leg muscles. This can help reduce the forces placed on the knee itself and improve the tracking of your knee cap.

Your therapist may also work with you to modify your running or biking form to reduce your knee pain. In addition, weight loss and modifications to your footwear can be helpful in relieving your soreness in certain situations.

Arthritis

Much like chondromalacia, acute arthritis aggravations can be improved by using the RICE principle (Rest, Ice, Compression, Elevation). Over-the-counter pain medication and striving to stay active are also important. Riding a stationary bike with minimal resistance or going for a short walk can help loosen up a stiff knee and improve your overall soreness. On the contrary, bed rest or remaining sedentary is rarely an effective solution.

Long term treatment of your arthritis may also include physical therapy designed to strengthen your supporting hip and knee muscles and improve your overall flexibility. The use of an orthotic in your shoe and maintaining a healthy weight can also help diminish the stress placed on your arthritic knee joint.

In some cases, unfortunately, conservative treatment is not effective in relieving your symptoms and surgery may be necessary. In this situation, a partial or total knee replacement may be performed and outpatient therapy is needed afterward.

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Article Sources
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  1. Cleveland Clinic. Knee pain (chondromalacia patella). Updated October 6, 2014. 

  2. Arthritis Foundation. Chondromalacia patella.

  3. Centers for Disease Control. Osteoarthritis (OA). Updated July 27, 2020. 

  4. American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (2nd edition). Updated May 18, 2013.