Why Do I Have Knee Pain When Going Up Stairs?

Pain in the knees when climbing stairs can have a few different causes. Two of the most common are chondromalacia patella (overuse injury) and arthritis, but there are also other possible causes.

These 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.

This article explains chondromalacia patella and knee arthritis symptoms, causes, diagnoses, and treatment.

Chondromalacia Patella

Chondromalacia patella, also called "runner's knee," occurs when the smooth, slippery cartilage that lines the back of your knee cap (patella) begins to soften and break down. When it functions correctly, as your knee bends and straightens, the patella slides up and down in a groove at the bottom of your upper leg bone (called the femoral groove).

But people with chondromalacia patella experience increased amounts of rubbing and friction. This extra friction occurs due to this cartilage breakdown, and it can irritate your joint.

Symptoms

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

A primary complaint of those with this condition is soreness when doing certain activities, like:

• Going up the stairs
• Squatting
• Walking downhill
• Running
• Standing up after a more extended period of sitting

Causes and Risk Factors

Several different risk factors can make you more likely to develop chondromalacia patella. These include:

• Having excess weight
• People with less muscle mass
• Those with a previous knee injury

Chondromalacia patella is also more frequently seen in individuals who participate in endurance sports like running or biking. In this situation, muscular imbalances cause the kneecap to track improperly in the femoral groove, leading to repetitive rubbing and irritation. 

Arthritis

As the cartilage breakdown progresses, the space between the bones in the knee (tibia, fibula, and patella) diminishes. When this happens, damage to one or several of them can develop, referred to as arthritis.

While there are many different varieties of this condition, the most prevalent is osteoarthritis (OA), a degenerative (wear-and-tear) form of arthritis.

Symptoms

Both chondromalacia patella and arthritis can make climbing the stairs, walking, and squatting quite painful. However, several other symptoms can help you distinguish between the two conditions.

Signs of knee OA include:

• Pain in the knee
• Stiffness
• Swelling
• Limited mobility
• Knee popping or locking

Osteoarthritis typically occurs in middle- and older-aged individuals. In addition, knee stiffness and swelling (particularly in the morning and after long periods of sitting down) can make it difficult to bend or straighten the knee. This stiffness can cause the first few steps of the day to be sore and challenging.

Causes and Risk Factors

Multiple different factors can put you at a greater risk of developing arthritis. These include:

• Excess weight
• A previous injury to their knee
• Those who play sports that place repetitive stresses on the knee joint
• Being a woman
• Genetics

Ligament Injuries

There are four different ligaments in the knee that can be injured. These include:

• Anterior cruciate ligament (ACL): Rotates the knee and controls the forward motion of your shin.
• Posterior cruciate ligament (PCL): Controls the backward motion of your shin.
• Medial collateral ligament (MCL): Stabilizes the inner knee.
• Lateral collateral ligament (LCL): Stabilizes the outer knee. 

Symptoms

Ligament injuries can cause pain when walking up stairs. It can be hard to tell the difference between a ligament injury and another type of knee injury. Often, these symptoms will appear immediately after an incident such as a sports accident or car crash. It's important to see your healthcare provider if you have:

• Swelling
• A popping sound or sensation in the knee
• Limited range of motion
• Buckling of the knee when you put weight on it

Causes and Risk Factors

These injuries often happen as the result of an impact or sudden twisting of the knee. You are at higher risk for a ligament injury if:

• You play certain sports such as basketball, hockey, skiing, or gymnastics
• You wear poorly fitting shoes
• You are female

A sudden impact such as something you might experience during a car accident can also cause a ligament injury. 

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome describes dull pain that occurs around the kneecap.

Symptoms

Patellofemoral pain syndrome can cause pain when you are active or after you've been sitting with bent knees for long periods of time. You may also experience:

• Instability of the knee
• Tenderness to the touch
• A grinding or clicking sensation in the kneecap when you move your knee

These symptoms are similar to some other causes of knee pain. This is why it is important to see a healthcare provider if you experience any pain in your knee.

Causes and Risk Factors

Patellofemoral pain syndrome can happen because of overuse of the knee or incorrect technique while playing sports. It can also be caused by:

• A particular pattern of walking or running
• A defect that causes the kneecap to be abnormally high
• Wearing shoes that provide poor support 
• Weak thigh muscles
• Tight hamstrings or Achilles tendons
• Injury
  

Diagnosis

When you see a doctor about knee pain that occurs when you climb the stairs, the first thing they will do is a physical exam. In addition, they will review your medical history and all of your symptoms.

Arthritis

When diagnosing osteoarthritis, doctors typically use an X-ray to visualize the space between the bones at the knee joint. An X-ray also allows them to see any damage that may have occurred to the bone itself.

If a doctor suspects another form of this condition, like rheumatoid or psoriatic arthritis (autoimmune forms), they may also do a blood draw to confirm their diagnosis.

Chondromalacia Patella

In the case of chondromalacia patella, you can't see the damage to the cartilage on an X-Ray. As such, a magnetic resonance imaging (MRI) is usually necessary to properly diagnose this condition.

Ligament Injuries

If your healthcare provider suspects a ligament injury, they may use ultrasound device to help diagnose the injury. These devices use sound waves to help your healthcare provider see the structures inside your knee. 

You may also need an X-ray or an MRI to help rule out other causes or to determine the extent of the injury.

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is typically diagnosed based on your health history and a physical exam. Your healthcare provide may also want to X-ray your knee in order to understand the extent of the injury.

Treatment

Many knee injuries can be well-managed with conservative measures initially, especially when the symptoms are mild to moderate. The suggestions below may help relieve the pain you feel when going up stairs.

Chondromalacia Patella

Chondromalacia patella is common in people who participate in repetitive activities like running. Therefore, chondromalacia can often be "cured" with rest and physical therapy. In addition, the following therapies may help:

• Icing your knee
• Over-the-counter (OTC) or prescription pain medication
• Losing weight
• Modifying your footwear
  

Physical therapy can help build up strength and flexibility in your leg muscles. In addition, this work 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.

Arthritis

Like chondromalacia, you can improve arthritis pain using the RICE principle (rest, ice, compression, elevation). In addition, the following may benefit knee arthritis:

• OTC pain medication
• Staying active
• Physical therapy
• Orthotics in your shoes
• Maintaining a healthy weight

Bed rest or remaining sedentary is rarely an effective solution. Instead, try riding a stationary bike with minimal resistance or going for a short walk. These activities can help loosen up a stiff knee and improve your overall soreness.

Physical therapy strengthens your supporting hip and knee muscles and improves overall flexibility.

Unfortunately, in some cases, conservative treatment is not effective in relieving your symptoms. In that case, surgery may be necessary. Surgery for knee arthritis may involve a partial or total knee replacement. Outpatient therapy is needed afterward.

Ligament Injuries

You can also manage a knee ligament injury at home with the RICE principle:

• Rest
• Icing and elevating the knee
• Using a compression wrap
• Taking over-the-counter medications such as NSAIDs

Knee-strengthening exercises can be helpful as you recover. You should wear a knee brace during activity and limit those activities that put strain on the knee.

Some ligament injuries require surgery. 

Patellofemoral Pain Syndrome

The most important treatment for patellofemoral pain syndrome is rest. You should avoid doing any vigorous activities until you can do so without experiencing pain. 

Additional treatment for patellofemoral pain syndrome includes pain management, RICE, and strengthening exercises. For example:

• Elevating and icing the knee
• Taking over-the-counter medications such as NSAIDs
• Using a compression wrap
• Stretching and strengthening the knee
• Wearing an arch support
  

Prevention

Knee injuries are largely preventable. Some of the things you can do to keep your knees healthy include:

• Wearing well-fitting shoes
• Warming up before exercise and cooling down afterwards
• Using proper technique during sporting activities
• Incorporate stretching exercises into your routine
• Wear knee guards while playing sports
• Maintain a healthy weight
• Choose low-impact activities

Summary

Arthritis and chondromalacia patella commonly cause knee pain. Knee pain can also be caused by a ligament injury or a condition called patellofemoral pain syndrome.

A healthcare provider diagnoses these conditions through imaging techniques, like X-rays and MRIs. Treatment may vary slightly depending on the cause, but typically rest, ice, and physical therapy help all these conditions. If you have arthritis, continued movement is vital to maintain mobility in the joints.