Knee pain going down stairs: patellofemoral pain and what to do

NHS Lanarkshire describes patellofemoral pain syndrome as a common knee condition causing pain at the front of the knee, around the joint between the kneecap (patella) and the thigh bone (femur). It is also called anterior knee pain. Pain is usually felt around or behind the kneecap, often as an ache that can sharpen with certain activities. It can affect one or both knees and range from mild to severe.

The NHS knee pain page lists several other causes of knee pain, which is why a clinician may need to examine the knee: sprains and strains, tendonitis, a torn ligament or meniscus, a dislocated kneecap, osteoarthritis, bursitis, bleeding into the joint, gout or septic arthritis, and Osgood-Schlatter's disease in teenagers.

Common symptoms listed by NHS Lanarkshire are pain at the front of the knee, worsening pain during or after increased activity, pain after prolonged sitting, pain when squatting or going down stairs, and sometimes a clicking or grinding noise when bending or straightening the knee. It says this noise does not mean you are damaging the knee and that it is important to keep moving it.

PFPS usually occurs without an injury, though a fall onto the knee can occasionally trigger it.

NHS Lanarkshire says it is often hard to find one specific cause. Contributors include starting a new activity, an increase in the intensity or frequency of an existing activity, a period of reduced activity that weakens muscles, muscle tightness or weakness around the hip and knee, unsupportive footwear such as high heels or very flat shoes, a job that involves frequent prolonged kneeling, and being overweight.

It explains this with the idea of a comfort zone: any sudden change that puts more load through the knee, such as extra shifts on your feet or increasing running distance, can take the knee out of its comfort zone and cause pain without any physical injury.

Exercise is the mainstay. NHS Lanarkshire says the latest research found exercise is recommended to reduce pain in the short, medium and long term and to improve function in the medium and short term, and that combining hip and knee exercises, such as squats, is recommended for all patients. Orthotics may help if foot alignment such as flat feet adds stress, and a physiotherapist may use patellar taping early on to reduce pain during exercise.

• Pace yourself rather than stopping all movement, because complete rest weakens muscles and may worsen the pain.

• Spread activity through the day with regular short rests, and break harder jobs into smaller parts.

• On stairs, use the handrail and go up one leg at a time until muscles are stronger; leading with the non-painful leg going up and the sore leg going down is easier.

• If running hurts, shorten the distance or choose a flatter route rather than stopping altogether.

• The NHS knee pain page also suggests an ice pack wrapped in a tea towel for up to 20 minutes every 2 to 3 hours, and paracetamol or ibuprofen gel or tablets.

The NHS says to see a GP if knee pain does not improve within a few weeks, and that in many areas you can refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy. It advises getting advice from NHS 111 now if the knee is very painful, you cannot move it or put weight on it, it is badly swollen or has changed shape, it locks, gives way or painfully clicks (painless clicking is normal), or you have a very high temperature or feel hot, cold or shivery with redness or heat around the knee, which can be a sign of infection.

A doctor may prescribe medicine or physiotherapy, or refer you for a scan or specialist treatment if needed, according to the NHS.

NHS Lanarkshire says only a handful of cases will ever need surgery and that PFPS usually responds well to specific exercise and lifestyle change. Because it is an overuse problem, long-term success depends on keeping up strength work for the hips and thighs after the pain eases and increasing activity gradually afterwards.