Why do my knees ache downhill?

commongrunninginjuriesknee-painQ) I have recently started getting a sudden pain in the front of my knee just below my knee cap when walking the kids to school and when I go for a run a couple of times a week. The pain happens when I walk or run down hills and I find I am going down the stairs like my Gran, one step at a time because the pain can be so bad. My friends have said it is my ligaments or my cartilage and the GP said that it’s probably ‘wear and tear’, to take Ibuprofen and to lose some weight. I have already lost a stone but the pain is getting worse and the Ibuprofen doesn’t help. What can I do? I don’t want to end up like my mum who can’t walk far without constant pain in her joints.

A) Pain in our joints that occurs while we are moving is usually caused by a mechanical problem within the joint. Most problems occur because the joint is not staying in its’ proper alignment so things catch or rub causing pain and/or inflammation.

The knee is a common site for this type of problem. As we walk and run our muscles have to hold the knee joint over the foot and ankle.  Normally our knee cap moves up and down in a groove at the end of the thigh bone so we can bend and straighten our knee to walk and run normally. If there is a problem with any of the leg muscles due to weakness, tightness or injury the tendency is for the knee cap to slide up and down slightly out of it’s groove. As this happens the knee cap often tilts or moves sideways, catching and rubbing structures inside the knee and this causes pain at the front of the knee, which is termed ‘Anterior Knee Pain’. Another cause can be due to problems with arch collapse in the foot. This is often due to how our feet have grown, which is often an inherent trait from our parents or it can be caused by problems with muscle control of the legs and hips and can be exacerbated by being a bit overweight.


The reason the pain is worse when you walk or run down hills or use the stairs is because we have to bend our knees more when on hills or stairs and the more bent your knee is the harder it is for your muscles to keep the knee in the right place. The kneecap is pulled harder into the groove on the thigh when the knee is bent. The harder the kneecap pulls, the more strength our muscles need to control the kneecap. If the pain only occurs when you move  it is unlikely there is any inflammation and so medicines such as Ibuprofen will not seem to help, especially at low doses. If the pain continues without treatment for some time you may start to find the ache occurs when you are not walking or running as the pinched structures start to become inflamed due to the repeated rubbing in the knee.


Physiotherapy is a great starting point for you.  At an assessment with one of our Physiotherapists we will look at what is causing the problem in your knee. It we think the cause is coming from your feet you could see our Podiatrist to have any problems in the feet investigated fully. You may need to shoe inserts that will make your walking better aligned, thus stopping the poor kneecap movement and rubbing. If the problem is more with your muscles you may need some stretches or muscle exercises to hold the kneecap in its’ correct placement. Sometimes people have problems with both the feet and the muscles and require both therapies to rid them of the pain fully and for the long term.


Doing the specific exercises that we can teach you it may take up to 6 weeks to see an improvement in the pain, but these exercises are very successful in fully resolving your pain. Left untreated anterior knee pain will lead to the ‘wear and tear’ the GP spoke of as the cartilage in our knees and hips wears out and becomes a chronic problem that cannot be healed. If we keep our joints working correctly as we age this ‘wear and tear’ on our joints is less likely and we decrease the risk of conditions like osteoarthritis, chronic knee, hip or back pain, ongoing disability and the likelihood of surgery to replace our knees and hips in future.


If you would like to book a FREE 10 minute check up to see if we can help you with this or any other joint problems please contact our reception team on 01706 819464.


Written by Kerensa McKie MSc MCSP Chartered Physiotherapist at Physio & Therapies Ltd.

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