Why Does My Knee Hurt When I Go Down Stairs, Squat, or Get Up From a Chair?

Why Does My Knee Hurt When I Go Down Stairs, Squat, or Get Up From a Chair? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Looking for physical therapy in North Hollywood? Explore our rehabilitation services at Nova Physical Therapy Services.

Walking on level ground feels fine.

Then you reach a staircase.

Step down → knee pain.

Or you squat to pick something up.

Knee pain.

Or you get up after sitting through dinner or a movie.

That familiar ache around the front of the knee returns.

Patients often interpret this pattern as:

“Something must be rubbing under my kneecap.”

“My cartilage must be wearing away.”

or

“I shouldn't squat anymore.”

But pain during stairs, squatting, or getting out of a chair does not automatically mean the knee is being damaged.

These activities simply ask substantially more from the knee than level walking.

One possible presentation associated with pain around or behind the kneecap during squatting, stairs, running, jumping, and prolonged sitting is patellofemoral pain. APTA describes this as a common musculoskeletal condition associated with anterior, retropatellar, or peripatellar knee pain and reduced function. APTA

But several conditions can produce knee pain.

The activity that hurts is a clue—not a diagnosis.

Patient Question

“My knee doesn't really bother me when I'm walking normally, but it hurts going downstairs, when I squat, and sometimes when I stand up after sitting. Does that mean something is wrong with my kneecap? Should I stop squatting?”

The Short Answer

Not necessarily.

Stairs, squatting, and sit-to-stand movements require your knee and surrounding muscles to manage considerably different loads than ordinary level walking.

Pain during these activities may occur with several musculoskeletal presentations, including patellofemoral pain, but symptoms alone cannot determine the cause.

For people whose presentation is consistent with patellofemoral pain, current evidence strongly emphasizes:

education + appropriately selected exercise therapy.

A major 2024 best-practice synthesis incorporated 65 high-quality randomized controlled trials involving 3,796 participants, patient perspectives, and expert clinical reasoning.

Its central recommendation was clear:

knee-targeted exercise, with or without hip-targeted exercise, underpinned by education. Other interventions can be added according to the individual's presentation. PubMed

The goal isn't necessarily:

“Never bend your knee deeply again.”

It may instead be:

understand what the knee currently tolerates → modify excessive demand when appropriate → progressively increase strength and capacity → return toward the activities you need.

Key Takeaways

1. Knee pain during stairs does not automatically mean arthritis or cartilage damage.

Several musculoskeletal presentations can produce this symptom.

2. Going downstairs is often harder than walking on flat ground.

Your lower-extremity muscles must control your body as gravity moves you downward.

3. Squatting isn't inherently bad for your knees.

The depth, resistance, repetitions, speed, and your current capacity all influence the demand.

4. Avoiding knee bending forever is generally not the goal of rehabilitation.

When appropriate, PT may progressively restore tolerance to bending and loading.

5. Hip and knee strengthening can both matter.

Current best-practice recommendations for patellofemoral pain support knee-targeted exercise, with hip-targeted exercise incorporated according to the presentation. PubMed

Why Does My Knee Hurt Going Down Stairs More Than Going Up?

This is one of the most interesting questions patients ask.

Going up requires your muscles to generate force to lift your body.

Going down creates another challenge:

Your muscles must help control your body against gravity.

Think of your quadriceps as part of your body's braking system.

As you step downward, the knee bends while the muscles control the descent.

If the knee currently has limited tolerance for that demand, going downstairs may expose it quickly.

That's why someone may say:

“I can walk for 30 minutes without a problem, but one flight of stairs bothers my knee.”

Those statements are not contradictory.

They're different physical demands.

Why Does My Knee Hurt When I Squat?

A squat progressively changes the demand placed through the lower extremity.

But there is an important detail patients often miss:

“Squatting” isn't one fixed amount of load.

Compare:

¼ squat

with

½ squat

with

deep squat

with

bodyweight squat

with

squat holding 50 pounds.

These aren't equivalent tasks.

Someone might comfortably tolerate a shallow sit-to-stand but experience symptoms during a deeper squat.

That doesn't automatically mean:

“My knee can't squat.”

It may mean:

“My knee currently tolerates this much squat.”

That distinction changes rehabilitation.

Is Squatting Bad for My Knees?

Not inherently.

Squatting is a normal human movement.

You perform versions of it when you:

• Sit down
• Stand up
• Use the toilet
• Pick something up
• Get into a low car
• Garden
• Exercise

If squatting is painful, one option isn't necessarily to eliminate it permanently.

We can sometimes modify the task.

For example:

deep squat → shallower squat

or

heavy squat → lighter squat

or

high volume → lower volume

and then progressively increase the challenge as appropriate.

That's load management, not fear-based avoidance.

The Question We Like Better Than “Can You Squat?”

Imagine two patients.

Patient A

Pain begins almost immediately at a shallow knee bend.

Patient B

Can squat comfortably until reaching a much deeper position.

Both technically have:

“knee pain with squatting.”

But their functional tolerance is very different.

So instead of only asking:

“Does squatting hurt?”

we also want to know:

At what depth?

With how much resistance?

During the lowering or rising phase?

How many repetitions?

Where is the pain?

What happens afterward?

Those details make the evaluation more useful.

Why Does My Knee Hurt When I Get Up From a Chair?

Standing from a chair requires the hips, knees, and ankles to work together to move your body upward.

The lower the chair, the greater the challenge may become.

That's why someone might say:

“My office chair doesn't bother me, but getting off my couch hurts.”

That is useful information.

Instead of labeling every sit-to-stand as one activity, we can examine:

chair height + movement strategy + strength + mobility + symptom response.

Why Does My Knee Hurt After Sitting for a Long Time?

Pain around the front of the knee after prolonged sitting is another symptom commonly associated with patellofemoral pain presentations. APTA's clinical summary specifically includes prolonged sitting among activities that may increase symptoms. APTA

Patients sometimes describe:

“My knee is fine during the movie, but when I stand up afterward, it aches.”

Or:

“After driving through LA traffic, my knee feels stiff when I get out of the car.”

That doesn't prove a specific diagnosis.

But it is useful symptom behavior for the physical therapist to understand.

Does Pain Around My Kneecap Mean My Cartilage Is Wearing Out?

Not automatically.

Pain is real, but its presence does not allow us to identify a specific tissue problem from symptoms alone.

Someone with anterior knee pain may immediately assume:

pain = cartilage damage.

That is too simplistic.

The physical therapist should consider the history, activity pattern, movement, muscle performance, functional limitations, symptom location, relevant testing, and whether additional medical evaluation is indicated.

Is This “Runner's Knee”?

Possibly—but that term can create confusion.

“Runner's knee” is commonly used as an informal term for patellofemoral pain.

But you do not need to be a runner to experience a patellofemoral pain presentation.

Symptoms can occur during:

stairs

squatting

jumping

prolonged sitting

and other activities that increase demand around the patellofemoral joint. APTA

So someone who hasn't run in years can still have an anterior knee-pain presentation requiring appropriate evaluation.

What About Knee Clicking or Cracking?

This is another major source of anxiety.

A patient squats and hears:

crack...pop...click.

Then immediately thinks:

“I'm grinding away my knee.”

Sounds by themselves do not tell us whether the knee is damaged.

The more useful questions are:

Is it painful?

Did it begin after an injury?

Is there swelling?

Does the knee lock?

Does it give way?

Has function changed?

A noisy knee and a functionally limited painful knee are not automatically the same problem.

Should I Stop Using Stairs?

Not necessarily.

This is where rehabilitation needs to reflect real life.

If you live on the second floor, saying:

“Never use stairs.”

isn't particularly useful.

Instead, depending on the evaluation, the therapist may temporarily modify certain activities while progressively building the strength and capacity required for them.

The long-term goal may be:

stairs become rehabilitation

rather than

stairs become something you're afraid to use.

Should I Strengthen My Quadriceps?

For many appropriate knee-pain presentations, strengthening the knee extensors can be important.

The quadriceps help control and produce knee movement during:

stairs

squatting

sit-to-stand

running

jumping

and many other activities.

The contemporary best-practice guide for patellofemoral pain identifies knee-targeted exercise therapy as a core intervention. PubMed

But strengthening doesn't mean:

“Everyone does exactly three sets of ten knee extensions.”

The starting resistance, exercise selection, range, volume, and progression should match the patient.

What About Hip Strength?

This is another important piece.

Your knee doesn't function independently from the rest of the lower extremity.

The hip helps control movement of the thigh and pelvis during activities such as:

walking → stairs → squatting → running → landing.

The current best-practice guide recommends knee-targeted exercise with or without hip-targeted exercise, depending on the patient's individual presentation. PubMed

So the modern approach isn't:

“Knee pain means only exercise the knee.”

But it also isn't:

“Your knee hurts because your glutes aren't firing.”

Both are oversimplifications.

Do I Need to Strengthen My VMO?

The vastus medialis is part of the quadriceps.

For years, patients with kneecap pain were frequently told:

“Your VMO isn't firing correctly.”

Then rehabilitation sometimes became an attempt to isolate one small portion of the quadriceps.

Contemporary rehabilitation is generally broader.

The goal is usually to improve the patient's overall ability to tolerate meaningful tasks—not simply chase one muscle in isolation.

Should My Knees Never Go Over My Toes?

This is one of the most persistent fitness myths.

Your knees naturally move forward during many normal activities.

Think about:

stairs

getting out of a chair

running

lunging

and

squatting.

The relevant issue is not simply whether the knee travels over the toes.

It is whether the individual can tolerate the specific demand being placed on the knee.

Sometimes limiting forward knee movement temporarily changes the load and may make an exercise more tolerable.

That can be a useful modification.

But:

temporary exercise modification ≠ permanent movement rule.

What About Lunges?

Lunges can be useful because they challenge:

strength

balance

single-leg control

and

functional loading.

But again:

short lunge

is different from

deep lunge

which is different from

weighted lunge.

If one version provokes symptoms, the therapist may adjust the movement rather than automatically declaring:

“Lunges are bad for your knees.”

What About Knee Braces or Taping?

Some adjunctive interventions can be useful in selected people.

The 2024 best-practice guide found that interventions such as:

taping

prefabricated foot orthoses

manual therapy

and

movement/running retraining

may be used as supporting interventions according to the individual's presentation.

But the central recommendation remained:

exercise therapy + education. PubMed

That's important.

An adjunct should support rehabilitation—not automatically replace it.

Do I Need an MRI?

Not necessarily.

A painful squat or painful staircase does not automatically mean imaging is required.

Whether imaging or medical evaluation is appropriate depends on factors such as:

• Mechanism of injury
• Trauma
• Swelling
• Mechanical symptoms
• Functional loss
• Medical history
• Examination findings
• Progress over time
• Other concerning symptoms

Imaging can be valuable when clinically indicated.

But rehabilitation decisions should not be based on the assumption that every painful knee needs an MRI before it can move.

Can Physical Therapy Help?

For appropriate knee-pain presentations, physical therapy may address:

• Quadriceps muscle performance
• Hip muscle performance
• Knee mobility when limited
• Hip and ankle mobility when relevant
• Squatting tolerance
• Sit-to-stand function
• Stair negotiation
• Single-leg control
• Balance
• Running or jumping when relevant
• Activity modification
• Progressive strengthening
• Return to work
• Return to exercise
• Return to sport

But here's the distinction I want Nova patients to understand:

The goal isn't to become good at physical therapy exercises.

If your problem is:

“I can't get downstairs without knee pain,”

then eventually rehabilitation needs to prepare you for going downstairs.

If your problem is:

“I can't squat to play with my child,”

then rehabilitation needs to prepare you to squat.

If your goal is:

“I want to return to hiking,”

then eventually the knee needs to tolerate hills and repeated steps.

Exercise builds capacity. Function tells us what capacity we need.

What Does Research Say?

2024 Best-Practice Guide

One of the strongest contemporary evidence resources for patellofemoral pain was published in the British Journal of Sports Medicine.

Researchers didn't simply perform another literature review.

They combined three different evidence streams:

research evidence + patient experiences + expert clinical reasoning.

The research component included 65 high-quality randomized controlled trials involving 3,796 participants.

The conclusion was that:

knee-targeted exercise therapy, with or without hip-targeted exercise, underpinned by education should be delivered.

Additional interventions can then be selected according to the patient's particular presentation and preferences. PubMed

That's very close to the philosophy we want Nova's content to communicate:

not one exercise for everyone—an individualized rehabilitation strategy.

APTA Clinical Practice Guideline

The Academy of Orthopaedic Physical Therapy/APTA maintains a clinical practice guideline specifically for patellofemoral pain.

The guideline provides evidence-based recommendations intended to help physical therapists classify and manage appropriate patellofemoral pain presentations. APTA

Updated APTA Clinical Summary

APTA's 2024 clinical summary describes patellofemoral pain as a common musculoskeletal condition associated with anterior, retropatellar, or peripatellar knee pain.

Activities commonly associated with symptoms include:

squatting, stairs, running, jumping and prolonged sitting. APTA

Why Education Matters

Research evaluating education for patellofemoral pain has found that education is important, but educational material alone appears inferior to exercise therapy for pain and functional outcomes.

That supports combining:

understanding the problem + appropriately dosed rehabilitation

rather than simply handing someone an informational sheet. PubMed

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for knee pain may include, when appropriate:

• Detailed history
• Symptom location and behavior
• Knee mobility
• Hip and ankle mobility when relevant
• Lower-extremity muscle performance
• Squatting
• Sit-to-stand
• Step-up
• Step-down
• Single-leg activities
• Balance
• Walking
• Running or jumping when relevant
• Functional or sport-specific tasks

But we also want to know something that can't be measured with a goniometer:

What can't you do anymore?

We may ask:

Does going up or down stairs hurt more?

How many stairs before symptoms begin?

Does a shallow squat hurt?

What about a deeper squat?

Does getting off the couch hurt more than getting out of a dining chair?

Does your knee hurt after sitting?

Is there swelling?

Was there an injury?

Does the knee lock or give way?

What exercise or activity are you trying to return to?

Those questions help turn:

“knee pain”

into an actual functional problem we can evaluate.

The Physical Therapy Board of California describes physical therapists as licensed professionals who evaluate physical status, establish plans of care and goals, and provide treatment intended to improve movement and function. Physical Therapy Board of California

Nova's role is therefore not to diagnose a medical disease based on an internet symptom pattern. It is to appropriately evaluate movement and functional limitations, provide physical therapy when indicated, and recognize findings requiring referral or additional medical evaluation.

When Should You Seek Medical Attention?

Knee pain that gradually appears during squatting is very different from:

“I twisted my knee, heard a pop, and immediately couldn't put weight on it.”

Seek appropriate medical evaluation for knee symptoms associated with:

• Significant trauma
• Inability to bear weight after an injury
• Major or rapidly developing swelling
• Obvious deformity
• A knee that becomes mechanically locked
• Significant instability after injury
• Significant redness, warmth, or fever
• Progressive neurological symptoms
• Severe or rapidly worsening symptoms
• Other concerning systemic symptoms

Persistent knee pain that does not progress as expected should also be appropriately reassessed.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our philosophy is simple:

We Care.

But here's what that means with knee pain.

One patient says:

“My knee hurts.”

Another says:

“I live upstairs, and every morning I turn sideways because I'm afraid going down normally will hurt.”

Those aren't the same story.

Another patient says:

“I stopped squatting at the gym because someone told me I'm destroying my cartilage.”

Another says:

“I can work all day, but after my commute home I struggle getting out of the car.”

And another says:

“My knee only hurts when I hike downhill.”

All five people may point to the front of their knee.

But their functional problems are different.

That's why we want to know:

What changed?

What activity brings the symptoms on?

How much of that activity can you tolerate?

What does your movement look like?

What does the physical therapy examination show?

What are you trying to get back to?

Then rehabilitation can be built around the person—not just the body part.

Our approach emphasizes:

• Individualized physical therapy evaluation
• Evidence-informed rehabilitation
• Progressive strengthening
• Functional exercise
• Appropriate load management
• Patient education
• Return to meaningful activity
• Appropriate referral when indicated

The goal isn't simply to make your knee feel good inside the clinic.

The goal is to help build the movement and functional capacity you need when you walk back out the door.

That's part of what We Care means to us.

Frequently Asked Questions

Why does my knee hurt going downstairs but not walking?

Descending stairs places different demands on the knee and lower-extremity musculature than level walking. This can expose a limitation that normal walking does not.

Why does my knee hurt when I squat?

Squatting increases lower-extremity demand as the knee bends. Pain may occur for several reasons, so a painful squat alone cannot establish a diagnosis.

Does knee pain with squatting mean I'm damaging my cartilage?

No. Pain during a squat does not by itself establish cartilage damage.

Are squats bad for knee pain?

Not inherently. Squat depth, resistance, repetitions and the individual's current tolerance can all be modified.

Should I stop using stairs?

Not automatically. Depending on the presentation, temporary activity modification and progressive strengthening may be more appropriate than permanent avoidance.

Why does my knee hurt after sitting?

Pain after prolonged sitting can occur with patellofemoral pain presentations, but the symptom is not specific enough to establish a diagnosis. APTA

Should my knees go over my toes when I squat?

Forward knee movement occurs naturally during many normal activities. It is not universally prohibited. Exercise technique and loading should be individualized.

Should I strengthen my quadriceps?

Knee-targeted exercise is a central component of current best-practice recommendations for patellofemoral pain. PubMed

Should I strengthen my hips too?

Hip-targeted exercise may be incorporated according to the individual's presentation and is included in contemporary best-practice recommendations. PubMed

Do I need an MRI for knee pain when squatting?

Not automatically. Imaging decisions depend on the history, examination, trauma, associated symptoms and clinical findings.

Can physical therapy help knee pain with stairs?

For appropriate musculoskeletal presentations, physical therapy may address strength, mobility, movement, load tolerance and functional limitations associated with stair negotiation.

Schedule an Evaluation

If knee pain is making it difficult to:

• Go upstairs or downstairs
• Squat
• Get out of a chair
• Get off the couch
• Get out of the car
• Run
• Hike
• Exercise
• Work
• Play sports

Nova Physical Therapy can evaluate your movement and functional limitations and determine whether physical therapy is appropriate.

Our rehabilitation approach focuses on:

movement + strength + progressive loading + functional capacity + return to meaningful activity.

Ready to learn more? Visit Nova Physical Therapy Services to explore our services and learn more about physical therapy care in North Hollywood.

Disclaimer

This article is for general educational and informational purposes only. It does not constitute medical advice, medical diagnosis, imaging guidance, exercise clearance, or individualized physical therapy treatment.

Knee pain during stairs, squatting, prolonged sitting, or sit-to-stand activities cannot independently establish patellofemoral pain syndrome, arthritis, meniscus injury, cartilage injury, tendinopathy, or another medical condition.

Physical therapists evaluate and treat movement and functional impairments within their regulated scope of practice. PTBC describes physical therapy evaluation as including health history, observation of posture and movement or limitations, and evaluation of relevant problem areas, followed by an individualized plan of care. Physical Therapy Board of California

Clinical practice guidelines assist clinical decision-making but do not replace individualized clinician judgment. APTA

Exercise examples and load-management concepts discussed here should not be interpreted as individualized prescriptions.

Physical therapy, exercise, manual therapy, taping, orthoses, activity modification, or other interventions cannot guarantee symptom resolution or prevention of recurrence.

Seek appropriate medical care for significant trauma, inability to bear weight, substantial acute swelling, deformity, mechanical locking, significant instability, signs of infection, rapidly worsening symptoms, or other concerning findings.

Individual results vary.

References

1. Neal BS, Lack SD, Bartholomew C, Morrissey D. Best Practice Guide for Patellofemoral Pain Based on Synthesis of a Systematic Review, the Patient Voice and Expert Clinical Reasoning. British Journal of Sports Medicine. 2024;58(24):1486–1495. The evidence synthesis incorporated 65 high-quality RCTs involving 3,796 participants, patient interviews and expert clinical reasoning. PubMed
2. American Physical Therapy Association / Academy of Orthopaedic Physical Therapy. Patellofemoral Pain Clinical Practice Guideline. Evidence-based recommendations for physical therapist management of patellofemoral pain. APTA
3. American Physical Therapy Association. Patellofemoral Pain Clinical Summary. Updated May 2, 2024. Describes common presentation, functional limitations and evidence relevant to physical therapist management. APTA
4. Winters M, Holden S, Lura CB, et al. Comparative Effectiveness of Treatments for Patellofemoral Pain: A Living Systematic Review With Network Meta-analysis. Research contributing to contemporary evidence-informed PFP management.
5. Barton CJ, Rathleff MS, Crossley KM, et al. Managing My Patellofemoral Pain: The Creation of an Education Leaflet for Patients. Patient education research developed through consultation with international experts and patients. PubMed
6. Patient Education for Patellofemoral Pain: A Systematic Review. Evidence examining education interventions and their role alongside exercise therapy. PubMed
7. Physical Therapy Board of California. Consumer Information and Physical Therapy Practice Act. Current California regulatory information regarding physical therapist evaluation and treatment. Physical Therapy Board of California

Evidence resources: APTA Patellofemoral Pain Clinical Practice Guideline · APTA Patellofemoral Pain Clinical Summary · 2024 Best-Practice Guide on PubMed · Physical Therapy Board of California