If you experience knee pain when climbing stairs

By Stella Oyefesobi - Nigeria

(dr.oyefesobi@lagoonhospitals.com)

Stella Oyefesobi

Going up and down the stairs, an activity we all take for granted, could bring up fear and reluctance in some people due to ensuing pain.

Knee pain, when on the stairs, is a complaint shared by many people who usually feel fine while walking; but pain begins either suddenly, or happens each and every time while they are on the stairs, with some days being less intense than others.

All the same, it can be a real problem that limits activities of daily living and overall quality of life, especially for those living in houses with one or more flights of steps.

Although there are several possible causes of knee pain, many knee problems feel worse on the stairs; but the three main problems where knee pain on the stairs is one of the most prominent features are: patellar tendinitis, chondromalacia and osteoarthritis. The focus today will be on patellar tendinitis.

Patellar tendinitis

The patella (kneecap) is the small bone in the front of the knee. The patellar tendon is a thick band-like structure that connects the bottom of the patella to the top of the large shin bone (tibia).

The muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella. This makes the patellar to glide up and down the groove in the thigh bone (femur) as the knee bends and straightens. Patellar tendonitis is the condition that occurs when the tendon becomes inflamed and irritated.

What causes patellar tendinitis?

Activities that subject this tendon to large amounts of stress will inevitably cause "micro tears" leading to inflammation and pain as well as degeneration in the tendon tissue.

In athletes, the most common of such activity is jumping, therefore patellar tendinitis is also known as 'Jumper's Knee'. Running, walking or cycling may also place repetitive stress on the patellar tendon.

In non-athletes, patellar tendinitis can also be caused by problems with the way your hips, legs, knees or feet are aligned.

Having wide hips, being knock-kneed, or having flat feet, can be predisposing factors for patellar tendonitis, because such body mechanics will place more stress on the tendon during normal activities.

Recognising patellar tendinitis

There could be pain and/or swelling of the patellar tendon at the lower tip of the kneecap which may also extend to the bump on the upper part of the shin bone.

The pain, probably accompanied with crackling noises in the knees, may increase with activities, such as jumping, running, or walking and may be worse when walking downhill or descending stairs.

What to do

Until the pain subsides, protect your knees from further damage and unnecessary aggravation. Bouncing up and down the stairs puts more stress on the kneecaps. When ascending stairs, the top leg carries more of the weight, so go up with the stronger leg leading.

Whereas, when descending, the leg on the lower level carries less weight.Therefore, you should come down with the more painful leg first; and pointing your toes down gives couple of inches to reduce the stress on the knees. Hold on to the handrails for added support.

Purchased from a pharmacy store, a fitting knee brace/elastic bandage over the knee or an elastic strap on the patellar tendon will assist in supporting the knee joint and help the alignment.

Applying ice packs for about twenty minutes twice a day will reduce the inflammation especially if the knee is already being protected from further injury. Massaging the knee with ointment, particularly over the patellar tendon if it can be tolerated, may relieve pain and reduce swelling.

Additionally for athletes, preventive measures and management techniques will include appropriate warm ups and stretches before physical activities. There should also be adequate rest and recovery between events.

Ibuprofen and such other medications would be useful in treating the pain and swelling, but talk to your doctor before starting. Definitely see a doctor if you are experiencing severe pain, even when not bearing weight or if the pain is accompanied with fever, redness or warmth around the knees or calf muscles; or if there's no improvement after three days of home treatment.

Effective physiotherapy

Few weeks of physiotherapy treatment has proven to be very effective in the treatment of patellar tendinitis with iontophoresis and ultrasound for pain reduction; and stretching activities with eccentric strengthening exercises of the quadriceps muscles to restore proper alignment to the knee.

Left untreated and with continued use, tendinitis can cause permanent damage to the patellar tendon and can lead to loss of flexibility due to scarring of the tissues which may require medical surgery.