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Walking across a room feels manageable. Then you reach the stairs, bend to pick something up, or lower into a chair, and the knee complains.
Pain around or behind the kneecap during stairs or squatting can be patellofemoral pain, sometimes called runner’s knee. You do not have to be a runner to experience it.[1]
That symptom pattern gives us a starting point, not a complete diagnosis. At At Ease Physiotherapy, we want to see the movement that is difficult and understand what has changed—not simply hand you a standard sheet of knee exercises.
Why These Movements?
Patellofemoral pain often appears during activities that repeatedly bend the knee under load. A change in training frequency, intensity, or activity can be part of the history.[1]
Perhaps you have added hills to your walks or returned to the gym after a break. Perhaps nothing obvious has changed. Either way, the assessment should explore your symptoms and current capacity rather than assume one explanation.
Arthritis and other knee problems can also cause pain on stairs. Injury, marked swelling, or a knee that locks changes what needs to be investigated.[1,3]
Start With the Task You Want Back
Susannah Reid has training in the Integrated Systems Model, Manual Articular Spine/Pelvis and Lower Extremity techniques, and Clinical Pilates mat and equipment work.
The Integrated Systems Model organizes assessment around a meaningful task: what would being better let you do?[4] That fits a concern like stair pain particularly well because the task is right there to examine.
We might look at:
- How you lower yourself from a step.
- How much bending is comfortable today.
- Foot and ankle movement during that step.
- Hip strength and how your trunk moves.
- Whether support, a smaller step, or a change in movement makes the task easier.
These are assessment options, not a predetermined checklist of corrections. For example, trying a smaller step can help us choose a starting exercise. It does not prove that your usual movement is damaging the knee.
Does This Mean My Hips Are Weak or My Knees Are Misaligned?
Not necessarily. Hip strength and movement can be useful to assess, but the finding that an exercise helps is not proof that weakness caused the pain.
The 2024 best-practice guide recommends knee-targeted exercise, with hip-targeted exercise and other interventions selected for the person’s presentation and preferences.[2] It does not prescribe one explanation or identical programme for everyone.
We would rather ask “What helps you do this task?” than give you a new worry about whether every squat looks perfect.
What Treatment Might Look Like
Build From a Manageable Movement
An exercise programme should have a starting point you can practise and a plan for progression. Depending on the assessment, that might involve a supported squat, a sit-to-stand movement, or another form of knee-strengthening exercise. Hip exercise may also be relevant.[2]
The particular exercise matters less than choosing it for a reason, teaching it clearly, and reviewing your response.
Use Hands-On Care for a Defined Purpose
Susannah’s profile describes gentle hands-on techniques integrated with movement practice. For knee rehabilitation, manual therapy may be considered when it addresses a relevant finding and supports the wider plan.
The best-practice guide includes manual therapy, taping, prefabricated foot orthoses, and movement or running retraining as possible supporting interventions. Exercise and education remain the primary treatment.[2]
If a technique makes a step more comfortable, we can use that information to guide practice. It is not proof that the kneecap was put back into place, or that an unrelated body system caused the pain.
Make Strength Work Specific to Your Life
Adapted Clinical Pilates is one possible way to practise movement and build strength under supervision. The eventual aim might be stairs, gardening, hiking, or lifting—not simply becoming better at one exercise on a machine.
The evidence cited here supports the components of exercise rehabilitation, not superiority of Pilates for patellofemoral pain.[2] The format should suit your goals and preferences.
Susannah also has needling training, but availability is not the same as an indication: the 2024 guide did not support dry needling for patellofemoral pain.[2]
Should You Stop Squatting or Exercising?
You may need to change the amount or difficulty temporarily rather than give up movement altogether. Activity modification and therapeutic exercise are common parts of conservative care for patellofemoral pain.[1]
For a non-urgent problem, useful discussion points include:
- Which activity most clearly aggravates the knee?
- Could you reduce repetitions, depth, distance, or hills for now?
- Is there a comfortable alternative that keeps you active?
- How does the knee feel later that day and the following morning?
Use those observations to adjust a plan with your physiotherapist. There is no single pain score, exercise dose, or return-to-running date that fits every person.
When to Get Medical Help
Seek urgent medical assessment if you cannot move the knee or bear weight, it is badly swollen or has changed shape, or it locks. A hot, red knee with fever or feeling unwell also needs urgent assessment.[3]
For pain that persists or keeps returning, arrange an assessment rather than repeatedly testing it with deeper squats. A useful plan should tell you what you can do now, how to progress, and when the findings warrant another opinion.
If stairs or squatting are becoming something you avoid, contact our South Surrey clinic. We can discuss your goals and the most appropriate practitioner, or you can learn more about our knee pain care.
References
- American Academy of Orthopaedic Surgeons. Patellofemoral Pain Syndrome. Symptoms, activity changes, assessment, and conservative treatment.
- 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;58:1486–1495. doi:10.1136/bjsports-2024-108110.
- NHS. Knee pain. Differential symptoms and urgent assessment guidance.
- Diane Lee & Associates. The Integrated Systems Model. Description of task-led clinical reasoning; not independent evidence of superior treatment outcomes.
