Short answer
Going downhill makes your thigh muscles work as brakes, which loads the knee much more than going up. Pain around or behind the kneecap on descents is usually patellofemoral pain; sharp pain on the outside of the knee is often ITB syndrome. Both respond well to strengthening and smarter descents.
Common causes
Patellofemoral pain
An ache around the kneecap on stairs, descents and after sitting.
ITB syndrome
Sharp pain on the outer knee that comes on at a predictable point on descents.
Unaccustomed descending
A big hike after weeks of flat running or none at all.
What usually helps right now
- Use poles on long descents.
- Take shorter, quicker steps downhill.
- Build quad and hip strength, including slow step-downs.
- Add downhill sections gradually.
What to avoid
- Long descents while the knee is sore.
- Relying only on knee straps.
When to book an assessment
- Pain is stopping you hiking or running.
- The knee swells or gives way.
Get urgent medical care if
- Swelling straight after a twist, locking, or the knee giving way: get assessed for a ligament or meniscus injury.
How we treat it
- AssessHistory, movement and clinical tests, with screening for anything that needs a doctor.
- ExplainA clear diagnosis in plain language, and what recovery usually looks like.
- TreatHands-on care where it helps: joint and soft tissue work, dry needling or adjustments.
- RebuildExercises and a training plan so it holds up, with an end point.
Questions
Why do my knees hurt going down but not up?
Descending loads the knee more, because the muscles work as brakes.
Do hiking poles help?
Yes. They reduce load on the knees on descents.