What is Really Causing Your Runner’s Knee?

Runner's Knee, Knee pain, Patellofemoral pain syndrome, IT band syndrome, Plica Syndrome

Knee Pain in Runners

Knee pain is one of the most common causes of pain and disability in runners. If you are a runner you know what I am talking about. The dreaded  “Runner’s Knee”, strikes fear in the hearts of many runners. 

So what is runner’s knee?

The answer to this questions would be different depending on who you talk to. Runner’s knee is a term used by many to represent any type of knee pain associated with running. This presents a real problem for runners out there looking for a cure for their runner’s knee. The treatments and therapy they are looking up on the internet may not be effective for them because they are not addressing the true cause of their knee pain.

So what really causes knee pain in runners?

There are many causes of knee pain in runners. And it would be impossible to cover them all here. Knee pain is most commonly caused by three things Patellofemoral Pain Syndrome, IT Band Syndrome, and Plica Syndrome. This article will focus on Patellofemoral Pain Syndrome.

Patellofemoral Pain Syndrome

Patellofemoral Pain syndrome Is the most common cause of anterior knee pain in athletes. It is estimated that a majority of all anterior knee pain is a result of this disorder. The symptoms of this condition include knee pain in the front of the knee that can be on either side of the knee cap. Most commonly the pain is on the lateral side (outside) of the knee cap.

The symptoms of this condition are caused by the knee cap tracking incorrectly over the femur as the knee bends. This is often caused by tight quad muscles especially the Vastus Lateralis muscle. This incorrect tracking of the knee cap can also be caused by a weak quadriceps muscle called the VAstus Medialsis.  Each of the above situations results in the Patella (knee cap) being pulled to the outside. This causes the underside of the patella to rub more on the femur. Over time this rubbing leads to inflammation and pain in the knee. Patellofemoral pain syndrome is common in runners because of the repetitive knee bending that happens in running. If it is not treated correctly it can result in permanent damage to the underside of the Patella called Chondromalacia Patella.

Runner's Knee
Tightness in the Vastus Lateralis can cause knee pain in running

How do I prevent Patellofemoral Pain Syndrome?

Patellofemoral Pain Syndrome is often a result of ramping up mileage too quickly. When a runner drastically increases miles in a short period of time the quad muscles and gluteal muscles have a hard time keeping up with the new workload. This causes tightness and pulling on the knee cap. The first step in preventing patellofemoral pain syndrome is to gradually increase your mileage.

The second step in preventing patellofemoral pain syndrome is proper stretching. All too often runners fail to stretch appropriately with running. Every runner should warm up and stretch prior to their run and should then stretch following their run. With patellofemoral pain syndrome is critical that the quad muscles are stretched especially the Vastus Lateralis.

Finally, it is important to strengthen the Vastus Medialis. Incorporating a leg workout into your weekly exercise routine can do wonders.

Runner's Knee, Knee pain
Vastus Medialis weakness leads to improper tracking of the knee cap resulting in knee pain

This leg workout should include single legged squats and lunges. These exercises help strengthen the Vastus Medialis thus preventing the knee cap from being pulled to the outside of the knee.

I already have Patellofemoral Pain Syndrome How do I Treat It?

Treatment for Patellofemoral Pain syndrome is much the same pattern as preventing it. A formula of rest, stretching, and strengthening, is key in decreasing pain and disability associated with this condition.

The first step in treatment is rest. This means that you need to cut back on the mileage. I know this is like a death sentence for most runners but trust me if you want the knee pain to go away you need to back off a little bit.

Second, you need to strengthen your quad muscles and your gluteal muscles. This can be done with plyometric squats a few times a week or can be done in the gym with weights and leg machines. the focus on these exercises in strengthening the inside quadriceps muscle the Vastus Medialis as well as the gluteal muscles.

Stretching and massage to lengthen and loosen the Vastus Lateralis is critical. As long as this muscle is tight it is going to pull on that knee cap. One of the favorite tricks that I like to teach my patients is the use of a rolling pin to help massage and lengthen the quad muscles. To do this take a rolling pin of any type and roll out the upper leg toward the knee. This should be done every night following strengthening and stretching.


Knee pain in runners is a very common complaint. If your pain is in the anterior and lateral part of your knee you may have Patellofemoral Pain Syndrome. Try the treatments above. If your pain is not improving after a few weeks make sure that your knee is evaluated by a qualified health care provider.


Dr. Craig Nuttall is a family nurse practitioner trained in family medicine and sports medicine. He is also an avid trail runner and outdoor enthusiast.



Why do I get clogged ears when I exercise?

Clogged ears

Why do I get clogged ears when I exercise?

Ear fullness or the plugged sensation that many people report with physical activity is commonly referred to as “Eustachian Tube Dysfunction” (ETD) this means that the inner ear is not able to equalize pressure. The middle ear is a hollow space that is periodically vented when the Eustachian tube opens. This tube is opened or ventilated when a person yawns, chews, or even talks; just like when flying in an airplane and you yawn to equalize the pressure and resolve that ear fullness or associated pain.

Clogged ear and eustachian tubes
Clogged ears are often caused by dysfunction of the Eustachian Tubes

For some people, this associated fullness is merely bothersome, and for others, it can cause significant pain and discomfort. Unfortunately for those people, it can become more bothersome with physical activity because with exercise comes increased blood flow to the mucosal lining of the nose and throat. This increased flow of blood is important for humidification and warming of air prior to it entering the lungs. As that mucosal lining becomes engorged with blood flow it can cause the Eustachian tube to close off hindering the middle ear’s ability to equalize pressure. Other irritants can cause this lining to swell, such as pollution, cigarette smoke, or even allergens (dust, pollen, molds, or even animal dander).

How do I fix my clogged ears?

Typically, conservative treatment is very effective at reducing the incidence and the intensity of ETD, it can be as simple as increasing hydration with exercise or periodically leaning the head back and yawning while running, or for others the act of chewing gum with exercise resolves the issue. Some people respond well to a nasal saline washes with a neti pot prior to exercise. If conservative treatments are ineffective, a trial of a nasal decongestant spray for up to 3 days (Afrin or oxymetazoline) may improve clogged ears.  Decongestants work by causing the blood vessels to constrict in the nasal mucosa reducing the inflammatory process. However, nasal decongestants should not be used long-term, or on a daily basis.  Runners can use them prior to a race or a longer training run when they know the clogged ears sensation will be more bothersome. A lot of providers will also have patients begin the use of a topical nasal steroid spray (Flonase- being one of the most common), steroids are used to reduce the inflammatory process and can be used long term as an effective way to control ETD. They do require ~ 7 days of consistent use to become effective, so if you get to this point, you should continue to use the nasal steroids for at least 2 weeks to determine effectiveness.

If there is a significant hearing loss involved, or your clogged ears do not resolve spontaneously shortly after stopping, or if your symptoms do not resolve with the mentioned treatments further evaluation should be sought, typically by an ENT (ear, nose and throat doctor).


Scott Summers is a Family Nurse Practitioner that specializes in Ear Nose and Throat. Scott is an avid trail runner and alpinist with several ascents in the Tetons and Mt. Rainier