Recently this week I had a client use our Telehealth service, contacting us through our Physio page to ask for a consultation relating to her knee.
She had been active for over a year, doing exercises at the gym and feeling proud of her strength training and gym routine. However, she points out that she’s feeling quite unsure these days as she’s been dealing with a particular ‘clicking’ or ‘popping’ sound that occurs with exercises such as barbell squatting or performing lunge type movements.
Over the years I’ve also had my personal handful of clients looking for guidance regarding their source of joint sounds and sensations.
For some of you, the feeling of clicky noises can be quite discomforting and be a main source of dissatisfaction and fear. So today we’ll talk about what’s potentially going on and what you might be able to do about it.
What is that sound?
Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. It’s important to be able to differentiate between what the literature describes as either ‘pathological’ noises or ‘physiological’ noises.
So far, MRI based studies have provided evidence that these sounds are related to changes in joint pressure, where the sound is formed either by the formation or the release of air bubbles in the joint. Some argue it’s definitely one, not the other, but we’ll talk more about that later.
In a paper by Song et al. 2018, he also notes that clicking and snapping occur in many other joints, whereby the sounds can be caused by the snapping of tendons over bony surfaces, which for the most part is completely normal.
Some papers mention an association relating crepitus to osteoarthritis, but to date, there has not been enough evidence to show a clear causation relationship between knee osteoarthritis and crepitus, the technical, umbrella term for sounds that occur at the joint level. It is also used as a term in medicine to describe lung sounds, but our use of the term will be in relation to joints.
So how to you know what to do next?
Is the knee sound associated with pain, or does the click, pop, or grating cause pain, or stop you from performing your day-to-day activities? Is there swelling or irritation in the knee afterwards?
If the answer to that question is yes, then you have reason to have your knee assessed and be provided tailored treatment and management through the guidance of a physiotherapist.
If however your answer is no, take assurance! If you aren’t bothered by it one bit, let it be.
Is that it? Is it that simple? I don’t need to care about crepitus at all?
Based on our current knowledge of crepitus, yes- if it is just simply the sound and it’s not accompanied by any symptoms, you can rest assured.
Now, are there ways to try to reduce the sounds? Absolutely. Part of our jobs as physiotherapists is to help you move better and feel better. This might include working on and correcting bio mechanics of certain movements to make you feel stronger, more confident, and comfortable, whether or not there is clicking present. If you’re looking for a physio interested in helping you get back to sport, or you have knee pain- please talk to your local physiotherapist or contact us and we’d love to help.
Song et al., Noise around the knee., Clin Orthop Surg. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851845/