Should we be concerned with noises in the knee?

There are a few things that we as individuals tend to be concerned about when it comes to our bodies, one of these things is what we call ‘crepitus’.

Now what is crepitus?

Crepitus is described as an audible pop/click/grinding sensation that is often experienced around joints, most commonly in the knee. There is the belief by many particularly the general population believe that ‘crepitus’ is a sign of degeneration and is one of the main reasons for lack of activity/exercise in people.

I am here to tell you that for the most part, crepitus is not something that we need to be concerned with. The literature states that ~99% of knees make some form of noise during activity. It is important to know whether these noises are pathological or physiological.

Again, what is the difference between these two?

Well, a pathological noise is typically accompanied by some form of injury. This might include:

  • Popping sound with a ligament tear such as the ACL (Anterior Cruciate Ligament) at the knee
  • Clicking, locking or catching with a meniscus injury
  • Grinding with associated pain from a degenerative/osteoarthritic (OA) knee

Typically you will find that the above noises will result in some form of swelling, pain or restriction when it comes to range of motion and strength.

Conversely, we have purely physiological noises. These differ from our pathological noises because they are not associated with pain or other deficits. These are the noises that you may hear around the joints e.g. knee during everyday moments but tend to not think about them because they don’t interfere with activities or produce pain.

It is very much demographic/population dependent. What I mean by this is that if you are hearing crepitus and you fit within the ranges of someone experiencing some osteoarthritic changes, then the crepitus might be more pathological in nature.

One specific study by Pazzinatto et al 2018, looked at the relationships and clinical implications of crepitus for patients and clients with knee OA. What they found was that the patients who experienced crepitus with OA tended to note lower self-reported function levels compared to those patients without any crepitus. Across the two different groups, they found that knee crepitus did not affect knee strength, function and pain in patients with knee OA, but rather the patients’ beliefs led to them having a negative health perception.

What does this mean for us in practice and how can we positively inform our patients in the clinic? Education is paramount for practitioners when explaining whether the crepitus or sounds that you are hearing are associated with a specific injury or purely physiological.

Noisy knees are normal, and we shouldn’t jump to conclusions unless we have completed a thorough assessment!

References:

Drum, E. E., Kovats, A., Jones, M. D., Dennis, S., Naylor, J., Mills, K., & Thom, J. M. (2023). Creaky knees: Is there a reason for concern? A qualitative study of the perspectives of people with knee crepitus. Musculoskeletal Care, 21(4), 1114–1124. https://doi.org/10.1002/msc.1793

Pazzinatto MF, de Oliveira Silva D, Faria NC, Simic M, Ferreira PH, de Azevedo FM, Pappas E. What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? An observational study with data from the osteoarthritis initiative. Brazilian journal of physical therapy. 2019 Nov 1;23(6):491-6.

 

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok – BeFit Training Physio Coogee

Jamie Cheok is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Jamie has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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