Creaky Knees Are Not Always A Sign Of Osteoarthritis

Creaky Knees Is Medically Known As Audible Crepitus

Almost daily in our Randwick and Sydney CBD physio practices I would have patients coming to me expressing concern around having noticed they have creaky knees. Frequently, these patients will be complaining that their knees are making sounds when performing squatting or bending movements, or when going up and down stairs. Sometimes the noises they describe are associated with pain and sometimes there is only an auidable creaking sound and no discomfort at all. This “creaking” sound made by joints and other tissues such as tendons is referred to as audible crepitus. Reproducing someones creaky knee sounds in a clinic setting is usually fairly straight forward. Simply asking the patient to repeatedly flex and extend their knee whilst sitting on the edge of the physio bed, or alternatively having them squat or lunge up and down a few times and that should pretty much do it. However, often truly audible crepitus may only be intermittent yet patients report a sensation of experiencing creaking, or even experiencing an uncomfortable grating sensation whilst flexing or extending their knee but in fact there is no truly audible sound to be heard. In these situations the creaking or grating can usually be palpated through gently placing a hand over the kneecap whilst the knee is bent back and forth few times and the crepitus can be felt even if it can not be heard.

So, What Is It That Causes Crepitus?

Crepitus in the kneecap area is caused from vibrations produced by the articular cartilage surfaces gliding across each other during flexion and extension movements of the knee. The good news is that frequently any actual underlying pathology causing the crepitus is quite minimal. Vibration waves are produced by articular cartilage of the knee joint during these flexion-extension movements as the approximating joints surfaces pass across each other with movement. The vibration waves are significantly different in asymptomatic patients with normal articular cartilage when comparing to patients with osteoarthritis of the joint.

Audiable Crepitus Is Often A Feature Of Osteoarthritis

This audible crepitus is a common feature with knee osteoarthritis; however degree of crepitus does not directly correlate to severity of osteoarthritis, nor does it correlate to the amount of discomfort, or any predictable functional limitation a patient may experience. A patient may in fact have no crepitus yet be diagnosed with significant osteoarthritis or anterior knee pain, or vice versa where they have significant crepitus yet no signs of osteoarthritis or knee pain. Therefore, although some degree of audible crepitus is a common sign noted with knee osteoarthritis the presence of crepitus in the knee does not necessarily indicate that the individual has osteoarthritis. Audible, or palpable crepitus may indicate other ailments, such as synovitis, or an articular lesion that is occurring in the absence of any osteoarthritic changes.

What Should You Do If You Have Creaky Knees?

As mentioned above having creaky knees (audible crepitus) can mean different things, and in fact asymptomatic patellofemoral crepitus is relatively common and does not require any treatment. Meaning if you have a creaky kneecap but do not actually experience any associated discomfort, or limitation in function then it is generally acceptable to give it little, if any specific attention.

• Creptius, is commonly associated with a patellofemoral syndrome called “Runners Knee”. Runners Knee is something that normally does require/benefit from treatment because classically with runners knee any crepitus is also associated with pain in the knee. Treatment for any patellofemoral pain syndrome is multifaceted whereby assessment and treatment of kneecap related pain issues typically require among other things looking at the patient’s lower limb biomechanics. This can include not just knee movement and control but foot biomechanics as well as over all postural control including trunk and lower limb strength. Separate to biomechanics assessment of other factors including lower limb flexibility and training loads… may be taken into account by your physiotherapist in an attempt to get to the bottom of why you are having issues. It is fair to say many running issues we see in our physio practices would be associated firstly with training errors (this being returning to prior levels of running after an extended break, ramping up training to rapidly without sufficient time for tissue adaption, alterations in running surface and gradients again carried out without sufficient time for tissue adaption, failing to provide suitable rest following significant events (1/2 marathons, marathons and ultra distance events)…

Frequently a cornerstone approach to treating patellofemoral joint syndrome is to target functional strengthening of the VMO and the trunk stabilizing gluteal muscles. Strengthening these muscle groups without provoking any knee pain (which will inhibit quads activation) is key. Occasionally this can be a challenge as the very exercises that are fantastic at strengthening the VMO and gluteal muscles are the exact exercises that trigger knee pain… But then this is where ideally your physiotherapist will earn their money and come up with progressive alternatives to target these muscles groups. Therefore still getting the desired strength and functional control gains but without exacerbating any pain. It can be a challenge and I feel typically a significant reason why patellofemoral joint syndrome can be a source of frustration for patients and therapists alike.

Pinpointing The Origin Of Your Crepitus

Pinpointing the cause of any crepitus and its relevance is a crucial first step in the management of any creaky knee complaint because as previously stated, not all “crepitus” needs to be treated. Crepitus deemed relevant and requiring treatment is managed in different ways with the approach as such ultimately depending on its cause. Getting an accurate diagnosis regarding the cause and therefore significance of any crepitus is the first step towards managing any creaking knee complaint. As a physiotherapist we are well placed to assess your knees (be they noisy or not) and provide an opinion about any creakiness and if any intervention is warranted. If you have a pair of knees that make consistent noise and wanted the relevance of this assessed then at Sydney Physio Clinic our physio team would be happy to provide this assessment and offer our advice.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding the management of their “creaky knees” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.