Knee Pooping – Why Does My Knees Pop? | Pain Care

Knee Pooping – Why Does My Knees Pop?

Knees are quite a common joint to crack, usually noticed when squatting. The cracking sensation associated with a popping sound is normally not a cause for concern when seen without pain or swelling.

Knee popping, also known as crepitus, can be treated at home, with symptoms going away in a few days. However, if the knee locks or is unable to take any weight, it is best to take medical advice. These sounds are common in arthritis sufferers. (1)

Benign knee popping can be caused by gas bubbles or snapping of ligaments or tendons. These sensations are common and are not a cause for concern as they usually do not present any associated pain.

However, a damage to the ligaments surrounding the knee could need medical intervention. These flexible bands help control motion and connect the bones.

A damage to the Medial Collateral Ligament or the Anterior Cruciate Ligament is common during sports-related activities.

These injuries can be prevented by proper techniques and use of support braces. Treatment is usually non-operative.

Ongoing Knee pain with popping can be caused by arthritis, cartilage tear, chondromalacia patella and runner’s knee.

A mixture of self-care techniques, weight management, and physical therapy can relieve these symptoms. 

However, precautionary measures to correct posture, support the knee and improve flexibility can help prevent injuries.

Types of knee popping:

  • Benign knee popping
  • Knee Popping with injury/pain
  • Ongoing pain with knee popping

What is Benign Knee Popping?

Painless knee popping is a benign condition most commonly caused due to a build-up of gas bubbles. The sensation can also be noticed when the ligaments or tendons above the knee snap.

Treatment is not required for these conditions, however, any pain with the below sensations should be investigated and treated appropriately.

Causes of pain free knee noise:

  1. Cavitation
  2. Snapping of ligaments or tendons.

Cavitation

Over time, with everyday use, the knee joint can see gas building in the surrounding areas.

This build-up results in the formation of tiny bubbles in the synovial fluid. The bubble formation is attributed to the changing pressure in the joints.

The synovial fluid, which contains carbon dioxide, nitrogen and oxygen gases, acts as a lubricant for the joint.

The knee popping sound is noticed when these gas bubbles quickly burst. This is known as cavitation.

Snapping of Ligaments or Tendons

A slight stretch in a tendon or ligament can result in a snap, which produces the popping sound. The stretch can occur during normal motions of the joint.

The knee clicking sensation is noticed when the soft tissues positioned around the knee stretch and snap back into place.

Knee Popping Associated With Pain

A damage to the Medial Collateral Ligament (MCL) or the Anterior Cruciate Ligament (ACL) results in a loud pop and knee pain.

A ligament, made of a lot of collagen fibers and little elastic fibers, not only functions to control excessive motion by limiting the joint mobility but is also a source of proprioception.

A ligament prevents a joint’s medial portion to widen under stress by resisting the forces applied from the knee’s outer surface.

Proprioceptors, which are present in ligaments, help in monitoring the position of our limbs as well as the effort used in lifting objects. (2)

Common causes of knee crepitus with pain:

  1. Anterior cruciate ligament injury
  2. Medial collateral ligament injury

Anterior Cruciate Ligament Injury

The Anterior Cruciate Ligament (ACL), which connects the femur (thighbone) to the tibia (shinbone) is necessary to stabilize the knee joint.

Anterior Cruciate Ligament Tear - ACL Tear

An injury to this tissue can damage it, resulting in a complete or partial tear. The ACL prevents sliding of the thighbone on the shinbone and is also necessary for stabilizing the knee from rotating.

Symptoms of an ACL injury include an audible popping sound, restricted movement and swelling.

Only 20% of ACL injuries are associated with direct contact, and the rest happens when the knee is awkwardly twisted.

Activities that put stress on the knees include incorrect landing from a jump, football tackle with a blow to the knee, slowing down suddenly and changing directions, and pivot against a locked knee. Such activities commonly occur during football, basketball and gymnastic actions.

Tackling in football or falling during skiing result in a direct blow to the front of the knee. This causes the tibia to be pushed forward.

Studies suggest that women athletes are more prone to this damage as they tend to show a strength imbalance in their thighs. This can be attributed to a difference in muscle functions and anatomy. The higher muscle elasticity in females results in a decreased protection to the ACL by the hamstring muscles.

An injury in the knee associated with a loud pop and intense pain pose as signs of an ACL injury.

The sufferer can have trouble straightening the knee within a few hours because of bleeding within the joint. Such injuries can affect your walking and weight-bearing abilities. (3)

Medial Collateral Ligament Injury

The ligament spanning the medial side of the knee is known as the Medial Collateral Ligament (MCL). An impact to the upper leg or lower thigh can cause an MCL injury.

A grade 1 tear is characterized by pain when applying force on a slightly bent knee. This tear occurs when less than 10% of collagen fibers are torn. Instability of the knee is not noticed in such tears. (4)

Complains of intense pain and swelling, without instability, indicate a grade 2 tear. While a complete rupture of the ligament is indicated in a grade 3 tear.

The symptoms include swelling, severe medial pain, instability, and difficulty bending the knee.

How to Treat Ligament Injuries?

Ligament injuries can be treated by non-operative measures.

A detailed history regarding the incident and position of the legs is necessary to treat the condition. Such injuries can be treated by strengthening the knee muscles.

1. Knee Stretch

Knee stretches are a part of the rehabilitory program post an ACL or MCL injury.

Quad Stretch: Stand straight with hands on a chair for support. Hold the ankle of a leg and stretch it backward, hold the position and repeat.

Hamstring Stretch: While lying flat on your back, bend the knee and pull the leg towards with one hand on the calf and the other on the back of your thigh. Hold and repeat.

2. Self-Care: Rest, ice, compression and elevation help relieve the pain and swelling in the first 48 hours post an injury.

3. Medications: Swelling and pain can be reduced by anti-inflammatory medications such as Ibuprofen.

4. Surgery: An orthopedic surgeon might recommend surgery for ACL or MCL tear for young athletes and those involved in intense activities such as heavy manual work, pivoting, jumping and side-to-side sports.

Ongoing Knee Pain with Popping

Constant knee pain with popping is caused by a damage to a cartilage surrounding the knee can result in persistent pain in the knee with popping sounds.

Cartilage/Meniscus Tear

The meniscus cartilage in the knee cushions and stabilizes the knee joint. The most common cartilage injury of the knee is a meniscus tear.

Such tears occur during a twist of the knee, common in contact sports.

Damage to the meniscus can happen because of a single event or can also be caused gradually with overuse. The latter results in degenerative tears, which is noticed in six out of ten patients over the age of 65. Many of these tears usually cause any problems or lead to a change in lifestyle.

The knee can also lock up if a piece of the shredded cartilage catches in the knee joint. As the cartilage weakens with age, it is more common in athletes aged 60 and over.

The knee popping and pain tend to be intermittent and happen when the shredded fragments move around the joint.

An indication of a meniscus tear is the knee locking up. The injury is associated with a popping sound and accompanied by swelling and pain. In some cases, the pain is noticed a while after the injury.

The outside rim of C-shaped cartilage has better blood supply as compared to the central part, therefore has better recovery potential.

Age is a contributing factor for recovery as the blood supply to the knee cartilage decreases with age. It is said that up to 20% of normal blood supply is lost by the age of 40. (5)

A large tear might require medical intervention to remove or repair the unstable edges. However, unrepairable tears can pose a risk of knee arthritis in the long term.

As meniscus tears are a result of accidents usually, it is difficult to prevent them. Precautionary measures such as maintaining flexibility, warm-up exercises, proper fitting shoes, and strong thighs can prevent such tears. (6)

It is quite common to mistake a meniscal tear with an MCL sprain. However, the tenderness associated with an MCL sprain usually resolves in several weeks but persists in meniscal injury.

Diagnostic imaging techniques such as MRI can help detect the torn cartilage.

Arthritis

Arthritis can affect any joint of the body, but it is more common in the knees.

Osteoarthritis, which is the most common form of knee arthritis, is noticed when the cartilage in the joint wears away gradually. This results in a bone rubbing on a bone as the protective space between them decreases.

The degenerative type of arthritis is common in people aged over 50. The condition develops slowly, with the pain increasing with time.

The risk factors for osteoarthritis include the following:

Knee Injury

A torn meniscus can lead to arthritis in the long term.

Joint diseases

Gout or rheumatoid arthritis damage the joint.

Overweight

Osteoarthritis is more probable in overweight individuals.

Gender

Women are more prone to suffer from this type of knee pain

Osteoarthritis is diagnosed by checking for tenderness, excess fluid, thinning of muscles, knee sounds, and restricted movement.

A prototype device developed by researchers measures the sounds made the knee to check for deterioration. This could help detect early onset of osteoarthritis. Arthritis Research UK has funded the development, however, tests are still ongoing and the device is not available for use now. (7)

Chondromalacia Patella

A damage or softening of the cartilage on the back of the knee causes Chondromalacia Patella.

This condition is usually noticed in young and healthy people associated with fitness and sports activities.

This condition is noticed when the under-surface of the patella grates along the femur. This grating is a result of abnormal tracking of the patella towards the outside of the femur. Chondromalacia Patella sufferers complain of chronic pain and inflammation.

The condition is most commonly noticed in knock-kneed or flat-footed runners and is more prone to develop in women. Its indications include a discomfort of the inner front of the knee.

The symptoms tend to get worse by prolonged sitting with knees slightly bent. Activities such as running and descending steps also aggravate the pain.

Instability is occasionally seen because of the associated loss of quadriceps muscle strength. However, this occurs when the initial symptoms are ignored and not treated.

Treating this condition involves correcting the tracking of patella during quadriceps contraction.

The physical therapy program focusses on strengthening the quadriceps. The exercise involves contracting the quadriceps while holding the legs straight. This position should be held for a few seconds and repeated.

A strong inner portion of the quadriceps acts as a prevention tool for Chondromalacia Patella.

Physical therapy can help relieve the symptoms in a few weeks.

Runner’s Knee

Pain at the front of the knee aggravated by walking up or running is usually seen to be runner’s knee.

The condition can impact people with a sedentary lifestyle as well as those associated with sports.

This condition is caused by the incorrect movement of the patella resulting in friction through the kneecap.

Muscle tightness around the kneecap can move the kneecap slightly to the side causing kneecap pain. Also, the support around the knee can be reduced if the muscles become weak. This puts more pressure on the knee cap.

Nearly 25% of all knee injuries reported in sports injury clinics are caused by runner’s knee.

How to Treat Ongoing Knee Pain?

Self-Care

1. ICE: Ice, compression, and elevation can help reduce ongoing knee pain.

2. Rest: Intense activities should be paced out to avoid cartilage tears and muscle weakness.

3. Knee Braces: The braces reduce the strain on the knee and can be worn as a preventive measure during sports activities or during the recovery period. Unloader braces that help shift the weight to a stronger area of the knee are helpful for arthritis.

4. Knee Sleeves: These can be worn to reduce pain and swelling by offering compression to the knee joint.

5. Tubigrip: The elastic bandage offers compressions and reduces swelling. The bandage can be used post an injury to get knee support. It can also be used for ongoing knee pain.

Strengthening Exercises

Quad muscles are located at the front of the thigh and used to straighten the knee. The weakening of these muscles is the most common cause of knee pain.

1. Marching Knee: March your legs while sitting on a chair with bent legs and feet on the floor. Continue for a few minutes and repeat after a break.

2. Strengthen Quad: Keep your leg and knee straight while sitting or lying on your back. Push the knee down and tighten the muscle on the front of the thigh. Hold for three seconds and repeat.

3. Quads and Glutes: Sit on a chair with feet firmly on the ground. Lean forward and lift your buttocks from the chair to stand up straight and sit down. Continue for 10 repetitions.

Medications

Painkillers and combined analgesics can help relieve the pain and stiffness associated with ongoing knee pain. However, these medicines will not repair the damage to the knee.

Anti-inflammatory gels can also help reduce the pain in arthritic knees.

Supplements

Glucosamine supplements, which are usually derived from shellfish, have been reported to improve the health of a damaged cartilage.

The compound is normally found in joint cartilages. However, diabetics should be careful before starting this supplement, as it is known to increase the sugar level in blood.

Ginger supplements are also found to be beneficial for arthritic pain.

Alternative Therapy

Acupuncture: The benefit of using acupuncture to relieve ongoing knee pain is the relative lack of side effects.

A study suggests that over 50% of mild arthritis sufferers have experienced relief. Electro-acupuncture has also shown success in relieving joint stiffness and inflammation. (8)

Tai Chi: The ancient form of Chinese mind-body exercise is helpful for reducing pain and increasing range of motion.

Use of Herbs: An ointment prepared with sesame oil, mastic, ginger, and cinnamon has been studied to be effective as a pain relief treatment.

Essential Oils: Basil, Eucalyptus, Marjoram, Tea Tree, Peppermint and Chamomile oils can be used for knee pain. Massage the diluted oil to relieve pain and inflammation. The dilution can be achieved by mixing it with sesame oil or vegetable oil.

How to Prevent Knee Popping and Pain?

Knee pain with popping can be caused by injuries or normal wear and tear of the body. Benign knee popping is not a cause for concern and does not require treatments.

However, knee popping caused by injuries to the ligaments or damage to the cartilage can be prevented by the following tips

Adherence to Perfect Knee Health Checklist

The recovery period post an injury is the most important part of a treatment program. During recovery, swelling and pain can go away in a few weeks allowing the person to resume their activities.

However, it is necessary to not over-exert your knee during this period. This might aggravate your knee pain.

Runners can take up a new activity such as swimming. Athletes should return to their normal routines slowly, with the intensity increasing as the strength in your muscles increases.

Adhere to the perfect knee health checklist before resuming intense physical activity can help to prevent knee pain or recover faster.

  • Check if you can fully bend and straighten knee without discomfort and pain.
  • Check for pain during walking, sprinting and jumping.
  • Check for swelling noticed in the knee.

Post these checks, you can increase the intensity of your activity. It is vital to take breaks to reduce the likeliness of muscle fatigue.

Use Supportive Knee Brace

Knee braces can be used to support the knee and can also act as a precautionary tool for injuries. Different knee braces are available depending on the level of support needed.

A basic level brace is ideal for ongoing knee pain, while an elite level is best suited for instability caused by knee pain.

Knee pads can also be used to protect the knee when kneeling.

Weight Management

Body weight is known to impact the strain on the knee. Having that extra pounds can put an unnecessary strain on your knee joint.

A healthy lifestyle with proper diet and regular exercise can help maintain the body weight and reduce the risk of arthritis.

Experts recommends to start with losing around 5 to 10 percent of your body weight to see if symptom improves or not.

Correct Posture

Most of the ACL injuries are a result of awkward knee positioning. Consult an expert to understand the correct posture while weightlifting and other exercises.

Understand your body’s flexibility and limitations. Build your flexibility with time, as undertaking strenuous activities suddenly can shock your body.

Ankle and hip mobility exercises can help avoid strain on the knees, learn these techniques before working out.

Take-Home Massage

Knee popping can be an uncomfortable experience for many.


The popping sound, if unaccompanied by pain, can be ignored. There is no research suggesting a link between cavitation and arthritis.


However, a popping sound associated with pain in the knee needs attention. To understand the cause of this pain, it is important to know the activity that led to it and position of the leg.


Ligament injuries can be painful and depending on the severity of the sprain and tear, it can take up to a few months to heal.


Surgery is often the last course of action and is recommended to young athletes. Self-care and stretching exercises can help relieve the pain and improve your knee health.


Ongoing knee pain and popping can be caused by damage to cartilages around the knee. A strong core and quad can help relieve the pain caused by these conditions.


Surgery is rarely needed as a remedial measure, but medical intervention is necessary if the pain is persistent or is accompanied by fever and weakness.

Dr. Sachin
 

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