Click crack and crunch!

When you get up out of bed, have you noticed that it almost sounds like you have gravel in your knees? You can’t remember when it started but it feels like it has been forever. Do you wonder whether its arthritis or worried that things aren’t moving right? That’s the case for Mrs X, the subject for today’s case study. This blog will shed some light on what to look out for and how you can help those around you too!

Mrs X is 30 years old who works in administration. She sits most of the day but she does try to get up and move regularly while she’s working and also exercises regularly afterwards too by doing yoga and going for jogs. She’s always been wary of the crunching and clicking noises her knees make but because it wasn’t painful it didn’t stop her from doing her work, her sports or even her day to day activities. So, Mrs X didn’t mind it too much and thought it was just her body getting old. Mrs X heard from her co-worker that she was also experiencing the same issues but was informed that the clicking was caused by gas bubbles collapsing in the joint. She was told it wasn’t anything to worry about and that it wasn’t going to cause any long-term problems.

One day, on one of her regular afternoon jogs she heard a pop but this time it was quite sore. There wasn’t any swelling, but it was very tender when she went to touch the side of her knee. Throughout that week she started to notice a dull ache in the front of her knee when she sat down for a while and that her knee would make a loud pop when she stood up. Going up and down stairs also started to become a problem. She started to become more worried day and after day and eventually decided to do something about it.  

After a visit to the doctor, Mrs X was prompted to get an x-ray to confirm whether there was any injury or arthritis. The results showed no significant abnormalities, no evidence of injury and very early stages of degenerative arthritis. Nothing to explain the clicking or the pain.

At this point, Mrs X was not only confused but started to feel frustrated. This just didn’t feel right, she knew something was wrong otherwise why would she be getting the pain?

A friend of Mrs X told her about trying physiotherapy. In her session, her physiotherapist firstly took a thorough history of the condition and then ran through a number of physical tests to help confirm and rule out a number of things. The following was assessed in the first session:

• History of any overuse or injuries in the hip, knee or ankle
• Muscular strength the hip muscles particularly the Gluteus Medius
• Imbalance in muscle strength and control for the quadricep muscles
• Muscle tightness around the hips, knees and ankles
• Alignment and biomechanics particularly with running
• Foot position, checking for excessive pronation

After a thorough assessment, 2 main problems were found. Firstly, Mrs X had tightness in her hamstrings from sitting all day. This increased the pressure between the kneecap and the thigh bone which explained the constant grinding sensation that Mrs X experienced throughout the day. Secondly, weakness in the hip area caused her foot to turn inwards and which changed the alignment of her kneecap movement. This explained the painful click as the kneecap flicked back and forth constantly when Mrs X went for her regular runs.  

Over a period of 3 months, Mrs X worked on improving 2 things.

1 Muscle tightness in the knee: Mrs X worked on the tightness around the knee which included hamstring lengthening exercises as part of her through a structured mobility program. As her tightness decreased so did the grinding in her knee.

2 Improving hip strength: Through a tailored hip strengthening program to correct the alignment of her hip and knee, Mrs X was able to get back into running and exercise with significantly less pain and clicking. However, she realised that because of her job, the muscles will eventually get tight again. She sees her physiotherapist every month to continue working on releasing out tight areas and to provide further correction of her movement patterns and strength to prevent advancement of her knee problems.

Although joint noises are common and doesn’t need immediate attention in most cases, discovering the underlying problem is important. The body learns to compensate when things don’t move correctly but it’s only a matter of time before the problem catches up.

If you’re getting any clickiness in your knees like Mrs X, do these 3 exercises!