Clicking in any joint is common and it’s not usually a cause for concern, but what is that popping in your knee and when should an investigation be considered?
The main sign I look for, is if there is any pain associated with clicking or popping. If there is no pain, then usually there is no need for concern. The noise is mostly due to air bubbles inside the fluid of the joint popping as pressure builds. The noise can also be due to soft tissues (ligaments or tendons) catching over a bony prominence.
When the popping is associated with grinding, swelling, catching, locking, giving way or pain; this is when treatment or further investigation is needed from either a physical therapist such as, an osteopath or a Consultant.
Was your knee ‘pop’ associated with an injury?
If you heard a loud ‘pop’ when the knee was twisted or bent awkwardly, that is usually a sign of ligament damage. The 2 most common ligaments that are injured in the knee are the ACL (Anterior Cruciate Ligament) or the MCL (Medial Cruciate Ligament).
ACL: The ACL sits in the centre of the knee joint and is usually damaged when there is a blow to the knee, a sudden twist or quick deceleration.
A pop followed by immediate pain is usually a sign of complete rupture and the knee often gives way when weight bearing. Treatment depends on the severity of the injury but, physical therapy, support braces and surgery are the most effective.
MCL: The MCL sits on the inside aspect of the knee and usually gets injured when there is a blow to the knee or an awkward twist.
The symptoms aren’t too dissimilar to an ACL injury, but the pain is often worse on knee flexion. Surgery isn’t usually required and responds well to physical therapy and support braces.
Is your knee ‘popping’ ongoing and not necessarily associated with an injury?
In some cases, popping can start out of nowhere and slowly get worse over time. The most common reasons are:
Cartilage/ Meniscal tear: The meniscus is the cushion of cartilage that sits inside the knee joint. Meniscal tears can also be acute and caused by an injury, but not always.
The symptoms include knee locking, swelling and clicking and this is due to fragments of cartilage, catching in the joint. Treatment depends on severity, but physical therapy or surgery are the most common options.
Chrondromalacia patella or Patella-Femoral Pain: This is inflammation/ irritation to the cartilage that lines the back of the kneecap (patella). It is a friction injury and is most common in adolescents and young adults.
Symptoms are pain and clicking when bending and straightening the knee. Treatment can be prolonged as it is a chronic issue, however physical therapy, strapping and ice are considered effective.
Osteoarthritis: This is degeneration or thinning of the cartilage of the knee and the popping and pain is due to the surfaces of the joint, becoming rough and the bones begin to rub against one another.
Osteoarthritis is most common over the age of 50 and other symptoms include deep aches, stiffness (usually in am) and swelling. Physical therapy is effective in relieving the symptoms, but in the most severe cases injection therapy or surgery is usually required.
Runners knee: You don’t necessarily have to be a runner to get runners knee, you can get it from being sedentary! This is when the knee cap (patella) rubs against the femur. Symptoms are usually grinding, worse for coming downstairs and this is because the patella isn’t tracking correctly over the joint. Runners knee responds well to physical therapy.
How can Osteopathy help?
I find one of the most effective forms of treatment for knee pain is looking biomechanically and working on all the joints that are closely associated with the knee; particularly the feet, hip, lower back and pelvic joints.
There is often a pelvic or muscular balance which is worsening the symptoms of the initial injury. I would use treatment techniques such as; massage and frictions to soft tissues, stretching, mobilisation of joints and exercise-based therapy to strengthen the lower back, hip, and knee. I can also give advice to follow at home which can help with recovery.
I am also trained to know when further investigation such as imagery or a consultant referral is required.
Please feel free to call me for further advice,