Joe A Shaw PA-C - 1/23/2008

Question
QUESTION: Hi Dr. Joe,

Would you be kind enough to answer a query relating to a sore knee joint that seems to be protesting with a 'click' noise?
If yes, then I could provide you with exact details.

Thanks,
Vidya, Melbourne

ANSWER: Yes I can give it a go.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your prompt response & accepting to look into my case.
I am 27, female, Asian origin. 5 Ft 2" & 48 Kgs.
I have been experiencing 'clicking' noise from my right knee when I climb upstairs: more pronounced (I hear it when I complete the motion of lifting myself OVER my knee with the weight applied completely on the knee) & very mildly when I climb down the stairs.
I am not experiencing any pain, just a soreness that runs along the inner side of my knee: from the centre downwards: a tad towards the front, under the knee cap.
I can 'feel' a creak if I cup the knee & extend the leg outwards while seated, I can feel a stretch on doing the same with the toes pointing outwards.
I did fall on this knee 8 weeks back; however, the soreness subsided with the bruising & I was back exercising.
It also hurts if I sit with the foot under my hip on the floor / sofa & get up. Last week it was knocking while STANDING for extended periods (while cooking in the kitchen); so I pulled back completely for 4 days & only took walks: this has helped immensely, this week it creaks & clicks on climbing stairs.
My weekly exercise routine:
Body Pump with light weights (4-6 Kgs. on the bar, none while doing lunges): 2 x some weeks an additional class over the weekend.
I can preform squats, but lunges with the right knee bent hurt. left knee bent does not.
Yoga: 1 x
Step: 1 x
Exercise cycle: 1 x
It is sore after a workout, but no 'shooting pains' there is no visible swelling in comparison to my left knee.
I began exercising in September last year & was sometimes taking two sessions in a row (like Jam followed by pump) & was doing fine.
After the fall I had taken a 3 week break over Christmas & on returning, I am encountering this problem.
If I ever skip a class (completely) I take a one hour walk on that day.
Am I over-doing anything? Do I need to take any precautions?
I hope I don't have to discontinue any of the exercising...
I would appreciate your guidance, additional muscle strengthening exercises and promise to inform of progress.
Thank you once again for the prompt response.
Warm regards.

Answer
Vidya,
It sounds like you may have crepitus (crackling/crunching sound with joint movement)which can be fairly common. If this is painless for the most part, there's not a lot to do. In the knees it is generally caused by the joint end of the upper leg bone(femur)rubbing on the inside or backside of your patellar (knee cap)the condition is called chondromalacia patellar..fancy words for roughness behind the knee cap. My right knee sounds like popcorn popping when I go up stairs x 15 yrs now.No real pain. On extreme cases or with pain they can scope and clean up the back of your knee cap.Sometimes real active people get this, possibly from the thousands and thousands of repetitions over the years.Possible started when you feel on knee?
I would avoid squats and the like,I don't cycle anymore and do the treadmill..walking instead. You can try tightening up the quads with leg extensions,light wt..but not the flexion part(sit w legs extended in front of you and let legs go down just 10 degrees or so and back up)I've been doing them for yrs and it really hasn't helped me.

Secondly it could be a meniscus tear (the cartilage in your knee)This however is usually described as pain,buckling,and/or a giving away sensation,with clicking of the knee.You will need an MRI to tell about the meniscus for sure. You can try the ice after workouts advil or the like for a few wks..and then if not better I would see an ortho.