Noisy Knees, Part 2: "Crunching"

Sports and training injuries, car accidents, or just plain aging, can all cause "noisy knees." Not the painful "popping" I talked about yesterday. I mean something called "crepitation" - crunching sounds you hear when you rise from a chair, climb stairs, or do a squatting exercise. Sometimes the crunch is so minimal it can only be felt. Sometimes it is so loud it can be heard across a room. It can be a mere nuisance, or so severe it becomes a disability.

A number of things can cause the sound. But the odds favor chondromalacia patellae ("soft cartilage" in Greek). This is a chronic degenerative softening of the cartilage beneath the kneecap. The normally ice-smooth tissue breaks up into a shredded surface that resembles crabmeat.

These multiple shreds of cartilage vibrate as they rub across the groove in which the kneecap rides. That's what causes the sound and sensation of crunching. The deeper the lesions, the closer they are to the nerves and the more discomfort you feel.

To treat this condition, first STOP doing whatever seems to cause the crunching.

If, for example, you're doing a squatting exercise, stop just short of where the crunching begins. Then, as you stand, tense your quadriceps strongly at the top, with your knee completely straight. This isometric contraction will strengthen the quads and pull the kneecap inward so it no longer rubs on the same spot. This will minimize the crunching (and the pain, if present). But notice I said minimize, not eliminate. Once you have this condition, you always will.

Only arthroscopic surgery can completely resolve crepitation. But if it doesn't hurt, leave it be. Unless severe pain persists, despite exercise and other conservative measures, surgery's not indicated for noise alone.

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