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Noisy Knees

By Alan Williams, PT, OTR/L, ATC, CSCS

I’m not really a car guy, but I probably should be considering how well they relate to my profession. When you think about it, cars are remarkably like the human body. When they’re young, they function dependably with only fuel and regular maintenance. As the years go by, however, the functionality starts to wane. Parts wear out and may even need replaced. And overall, things get a lot noisier; squeaky brakes, squealing belts, and grumbling engines are familiar sounds to everyone who owns a “senior vehicle.” In fact, how many of us have taken our car to the mechanic, and when asked what needs fixed, shrug and say, “It’s making a funny noise”?

A grinding noise that accompanies knee movement is a complaint I often hear from people who have a lot of “miles” on their knees (such as athletes and the elderly) and from those whose knees experience a lot of stressful wear-and-tear (such as the obese, those with flat or overly arched feet, and those with poorly-healed previous injuries). Women are also more prone to this, due to mechanical differences in the knee. Depending on your age and lifestyle, your symptoms can probably be described as one of the following of conditions. Neither is a diagnosis; rather they are umbrella terms used to identify a set of symptoms.

Patellofemoral syndrome is the term used to express pain on the sides or top of the kneecap due to changes in the joint. The term patellofemoral comes from the patella (kneecap) and the femur (upper leg bone). Thus, as the name describes, patellofemoral syndrome occurs when the kneecap slides improperly and comes in contact with the femur. The syndrome may develop to the point where the contact creates a grinding noise. This off-tracking of the kneecap is usually caused by an imbalance of strength in the muscles and tendons around the knee or by a misalignment of the kneecap itself.

Chrondromalacia patella (CMP) is very similar to patellofemoral syndrome except that it hinges specifically on fraying or other damage to the cartilage underneath the patella. The term chrondromalacia means “soft cartilage under the kneecap.” As it suggests, CMP occurs when the cartilage is worn away, decreasing the natural padding between the kneecap and the femur, causing them to come into contact.

Because the causes and treatments of patellofemoral syndrome and CMP are so similar and their distinctions so minute, it’s not imperative that you be able to name your grinding knees under one or the other (although your physical therapist will be able to give you an underlying diagnosis if you’re really curious). In order to improve your symptoms, it’s most important to identify your contributing factor(s) and work to modify or eliminate them.

Both syndromes are referred to as overuse or overload conditions because they are brought about when the knee must endure forces beyond that which it is ready to handle. They are often nicknamed “runners’ knee” because of the frequency with which they appear in athletes, especially runners, snow and skateboarders, and those who play soccer, volleyball, and tennis. Anything that increases the amount of friction experienced by your knees can be a contributing factor. While some of those factors are unchangeable without drastic measures (like aging, being female, or kneecap misalignment), most can be lessened by losing excess weight, balanced strength training, wearing orthotics and properly fitting shoes, switching to low impact activities (such as swimming or cycling), and receiving adequate rest between sports activities. Your physical therapist will be able to further suggest ways to improve and eventually eliminate your symptoms. In severe cases, that may require surgery.

Patellofemoral syndrome and CMP are two conditions which require time, sometimes lots of time, to heal. Being patient and taking care of your knees will help you get many, many more miles out of them.

Don’t let knee pain hold you back. Call 463-0022 today to schedule your FREE Knee Pain Assessment!