Introduction
* The knee joint is the largest joint in the human body, and the joint most commonly affected by arthritis. Knowing about knee anatomy can help people understand how knee arthritis develops and sometimes causes pain.
* The knee joint is a hinge joint, meaning it allows the leg to extend and bend back and forth with minimal side-to-side motion. It is comprised of bones, cartilage, ligaments, tendons, and other tissues.
* Three bones meet and move against each other at the knee joint:
* Bones and arthritis: One sign of arthritis is the development of osteophytes, or bone spurs, at the joint. These small growths on bones can create friction and affect a knee’s range of motion.
*Cracking the knees with motions such as squatting or stair climbing can be very common though it is usually harmless. Through the normal aging process, the cartilage covering the joint surfaces of bones can develop uneven or rough areas that can create a sound when gliding across each other.
* Soft tissues such as the joint capsule, muscles, and fascia can also create a popping or cracking noise as they glide and stretch across other tissue layers due to joint movement. Other times, an audible popping noise can be heard when the pressure quickly changes in the joint capsule as the space between the two joint surfaces expands. Occurring most commonly in the hand’s knuckles, this rapid expansion of the joint space releases gas as the pressure changes within the joint and an audible pop or crack is heard. Your doctor or physical therapist can determine whether the painful popping results from a meniscus tear, severe cartilage wear, or even ligamentous instability.
* The four main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:
1.Anterior cruciate ligament (ACL) - The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).
2.Posterior cruciate ligament (PCL) - The ligament, located in the center of the knee, that controls backward movement of the tibia (shin bone).
3.Medial collateral ligament (MCL) - The ligament that gives stability to the inner knee.
4.Lateral collateral ligament (LCL) - The ligamnt that gives stability to the knee.
The meniscus is a c-shaped pad of cartilage in the knee that acts as a shock absorber. Each knee has two menisci. Meniscus tears are common knee injuries. Knee arthroscopy is often used to treat meniscal tears.
causes of knees crack
Tight or misaligned muscles
Tight or misaligned muscles will pull the kneecap out of balance Over time that imbalance can cause clicking or popping, which could be a potential problem. the cartilage can become worn down and potentially lead to early onset arthritis, as well as many issues involved with deterioration of the joint.”
If your muscles aren’t in the right spots, or if one is working a little harder than another, that can lead to cracking and popping.
Arthritis
Arthritis, which is a term for inflammation of the joints, can also lead to cracking, clicking, and popping . This condition breaks down the padding within the joint due to erosion of the bone and cartilage, which interferes with the knee’s ability to glide and function smoothly. And that can lead to noise.
A previous knee injury
Often, people who had an injury in their teens or twenties will develop cracking and popping down the road.
Loose cartilage
Cartilage is the one of the main types of connective tissue in your knee, and it’s responsible for lubrication and helping cushion your knee. If the cartilage around your knee is loose (say, due to arthritis or an injury), it prevents the joint from operating as well as it should, leading to popping and catching or locking.
ACL Tears
The Anterior Cruciate Ligament (ACL) is one of four major ligaments in the knee. It is an important stabilizer of the knee and prevents the shin bone (tibia) from sliding in front of the thigh bone (femur).
Knee Arthritis
loss of the hyaline cartilage plus other changes that happen to the bone such as additional bone being laid down (bone spurs/osteophytes). The cartilage layer is worn down to the point of exposing the underlying bone they cover…
Other Common Causes
Baker’s cyst: Swelling in the back of the knee joint. May be due to a meniscus tear. Can cause a “tightening” pain, stiffness, and a visible bulge that gets worse with activity.
Prepatellar bursitis: Swelling of the prepatellar bursa (fluid-filled sac over the kneecap). May cause a mild ache. Can result from kneeling a lot (e.g., gardening, laying carpet).
Iliotibial band (ITB) syndrome: Swelling of the ITB (thick fibers on the outside of the thigh). Often caused by overuse. Causes aching and burning pain on the outside of the knee joint.
Symptoms
Crepitus – or joint sounds and bone cracking – can be a normal part of movement. Many people experience popping joints, especially as they get older. You may notice:
Sounds of knee popping or knee cracking when you bend your knee
Popping or cracking when you bend your elbow
Crunching sounds in your knee when you go up or down stairs or kneel
Crackling or grinding sounds or a crunching sensation when you move your shoulder
Occasional or continual swelling around the joint
Treatment
* RICE: resting, perhaps ice, heat, or compression, elevating the leg if there is some swelling.
* Physical therapy
. Rehabilitation exercises
. Advanced technique
. Stretching exercises
. Conventional technique
. manual therapy
Physiotherapy Management
1.Manual Therapy - manual therapy is any form of hands-on treatment used by a therapist.
These techniques may include:
Active assisted range of motion (AAROM): a client moves a joint through their available range of motion while the therapist gives assistance to achieve as much range as possible
Passive range of motion (PROM): a therapist moves a client’s joint through the available range of motion with no assistance from the client
Passive stretching: a therapist places a muscle in a lengthened position and provides a static sustained hold for a duration of time
Soft tissue massage: manipulation of the soft tissue (muscles, tendons, ligaments or fascia) through direct physical contact (e.g. hands, forearm, elbow). Therapist will use different pressures and depths to act on the soft tissue
Manual traction: providing a distraction force on a joint to allow for decompression or gapping to occur in the joint space
Joint mobilizations: specific passive movements working directly on the movement at joint surfaces through different velocities and amplitudes
Instrument assisted soft tissue mobilization (IASTM): use of specific tools to eliminate soft tissue and myofascial restrictions
Trigger point release: trigger points are palpable nodules that create taut bands in the muscle. Trigger point release is the act of applying pressure to these taut bands to ‘release’ or remove these nodules
Myofascial release technique (MRT): application of consistent pressure to restrictions in the myofascial tissue.
* Hip flexor stretch -
Knee to chest stretch
.Lie on your back with your legs extended on the floor. Slowly bend one knee toward your chest.
.Keeping your back flat, pull your knee as close to your chest as is possible without discomfort.
.Stretch your straight leg out as far as possible and squeeze your glute.
.Return to the starting position and repeat with your opposite leg.
.If you do not feel a stretch, try performing this stretch on a bench with your lower leg hanging off.
*Calf stretch
Purpose: This is one of the best calf stretches for gastrocnemius. Simple but really effective.
Starting Position: Stand leaning onto a wall with your toes pointing straight forwards (not out to the side). Place the leg to be stretched behind you
Action: Lean forwards keeping your back and the stretching leg straight until you feel a stretch in the back of your calf. Make sure you keep your heel on the floor. Hold for 30 secs
Repetition: Repeat 3 times, 2x daily, and before and after sport/exercise
Progression: Stretch further by taking your leg further back behind you.
* IT band stretch
Seated spinal twist
1.From a seated position on the floor, bend your left leg and place your left foot on the outside of your right hip.
2.Bend your right leg and place your right foot flat on the floor on the outside of your left thigh.
3.Exhale as you twist your lower body to the right.
4.Place your left fingertips on the floor, bending your hips.
5.Wrap your elbow around your knee, or place your elbow to the outside of your knee with your palm facing forward.
6.Gaze over your back shoulder.
Hold this position for up to 1 minute, then do the opposite side.
3.Conventional Therapy
Conventional physiotherapy is defined as the treatment of movement disorders caused by impairments of joints and the muscles that move the joints.
attribute movement disorders to changes in joint mobility and thus apply specific, mobilisation-based treatment techniques (osteopathy, chiropractic, manipulative therapy, etc.). Others attribute movement disorders to muscle weakness and therefore recommend limb and/or core muscle strengthening exercises.
We can also use modalities like TENS ,IFT , laser etc.