If your knees grind, creak, grate, pop, thump, crack or crunch when you move through a particular range of motion, you have crepitus. Don't worry, it's not as bad as it sounds. Get-Fit Guy explains why your joints make noise and what you can do about it.
Get-Fit Guy podcast listener Brian wrote to me earlier today:
Hi, Brock. I just received the news from my doctor that I have Crepitus in my right knee. It does not hurt a lot and I have not seen a PT yet. I stopped running and am using the RICE protocol on my knee. But do you have any other suggestions? What exercises do you suggest? Should I put a knee brace on? Thank you for your help.
After doing some deep breathing relaxation exercises so I didn't lose my cool, this is what I wrote back to him:
First off, Crepitus is not a condition. It's simply a fancy way of saying 'noisy body part.' It doesn’t mean that anything is wrong, per se, especially if it isn’t paired with pain. Although it can be annoying, most of us get crepitus in one joint or another as we age.
Yes there are things we can do to minimize it, but please don’t wear a knee brace. Unless you have pain and a very particular type of injury, a knee brace will most often make matters worse. You need to allow your joints to move through their full range of motion. It’s when we stop using our full range of motion that we allow problems to become bigger and harder to correct.
If you are concerned about this issue, go see a physical therapist (or sports doctor) who specializes in joint function. Frankly, your doctor doesn’t sound like they have a lot of training or understanding of this stuff—especially if the diagnosis was 'crepitus.'
Yes, I know I could have gone easier on Brian’s doctor, but Brian sounds worried, and rightly so. Crepitus sounds like a scary problem if you don’t know what it is. So, let’s take a closer look and hopefully put Brian’s mind (and yours) at ease.
What is crepitus?
Crepitus (or the more fun way of saying it: crepitation) describes any type of grinding, creaking, grating, popping, thumping, cracking, or crunching that happens in a joint when we move it through a range of motion. We can experience crepitus at any age but generally, it doesn’t usually show up until we get older. Many people experience crepitus in their knees but you can get it in other joints, like the hip, neck, shoulders, or spine.
Incidentally, the word crepitus can also be used to describe the sound of other conditions like lungs crackling during bronchitis. It's not just about bones or joints.
Some common theories about what causes crepitus are bubbles popping inside the joint or tendons and ligaments snapping over a joint's bony structures. The bubbles don’t cause pain but the ligament snapping can sometimes be painful. I actually have a rather loud thump in my right shoulder when I do big arm circles. But aside from drawing some extra attention from my fellow gym goers, it doesn’t bother me at all.
On the other hand, a more serious cause of crepitus can be arthritis which causes a joint’s articular cartilage (the smooth, white tissue that covers the ends of bones) to degenerate. If you have severe crepitus, especially if it causes pain, you should get checked for arthritis. Incidentally, many of the techniques to alleviate crepitus that I will discuss today can also work for arthritis. But just because you have noisy knees, Brian, doesn’t mean you have—or will ever get—arthritis. So don't panic just yet.
Should you worry about your creaking and cracking knees?
Crepitus is usually not a cause for concern. In fact, it is considered pretty normal for our joints to pop or crack occasionally. It's when the crepitus is accompanied by swelling, areas of hot skin, or any pain in the joint that it may be an indication of something more serious.
But just because something is normal (especially in our sedentary society) doesn’t mean that we should just shrug our shoulders and give in. No way. That is not how we fit folks roll. What we do is work on finding the root of the issue and then do what we can to eliminate or at least manage the problem.
My thunking shoulder, for example, has become a hard target for my morning and evening warm-up and cool-down routines. And although it's still making an audible thunk, thanks to some love and attention, it isn’t getting worse, it still doesn’t hurt, and I can use that shoulder the same as I could when I was 20. #winning
What you can do about crepitus
Here is a short list of tips for anyone who wants to do something about their creaking, clunking, or cracking joints:
If there is tension in the area of your body around the creaking, we want to loosen it up and give it some space. To do this, we need to look for tightness above and below the area that is being noisy.
For example, if your knee is making a racket, you can stretch, foam roll, and massage just above the knee (suprapatellar pouch), the quads (rectus femoris), and calves (gastrocnemius) to relieve any tugging that could be contributing to the noisiness of the area.
Ideally, you would do this a couple times per day and spend a two to three minutes on each body part. Remember to actually lengthen a muscle, not just loosen it, it needs to be stretched for a lot longer than we think. Check out this episode The Truth About Flexibility vs. Mobility for more info on that.
Keep it Moving
Chronic sitting and general immobility puts our muscles’ attachment sites closer to each other, which requires our muscles to tighten (and shorten). This happens because our muscles never just flop around under our skin which is the double-edged sword of our muscular system. If we aren’t moving our muscles through their full ranges of motion on a regular basis, they respond by reducing their length and becoming tight. That, in turn, causes the tugging on the joints that I just mentioned and no matter how much foam rolling you are doing, you will have creaky joints.
This is why I told Brian not to use a knee brace. There is a time and a place for bracing an injured limb or joint but this is not it. In fact, bracing and limiting the joint's motion is the cause, not the cure, of this issue.
Poorly lubricated joints brought on by a lack of hydration can be the cause of many issues, including crepitus. Imagine your dehydrated knee joint as a squeaky old door hinge. If you lube it up with some grease, open and close the door a few times, the door will be quieter. The same can be said for our joints. Hydrate yourself properly (with water, not grease) and then move your body more and more often and your joints will be happier and quieter.
While I don’t usually get into nutrition (I leave that to Nutrition Diva) and I don’t often get on board with vitamins in general (give me good old whole food instead), supplements such as glucosamine and chondroitin may have some long-term benefits for your joints. Both are considered natural building blocks for the hyaline cartilage that covers the ends of bones. In a few studies, it has been shown to help reduce the crunchy noises associated with crepitus.
The new darling of the supplement aisle (at least for my mom and her arthritic friends) has been touted for everything from preventing blood clots, to fighting depression, combating obesity, regulating your cholesterol, and reducing inflammation (which it really does do). The other thing that turmeric has been proven to do is to be a natural painkiller. In fact, an evaluation of randomized clinical trials published in the Journal of Medicinal Food, found that 1,000 milligrams daily of curcumin extract (the active compound in turmeric) can be effective for the treatment of osteoarthritis.
It is thought to do this by reducing the levels of inflammation in the body which can also help with those creaks and cracks. In a paper called "The Spice for Joint Inflammation: Anti-Inflammatory Role of Curcumin in Treating Osteoarthritis, “crepitation” was one of the factors shown to be helped with turmeric supplementation. You can find out a lot more about turmeric by doing a search on Quick and Dirty Tips website.
When you have crepitus in the knee (or shoulder, neck or wherever), what you are really experiencing is consistent rubbing of bone on bone. And yes, that can lead to arthritis but until that point, this is not a disease or anything to fear. It is simply a mechanical situation that can be fixed—or at least maintained—with a little time, energy, and elbow grease.