Chiropractor Chandler AZ
Knee popping and cracking can be very alarming. Sharp and stabbing internal knee pain when climbing stairs can be a sign of a serious meniscus or internal cartilage tear. Fortunately, most cases of knee popping and cracking are the result of improper muscle balance causing a sticking of the knee as it flexes and extends. It can also be the result of the patella sliding improperly in its groove across the femur.
Knee meniscus tears that cause sharp stabbing pain and popping while going up and down the steps are the result of the femoral condyle rotating and "flicking" a flap of cartilage during movement. A meniscal flap tear can be very painful and may require surgical intervention.
Soft tissue injuries to the muscles, tendons, and ligaments result in muscle spasms and tightening. The muscle imbalance alters normal hinging and rotating during walking, going upstairs, or downstairs. Mild alterations to knee movements produce a "catch-like" feeling. Many times muscle and tendon damage leads to increased clicking and popping during knee motions and movements. Treatment involves identifying the damaged soft tissue and applying appropriate treatment to eliminate future popping and clicking.Popping in the Front of the Knee
When the popping and clicking feels like it is in the front of the knee and underneath the kneecap, then it is the result of improper patella gliding across the femur. Normally the patella slides across the femoral groove without any restriction or catching. A variety of soft tissue injuries and muscle weakness cause the patella to glide more on the outside of the groove and grind as it crosses the femur. This can result in damage to the hyaline cartilage underneath the patella or on the front of the femur. In some cases, this can result in plica formation on the patella bone.
Many of these conditions are more likely to occur with degenerative changes to the knee itself. Osteoarthritis or bone degeneration cannot be improved but the symptoms can be managed - especially with proper therapy that increases muscle strength, endurance, and proprioception. Together these activities help stabilize the knee and prevent additional damage to the bones and soft tissue.
The large femur sits atop the tibia, much like two pillars stacked on top of each other. The smaller fibula bone is on the outside of the tibia in the lower leg. The fibula provides some weight bearing, but not nearly as much as the tibia does. At the end of the femur are two large condyles with rounded edges that allow for the rocking or hinging motion associated with knee movement.
In between the femur and the tibia are fibrocartilage shock absorbers, or meniscus. Several large stabilizing ligaments on the inside and outside of the knee prevent excessive forward and backwards movements. These stabilizing ligaments include the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL).
The patella bone sits in front of the femur and slides in a groove. The backside of the patella is covered with hyaline cartilage along with the front side of the groove on the femur, which minimizes the friction as the patella slides. The patella is a large sesamoid bone, which means it is surrounded in muscle or tendon. Sesamoid bones act as a pulley system to change the direction of forces, in this case from the quadriceps muscle to the tibia.
The knee is a complex joint that is surrounded by a ligament joint capsule and lined with a synovial membrane that produces synovial fluid, which helps lubricate the knee. The lubrication reduces friction and damage to the internal components of the knee. Bursa are fluid-filled sacs that help reduce friction as muscles and tendons glide across the bursa.
At home the first step is always PRICE: protect, rest, ice, compress, and elevate. Reduce the stress and strain to the knee. Over the counter nonsteroidal anti inflammatory drugs (NSAIDs) as recommended by your doctor can help reduce pain and inflammation. Ice helps block the knee pain and reduce inflammation.Medical Treatments
NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options, as well. Pain management is not usually required unless stronger medications or joint injections are involved in treatment.
MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss.Conservative Treatments
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
Iliotibial band Syndrome is common because of weakness and poor stabilization of the leg and hip muscles. Specific knee exercises are given to increase strength and endurance. Proprioception exercises help teach the muscles how to work together again to stabilize the knee during walking or running.
When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and during recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, an exercise ball, and BOSU balls can be performed on the floor. The more unstable of the surface, the more effort and stabilization is required of all the lower extremity muscles.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.
Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.