Joint Sounds: Causes and Solutions for Knee and Other Issues

Q: Joint Sounds: Causes and Solutions for Knee and Other Issues

Panic： It seems you have quite a few issues that should be evaluated by a sports medicine specialist first. <br>If minor injuries are not addressed properly, they could lead to further problems. <br>If you are considering a career in professional sports, it is even more important

I have many issues with my muscles and joints, especially my knees. Please help me!

Hello, doctor.
I would like to ask:
1.
My (ankles) (wrists) (shoulders) (knees) (left elbow) (right hip joint) (coccyx) all make continuous cracking sounds, and the frequency is quite high.
Each sound worries me, and it causes me panic.
I have checked many sources that say if there's no pain, it won't lead to anything serious, but I am afraid there might be joint wear or ligament friction against the bones.
2.
I have never had a severe ankle sprain (rarely twist my ankle).
I remember having these sounds since three years ago (when I was 14), but I have never felt pain.
Over the past three years, I have had a few minor sprains, which were the kind that didn't hurt after half an hour, and there were less than five instances (seems to be mostly on the right foot).
Now, my left ankle is the worst in the morning; it cracks with every step, but it doesn't hurt.
The right ankle only makes sounds when I move it myself, and it also doesn't hurt.
3.
My wrists might be cracking due to frequent dumbbell lifting, but they still don't hurt.
I would also like to ask what the difference is between "overuse" and "wear and tear"?
4.
Right shoulder: I fell while playing basketball over a year ago, landing on my palm.
At that moment, I felt a "shock" to my shoulder, but there was no "pop" sound.
Since then, when I perform a one-handed throwing motion, the "tendon inside the shoulder" hurts severely (I have accidentally sprained my shoulder over 20 times in this past year).
The pain lasts from a few hours to 2-3 days, and it also cracks regularly.
I have been seeing both traditional Chinese medicine and Western medicine for my right shoulder, and I have had X-rays and ultrasounds done, which indicated a partial dislocation.
They advised me to strengthen my back muscles, and I have seen significant improvement; my range of motion has increased, and I don't experience pain in many angles like before.
Left shoulder: For some reason, after a year, my left shoulder also started cracking, but it doesn't hurt (not sure if it's due to frequently doing push-ups?).
It cracks when I cross my arms in front of my chest, raise them high, or shrug.
5.
Knees: I used to play basketball almost every day (continuously for a year).
After returning home, I would still do horse stance squats and frog jumps, which resulted in pain in the "deep middle part of my right knee" for a week.
After that, I stopped doing frog jumps.
A few months later, I noticed both knees started cracking, but without pain.
A few months later, when I "stand straight and forcefully extend" my knees, the area where my right knee previously hurt starts to hurt again.
It also hurts during physical education class when doing leg stretches.
Today, while sitting, when my "left foot pressed on my extended right leg," it hurt again.
These recent pains are very close to being severe, and since then, I have been afraid to fully extend my knees or jump vertically with full force, and I am also afraid to apply pressure to my straightened (180-degree) right leg (I am afraid to push my calf backward).
I suspect my ligaments are loose; I wear knee braces tightly while playing basketball.
Which ligament do you think I have injured? Should I see an orthopedic doctor?
6.
Left elbow: The cracking is quite severe.
Every time I do push-ups, I don't use my left triceps, and my left elbow feels sore (normally, it should be the triceps that feel sore).
Therefore, I stopped doing push-ups.
It feels very loose overall; it seems to be the loosest joint in my body.
I had to use another training method (one that relies entirely on triceps strength).
After training, my elbow feels more stable and cracks less (is it because the triceps become tighter after training?), but the next day it returns to cracking.
What should I do?
7.
Coccyx: My lower back cracks when I twist my waist.
Previously, it would crack only once a day, but since I injured my lower back (coccyx area) while playing basketball, it now cracks several times a day.
I previously injured my back to the point where I couldn't bend or run, which was very painful.
It took two months to recover, but it was only about 90%.
After a month, I reinjured it while playing basketball, and this time it took three months to heal, but it still isn't 100% better.
Now, if I bend backward too much, it causes a dull pain, but I can sprint and bend forward.
In summary: I play basketball almost every day, continuously for a year, but now the frequency has decreased significantly.
Currently, I am most worried about my right knee (it doesn't hurt while playing basketball, nor does it hurt after playing, and it doesn't hurt when squatting, but it does hurt when I jump forcefully, and when I apply pressure with my palm or push my calf backward, it hurts.
The pain is in the middle part of the knee, and it's quite painful).
The cracking sound in my knee temporarily disappears after icing, but it returns after a few minutes, especially after playing basketball, where the cracking is most severe, even while riding my bike home.
Please, doctors, I really need your help! I don't want to become disabled; I am only 17 years old and I don't want to give up my favorite sport, basketball!

Konghuan, 10~19 year old female. Ask Date: 2012/07/23

Dr. Wang Shouji reply Orthopedics

Panic: It seems you have quite a few issues that should be evaluated by a sports medicine specialist first.
If minor injuries are not addressed properly, they could lead to further problems.
If you are considering a career in professional sports, it is even more important to take this issue seriously.
For example, Wang Chien-Ming took two years for injury treatment and rehabilitation before returning to competition.
At this age, if there are sounds coming from the joints without accompanying pain, it is mostly due to the friction of joint creases against the bones.

Reply Date: 2012/07/23

More Info

Understanding joint sounds and associated discomfort can be a complex issue, especially for someone actively engaged in sports like basketball. Your concerns about the "clicking" or "popping" sounds in various joints, including your knees, shoulders, and ankles, are valid and warrant a thorough examination.

1. Joint Sounds: Causes and Concerns
The sounds you hear in your joints, often described as "crepitus," can arise from several factors. In many cases, these sounds are harmless and result from the movement of tendons or ligaments over the bones or the release of gas bubbles within the joint fluid. However, persistent sounds accompanied by pain or discomfort may indicate underlying issues such as joint instability, cartilage wear, or ligament injuries.

2. Specific Joint Issues
- Knees: Given your history of basketball and the specific pain you experience when jumping or applying pressure, it’s possible that you may have injured a ligament, such as the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL). The popping sound could be due to the patellar tendon or other structures moving over the knee joint. If you feel pain deep within the knee, it could also suggest issues with the meniscus, especially since you mentioned previous injuries.

- Shoulders: The clicking in your shoulders, particularly after a fall, may indicate a partial dislocation or instability. The fact that you experience pain during certain movements suggests that the rotator cuff or surrounding muscles may be strained. Strengthening the shoulder girdle can help stabilize the joint, but it’s crucial to ensure that you’re not exacerbating any underlying injuries.

- Ankles and Elbows: The sounds in your ankles and elbows, especially if they are not accompanied by pain, are often benign. However, if you notice swelling or discomfort, it may be worth investigating further. Regular strengthening and flexibility exercises can help maintain joint health.

3. Distinction Between "Labor Loss" and "Wear and Tear"
In terms of terminology, "labor loss" typically refers to injuries or conditions resulting from overuse or repetitive strain, while "wear and tear" (or degenerative changes) refers to the gradual deterioration of joint structures due to aging or prolonged stress. Both can lead to discomfort and joint sounds, but they arise from different mechanisms.

4. Recommendations for Management
- Consultation with a Specialist: Given the complexity of your symptoms and your active lifestyle, I recommend consulting with a sports medicine specialist or an orthopedic surgeon. They can perform a detailed assessment, including imaging studies like MRI, to evaluate for ligament injuries or cartilage damage.

- Physical Therapy: A tailored physical therapy program focusing on strengthening the muscles around your joints can significantly improve stability and reduce pain. This is particularly important for your knees and shoulders.

- Activity Modification: While it’s essential to stay active, consider modifying your basketball practice to reduce high-impact activities until you receive a proper diagnosis and treatment plan. Cross-training with low-impact exercises can help maintain your fitness without stressing your joints.

- Rest and Recovery: Ensure you allow adequate recovery time between intense training sessions. Ice therapy can help manage inflammation, especially after activities that exacerbate your symptoms.

- Strengthening Exercises: Focus on strengthening your core, hips, and legs, as these areas support your knees and overall stability. Exercises like squats, lunges, and resistance training can be beneficial.

Conclusion
Your concerns about joint sounds and pain are legitimate, especially as a young athlete. While many joint sounds are benign, the presence of pain, particularly after a history of injuries, should not be ignored. A comprehensive evaluation by a healthcare professional, combined with a structured rehabilitation program, can help you manage your symptoms effectively and allow you to continue enjoying basketball without the fear of long-term damage. Remember, prioritizing your joint health now will pay off in the future, ensuring you can pursue your passion for the sport safely.

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