Knee Osteoarthritis, Crepitus and What Rehab Can Realistically Do

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey again, it's Dr. Sebastian Gonzales, your host for the Performance Place Sports Care Podcast. Thanks for joining me. This topic today is going to be on arthritis in the knee. I had a question that came, they were talking about some exercises. So they asked if it would help with knee creaking when they first walk upstairs. They said their right kneecap has been creaking since February, and this is of last year.

So I'm really going to take this question and digest it down a little bit. And I'm thinking of if this person were to come in to me as a patient, what would I recommend? What type of questions they would have? Because I'm sure a lot of you guys, too, you've heard about arthritis in the knee. If you're over probably 35, you probably have arthritis in the knee, too. The creaking that he is talking about or grinding is usually, it's called crepitus. Crepitus. And crepitus is just a fancy term for saying it's a friction between the bone and the cartilage, and it sounds like almost like a grinding. It actually feels, it feels very interesting when you actually feel it on somebody.

I remember the first time that I felt it on a knee, and it was almost like, I feel like it's almost like a record skipping, or almost like you had, like you had, you can feel the friction on it, and then when you push a little bit further, it almost jumps a little bit, and then it catches again. And this is definitely an arthritic condition, if it feels like this. It doesn't have a really soft end feel. There's all these catches in it. And by end feel, I mean when you bend a joint, usually there's an ending point to it. If you have a muscular condition, a lot of times you have a soft end feel, which means you can push it a little bit further.

This is what happens when you end up stretching, like say, you're stretching your hip. If you can increase the range of motion, and it's really like pliable, then it's probably a muscular thing you're working with. But if it's a crunchy, skipping, creaky type of thing, well it almost feels like a rusty door hinge, then it's going to be arthritic conditions. Now, arthritis, I see a lot of people thinking that arthritis is like a death sentence to them, and it's really not. Arthritis is not always something you really have to heal, quote unquote. And if you look at a lot of people's x-rays who have arthritis, and if you ask them, and don't even tell them they have any arthritic findings, and this goes for almost any part of the body, if you ask them if they have any pain, they'll probably say, a lot of them will say no.

And the reason is because arthritis is not a death sentence for feeling pain. Okay, let me say that again. Arthritis does not mean that you have pain. Pain does not also mean you have arthritis. Okay? So, it's really, really important to realize that because arthritis, when in its lower stages, is something that I would consider it more of just like a wake-up call. If it's an osteoarthritis type of condition anyways, it's a wake-up call. And if it's only on one side of the body, I would figure out why it's happening. A lot of the reasons why it's happening are because you're asking too much of that area, and the bones and surrounding tissues are starting to build up.

They're building up some support. Now, in the past, we used to think osteoarthritis or, quote unquote, old age arthritis was just an old age thing, and it was hereditary and so on. And there are other types of arthritis that are actually hereditary. We call these inflammatory arthritides. And grouped in this category are psoriatic arthritis. I think Reiter's syndrome is in there. Rheumatoid arthritis. And these are the ones that really destroy your joint. They function very differently than osteoarthritis. So, if you have one of those, you should definitely go in and talk to somebody. Because they might recommend you to take some type of medication.

I've seen that those, when they actually go on for a long time, they start to erode the joint away. And not to tangent too far off on that, some people say that you can control it with eating clean and making sure that you're more of an anti-inflammatory diet. I'm not going to quote yes or no, whether I think that works. But for the most part, if you do have an inflammatory arthritide, you need to go see somebody. And I would probably do it within the next month or so because you don't want to put these off too long. But osteoarthritis, it's more of a, in its infancy, you have to just realize that something's going on where you're loading the area more.

The reason why I believe this to be anyways is with the shoulder, the shoulder is not really an area where you have osteoarthritis form typically, unless there's been some type of past trauma. There's been something that happened to the joint to where now the thing starts to change its bony configuration. And this is the reason I think why they used to believe it was an old age thing or it's mainly in weight-bearing joints. It happens in the hip, happens in the back, in the knee, in the ankle. But you don't see it in the shoulder quite as often. But when you do, it's usually after some type of past trauma, a shoulder dislocation, overuse of the shoulder, rotator cuff tears, things of that nature.

So going back to this guy's question, so the right kneecap's creaking, it's been creaking since February. Will this exercise help when he's going upstairs? I think there's probably a lot of things that this guy's got to do to improve the function of the knee. And it all starts with, can we improve the surface contact of the knee? So I want you to all take your iPhone or your Droid, what you have next to you. I'm sure it's right next to you when you listen to this. So actually, it might be coming out of this thing, won't it? So I want you to take it and put it on a smooth surface next to you. So where I'm at, I have my computer right in front of me, so I'm going to take my iPhone, I'm just going to put it, put the top end on it, and just slide it across the surface, just towards the keypad.

Just because this is a laptop that I'm using, or a MacBook. So right now when I'm doing this, it's really smooth, it moves really nicely. I can probably do this for a year, and the only thing that's going to happen is it's going to take some of the paint off of the iPhone case. It'll probably leave the computer perfectly fine, and nothing else is going to happen. Because these are two surfaces which are having equal pressure on each contact point, and it's a very broad contact point. This is theoretically, say, how they are intended to work. Now, taking that same analogy, and we'll tip the phone now to where there's only the edge of the phone scraping.

Now, because there's the same amount of pressure, and that's the pressure of gravity at least, unless you're pushing down on it, then that would accelerate the process. Because all gravity is forced now is through that one part of the phone, and going into that one part of the computer surface, it's going to wear a lot faster. And it might not happen today, it might not happen next year, but at some point it's going to wear it. And this is what happens with knee conditions, typically. I've noticed that if there's unstable, or if there's unsmooth rubbing surfaces, or like if you're not getting actually the bones to rub the way they're supposed to, with the collage between them, then you'll end up wearing things down and softening things.

I remember actually watching a procedure where they were cleaning out or debriding the knee on this lady who was, she was definitely an overweight lady. And I think she wasn't, she probably was, she wasn't 50, but she was over 40. But I remember seeing all this, it looked like shag carpet. And I definitely suggest go onto a YouTube video and search debridement of a knee. And you'll see that it looks like, probably even a thumbnail will look like shag carpet just hanging around. It's just kind of like white, pinkish, I apologize because I'm colorblind, so it might not exactly be those colors. But it's this, it looks like it's just hanging all down.

And when I was talking to the surgeon about this, I'm like, what's all that stuff? You know, and he's like, well, that's just softened cartilage, which is just hanging down. And there were a bunch of floating pieces in there too. I'm like, what's all that? And he's like, well, that's floating pieces of cartilage within the synovium, which is within that fluid that's in the knee. So he takes this little grinder thing and goes in there and looks, and he's also got this, this, these snippers, which look like, they look like alligators kind of coming through the screen or like hungry, hungry hippo.

So he goes through and he's cutting, he, he's shaving off all the parts where there's the shag carpet. And you can see underneath, there's actually visibly bone there. So he had worn all the way down. And then around the edge where there's the meniscus, he starts using the alligators a little bit. And he's clipping these, he's, he's trimming it up, making it so it's clean and stuff. And, and this is what happens in these conditions. When you have these surfaces rubbing and they're creating a lot of pressure in these areas, then you'll end up getting this debris. And it sucks to have it. Cartilage conditions really don't heal well.

They don't heal quickly. And there's only one cartilage in the body, which has blood supply, which allows it to heal better. And that's the outer third of the meniscus of the knee. So I would definitely take care and make sure that you're getting these surfaces to rub well. And you might be asking, well, how do I do that? And this is, so this is all what, what rehab or therapy is about. With knee conditions anyways, there's been a lot of studies to show that if we improve function of the hip, function of the trunk or core, and also landing mechanics, how you squat, how you deadlift and bend down, then we can improve how your knee functions and decrease the possibility of these surfaces rubbing excessively in creating this degrade.

Now, once you have the degrade, it's kind of already there. And so this guy, back to the original question, will it help the creaking of his knees? I don't think so, because I think you already got stuff going on there, which is not going to be anything that these exercises are going to, are going to improve dramatically. Now, they can a little bit, but I've told people in the past with, you know, snapping conditions, with creaking and crunching and all that kind of stuff that don't expect therapy to get rid of that. If it does get rid of it, it's probably going to be the one of the last things to go.

First thing it's going to go is their pain after that. Though it should be able to move better pain-free, but they might still notice that, the noise or the cracking. So his right knee has been cracking a bit. I don't know how old this guy is, but there's a possibility that it's kind of long gone in regards to getting rid of that part. He might have had all these surfaces kind of rubbed away already, which changes the mechanics of the knee. So if you guys have more questions on how I like to improve or how to rehab a knee, I actually have a lot of this online already. I put a lot of work into the P2 Sports Care site.

I try to make it really easy to navigate. So if you go in there and you check out the, you can go in the start now, or you can go just below it into the About My Injury section. You'll see three pictures. You'll see a baseball player, a golfer, and a runner. Probably the runner and the baseball player are going to be the ones where I put a majority of the information of how I would rehab a knee and a lot of the ideas surrounding it. There's also a lot of terminology on pathology there, like patella tendinitis, meniscal tears, pleca syndrome. These are all the things that someone's going to tell you that you have.

But a lot of times rehab of the knee is very, very similar to the other condition, unless that condition is an extreme version. Example again, knee arthritis. If it's really, really severe and we can't bend the knee because it's just riddled with bone in there, extra bone, then perhaps they might replace it. But how that got there usually is part of the rehab process. We need to control that anyways. So they might get to do that after their procedure or their surgery. So go on to p2sportscare.com and check that out. I spent a ton of time on it, so really spend some time. I try to put the best information I possibly could on there.

Now, if you have more questions for me on these podcasts, feel free to go on to the sidebar on that same site, p2sportscare.com. There's a voicemail button, and you don't need really anything. You don't need your phone. You can do it right through your computer if you want, or you can do it on your phone. But I think you've got to download the SpeakPipe app. But it's really quick. Just send a question to me. I think you get about 90 seconds to say whatever you've got to say. The more detail, the better. I'll feature your voice right on air when it comes in, and I'll answer it to the best of my ability.

But this whole thing, this whole podcast, the reason I put it together again is because I believe that patients need to have better communication with them. And it starts partly with your education of our lingo, but also I need to break down our lingo to you. And you need to make sure that you understand some anatomy, some mechanics, and part of the theory of how you rehab these areas. Because when you go into your doctor's office or your PT or Cairo's office, they're going to say a lot of these same things. And if you come through and you just already know the stuff and you're already just kind of going through and you know the anatomy, you know how to rehab it, all this stuff that they're talking about with you is going to go so much faster.

And you'll get through so much better care and better rehab sooner if you comply with the treatment plan they're giving you. Because lack of compliance is one of the biggest barriers that we have on the provider side is because if a person doesn't know why they're supposed to do something, a lot of times they won't do it. So hope this was helpful. And don't forget to subscribe and like this and share this. I'm thankful for you guys as my listeners. Thanks so much. Bye.