Knee Clicking when squatting is often normal and expected, particularly as we age. This occurs due to changes in pressure within fluid- and air-filled pockets inside your joint capsule; a process known as crepitus.
Clicking and snapping sounds are caused by the sudden movement of tendons spanning your knee joint from one position to the next, which forces them to rub against bumps or lumps on its bone surfaces and produce clicking/snapping sounds.
Synovial Plicae
Synovial Plicae are small folds of tissue within the synovial membrane that lines your knee joint. While typically symptomless, they may become irritated and thickened, leading to Plica Syndrome in some individuals; typically seen among young people and athletes and typically producing an unpleasant “clicking sensation when moving the knee. Most commonly symptoms of Plica Syndrome include front knee pain especially when climbing stairs or hills as well as locking or catching of knees along with general instability in knee.
The plica is thought to be remnants of a membranous partition that developed during foetal development of the knee joint. There are four types of plica, the most prevalent being medial (sitting inside of knee) found in approximately 50% of patients; other variants include infrapatellar, lateral and fenestra plica.
Repetitive activity and trauma can irritate the plica, leading to build-up of tissue fibrosis and loss of elasticity in its layers, eventually impinging against intra-articular structures in the knee and producing inflammation or mechanical symptoms.
Doctors need to identify what is causing their patients’ symptoms and any possible issues in order to devise the most suitable plan of treatment – which might involve physiotherapy, injections or even surgery.
Inflammation of the plica can also be caused by other conditions, including osteochondritis dissecans, pathological fractures and patella subluxation. Therefore it is crucial that weight bearing anteroposterior, lateral and patella skyline radiographs of the knee be taken in order to rule out these other possible sources of inflammation.
Plica Syndrome symptoms typically include intermittent knee pain when climbing stairs or hills, catching or locking sensations in the knee, as well as feeling of instability and giving way in the joint. Arthroscopic examination is usually the most reliable means of diagnosis while Plica Resection offers mechanical solutions with promising clinical results.
Iliotibial Band Syndrome
The Iliotibial Band (IT band) is a fibrous tissue running from the hip to just below the knee along the outside of the leg. It often becomes tight and irritated from repetitive motion and friction against the bones during activities like running, cycling, and sports such as soccer, basketball, and rowing. This irritation is one of the most common overuse injuries among runners and cyclists, though athletes in other sports can experience it too due to the continuous rubbing during training and competition.
As you bend and straighten your leg, the IT band travels along your knee and hip bones. A fluid-filled sac known as a bursa normally assists in helping the IT band pass easily over these bones; however, when too much tension builds up or you increase training intensity rapidly, friction occurs between its tightened area and knee bones, leading to discomfort in outer knee areas known as IT band syndrome.
Symptoms may include pain on the outside of your knee that increases as you exercise or train, radiating down into your thigh or calf and making a clicking/grating sound when bending/stretching it. Your physician will discuss these symptoms, conduct a physical exam and may order an X-ray or sports ultrasound scan to assess other possible sources for your discomfort.
Some factors that contribute to IT band syndrome may be beyond your control, such as running only on one side of the road or on an inclined track. Anatomical differences, like tilted pelvis or bowing legs, may also exacerbate IT band syndrome by tightening it and making it rub against knee bones more frequently.
Thankfully, if this problem arises, it can be treated with rest, ice, compression and physical therapy. Healing time varies; most individuals who follow their provider’s care plan will return to sports without further issues.
Baker’s Cyst
Baker’s cyst is a fluid-filled swelling behind the knee that may cause pain when straightening or bending it fully, as well as to move around or exercise, especially as it worsens. It often forms due to arthritis or meniscal tear affecting other aspects of joint health in addition to this particular one.
Your knee has many tendons running over and through its back. At each intersection where these tendons cross bones or other tendons, small sacs (bursa) filled with synovial fluid are present to reduce friction between these tendons and bones and other tendons. Unfortunately for some individuals, however, their knee produces too much synovial fluid which drains directly down into their popliteal bursa at the back of their knee and cannot escape again, causing it to build up over time until finally swelling occurs and creating Baker’s cysts.
If you suspect you have a Baker’s cyst, it is imperative that you see your healthcare provider immediately as its symptoms can resemble that of deep vein thrombosis (DVT).
Your doctor will diagnose the condition by performing a physical exam and gathering information about your symptoms. They may also recommend an ultrasound or MRI scan in order to check for DVTs or other serious health problems.
Conservative treatments for Baker’s cysts include taking analgesics (painkillers) and using a knee support. Ice may also help reduce swelling and relieve discomfort.
At times, doctors will use a needle to drain excess fluid from a Baker’s cyst in order to alleviate symptoms, but the cyst often re-forms over time. Cortisone (steroid) injections may help reduce inflammation but don’t always prevent its return.
Surgery to treat Baker’s cyst may be considered, if other treatment options have failed. Keyhole surgery entails closing off the connection between the Baker’s cyst and knee joint for proper healing.
Knee Cap Syndrome
Inflammation or damage to the kneecap itself may result in clicking noises when performing squats, commonly known as “runner’s knee.” This condition, also referred to as patellofemoral pain syndrome, may be brought on by long distance running, stair climbing and repetitive physical activities that overstrain them resulting in overuse syndrome or patellofemoral pain syndrome. Common symptoms associated with runner’s knee include pain, stiffness and an uncomfortable ‘grinding’ sensation when moving or rotating them during squats – more information can be found within our Runner’s Knee section.
Clicking in your knee may also be due to changes to the cartilage within your joint capsule, known as osteoarthritis and one of the leading forms of knee arthritis among those aged 40+. In osteoarthritis, cartilage that lines and protects the knee joint gradually wears away over time causing inflammation, pain and limited movement.
Another cause of knee clicking can be ligaments catching or snapping when they move, known as snapping syndrome. This may occur from kneecap dislocation too far out of alignment with other parts of the knee, sudden increases in physical activity, or changing types of exercise you regularly participate in.
If you experience discomfort in the back of your thigh when squatting, this could be caused by problems with the hamstring muscles – these run along the back of your leg to bend your hip and extend your knee. Overuse or specific injuries such as tears, strains and tendonitis may contribute to this problem; more information regarding common causes, symptoms, diagnosis and treatments of hamstring injuries can be found within our Hamstring Injury section. Chondromalacia patella may also cause front of leg knee pain when you squat, as this occurs due to softening of cartilage lining the back of your kneecap. You’ll likely experience dull, achy pain that might even turn into grinding when moving your knee.
