Exercises for a Clicking Knee

Do you have a clicking knee? This blog post will cover the exercises and strategies that will help address this noisy issue!

Why is my knee clicking?

A clicking knee is due to the knee cap (Patella) rubbing against the leg bone (Femur).

This occurs at the Patellofemoral joint.

The clicking will usually occur as the knee bends and/or straightens (eg. walking, walking down stairs, squatting).

(The clicking/grinding/popping noise produced is referred to as “Crepitus”.)

Note: These will not specifically be covered in this blog post. (Although – many of the exercises mentioned will likely still help!)

What causes the clicking?

Ideally – The Patella should glide in a specific pathway at the front of the knee.

If there is any deviation from this optimal alignment, this will likely increase the contact between the Patella and Femur. (… which can lead to clicking in the knee.)

This is referred to as Patellar Tracking Disorder.

Here’s an analogy: The Patella is like a train that needs to be precisely positioned in line with the train tracks. Issues may occur if there is any deviation from this alignment.

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Is a clicking knee bad?

Clicking in the knee (without the presence of any other symptom such as pain, swelling, giving way and/or locking) is not inherently a serious problem… in the immediate term.

However – in my opinion, it is not ideal.

The increased friction between the bony surfaces over time may potentially lead to issues in the future.

How to Fix a Clicking Knee

1. Releases

Tightness in the muscles that directly attach onto the Patella can cause compression in the Patellofemoral joint. This can increase the likelihood of the Patella rubbing against the Femur.

a) Front of thigh

(Target muscles: Rectus Femoris, Vastus Lateralis/Medialis/Intermedius)

Instructions:

• Place the front of your thigh muscles on top of a foam roller.
• Apply as much pressure as you can comfortably tolerate.
• Make sure to cover the entire length of the thigh.
• Continue for 2 minutes pausing on any areas of increased tightness.
• Note: Focus on the areas where you are tight!

b) Above knee cap

(Target muscles: Distal Quadriceps)

Instructions:

• Place the area immediately above the knee cap on top of a foam roller.
• Apply as much pressure as you can comfortably tolerate.
• Continue for 1 minute.

c) Under knee cap

(Target: Patella tendon)

Instructions:

• Whilst sitting down on a chair, straighten your leg in front of you.
• Keep the leg completely relaxed.
• Using the tips of your thumbs, press and massage into the Patella tendon.
• Continue for 1 minute.

d) Side glides

(Target area: Retinaculum/Fascia)

Instructions:

• Whilst sitting down on a chair, straighten your leg in front of you.
• Keep the leg completely relaxed.
• Using the tips of your fingers, slowly press and glide the skin on the sides of your knees in a downward motion.
• Repeat 5 times.

e) Front/side of shin

(Target muscles: Tibialis Anterior, Extensor Digitorum, Extensor Hallucis Longus)

Instructions:

• Place the front part of your shin on top of a foam roller.
• Apply as much pressure as you can comfortably tolerate.
• Make sure to cover the entire area.
• Continue for 1 -2 minutes.

2. Stretches

Stretching tight muscles around the knee can help reduce the pressure on the Patella.

a) Quadriceps

Instructions:

• Whilst standing, pull your ankle towards your buttocks.
• Stay up right and keep your knees in line with each other.
• Tuck your tailbone and drive your hips slightly forward.
• Aim to feel a stretch at the front of your thigh.
• Hold for 30 seconds.

Would you like other ways to stretch the thigh muscles? Check out this post: 8 Quadriceps Stretches.

b) Tensor Fasciae Latae

• Assume the forward lunge position. (see above)
• Keep your feet in line with each other.
• Proceed to lunge forward.
• Tuck your tail bone underneath you.
• Lean your hips towards the side of the back leg.
• Aim to feel a stretch in the front/outer side of your hip.
• Hold for 30 seconds.

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c) Adductors

Instructions:

• Perform a lunge towards the side.
• Aim to feel a deep stretch in the inner thigh region.
• Hold for 30 seconds.

d) Hamstring

Instructions:

• Whilst standing, place your straightened leg in front of you on a block.
• Keep your foot pointed.
• Bend forward by hinging at the hips.
• Keep your back straight.
• Aim to feel a stretch at the back of your thigh.
• Hold for 30 seconds.

e) Calf

Instructions:

• Place the front of your foot onto a block.
• Whilst keeping your leg completely straight, lean your body forwards.
• Aim to feel a stretch in your calf muscle.
• Hold for 30 seconds.

e) Outer shin

Instructions:

• Whilst sitting, place your ankle on top of the other knee.
• Place one hand on top of the ankle and the other on the forefoot.
• Whilst anchoring the ankle joint down, pull the fore foot towards you.
  • (Include the toes!)
• Aim to feel a stretch on the out side of the ankle/shin.
• Hold for 30 seconds.

3. Joint mobilization

There are multiple layers of soft tissue that can directly pull the Patella out of the ideal alignment. The following joint mobilizations will help stretch these tight layers.

(Note: Do not attempt this by yourself if you have a history of Patella Dislocations.)

a) Glides

Instructions:

• Sit with your leg relaxed in front of you.
• Use your thumb and index finger to firmly glide the patella in the following directions:
  • Up/Down
  • Side to Side
  • Diagonally
• Repeat 20 glides in each direction.

b) Tilts

Instructions:

• Sit with your leg relaxed in front of you.
• Use your thumb and index finger to firmly tilt the patella in the following directions:
  • Up/Down
  • Side to Side
  • Diagonally
• Repeat 20 tilts in each direction.

c) Tibia rotation

Instructions:

• Sit down with your hip and knee bent at 90 degrees.
• Keep your knee pointing forwards throughout this exercise.
• Turn your lower leg inwards.
  • (Internal rotation of the tibia bone)
• Make sure your foot does not lift off the ground.
• Repeat 30 times.

4. Understanding lower limb alignment

For the next set of exercises, it is important to understand how to keep your Foot, Knee and Hip in the correct alignment.

As the knee bends and straightens whilst performing the following exercises, the aim is to keep the knee in line with the foot and hip at all times.

5. Strengthening exercises

The level of difficulty in the following exercises can be modified by varying the Depth, Speed, Load and Amount of Support provided. Adjust these variables accordingly to your ability. The aim is to perform the exercises without reproducing the clicking in the knees.

The following exercises are divided into separate levels based on ascending pressure on the knee.

Level 1:

These are gentle exercises to help warm up the knees.

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a) Knee extension/flexion (VMO/inner thigh bias)

Instructions:

• Sit down on a chair.
• Whilst keeping your hip in a slightly externally rotated position (toes pointing outwards), straighten your leg completely.
• It is important that you can feel the contraction of the inner thigh muscles.
• Hold this position for 5 seconds.
• Bend your knee as far back as possible.
• Repeat 20 times.

b) Stationary bike

Instructions:

• Cycle on a bike with an appropriate amount of resistance.
• Make sure that the seat is adjusted to the correct height.
• Continue at a comfortable pace for at least 10-20 minutes.

c) Walking in the pool

Instructions:

• Walk forwards, backwards and side ways in a pool for at least 20 minutes.

Level 2

The following exercises will place a small amount of your body weight through the knee.

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a) Wall plunge

Instructions:

• Place your foot onto a step.
• Have both of your hands supported onto a wall that is in front of you.
• For the leg on the step, keep the knee in line with your toes throughout this exercise.
• Plunge forwards.
  • Make sure to keep most of your body weight on top of your heels.
  • Move your knee forwards as much as you can without allowing for the knees to click.
• Provide as much support from your hands as required.
• Perform 20 repetitions.
• Progression:
  • Allow the knee to move more forwards.
  • Gradually reduce the amount of support being provided by your arms.

b) Lean back squat with support

Instructions:

• Hold onto a stationary object that is in front of you.
• Keep your feet shoulder-width apart.
• Keep the knees in line with your toes throughout this exercise.
• Lean backwards so that your entire body weight is relying on your arms.
• Drive your hips backwards as you squat down to a depth without reproducing the clicking in the knees.
  • Most of your body weight should be resting on your heels.
• Perform 20 repetitions.
• Progression:
  • Gradually reduce the amount of support being provided by your arms.
  • Squat deeper

Level 3

The following exercises will place a moderate amount of your body weight through the knee.

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a) Step up with support

Instructions:

• Place your foot onto a step.
• Hold onto a stationary object in front of you.
• For the leg on the step, keep the knee in line with your toes throughout this exercise.
• As you perform a step up, use the towel to help pull yourself upwards.
• Make sure that you are driving through your heel.
• Slowly lower yourself back to the starting position.
• Perform 20 repetitions.
• Progression:
  • Use less arm support.
  • Use a higher step

b) Backwards Lunge with support

Instructions:

• Hold onto a stationary object that is in front of you for support.
• For the leg at the front, keep the knee in line with your toes throughout this exercise.
• Perform a backwards lunge.
• Make sure to place the majority of your weight onto the heel of the foot that is at the front.
• Lunge as deep as you can comfortably tolerate.
• Perform 10 repetitions.
• Progression: Use less arm support.

Level 4

The following exercises will place the full amount of body weight through the knee.

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a) Sit to stand

Instructions:

• Sit down on a chair.
• Keep your legs shoulder-width apart.
• Keep the knees in line with your toes throughout this exercise.
• Drive your knees outwards.
• Stand up.
• Make sure to drive through the heel of the foot.
• Perform 20 repetitions.
• Progression:
  • Hold onto weights.
  • Use a lower chair.
  • Perform the exercise slower.

b) Step up

Instructions:

• Step up on to a block.
• Keep the knees in line with your toes throughout this exercise.
• Make sure to drive through the heel of the foot.
• Perform 20 repetitions.
• Progression:
  • Hold onto weights.
  • Use a higher step.
  • Perform the exercise slower.

Level 5

The following exercise will require the knee to move forwards during motion. This movement will naturally place more pressure through the front part of the knee.

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a) Knee forward squat

Instructions:

• Stand with your back and heels against the wall.
• Keep the feet shoulder-width apart.
• Keep the knees in line with your toes throughout this exercise.
• Slowly bend your knees forwards as you slide down the wall.
• Only squat to a depth that you are comfortable with.
• Perform 20 repetitions.
• If required- you can take some weight off your knees by holding onto a table for support.

b) Toe tap

Instructions:

• Stand up right and hold onto a stationary object for support.
• For the leg that is on the ground, keep the knee in line with your toes throughout this exercise.
• Reach and tap your toe as far forwards as possible.
• Return to the starting position.
• Perform 20 repetitions.
• Progression:
  • Use less arm support.
  • Reach your foot further.
  • Perform the exercise slower.

c) Step down

Instructions:

• Stand on top of a step.
• Hold onto a stationary object for support.
• For the leg that is on the step, keep the knee in line with your toes throughout this exercise.
• Slowly reach your foot down to the floor.
• Return to starting position.
• Perform 20 repetitions.
• Progression:
  • Perform the exercise slower.
  • Use a higher step.
  • Use legs arm support.

 

Other areas To Consider

If you are experiencing difficulty maintaining the correct alignment of the knee as you perform the exercises, you may need to address the Hip and/or Foot.

The reason behind this: The alignment of the knee is significantly influenced by the amount of control at the Hip and Ankle.

The Hip:

The main muscle to address in the hip is the Gluteus Medius.

Instructions:

• Lie on your side with your bottom leg bent.
• Keep the upper leg straight.
• Elongate your upper leg away from you.
• Lift your upper leg as high as possible without moving your spine or pelvis.
• Aim to feel a muscular contraction on the side of your hip.
• Hold for 5 seconds.
• Repeat 20 times.

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The Foot:

a) Maintain the Foot Tripod

When performing exercises for clicking knees, it is important that you “Maintain the foot tripod”.

What this essentially involves is loading the foot equally between the 3 points as shown above.

b) Maintain the neutral arch

If you have flat feet or high arches, you will need to learn how to maintain the medial arch of your foot in a neutral position.

Here is a great exercise for it:

Instructions:

• Stand with your feet facing forwards and shoulder width apart.
• Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
  • Drag the base of your big toe backwards towards the heel.
• Keep the base of the big toe in contact with the ground to prevent this area from lifting.
• Gently push the tip of your big toe down onto the ground.
• Aim to feel a strong contraction of the muscles underneath your foot.
• Hold this for 5 seconds.
• Repeat 20 times.

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Taping to reduce Clicking in knees

Taping can help support the knee whilst being used in conjunction to the mentioned exercises.

(Note: Do not apply tape to your knee if you are allergic to adhesives.)

a) McConnel taping

This style of knee taping will address a knee cap that tends to tilt and/or glide towards the outside. (which is the most common presentation)

[See video by Six Physio]

Instructions:

• Place a rolled up towel underneath your knee.
• Make sure that you keep the knee completely relaxed.
• Glide and tilt the Patella towards the midline of the body.
• Apply tape in the direction from outside to inside.
• Pull up the skin located at the inner knee before anchoring the tape down.
• There should be a small crease in the skin on the inner side of the knee cap.

b) Kinesio taping

This style of taping will help by taking some pressure off the knee.

[See Video by RockTape]

Instructions:

• Bend your knee to 90 degrees of flexion.
• Outline the border of the knee cap.
• Starting from the top of the knee, apply 2x intersecting tape at 30 % stretch towards the bottom of the knee.
• Apply decompression tape horizontally across the patella tendon at 80% stretch.

Knee Braces

Braces can help stabilize and support the knee as it bends/straightens.

The most important aspect when determining which brace to use is finding a brace that fits your knee properly.

As every one has differently-shaped knees, you will likely need to try on multiple braces until you find the right one.

Quick Tips

Here are some helpful tips that might help reduce the amount of clicking in the knees.

a) Reduce body weight

An increase in body weight will automatically place more load onto the knees.

b) Move more!

If you are sitting with your knees in a bent position for a prolonged amount of time, the knee joint can become stiff. Try to move your legs every 20-30 minutes.

c) Place more pressure on the heel (vs forefoot)

As you place your weight onto your foot (For example – when walking up stairs), make sure that you bias your load onto the heel as opposed to the forefoot.

This will help take some pressure off the front of the knee.

d) Minimize anterior knee translation

When the knee is bending (eg. walking down stairs), try to limit the amount of forward motion of the knee relative to the foot.

The more forward your knees moves, the more pressure that will be placed on the knee joint.

As your knee becomes stronger, it is important to gradually expose yourself to this movement.

e) Avoid kneeling

Kneeling places direct compression onto your Patella which can increase the amount of contact between the bones.

Minimize the amount of kneeling if possible.

If you need to kneel, consider placing a soft sponge/foam underneath the knees.

f) Supplements for clicking knees

The typical knee joint supplements that people generally take are :

• Chondroitin
• Fish oil
• Glucosamine
• Krill oil

(Note: Consult your healthcare provider before taking a new supplement.)

Surgical intervention

If you have persisted with the exercises for 3-6 months and there has been nil improvement, here are some surgical interventions that you could consider.

a) Shaving behind the Patella: Ideally – the surface area behind the knee cap should be fairly smooth. (This is to encourage the smooth gliding motion of the knee cap.)

However, with the constant friction in this region, the cartilage behind the knee cap wears out leaving a rough surface area.

This can further increase the amount of friction between the bones.

b) Gel injection: A gel is injected in the area underneath the Patella. This is to help “float” the Patella on top of the femur bone as to reduce friction.

c) Retinaculum release: If there is a significant amount of tightness in the soft tissues around the knee, this can lead to the Patella being pulled out of the ideal alignment. Cutting through these tight structures may help the Patella assume a more neutral position.

(Keep in mind – I would strongly suggest that you do not consider surgery… especially if there are no other symptoms along side the clicking!)

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Conclusion

The exercises mentioned in this blog post are aimed at addressing a clicking knee that is caused by the knee cap rubbing against the leg bone.

Having a clicking knee is not a serious problem in the immediate term, however, it is not ideal.

To address this problem, I would recommend that you try the Releases, Stretches, Joint Mobilizations and Strengthening exercises as mentioned in this blog post.

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Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.

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