Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
In this article, you will find out everything you need to know about creaky knees and the most effective ways to treat it, including an advanced treatment called prolotherapy.
Creaky knees are a common condition, especially in people over 40. Studies show it affects 38.1% of women and 17.1% of men in this age group.1
What are Creaky Knees?
Creaky knees refer to noises—such as popping, clicking, or grinding—heard during knee movement, especially when bending, squatting, or climbing stairs. While some knee sounds are harmless, others may indicate underlying joint issues. Notably, 96.5% of people with knee pain and popping sounds had posterior root tears in the medial meniscus.2
Types of Knee Sounds and What They Indicate
Knee sounds are described as snapping, popping, clicking, crunching, crackling, grinding, grating, clunking, creaking, and catching. Collectively, these are known as crepitus. Here’s what the most common sounds may indicate:
- Popping: Sudden, sharp sound, often from meniscus tears or ligament detachment.3
- Clunking: Loud, single sound, usually from the patellofemoral joint, often after fibrotic nodules are trapped and released.4
- Clicking: Single, tiny click during knee movement, commonly from meniscal tears.5
- Grinding/Grating: Continuous scratching sounds, often linked to osteoarthritis or patellofemoral pain syndrome.6
How To Differentiate Between Pathological and Physiological Creaky Knees?
Physiological crepitus is usually painless, intermittent, and not associated with swelling or injury. It often results from air bubbles in the synovial fluid or normal ligament movement.9
Pathological crepitus is typically accompanied by pain, swelling, or a history of injury. Persistent or worsening sounds, especially after trauma, may indicate cartilage lesions, meniscus tears, or arthritis.7 Pathological sounds are consistent until the underlying issue is treated, unlike physiological sounds, which are usually brief and self-limiting.8
Causes of Creaky Knees
Physiological Factors
The knee is the largest joint in the body, formed by the femur, tibia, and patella. Physiological crepitus can be caused by:
- Air bubbles in synovial fluid
- Ligament or tendon snapping over bony structures
- Normal movement of the plica or synovium
- Discoid or hypermobile meniscus
- Perceived sounds due to emotional concerns
Persistent crepitus may signal early joint issues like osteoarthritis or cartilage damage. Remedies include physical therapy, strengthening exercises, and muscle group-targeted pain relief to improve stability and mobility.
The knees crepitus often occurs in a repeated manner due to the rubbing of anatomical structures against each other. An example of physiological knee crepitus is cracking sounds; however, they are unlike others. This is because these sounds have a refractory period; hence they are not continuously repeated on movement like the others.
A number of reasons have been proposed for the origin of this sound by experts. Some believe that knees creak when a sudden air bubble collapse in the knee cavitation, causing a loud crackling sound. The other believes that it is the formation of the air bubble or clear space that causes the sound.9 Another type of common physiologic Crepitus is the clicking sound, which is caused by the stretching of ligaments and tendons in the Knee and then eventual snapping back into place as they pass over bony lumps.
Osteoarthritis and Rheumatoid Arthritis
Both conditions cause progressive changes in the knee, such as cartilage loss and bone spurs, leading to crepitus. Up to 80% of people with crepitus in the KL 1–3 range may have knee osteoarthritis.10 Knee crepitus is also a predictor of future osteoarthritis.11
Pathological Changes in Plica
Inflammation, thickening, or loss of elasticity in the plica (a synovial fold) can cause pain and clicking sounds, especially if friction leads to synovitis.
Joint Instability
Patellofemoral joint instability, meniscus tears, chondromalacia, or ligament defects can cause abnormal patella movement and crepitus.12
Post-Operative Creaky Knees
Surgery (e.g., arthroscopy, meniscectomy) can increase crepitus risk due to inflammation or changes in joint structure.13 The degree of crepitus varies by patient and surgical technique.14
Management of Creaky Knees
Treatment depends on the underlying cause. For physiological crepitus, reassurance and education are often sufficient. For pathological crepitus, addressing the root cause is key.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat creaky knees.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with creaky knees.
As prolotherapy is helping to treat the root cause of creaky knees, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Other Less Effective Treatment Options
Management of Physiological Crepitus
Harmless knee sounds often require no treatment. Patient education and reassurance are key. Strengthening exercises, weight loss, and stretching (e.g., resistance band side-stepping, squats, hamstring and hip flexor stretches) can help prevent ligament snapping and improve joint stability.
Management of Pathological Crepitus
For pathological causes, treatment may include anti-inflammatory supplements (curcumin, ginger, omega-3), physical therapy, and, if needed, surgical intervention. Arthroscopy may be used for plica excision, while ligament or cartilage repairs may require more advanced surgery. Always consult a healthcare professional for persistent or painful crepitus.
Frequently Asked Questions
Are creaky knees always a sign of arthritis?
No, creaky knees can be physiological and harmless, especially if not accompanied by pain or swelling. However, persistent or painful crepitus may indicate arthritis or other joint issues.
When should I see a doctor for creaky knees?
If you experience pain, swelling, or a sudden change in knee sounds after an injury, consult a healthcare professional for assessment and treatment.
Can exercise help with creaky knees?
Yes, strengthening and stretching exercises can improve joint stability and reduce crepitus, especially if the cause is physiological.
Is prolotherapy safe for creaky knees?
Prolotherapy is considered safe when performed by a qualified practitioner and has shown benefits for pain relief and joint regeneration in creaky knees.
Can surgery cure creaky knees?
Surgery is usually reserved for severe or persistent cases where conservative treatments have failed. Most cases improve with non-surgical management.
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating creaky knees, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with creaky knees and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile
References
- Ho-Pham, L. T., et al. (2014). Prevalence of radiographic osteoarthritis of the knee and its relationship to self-reported pain. PloS one, 9(4), e94563. https://doi.org/10.1371/journal.pone.0094563
- Bae, J. H., et al. (2013). Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy, 29(3), 545–549. https://doi.org/10.1016/j.arthro.2012.10.026
- Jackson, J. L., et al. (2003). Evaluation of acute knee pain in primary care. Annals of internal medicine, 139(7), 575–588. https://doi.org/10.7326/0003-4819-139-7-200310070-00010
- Dajani, K. A., et al. (2010). Arthroscopic treatment of patellar clunk and synovial hyperplasia after total knee arthroplasty. The Journal of arthroplasty, 25(1), 97–103. https://doi.org/10.1016/j.arth.2008.11.005
- Additional references available upon request or at PubMed.
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.