Creaky knees: is there a reason for concern? A qualitative study

Key points

1. 01Most participants remained physically active and did not stop exercising because of crepitus
2. 02Concern centred on what the noise might mean for future joint health, not the noise itself
3. 03Pain was ranked as a more pressing symptom than crepitus by all participants who had both
4. 04Some participants started or increased strength training in response to crepitus, with no regret reported
5. 05Most had not consulted a health professional specifically for crepitus, and wanted more information on safe exercise

How it was conducted

Design

Qualitative study using inductive thematic analysis informed by a grounded theory approach

Data collection

Semi-structured focus groups and individual interviews conducted online or in person, April to August 2022

Participants

24 adults (16 female, 8 male) aged 21-69 years (mean 47.9 years, SD 13.4) with knee crepitus causing concern

Inclusion criteria

Age 18 or older, with or without knee OA, with audible or repeatable creaking, grinding, or popping in the knee

Analysis

Transcripts uploaded to NVivo v12; thematic saturation reached after 6 focus groups and 6 individual interviews

Primary outcome

Themes capturing beliefs about crepitus, its meaning, and its influence on exercise behaviour

What they found

• Five main themes identified: individual variation of crepitus, occurrence of crepitus, meaning of crepitus, attitudes and exercise behaviours, and knowledge deficits and needs
• 24 participants interviewed; 16 female, 8 male; age range 21-69 years; mean age 47.9 plus or minus 13.4 years
• Approximately half of participants reported experiencing crepitus without any associated pain
• Nearly half of participants described having crepitus for as long as they could remember or for more than 10 years
• Most participants who had crepitus for several years reported that concern had decreased over time as joint health had not seemed to decline
• Slightly fewer than half of participants decreased their exercise amount; for those who did so due to symptoms, pain was the primary driver, not crepitus
• A small number observed crepitus increased when they first began strength training, but many noted that after time crepitus occurred over a smaller range of motion or ceased entirely
• Approximately one third of participants believed the cause of their crepitus was wear and tear or a part of ageing

Limitations

• All participants were self-reported as physically active, limiting generalisability to less active or sedentary populations
• Sample size of 24 may not capture the full range of beliefs across different health literacy levels
• Recruitment via arthritis groups, university, and gyms may have introduced selection bias toward health-engaged individuals
• No objective measures of crepitus severity or joint health were collected, so reported beliefs cannot be linked to clinical status

Why it matters

For patients

If your knees creak but are not painful, most people in this study continued exercising and found that strength training sometimes reduced their symptoms over time.

For clinicians

Patients with crepitus want clear, individualised guidance on safe exercise; reassurance alone may be insufficient, and conflicting or dismissive advice from clinicians was reported to increase anxiety.

For readers

This qualitative study highlights a gap between patients' desire for evidence-based education about knee crepitus and the limited or inconsistent information they currently receive from health professionals.