knee pain, knee clicking / crunching, knee instability

Hi All,

I’ve joined this forum in the hope that a knowledgeable member can offer me some advice regarding a long standing condition. Sorry if this is a long post but I’ve tried to include everything related.

I’ve had a problem with both knees for many years now which is getting progressively worse. During normal activities such as walking up and down stairs I get pain in both knees and a loud clicking and crunching noise can be heard. It is difficult to pin-point where the pain is, but feels central in the knee.

If I walk long distances, kneel on the ground, spend an extended time on bended knee, or take part in any high - impact exercise on, i.e. running, aerobics, skipping (and as such now avoid) my knees will within a few hours become very tender. Later and by the next day some swelling can be seen and my knees in general are stiff and aching. I will get sharp pains in the left knee (sometimes right also), which again feels central in the knee.

On several occasions in the past my left knee has given way and has made me fall to the ground. I’d say this happened around 6 or so times – but since then I have been very conscious about stepping or turning in an awkward way to avoid a repeat fall. My left knee on many many other occasions feels like it is about to give way or is unstable.

In the past when I have run for any length of time I would always get very strong pains in the shin area of both legs, I believe these are known as shin splints?

I am uncertain whether the following is the cause of the on-going instability of the left knee - I can remember vividly when I was at school (1993) during sports doing a long jump exercise, I landed badly in way that pushed my lower left leg upwards and into my upper leg and was left in severe pain. I could walk after this, but my memory of anything else is a little hazy.

At present I don’t take part in any high – impact sports such as running, jumping skipping.

I haven’t received any medical treatment or advice until February of this year (2011).

I have seen a musculoskeletal physiotherapist and I’m now currently seeing an extended scope physiotherapist. The ESP has left me to do moderate single leg squat exercises to strengthen the quads for 2 months (note that I’ve been told to and have been bending only in the pain free zone). These exercises do seem to have improved the crunching noise slightly but not significantly (I presume because the patella is beginning to track properly?). The pain still remains and there is little if any improvement. I’m due to return to see the ESP soon.

At my last appointment with the ESP I was told if there was no improvement I would be referred to a specialist to look at my feet and mentioned the possibility of having orthotics fitted. I have been told by both therapists that I have flat-footedness. While I understand the way I stand / walk affects my knee joint, I don’t see how this will improve the existing clicking / crunching and more importantly the deterioration of the cartilage.

My main worry is the pain which I fear may become much worse when I am older which may limit my mobility significantly, but I am also concerned about further deterioration of the cartilage at the back of the patella (presuming what I have been told is the case). My other worry is that this may lead to arthritis, which one of my grandparents suffered badly from and my mum seems to have early signs of.

What is also at the back of my mind is should I have had an X-ray to fully establish my condition(s)? Or is what is happening clear from the symptoms?

If anyone can offer any advice beyond what I already know I’d be very grateful for your time.

Thanks all