Ask Dr Gary: Clicking joints can be a pain

Over the last year my joints have started clicking. I didn't think much of it, as it never hurt, but now my knees hurt a lot. I've also started getting real bad cramps in my calf muscles and my feet so bad I can't walk. I'm a bit worried as I am only 31, don't do drugs of any kind, take no caffeine, and don't smoke (since two years ago), and I'm only a light drinker of low carb beer. I do have a physical job being a painter but don't play sport as my kids give me a good run around. I'm 172cm tall and 65kg, I eat well and drink either water or juice and keep sugars at a healthy amount. It'd be great if you had any ideas. - Roger

Knees that snap, crackle and pop - painlessly - are almost always normal. The sounds are called crepitus, and are thought to be from dissolved gases in the joint fluid forming bubbles as we stress the joint by bending, crouching, or squatting. Ligaments stretching, or rubbing past bony protuberances can also make noise.

It becomes an issue only when there's pain involved, which generally suggests cartilage injury or an inflammatory process in the joint fluid itself.

Osteoarthritis (OA) is the name for wear-and-tear joint pain that is extremely common in tradespeople like painters, roofers, and carpet-layers. Rheumatoid arthritis (RA) is also a cause of knee pain, but is treated quite differently, as it's caused by an autoimmune process. It typically affects the wrists and hands, often runs in families, and is more common in females.

Your doctor may end up evaluating you with x-rays or blood tests, but most important of all will be a thorough history, considering everything from the work you do to your family history; causes varying from fibromyalgia and insect-borne diseases, to biomechanical problems or even gout.

As for cramps, there are a couple common risk factors: overuse/overtraining, sodium and potassium deficiencies (especially in dehydrated athletes or labourers), cholesterol medications and diuretics (water pills), and in those who are pregnant, or have thyroid disease. The cause of many cases of recurrent cramps remains uncertain.

Gary Payinda, MD, is an emergency physician who would like to hear your medical questions.

Email: drpayinda@gmail.com (This column provides general information and is not a substitute for the advice of your doctor.)