Sporadic Knee Pain with crunching sound now

Dear Ask The Doctor: I have had pains ever so often in both of my knees for years. But in the past 6 months the pain is more frequent and there is also a crunching sound when I squat down. I went to the doctor when I first noticed the noise and got xrays and an MRI. No loose or worn down cartilage was found. I really didn't get an answer of what it was, just that i "could" just be arthritis. And that i would just have to live with it. When the pain gets bad I just take ibuprofen and deal with it. But the crunching sound bothers me.... it sounds rough... like its ripping inside my knee.

Dear Jamie: Most likely the picture that you described correspond to a Patellofemoral syndrome or Chondromalacia patella. The pain typically is located behind/under the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (e.g, during squats, bicycle, ascending/descending stairs or pendants). It is not uncommon what you referred as “crunching sound”. Pain may be worsen by sitting with the knee flexed (“indian style”) for a long period of time, such as while watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory medication (i.e.: “Aleve”, “Advil”), education so  you understand which activities avoid because those can aggravate patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. The physical therapist should educate you about a home exercise program Allow time for these conservative measures (e.g.: exercise program) to have an effect , usually 4-6 weeks is adequate for some resolution of symptoms.