This is a common issue, but can be very tricky to deal with. There’s clearly a lot of fear going on here, given her thought processes. It turns out there is actually some research on this – though “hard data” isn’t often enough to overcome these deep-seated fears and emotions people have about their bodies, some of this might be helpful in the educational process.
https://www.sciencedirect.com/scienc…68781217300309
This paper looks at people’s beliefs about the meaning of crepitus (though this was in the context of patellofemoral pain) and the impact of these beliefs on their subsequent behavior. A few interesting quotes:
No research has demonstrated a definitive link between noise and pathology, and McCoy et al. (1987) demonstrate that 99 percent of a cohort of subjects with no pain had patellofemoral crepitus. Overall its importance and meaning is unclear. Furthermore, crepitus is often present in the complete absence of any joint pathology (Robertson, 2010).
The subjects in the study were most concerned about the meaning of the noise. They often thought it meant they were damaging their joints and that it represented “premature aging” or “degeneration”, which made them feel “old”, anxious, and fearful. Interestingly, they also felt embarrassed when the noise was audible in the presence of others – particularly when other people responded negatively to hearing the noise (commenting on it, “wincing”, or voicing concerns like “you should get that checked out”). This might be especially pertinent if you are coaching her.
As a result, subjects were found to significantly alter their behavior or even stopping certain hobbies (consistent with the generally accepted fear-avoidance model), especially when in a quiet environment where the noise is more audible. Additionally, people who had a relative with knee problems assumed that their crepitus was a manifestation of the same process, reinforcing the cycle of fear and subsequent reduced activity. It may be worth asking your trainee whether she knows anyone who has knee issues, which may be influencing her feelings about her own knees.
Finally, as usual, there was also frequent negative influence from healthcare professionals:
Most participants had had a negative experience of interacting with a health professional with respect to their crepitus, and felt that it was not taken seriously, and was poorly understood as a symptom. This is unsurprising when there is a lack of literature and education on the topic. However, it is well understood from the literature on low back pain that physiotherapists belief systems will in turn impact on patient management, and hence outcome (Daykin, 2004)
Interestingly, they cited similar data on inaccurate subjective theories as to the meaning of bodily sounds in the setting of irritable bowel syndrome, another diagnosis often associated with lots of anxiety and fear issues.
Here’s one other potentially useful paper on the topic from an orthopedist:
http://onlinelibrary.wiley.com/doi/1…i.492/abstract
My overall approach would include lots of education, and strategies to reduce her attention/hypervigilance to the noise – wearing some knee sleeves to “muffle” the sound/sensation, and once she doesn’t need regular verbal cueing during a set, playing some music or using some headphones and having her shift her focus during the set. You’ll need to be very patient and careful with your own language here if you want to make progress with her.
