Snap, Crackle, Pop - Joint Crepitus
As Physiotherapists, we see people everyday with joints that pop, crack, creak, grate, snap, click, grind, and crunch. Most people want to know:
A) What’s causing these strange noises? and;
B) Is it something they need to be worried about?
The first thing to know is that these weird noises, generally known as “crepitus” in the medical community, are usually completely normal. I don’t have any stats to back me up, but I’d bet you’d be hard pressed to find someone who doesn’t pop or crack occasionally. The other important thing to keep in mind is that crepitus alone is not a sign of damage or injury. One study, looking at crepitus in the knee, found that the majority of people associate the noises with premature aging, wearing away of their joints, creating permanent damage, and other negative emotions. These unfounded beliefs are the real danger! Negative beliefs can lead to behavioural changes based on their perception of damage or injury. Changing movement patterns or cessation of movement altogether are all too common and are much more likely to cause real problems. So, let’s set the record straight and find out exactly what these noises are and if you should have them examined by a professional.
There can be many different causes of crepitus from various structures within the body. The most common, and completely harmless, comes not from the joint itself, but from the fluid within the joint. This synovial fluid is contained within a capsule in joints such as your knuckles and knees and can be responsible for different sounds depending on how it is moved. Cracking your knuckles rapidly pulls the fluid apart creating a gas bubble within the liquid and a loud “popping” noise. (So no, cracking your knuckles is not your bones grinding together and will not give you arthritis!) The synovial fluid can also be heard moving over the surfaces of other structures within the joint such as cartilage and bone. This is common in the knee where it is often described as a fine gritty or grinding sound. Again, this does not signify that there is any damage within the joint. Another cause of crepitus can be from tendons crossing joints. As the joint moves, the tendon can catch on other structures and “snap” loudly back into place. This is a common occurrence in the ankle and shoulder and is nothing to be worried about, provided it isn’t associated with any pain.
While painless synovial and tendon crepitus are normal and not concerning, are there any noises that you should be wary of?
A “bone-on-bone” description is often used by patients to describe their symptom and is commonly believed to be a sign of osteoarthritis. This is only partially correct. While it is true that bone may come into contact with another bone, this will only occur in the late stages of the disease, long after other symptoms have already presented. Crepitus alone can not be used as a reliable diagnostic symptom for osteoarthritis.
Joint noises associated with a catching, locking, or giving-way feeling of a joint can be suggestive of labral or meniscal issues that may need to be more thoroughly assessed. However, it’s important to note that these damages typically occur during a traumatic injury or with excessive overuse of the joint and will often be accompanied by other symptoms, pain and/or loss of function.
How do you know if your joint need to be examined? Here’s a quick checklist, if you answer YES to any of the below questions you should consider seeking a professional assessment.
Did the crepitus begin with a traumatic injury?
Is the crepitus associated with pain?
Does the crepitus limit your ability to complete any activities?
Do you experience a catching or locking that affects the movement of the joint?
If you came back with four NO’s, hooray! The clicking/clacking/popping you’re experiencing is likely completely normal and nothing to worry about! Keep doing what you’re doing and remember that regular activity is the best way to keep your joints healthy.
Do you have an ache or pain? Book in to see one of our physio's today - book online here or call us on (08) 9448 2994!