Do your knees creak? Does your neck crack? Do your ankles, wrists or hips click? Have you ever wondered if you need to see a Physiotherapist about these noises? Or are noisy joints better ignored?
The good news is that in most cases, as long as there are no other symptoms, you don’t need to worry about your noisy joints at all!
The most common noises are benign pops or high-pitched snaps. These are thought to occur when the fluid-filled sac within our joints is stretched by a sudden change in position.
This sudden change in position causes pressure and volume changes within the joint. Dissolved gases are then extracted from the joint fluid. These gases make bubbles that are unstable and pop.
This is thought to be the source of the sound when you crack your knuckles.
The evidence from knuckle crackers is that it’s harmless. But you don’t have to physically crack your knuckles to create these sounds. Any movement that causes a sudden change in joint volume will do it. But it has to be rapid. The same movement done slowly won’t produce a crack.
For example, your ankle might crack when you run but not when you walk. Even though it’s the same movement, when you run there is more weight placed through the ankle joint. The volume change is quicker, which is why you’re more likely to experience a cracking sound.
Muscle tightness in the neck can also cause these pops. As you turn your neck there is resistance. This builds up pressure in the joint, and when the joint moves quickly it creates a pop.
Rubbing and Grinding
While pops are relatively harmless, rubbing or grinding noises (known as crepitus) can be a sign of age related changes in the joint cartilage.
Cartilage deteriorates as we get older. It’s a normal part of the ageing process. As the cartilage wears away the joint surfaces become rough. The creak and grind you hear is fluid passing through the fissured surfaces.
It’s important to remember that this is a normal age related change we all experience. The majority of people without any pain will still experience some crepitus in their joints.
This is different to osteoarthritic crepitus that sounds like a creaking door. This is due to uneven joint surfaces.
In this case, as the cartilage degenerates, the joint is no longer adequately protected against friction and impact. The loss of cartilage alters the biomechanics of the joint. This causes the bones to grind against each other. This grinding can result in crepitus being felt or heard.
Unfortunately there’s nothing you can do to improve a worn out joint. But there are things you can do to help reduce symptoms such as pain. Strengthening exercises will help keep your muscles strong and protect the joint. Keeping your weight under control is also beneficial in reducing the load on the joint.
If you are experiencing a lot of pain in a joint, it doesn’t necessarily mean you’ve lost a lot of cartilage. The reverse is also true. But if worn cartilage is thought to be the cause, you should continue to be as active as possible. This is because cartilage has a poor blood supply. It relies on movement to pass blood and articular fluid in and out of the joint. It is also how the joint gets its nutrients.
It is wise though to minimise high impact activities, such as repetitive jumping, as these are known to aggravate symptoms.
Physiotherapy can help some types of painful crepitus. By improving muscle strength physiotherapy can help stabilise the joints.
When tendons rub over bone it can also cause crepitus. This usually only occurs when the tendon is inflamed due to repetitive movement. In these situations you are more likely to notice the pain first.
Repetitive movements (such as typing) can irritate the tendon sheath and cause swelling. As the tendon moves over bone you get a grinding noise. This is because the tendon isn’t gliding smoothly in its sheath.
When this occurs it’s important to rest from the aggravating activity. Start by trying to nurse the injury along. Rather than completely stopping the activity, try reducing the amount of time you spend doing it first. A short burst of anti-inflammatory tablets or rub-on gels may also be helpful. You can also use ice to try and reduce the pain.
The Bottom Line
The bottom line is that noise + pain is more likely to be a sign you have a problem than a noisy joint alone.
Most people’s joints crack or pop occasionally, and it is actually quite normal. If your crepitus is accompanied by pain, swelling or other problematic symptoms please ask your Physiotherapist to check it out. But if you only get a little bit of crepitus or cracking, unfortunately it is more likely to just be a sign of getting older.
About the Author:
Heather is an experienced physio of some 25 years. She enjoys treating all conditions, but is particularly interested in tendinopathies and shoulder problems. Heather uses her exercise science background to implement an active management approach in building each clients capacity, and working towards their individual goals.
Outside of work Heather is a busy Mum of two teenagers and enjoys mountain biking, bushwalking, camping, and gardening.
Heather is also a volunteer for Wombat Rescue Tasmania, treating mange affected wombats in the North of the state.