Noisy Joints

If I had a nickel for every time a client asked me about their noisy joints, I would probably be retired on a beach somewhere instead of writing this blog!

As humans, we often fear the unknown and hearing weird noises from our bodies can be worrying and unsettling. These negative emotions can lead us to alter our behaviours to avoid the movements that may cause our joints to click [1]. This unnecessary fear can prevent us from being active and doing the things we love to do, such as pole. That’s why the aim of this blog is to put your worry to rest, or at least try to resolve some of the mystery behind noisy joints!

We’re going to now answer some of the most common questions we get as physiotherapists when it comes to clicky joints!

Question #1: Why do my joints click?

Our joints can make an array of weird noises. Common descriptive terms that people use for their noisy joints are “grinding, clicking, creaking, clunking, or snapping”, just to name a few. As physios, the term we use for noisy joints is crepitus. Quite often, the type of noise can give us an indication of what is occurring at the joint.

There are several reasons why our joints can make noise. For simplicity's sake, think of the noises arising from two possible sources: from within the joint or from outside of the joint.

Noises from outside the joint could be soft tissue related (ie. muscles, tendons, ligaments) that attach to or support the joint [2]. Normally, the tendons of muscles roll over bony prominences with ease, but if more taught then they can snap back like a rubber band [3]. Poor local joint control and altered muscle firing patterns can lead to a muscle feeling ‘tight’ because it has to do more work. Basically, if the muscles that stabilise the joint aren’t sharing the burden of the load then more stress can be put on to one structure. This makes me think of group projects in school!

A good example of this is the “snapping” hip. Commonly with this condition, the hip flexor “snaps” over the joint because it's taking on more of the stability work secondary to reduced strength around the hip, pelvis and lumbar spine - more on this specific condition here.

When thinking of noise sources from within the joint, we can further break those down into physiological (mechanical in nature) and pathological (presence of injury or disease).

A common physiological noise occurrence from within the joint is the one we hear when cracking knuckles. This type of “popping” noise is known as joint cavitation. Over time, a build-up of nitrogen gas bubbles occurs in our joints, sometimes causing them to feel an increased sense of pressure [2,3]. By stretching or moving the joints in a certain way, we can release these bubbles which produce the audible popping sound. Cavitation is what occurs during manipulative treatment performed by a physiotherapist, osteopath, chiropractor or doctor. This audible sound is not the sound of a ‘joint going back into place’, it is simply gas being released from the joint under high velocity. This is thought to assist with neuromodulation (a fancy word for changes that occur to the nerves) which can temporarily assist with pain relief.

Pathological joint noises occur due to damage within the joint itself. An acute injury, such as a ligament tear may cause a “popping” sound at the time of injury. Degenerative changes of joint surfaces, such as with osteoarthritis (OA), can cause distinct “grinding” or “creaking” noises - think of noisy knees as a good example. Many pathological joint noises are often accompanied by other symptoms such as pain and swelling [2,3].

Question #2: Is it bad that my joints click?

The short answer is no!

Research has not found a strong link between joint crepitus and pathology [1-4]. Meaning that more often than not, you can experience noisy joints, but there is not likely anything wrong with the joint itself. Therefore, in the absence of other symptoms such as pain, instability, locking/jamming, reduced range of motion, weakness and/or swelling, then we do not need to worry about pathology or damage occurring within the joint.

Now what if you are experiencing pain (or other symptoms) with your noisy joint? Then it would be a good idea to see a physiotherapist who will be able to assess the joint to establish the cause of those symptoms and create a treatment plan to address your concerns. I’ll give some specific examples further down.

Question #3: Are clicking joints a normal part of aging?

Totally! Noisy joints are normal joints, especially with aging. Without going into too much detail, there are natural changes that occur in our muscles and joints with aging. Our muscle mass and strength decreases (known as sarcopenia), our tendons and ligaments become less elastic, and our joints stiffen up. Given these changes, of course our joints are going to make some funky noises.

For some, these changes can lead to painful joints, but the research actually shows poor correlation between joint space narrowing and pain [5]. Meaning that you can have age-related changes in a joint, but be completely asymptomatic!

As always, movement is medicine and, with an appropriate tailored exercise regime, you can modify the effects of aging.

Question #4: Are clicking joints a sign of arthritis?

Did your mom ever tell you to stop cracking your knuckles because it will cause arthritis? Well I am here to say that this is just an old wives tale and your mom probably just found the sounds annoying.

Many research studies have looked at evidence to support this point. One in particular compared older people with and without hand osteoarthritis (OA) who are chronic knuckle crackers to those who are non-knuckle crackers. No significant correlation between knuckle cracking (both duration in years and frequency in a day) and the presence of OA was found [6].

Now, keep in mind, joint crepitus is a common symptom of OA, but is only one of many non-radiographic tests for diagnosis of joint OA which include pain, morning stiffness and limited function as well as other predisposing factors such as age, occupation, weight, and gender [7].

What’s important to note as well is that joint crepitus is not a predictor of joint strength or function as was found in a study comparing individuals with knee OA with and without crepitus. More often, individuals' negative beliefs and self-reported limited behaviours were a greater indicator of decreased function and poorer quality of life with OA and crepitus [8,9].

Question #5: Is it normal for my shoulder to click?

It goes without saying that our shoulders are one of the most important joints for us as pole athletes. I know first hand how concerning it is to hear clicking in your shoulder when climbing several feet in the air on the pole. It is common for the shoulder to click, but not normal, or rather, ideal. Let me explain.

The shoulder is known as the glenohumeral joint (GHJ). It is a ball-and-socket joint made up of the rounded head of the upper arm bone (humerus) and the corresponding concave surface on the shoulder blade known as the glenoid. I like to think of the shoulder joint as an ice cream scoop sitting on top of an ice cream cone. Compare it to the hip, which is technically the same joint, as an ice cream scoop sitting in a cup. The ball of the shoulder sits in a much shallower groove compared to the deeper socket of the hip joint. This type of joint provides the arm the freedom to articulate in all three planes of movement making it the most mobile joint in the human body [10]. But the downside to the GHJ is that the added mobility sacrifices overall stability compared to other joints in the body.

We ask a lot of our shoulders in pole, but we know from earlier in the blog (question #1) that noises in our shoulder aren’t necessarily harmful. Noises like “popping” and “clicking” with movements that are pain free can simply mean that the muscles that stabilise the joint aren’t working efficiently. This is especially the case for the shoulder given the nature of the joint. These types of shoulder noises are generally not a concern and with regular tailored strength work (on or off the pole) you can keep your shoulders in good shape.

Sometimes, overloading of the GHJ through repetitive movements and insufficient stability, the shoulder can be put at more risk of injury. The most common disorder of the shoulder is Subacromial impingement syndrome (SAI). This is an umbrella term that encompasses rotator cuff tendinopathies, rotator cuff tears, and subacromial bursitis. While some non-modifiable anatomical influences may contribute to SAI, research shows us that poor scapulo-humeral kinematics from muscle imbalances will lead to SAI. Proper physiotherapy management can help modify pain associated with SAI and correct the muscle imbalances causing this disorder [11].

In some cases, noises in the GHJ can indicate joint pathology, or at least prompt a healthcare practitioner (HCP) to further assess the shoulder. For example, a common sign of a glenoid labral tear is, in fact, clicking [12]. Whilst clicking on its own does not mean you are injured, if you are experiencing other signs or symptoms of injury such as pain with overhead activities and/or instances of instability of the shoulder, it would be wise to have a HCP assess the shoulder to determine the underlying cause of the clicking.

Question #6: Can I fix my clicking joints?

As mentioned above, if you have noisy, painful joints that restrict your movement and strength we would advise you to seek help from a physiotherapist for assessment and they can devise a treatment plan for you.

In the case of the shoulder, it is likely that you can improve the joint clicking by performing the right corrective exercises. No surprise that muscles around the joint will need to be strengthened. But I bet you wouldn’t have guessed that strengthening your core can strengthen your shoulder! (*groan* - more core work!) The way the GHJ is connected to our chest cavity and subsequently our spine, we need good core strength to provide a stable platform for the shoulder to move in a coordinated manner and produce sufficient power [10].

Hopefully by now we’ve answered all your burning questions related to creaky and cracky joints.

Wanting tailored guidance, assessment and rehabilitation for your clicking joints?

Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.

Until next time, train safe.

The Pole Physio

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Disclaimer: This information and these exercises are not tailored to you as an individual and do not constitute as medical advice. If you have medical or injury concerns, then please individually consult with a medical professional.

References

1. Robertson, Claire J., MSc PGCE MCSP, Hurley, M., PhD, & Jones, F., PhD. (2017). People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskeletal Science & Practice, 28, 59-64.

2. Robertson, C. J. (2010). Joint crepitus - are we failing our patients? Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy, 15(4), 185-188.

3. Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the knee. Clinics in Orthopedic Surgery, 10(1), 1-8.

4. de Oliveira Silva, D., Barton, C., Crossley, K., Waiteman, M., Taborda, B., Ferreira, A. S., & Azevedo, F. M. d. (2018). Implications of knee crepitus to the overall clinical presentation of women with and without patellofemoral pain. Physical Therapy in Sport, 33, 89-95.

5. Halilaj, E., Le, Y., Hicks, J. L., Hastie, T. J., & Delp, S. L. (2018). Modeling and predicting osteoarthritis progression: Data from the osteoarthritis initiative. Osteoarthritis and Cartilage, 26(12), 1643-1650.

6. Deweber, K., Olszewski, M., & Ortolano, R. (2011). Knuckle cracking and hand osteoarthritis. Journal of the American Board of Family Medicine, 24(2), 169-174.

7. Zhang, W., Doherty, M., Peat, G., Bierma-Zeinstra, M. A., Arden, N. K., Bresnihan, B., Herrero-Beaumont, G., Kirschner, S., Leeb, B. F., Lohmander, L. S., Mazières, B., Pavelka, K., Punzi, L., So, A. K., Tuncer, T., Watt, I., & Bijlsma, J. W. (2010). EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Annals of the Rheumatic Diseases, 69(3), 483-489.

8. Pazzinatto, M. F., de Oliveira Silva, D., Faria, N. C., Simic, M., Ferreira, P. H., Azevedo, F. M. d., & Pappas, E. (2019). What are the clinical implications of knee crepitus to individuals with knee osteoarthritis? an observational study with data from the osteoarthritis initiative. Revista Brasileira De Fisioterapia (São Carlos (São Paulo, Brazil)), 23(6), 491-496.

9. Pazzinatto, M. F., de Oliveira Silva, D., Azevedo, F. M. d., & Pappas, E. (2019). Knee crepitus is not associated with the occurrence of total knee replacement in knee osteoarthritis – a longitudinal study with data from the osteoarthritis initiative. Revista Brasileira De Fisioterapia (São Carlos (São Paulo, Brazil)), 23(4), 329-336.

10. Panayiotou Charalambous, C., SpringerLINK ebooks - Medicine, & SpringerLink (Online service). (2019). The shoulder made easy (1st 2019. ed.). Springer International Publishing.

11. Umer, M., Qadir, I., & Azam, M. (2012). Subacromial impingement syndrome. Orthopedic reviews, 4(2), e18.

12. Liu, S. H., Henry, M. H., Nuccion, S., Shapiro, M. S., & Dorey, F. (1996). Diagnosis of glenoid labral tears: A comparison between magnetic resonance imaging and clinical examinations. The American Journal of Sports Medicine, 24(2), 149-154.