There are many sounds our joints make and it seems more so as we get older! The grinding, cracking, and snapping sounds our joints make day to day are typically nothing to worry about. So, what do these sounds mean and should it be cause for alarm?
The painless noises our joints make are both common and normal. One explanation is the nitrogen gas bubbles that build up in our synovial fluid, the fluid that lubricates and protects our joints. When the gas pressure builds up and a joint makes a popping sound, it is much like the pressure being released when a jar is opened. Another reason for a snapping sound some joints make, is when our muscles/tendons may slide across a boney prominence. If we roll our shoulder blades in a circular motion, you may hear some snapping sounds. When painless, this may be the long muscles from the shoulder blade to the neck, sliding and snapping across the edges of the shoulder blade. While this may indicate that these muscles may be tighter than we’d like, it is not a cause for concern. Or, when you reach behind into the back seat of the car and hear/feel a snap in the shoulder – this may be certain muscles snapping across boney bumps on the humerus/shoulder bone. Again, if painless and occasional, not a concern.
A common ‘favourite’ is the grinding in our knees…this one can really make someone feel old! This is called crepitus and again is common and typically not painful. Going up and down stairs, squatting, or rising from a chair all may elicit a grinding/crunching sound. This often makes people nervous, afraid and certain they have terrible arthritis. The Journal of Musculoskeletal Science and Practice showed that “knee crepitus is extremely common with 99% of knees making some sort of physiological noise” (Robertson et al. 2017). These noises can be distressing and lead to fear avoidance behaviours and beliefs about exercise and movement causing damage to our joints. Recent studies have shown that the majority of knee noises are physiological (normal) rather than pathological.
Pathological reasons would be a structural issue caused by an injury or repetitive strain, such as a meniscal tear, capsule tear or a muscle imbalance causing poor joint movement. If a movement is associated with a painful click, locking, sharp pain or weakness – this is more of a concern. Common injuries would be a torn ligament or muscle which is often associated with a painful popping sensation or a tearing feeling. In both cases, there would typically be swelling, pain and weakness. A meniscus is a structure in the knee that is a shock absorbing layer between the two bones. This may be injured by a sudden twist motion, a fall, or a sports injury. A tear in the meniscus may click or cause a locking sensation at the knee. There would be a range of motion deficit and likely a feeling of vulnerability or the joint giving way. Walking, stairs and hills are likely painful and you may walk with a limp.
The gradual onset of a dull ache, grinding, radiating pain and weakness at the knee may be associated with a muscle imbalance and poor tracking of the kneecap. The biomechanics of our lower leg must ideally move in optimal alignment between the hip, knee and ankle. Poor arch support, tight outer thigh fascia (the IT Band from the hip to the knee), weak glute muscles, and tight hip flexors are just a few of the issues that may cause poor movement patterns over time. As the patella (kneecap) is really like a “floating” bone within the thigh muscle it may be pulled on, compressed or track poorly as the knee bends and straightens. This may cause painful popping, grinding and sensations of weakness.
In summary, pain and noisy joints are not interdependent. Noise is common, normal and most often NOT associated with arthritis. It is important to not avoid activity and exercise because of a fear of damaging your joints. However, when a joint noise is accompanied by pain, weakness, heat, swelling or radiating nerve sensations, it is time to see a medical professional. Whether there is a mechanism of injury or a gradual onset, there is an imbalance in your movement patterns and likely a structural tissue at fault. The team of therapists at Bragg Creek Physiotherapy are well equipped to assess your biomechanics, posture, and gait to help determine the structures at fault. We may educate you regarding appropriate stretches, strengthening exercises, manual therapy techniques and lifestyle modifications.
Jennifer Gordon (BScPT, GunnIMS, AFCI)