Living With Chronic Pain

Are Noisy Joints A Problem?

I am frequently asked if noisy joints are a problem. The quick answer is, it depends on the situation.
At some point, most of us have heard a squeaky joint or two. Knees, knuckles, wrists, or ankles can all make alarming cracking and popping sounds when moved. Some may be subtle, more sensed by the individual, others can be loud enough to concern those around us. Even our lungs can participate in this symphony. No wonder patients get concerned.

It’s unclear exactly what causes these sounds but it’s speculated to be due to:

Escaping gases: Synovial fluid acts as a lubricant for joints. It contains gases filled with oxygen, nitrogen and carbon dioxide. When the joint capsule is stretched rapidly, it can release nitrogen bubbles that cause a popping or cracking sound. I knew someone growing up who was a virtuoso at cracking his knuckles. I can make my wrists speak as well. But once spent, it can take up to 30 minutes for the bubbles to reform before they can perform again. And no, cracking your knuckles does not cause arthritis or harm them in any way. It can also occur when joints are suddenly moved after a period of rest, so don’t worry if you make noise when getting out of bed in the morning or a chair after working for a period of time.

Aging joints: Wear and tear, excessive weight, repetitive activity, among other things, can cause osteoarthritis which decreases the cartilage and cushioning effect between bones. Bone Spurs can also occur. In time, joints become stiffer, less flexible, synovial fluid within them decreases and minerals may get deposited in the joint space (calcification). As a result, the surface becomes rougher and noises are heard when they rub against each other.

Movements: Tendons connect muscle to bone. Position changes may cause them to move slightly out of place, making a snapping noise when returning to their original position. If not stretched properly before exercising I often hear a snapping in my right hip. Ligaments are bands of strong fibrous connective tissue that connects bone to bone. They can tighten as we move, causing a cracking sound, especially in the knees or ankles. But any joint can be affected.

Most of the time, crepitus (the medical term for the noise we hear) without pain or swelling is not concerning. Here’s when it may be signaling a problem worth investigating.

Progressive osteoarthritis: This is when the wear and tear goes beyond just thinning of the cartilage. The cushion is completely worn away, resulting in bone grinding on bone. This often causes pain, swelling, redness and/or loss of motion.

Ligament or tendon tears: In weight bearing joints such as the knees or ankles the cushion can be torn, shredded or ruptured. Popping and grinding now occurs with pain, swelling and in some cases instability- when the joint feels like it can’t take your weight. A dull ache and popping under the kneecap with motion could indicate a problem as well.

Injury or past surgeries: Any recent trauma that doesn’t resolve quickly, but instead persists with pain, noises with movement, redness, swelling and/or warmth should be assessed. Past injuries or surgeries can also result in noise when the affected area is moved. Seek professional attention when accompanied by other concerns.

Respiratory: Some sounds that are audible such as wheezes may indicate a respiratory concern or response to lung irritants such as smoking or vaping. Other noises may only be heard through the stethoscope. Either can indicate lung disease from a chronic source or an acute process. Both need to be evaluated.

Inflammation: Tendinitis and bursitis can cause painful popping as the affected joint is moved. It’s not just audible, but painful and often red or warm as well. Injury, overuse, arthritis and other factors can be the underlying causes.

Seek professional help when the sound is accompanied by:

  • Pain
  • Redness
  • Swelling
  • Injury
  • Loss of motion or strength
  • Joint locks up or gives way
  • Bruising

How to lessen the noise

  • Treat the underlying inflammation. Sometimes just rest, hot or cold packs, topicals and anti- inflammatories will do the trick.
  • Warm up the joint, tendons and ligaments before exercising or stretching.
  • Move frequently throughout the day so they do not tighten up. The more you move the joints, the more they stay lubricated, “motion is lotion.”
  • Stay active and practice healthy body mechanics throughout your daily activities.
  • Stretch and mobilize every day. This will prevent injury as well as strengthen muscles and their joints, ensuring ligaments and tendons properly track throughout their range of motion.
  • Prevent further wear and tear by maintaining a healthy weight and diet.

Sometimes it’s a just habit, giving a physical outlet to emotional stressors. The first step is to be more mindful and think why you’re cracking a joint and when. I get it that it “hurts so good.” But the moment you become aware of what brought it on, it’s easier to stop. Sometimes just holding my hands in my lap for a minute breaks the desire.

Noise alone is rarely cause for alarm. Often a healthy diet, weight loss, regular exercise with proper stretching and strengthening, while avoiding excessive weight lifting, rapid torque or repetitive movements will help keep them quiet.


Sources:

-https://www.verywellhealth.com/what-causes-popping-joints-2552212

-https://www.health.harvard.edu/staying-healthy/are-cracking-joints-a-sign-of-arthritis

-https://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/sports-medicine/conditions-we-treat/joint-popping-cracking.html

-https://health.clevelandclinic.org/snap-crackle-pop-need-know-joint-noises/

-https://www.loc.gov/everyday-mysteries/biology-and-human-anatomy/item/what-causes-the-noise-when-you-crack-a-joint/

-https://www.nature.com/articles/s41598-018-22664-4?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=3_nsn6445_deeplink_PID100090071&utm_content=deeplink

-https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119470

-https://www.jabfm.org/contento/24/2/169.long

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