We've all experienced a joint making a click, crack or crunch noise at some point. Some people much more than others.
But what is it that causes a joint to become noisy like this? And does it spell bad news for your joints down the track?
Cavitation - The Gas Bubble
Cavitation is normal and not dangerous. Most popping and cracking joint noises are likely to be caused by cavitation - that is, the formation of a gas bubble within the joint.
Now you may have heard that joint noises are the popping of an existing gas bubble within the joint, however an interesting study published in PLoS One (Public Library of Science) in 2015 used real time visualisation of a joint under MRI to see exactly what occurs in the joint space when you crack a knuckle.
What they found was that when the joint separated, it formed a bubble, rather than popping an existing bubble.
Its called tribonucleation - this complicated sounding word describes the process of creating gas bubbles between two objects. It involves two solid surfaces that are covered in a liquid that contains dissolved gas. The surfaces resist being pulled apart because the liquid creates a suction effect, until enough force is generated to suddenly break the contact with each other, resulting in creating a gas bubble.
In a joint, the solid surfaces are the two bones and articular cartilage surfaces that form the joint. The liquid containing dissolved gas is the joint fluid, called synovial fluid, that lubricates the joint surfaces to make it easy and smooth for the cartilage-covered bony ends to slide over each other. When a joint is put under enough force, the bony ends can be moved far enough from each other to break their contact momentarily, and cause that familiar pop noise.
This can happen from purposefully trying to crack a joint, like cracking your knuckles, or from movements like squatting which can make your knees crack, or doing a spinal twist stretch which might crack your back either intentionally or unintentionally.
People with hypermobility in their joints can experience a lot more popping and cracking noises than other people. This is because their joints tend to have more freedom of movement due to having stretchy ligaments so its easier for cavitation to occur. The role of ligaments is to connect the two bones of a joint together and keep it stable and stop the bony ends from separating.
Will it cause arthritis? Its unlikely that cracking your knuckles and achieving that satisfying cavitation "pop" will cause you to develop arthritis in the long term, there are many more factors involved in developing arthritis.
Movement of Tendons over Joints
These sounds tend to be more of a snapping type of sound, because its the sound of the tendon moving over a bony area of the joint.
Tendons are the strong connective tissue bands that connect muscles to bones, and for muscles to move a joint they need to cross over it. This means that sometimes the tendon will have to slide over a bony point where it will have to stretch like a rubber band to maneuver it, and will "snap" back due to elasticity of the tissue.
Common snapping sounds from tendon movement can be heard in the knees, hips and shoulders.
These movements shouldn't be painful, but if you do start to feel pain when you're hearing or feeling the movement of the tendon over your joint, get it checked out. Your myotherapist may be able to make a big change to the discomfort through simple muscle relieving techniques.
Changes in Articular Cartilage
Sounds from changes in articular cartilage tend to sound crunchy, crispy or "like gravel". Its called crepitus, but the sound is often worse than the sensation, and many people don't feel any pain at all.
The term "bone on bone" gets thrown around, and this scares a lot of people because they visualise the bones literally grinding away at each other. The reality is that the ends of our bones are covered in articular cartilage, which is a smooth, squishy padding on the ends of bones that makes movement easy, fluid and painless and which prevents any direct "bone on bone" contact. Over a lifetime there will be normal changes to your cartilage, just like there is to a car, or a pair of shoes, or a well used garden pathway.
Sometimes the changes in the cartilage can be that it becomes torn or damaged, for example if you have an accident, take a big impact to the joint, or get an infection. It can also build up over time from things like high intensity sports, repetitive use of the joint, or increased load on the joints from growing quickly or rapid weight gain such as pregnancy.
Damaged cartilage can break down and remain in the joint space, which means the once-smooth surfaces become a bit rough, and there may be particles in the joint fluid. This can cause noisy movement of the joints, but its often painfree. Sometimes this can cause the joint to become irritated, which may cause it to swell up or become hot and inflamed, and then it can be temporarily painful.
Do you need surgery? Many kinds of surgeries are used for joint problems, but not every person needs to go down the surgery avenue. Surgeries range from very short day procedures like arthroscopes which clean out cartilage debris in the joint space, to full joint reconstruction or replacement surgeries. Many people find they can prevent surgery for a long time with a tailored exercise program to strengthen the joint and reduce load on it, and using supports like braces or taping. Surgery is not guaranteed to fix the problem.
If you're having significant pain with your noisy joints, see your Myotherapist or your GP to start investigating the causes and working on a treatment plan.
Most people understand joint dislocations. But subluxations, or partial dislocations, are a bit different. As a myotherapist, I see plenty of subluxations and related injuries every week. So let’s look at why subluxations aren’t quite dislocations, and what you can do about them!
What is a subluxation?
Unlike a dislocation, a subluxation is a partial displacement of the joint. With a dislocation, the bone is completely out of the joint it belongs to. But with a subluxation, the bone is only partly out.
Just because it is not a full dislocation doesn’t mean that it won’t hurt! Subluxation can still be painful, as the joint is being wrenched out of its usual spot. It can also leave you at higher risk of chronic pain if the joint isn’t rehabilitated after the injury.
In the image above, we're looking at the ball and socket joint of the hip. The Normal hip joint shows the ball of the femur (thigh bone) sitting neatly inside the socket joint of the pelvis. In Dysplasia, the shape of the socket is not correctly formed so the socket doesn't snugly hold the ball of the femur. In Subluxation, the ball of the femur has partially slid out from the socket, and while its still almost in the right spot, it likely won't move smooth and painfree like the normal hip. And in the Dislocation, the ball of the femur has entirely moved out of the socket.
Why do joints sublux?
It is easier for a joint to sublux than it is to dislocate. That being said, if you have full strength and integrity in your joints, it will take a high-impact injury to sublux a joint. This is usually something like a fall, car accident or a sports injury.
However, some people are at a higher risk due to weak, unstable or unusually shaped joints. A previous history of dislocation or subluxation can weaken the joint and make it more prone to a sublux.
People with hypermobile joints can sublux joints with minimal force, because the ligaments (connective tissue that holds the joint together) are more elastic than they should be. This can lead to the person being very flexible but also more prone to subluxations – some of my more hypermobile clients can sublux joints while walking, sitting, or even sleeping!
You can also have variations in the shape of your hip or shoulder joints that make it easier to sublux. Hip dysplasia is one common variation that increases the risk of subluxing a hip joint, like in the image above.
Joints at risk of subluxation
In the clinic, I’ve seen almost every subluxation possible, thanks to my hypermobile clients! But there are several joints that are easier to sublux due to their location and structure:
If you have hypermobile joints, you may be at risk of subluxing other joints like ribs, jaw and collarbone.
How is a subluxed joint rehabilitated?
It can depend on the type of subluxation, and how it occurred. If it was due to high-impact trauma, there’s likely to be a decent amount of joint damage that needs attention. It could take weeks before the pain subsides enough to focus on rehabilitation.
But if the sublux occurred due to hypermobility or dysplasia, it might just need a little TLC for a week or two. After that, the focus will be on building up the muscles that support the joint to reduce the risk of recurrence.
Either way, the focus for rehabilitating the joint will include stabilising it, minimising any symptoms, and rebuilding the strength and integrity.
What can a myotherapist do for subluxations?
If you’re dealing with a subluxed joint (or multiple!), I’m here to help. Let’s look at how myotherapy can help with subluxations:
So don’t sit at home and feel sore after a joint has subluxed. Come see your favourite myotherapist. We’ll have you feeling better in no time! Click here to book an appointment.
Many people know what it’s like to have a loose joint. Maybe you even considered yourself ‘double jointed’ when you were in primary school. But hypermobility is something that can be benign, or it can be a serious concern in some cases. So let’s look at hypermobility and how you can support a loose joint naturally.
What is hypermobility?
Hypermobility is when a joint has a greater range of movement than usual. This can be caused by a handful of factors, including:
Is hypermobility a bad thing?
Not always. Some people can actually train their joints to become hypermobile over time – think people who do gymnastics or calisthenics. This isn’t a problem, as long as the joint isn’t damaged and the muscles are strong enough to prevent the joint from slipping out.
There are also people that have one or more hypermobile joints, but don’t have any problems as a direct result. This is generally described as benign hypermobility.
But it can be problematic for some people. Sometimes, it’s a short-term problem – like if you dislocate a shoulder during football. This will mean you need to nurse the joint back to normal mobility to prevent further injury.
Sometimes, hypermobility is part of a bigger concern. There are conditions that present with hypermobile joints, including most forms of Ehlers-Danlos Syndrome and Marfan Syndrome. Sometimes, hypermobile joints that become problematic are the first clue that there is an underlying issue.
Tips to support a hypermobile body part
If you have some hypermobility and it’s not causing you any issues, you might be just fine. But if your joint is causing you pain, is unstable or affecting your life in any way, here are some tips to support it back to health.
Keep exercising within your limitations
The body thrives off movement, and it boosts blood flow throughout, which is needed for healing. If you have an injured body part, do any kind of exercise that doesn’t cause pain or discomfort. For example, if your shoulder is the issue, go for a daily walk still. If it’s an ankle, keep doing upper body work at the gym that doesn’t require standing.
Remember, if you’re not sure how to exercise safely due to injury, the best course of action is to consult a myotherapist who can assess the situation for you.
Use taping and other tools to increase proprioception
One issue that is common with hypermobile joints is a loss of proprioception. Proprioception is where your brain thinks your joint is. If you lose proprioception, your body can start to think that the correct position for your joint is partially dislocated, or subluxed.
A good tool to use to increase proprioception is taping. By taping a joint, you can stabilise the joint when it is very unstable. Once the joint improves, kinesiotape can help to increase your awareness, or proprioception, of the joint.
In the clinic, I offer both rigid and kinesio taping services. In fact, return clients can book in a follow-up taping session, so we can re-tape a loose joint until it regains stability. To book a taping session, contact me directly.
If your joint is particularly loose, you can also consider tools like splints, supports or orthotics to help with proprioception. These are most useful for highly unstable joints, or for times when you can’t focus solely on where a joint is. Not sure which tool is best for you? Ask your friendly myotherapist.
Be cautious with stretching and yoga
Stretching and yoga can have oodles of benefits. But if a joint is already stretched out of place, the wrong stretches or yoga poses can exacerbate the situation. Just because you can move into an extreme stretch doesn't always mean you should - often the safest option is to stop short of your absolute maximum stretch, because here you'll have the most control over your movement. Control at our very end range of movement can be difficult, and if your joints are prone to dislocation and instability due to loose or unreliable ligaments then ideally you should be aiming for a stretch where you can still keep excellent muscle control over the joint. If you’re not sure what is safe to do, have a chat to your practitioner or yoga teacher.
Work with a hypermobile-literate myotherapist
If your body is sore, a massage therapist can relieve some pain. But if you want to get the injury rehabilitated, you want to work with a myotherapist who is familiar with hypermobility.
With myotherapy, we can not only give immediate relief using massage and other treatment techniques, but also put together a personalised treatment plan. A hypermobility management plan will include targeted strength and proprioception exercises. By rebuilding the muscles and teaching your joint where it should sit, you can get back on track.
I’ve had the opportunity to work with many people who have hypermobility – both short-term and chronic. So whether you have a loose joint post-injury or a condition like Ehlers-Danlos Syndrome, I’m happy to help. Click here to book in an appointment.
Everyone knows someone who is a bit of a klutz. But often, there is a reason behind someone being naturally clumsy. It all comes down to what we call proprioception.
What is proprioception?
To put it simply, proprioception is a fancy way of describing where your brain perceives your body to be in space. If you have good proprioception, your brain knows that your arms and legs are where they are.
But if you have issues with proprioception, your brain might think that you’re a little more to the left or right of where you actually are. This is where it’s common for people to do things like walk into doorframes, stub their toe or miss a step.
Some people can be born with a reduced sense of proprioception, particularly if they have neurological conditions such as autism. Others may have proprioceptive issues because of hypermobile joints. Sometimes, proprioception of a particular body part can be reduced through injury, such as a dislocation.
What are signs of proprioception issues?
There are some common signs of proprioception issues, including:
It can also come with other signs, depending on the cause. Proprioceptive issues will come with sensory signs in people with autism. Hypermobile people will often experience more injuries such as rolled ankles because they have more flexible joints than most people.
Have you ever noticed that if you have an injury, you will be more likely to bump that injured limb or area? Thats because that area is where the misinformation is coming from - for example, I cut my finger a few weeks back, and managed to bump it on something on at least 3 different occasions that day! My general awareness of that finger was raised, but my ability to hone in on the location-specific proprioception was decreased due to injury.
How can I fix my proprioception?
The good news is, you can work on your proprioception and reduce the clumsiness. Proprioception is influenced by information from your nervous system and your balance. Here are some ways to retrain your brain and increase body awareness.
Move your body
A lot of people will avoid exercise because they think they are clumsy. But the more that you move your body, the more chances your brain gets to correct itself. So don’t avoid exercise – just stick to gentler options while you retrain your brain.
Retrain your balance
There are specific exercises that can challenge proprioception and retrain the brain. Stability and balance exercises are the most effective. These start with very simple and supported movements, then increase in difficulty as your proprioception adapts. For example, you might stand on one leg with your eyes open. Once you can do that easily, movements of your raised leg can be included which will challenge your balance. If that becomes easy, you can try it with your eyes closed, or add a wobble cushion or balance board.
Exercises will need to be tailored to your specific proprioceptive needs. As you can see from the example above, there are many stages of these exercises that progress to harder and more challenging movements as your proprioception enhances.
Neurons that Fire Together, Wire Together
Have you heard this phrase before? The brain loves short cuts, so movements, actions, thoughts and sensations that are often felt together can become neurally linked. We can use this to our advantage by using exercises and movements in a way that can "rewire" the proprioception of a joint so it relearns its movement or activation patterns.
Using tape can help to retrain your proprioception in conjunction with stability exercises. It helps to indicate where the body part is because the tape is slightly stretched on your skin for a number of days - your brain gets a consistent signal from the sensation receptors on the skin saying "Hey! Here I am!".
Taping can also help with holding the joint or body part where it should be, preventing issues such as hunching or rolling of the shoulders. It’s best to get taping done by a qualified practitioner who can tape you correctly. This is why I offer taping sessions for my clients who need re-taping between appointments.
Do you want to work on retraining your brain and increasing your proprioception? I can put together a personalised management plan to help. Book in an appointment today to get started.
Mel is a Myotherapist based in Ferntree Gully.