We are asked this question on a daily basis. The simple answer is . . . “Well, it depends!!” Obviously not very helpful and so I hope the following information may help to clarify the answer.
Joints make all sorts of noises from continual grinding to one-off, sudden ‘pops’. The nature of the sound, the movement required to achieve it and whether or not it is repetitive, help to identify what it means.
When hearing a joint make a noise it is common for people to assume they have ‘arthritis’ or wear and tear in the joint. A truly osteoarthritic (OA) joint can make some nasty sounds – probably repetitive and associated with pain. However, one result of OA is that a joint may become very stiff and hence not make any noise at all. An OA joint tends to be thickened whereas, although a rheumatoid (inflammatory) arthritis (RA) joint will be swollen, it is likely to be misshapen as well. However, after a period of instability during the inflammatory stage, the RA joint will become stiff with less chance of any clicking sounds.
Something we are often presented with is the complaint of a stiff neck with associated grinding noises. This often reflects the quality of the neck movement rather than any real damage. Factors such as fatigue and stress can lead to increased tone of the muscles in the upper spine which can then compress the joints of the neck preventing good, easy, fluid movement – a bit like guy ropes pulling very tightly on a tent. This condition can be seen in young mothers as well as in older patients and can potentially be fully eased.
Another common problem is with knees cracking loudly on squatting, often repeating a few times. This, we believe, is when the tendons of the long muscles of the legs act like rubber bands as they get slightly caught / tense before suddenly releasing. Not harmful in itself but strengthening the legs to ensure that movement of the joint is within sensible limits is advisable. This is also common around the hips when lying on your back and lowering a leg from 90 degrees – something to avoid if possible as if repeated a lot it may create a soreness.
People get into habits of clicking their own joints such as knuckles of the hands or neck joints. This probably starts because it gives some relief from stiffness but can also be of psychological / stress origin. The original stiffness is probably a stress related issue rather than a physical one and therefore the joint is easy to release. Clicking it will give a brief feeling of relief, before needing to be done again. This will then become a cycle and will likely lead to repetitive clicking. If this process does not involve extreme range of movement or force to achieve the click then the research does not give any evidence that the joints are being damaged. However, if the click only occurs when the joint is being fully stretched and then forced, there is a danger that the joint is being continually strained and therefore the muscles become tighter to protect it – hence the cycle continues.
Another cause of joint clicks is when there is damage to the meniscus (cartilage) within the knee and this can make a loud click, sometimes with pain and probably not repeatable. In the shoulder and hip joints the labrum (which provides a seal like structure around the joint) is made of cartilage /connective tissue which can become detached. This will often make a clicking sound as the joint is put through its range of movement.
So when do we as Osteopaths manipulate joints using High Velocity Thrust (HVT)?
We will only apply this technique to a joint that is stiff and with limited range of movement where we would like to improve the quality and range of movement. There are various theories as to what makes the noise when we do this: It is commonly accepted that the pressure change within the joint as the surface gap suddenly produces a gas bubble within the joint, creates the sound as it forms. Once formed the bubble will slowly be reabsorbed and therefore it is not possible to repeat the procedure for about another 30 minutes. The main reason why an Osteopath will perform this technique is to assist with the relaxation (reducing the tone) of deep muscles around the joint by effecting the local receptors. The training that we have ensures that we only perform this technique within the range of movement of the joint and by combining different planes of movement to create a tension so that the joint is not strained and it should not be painful. As you can imagine, everyone has a different attitude towards this: If, as a patient, you are nervous and tense then the technique will not work and we would apply other treatment instead. This is why communication between osteopath and patient is key.
There is normally a reason why one particular joint or even a group of joints are stiffer. There may have been a traumatic history, such as a car crash, or a postural pattern that results in pressure at a particular point of the spine. The hands-on treatment is only a part of the mechanism to correct the issue – lifestyle, habits, history etc will all play a major role as well.