Expert: Dr. J. Shawn Leatherman - 8/1/2008

Question
Dear Shawn

For years there often have been a cracking or popping sound from my joints when I move, especially from the hips and knees.  Recently, the occurence has increased noticeably, sometimes with multiply pops, and from other areas such as the back and shoulders.

I have read on the web and been told by my physiotherapists that the sound comes from air escaping from crevices in the joints.  However, why so often?  And what causes the crevices?  Are materials around the joints or the joints themselves being worn down so creating the crevices and allowing air to get in?

As background information, I am a 45 year old female, and have been suffering from back problems for over 15 years such as degenerative disc disease, scralization at L5 and S1, and have had bulging disc problems a couple of times in the past.  My mother suffers from osteoarthritis.

What can I do about it this condition?  Currently I am taking omega 3, glucosamine, and calcium as supplements.  And I also exercise regularly but not strenuously.

I look forward to hearing from you.

Yours sincerely
Katherine


Answer
Dear Katherine,

First of all your physiotherapist is correct in stating that popping noises are from gas escaping from inside the joint capsules...this is called joint cavitation.  However, when this occurs it should not happen again in the same joint space for approximately 15-20 minutes.  It takes time for the gas to re-absorb into the joint, and often when it does, the joint moves appropriately and the pop will not occur again.  If you are hearing multiple pops arising from the same joint, then the noise is not likely from the gas escaping but from tendons or ligaments snapping back against the tissue.

For instance:  I have permanent ligamentous laxity and damage in my ankles from old soccer injuries.  When I walk, the ligament on my outer left ankle snaps against the bone on almost every step.  My staff jokes that they always know where I am in the clinic because they can hear me coming and going.  This however does not impede my activity or cause any pain, it is just annoying.  

The crevices you have described are actually pores in the joint capsules.  They are normal anatomy and are there so that gas exchange can occur in the joint space to allow for movement and provides a measure of pressure escape.  When the joints become fixated or move less appropriately, the gas can build up and increase pressure.  When it escapes the joint should move more freely.  It is however possible that the pores can become damaged with injury thereby creating a smaller or larger space for gas exchange...either one should be considered abnormal.

Now you are doing the right thing, utilizing nutritional supplementation, however, you need to make sure that you are taking the right amounts.  Concerning the calcium what form are you taking and how much?  Does is also include magnesium and vitamin D3?  Not to mention why are you taking the calcium...have you had a dexa scan showing that you are losing bone mass.  I can recommend a very sensitive urinary test to determine if you are currently losing calcium from the body, and this will determine if you actually need the extra calcium supplementation.

Omega III:  Again look at the product, many are poor quality.  You want to take 3000 to 4000 mg per day of omega III fatty acids, and 50% of them should be in the form of EPA (eicosapentanoic acid) and DHA (docosahexanoic acid).  The product should be molleculary distilled for purity or state that it is proposition 65 compliant.  Furthermore, there should be some form of vitamin E, or citrus oil added to reduce oxidation of the product.  Put it in the refrigerator and if it gets cloudy at all, it is bad.  You should look to pay about $30.00 a month for a top quality product.

Glucosamine:  The correct form to take is glucosamine sulfate, do not take the HCL form it is inferior.  You need a minimum of 1500mg per day to have any clinical effect, and you should look for a form that additionally has 750mg of MSM (methylsufonlymethane) which is a joint lubricant.  I would also try to find a product that has anti-inflammatory enzymes included.  I utilize such a product in my office with patients all the time and we get good results.  You should look to pay about $40.00 month for a top quality product.

Lastly:  your supplements should state right on the bottle that they do not use or contain - fillers, sugar, starch, artificial flavors or colors, preservatives, corn, yeast, wheat, grain, gluten, egg, or milk.  They may also state that they meet USP XII standards which means that they meet the highest international standards for processing, dissolution and absorption.

Concerning the exercise, I would suggest that you seek out forms that are more concerned with flexibility, stamina, and stability such as Yoga and Pilates, and couple that with walking, swimming, or recumbent bike.  This will reduce the stress on the disks and joint spaces while increasing the cardiovascular benefits and up-regulating your metabolism and immune system.

Write me back about the calcium stuff Katherine and anything further you have questions on.  If you would like some help concerning at home testing or supplements fell free to inquire back and I would be more than happy to help.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net