Expert: J.R. Strecker, B.S., D.C. - 8/1/2008

Question
Dear JR

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
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Hello K.,

Thank you for your clear and concise explanation.  You have some really great questions.  Your questions are something chiropractors are asked all the time, but on occasion, some patients ask out of concern that their joints are “popping” too much.

I have dealt with one patient in my own office in particular who, just like you, noticed his joints were popping more excessively.  He had been to many different specialists in search of an answer.  All doctors just scratched their head in confusion.

The reason why is we still don’t know exactly what is going on.  Yes, like your physical therapists said, it is believed that gas pockets or “bubbles” are escaping or releasing in the joints.  However, the research is inconclusive, and because joint “popping” doesn’t typically inhibit a patient’s life, it’s really not researched much at all.  The gas releasing, from what I know, is still speculative.  It is the most accepted understanding of what is going on, but no can say for sure.  The other thing is that internal scar tissue, from prior surgeries and traumas several years before, can also cause “cracking.”  Adhesion or fibrotic tissue (scar tissue) can build up in the muscles, tendons, and ligaments whenever there is insult to the tissue.  As time progresses, the prior trauma predisposes the tissues degeneration.  Sometimes “cracking” and “popping” sounds result when the tissue is worn or broken down.  In moderation, certain “cracking” and “popping” can be a good thing, but as with all things in life, in extreme situations it can be worse for the tissue.  For example, the joints often “pop” when they are manipulated by a practitioner.  In moderation, that’s deemed to be healthy and beneficial for the joints.  But with excessive force (such as a car wreck or joint sprain) or with excessive frequency (manipulating your joints on a daily basis), it can actually be harmful to the joints.  So goes the saying, “too much of a good thing is a bad thing.”

In reference to your situation, what we know about joint “popping,” which is sometimes be referred to “crepitus,” is often related to degenerative or degenerating joints.  (Creptitus has a tendency to refer to the “grinding” sounds of joint degeneration and “popping” has a tendency to refer to a broader sense of joint sounds, not necessarily associated with a degenerative joint).  With your history of joint degeneration (including disc bulges as a type of joint degeneration), as well as your family history of osteoarthritis, it is common for popping sounds to take place.  As I stated earlier, the entire pathophysiology is not completely understood, but it is a common association.  In answer to your questions, I wouldn’t necessarily say more crevices are being formed allowing more gas to get trapped.  As practitioners, we really need to know more about the process in order to say that is going on.  You may notice the “popping” sounds increase as you age, and then stabilize at some point.  It just depends.  The most important thing is that you not have any pain associated with the joints when the “pop.”

As a side note, I would also let you know that some people have a tendency to “pop” more than others for no known reason, and you may be one of these people.  Personally, I am one of these people.  Every joint in my body “pops,” even without history of traumas, scar tissues, or intentional manipulation.  I personally believe that in some people, it can have something to do with increased laxity or flexibility of the ligaments.  I have some patients that every single joint in their body “pops” when I adjust them with little to no effort, and then others who have joints that never make a single sound when they are adjusted.  When it comes to joint “popping” there are a lot of individual variations that are not understood and have nothing to do with degenerative processes associated with joints that I highlighted above.

In answer to what you can do about it, it definitely sounds like you’re doing exactly what you should be doing.  Glucosamine chondroitin is a great idea for cartilage (joint) health and repairing joint degeneration.  Some studies also suggest MSM is very beneficial, but the studies for glucosamine are much more convincing.  Additionally, there are some people who have “cracking” joints that eventually clear up with a handful of adjustments from a chiropractor.  It’s impossible to know if you are one of these people, but this is a very common association noted with chiropractic patients.

Though I cannot give you a clear-cut answer, I hope the information I’ve provided you is informative and will give you a little background about what is believed to be going on.  If you start to notice increased pain with the “popping,” then let your doctor know.

I hope this helps, and best of luck!
Dr. J.R. Strecker, D.C.