For many people this is a daily event. Their joints crack, pop, and click. We crack our knuckles, back, and other joints. We’ll also look at the similar problem of snapping tissues as well.
First let us separate two different phenomena. Cracking and popping are the same issue, but clicking is a fundamentally different issue. We will examine these in turn.
There are many causes for how they arise. Thus, by looking at how they arise we can evaluate the situation if there is a need for proactive prehabilitative protocol.
Joint cracking & popping
First, the theory on how joints pop and crack is due to cavitation. When the joint is ‘cracked’ the volume within the joint capsule is increased through stretching. When this occurs, the pressure drops within the synovial fluid which causes the small amounts of air dissolved within the fluid to come together and form bubbles. They then collapse on themselves. The formation of these bubble and collapse via cavitation causes the popping/cracking sound.
There are various studies on the subject (1), (2), (3), (4), (5), (6), (7). There was also a 50 year case study done.
One of the studies above showed that the forces involved with the joint manipulation may have forces that exceed the force needed for articular damage. However, as a whole the evidence points to no increases in arthritis.
One of the studies also indicated that knuckle cracking increases the preponderance for joint swelling and grip strength loss as well as other traits such as manual labor, biting of the nails, smoking, and drinking alcohol. However, none of the other studies concluded this. There may be some logic to this in that people with overall bad habits and lots of stress may have increased cortisol production and the accompanying negative effects such as poorer recovery. However, I would not worry about it too much.
The swelling and loss of grip strength is particularly interesting though. Everyone has different genes for how tight the articular capsules of their joints are. If you have joints that are particularly lax (meaning “double jointed” in laymans terms), it may not be a good idea to crack your knuckles.
Lax joints are associated with increases in orthopedic injuries and lower strength. Since the joints themselves are a bit more unstable because of the looseness of the connective tissue, the body cannot generate as much force lest it injure itself. Therefore, potentially increasing this joint laxity may be a problem.
This is common in sports with excessive flexibility work such as rhythmic gymnastics where the articular joint capsules can be stretched out significantly. As a precautionary measure if you have looser joints I would avoid cracking them just in case it may present problems down the line. This is especially true if you notice that your joints are being “stretched out” so that they can move further and further each time you crack them.
Obviously, laxity in joints can be compensated with proper strength work to an extent so such things are always beneficial as well.
Finally, crepitus can be present where there is degeneration in the joint, and it cracks inadvertently. If you suspect you have something similar, it’s obviously best not to crack them more than they are.
Joint clicking
The common answer to joint clicking is that if it is painless it is fine. I agree with this assessment especially if you have always had it.
For example, people with more lax joints as described above may have always had issues with clicking albeit not painful clicking. This is fine. The general solution with lax joints and clicking in the knees, hips, elbows, and shoulders is proper strength work. Keeping the joints strong and balanced with proper biomechanical movement will stave off potential injuries.
However, if you have not always had joint clicking, and it is acute onset from particular sports, weightlifting, or other activities I would reexamine the activity to ensure that the clicking may not devolve into something insidious.
In most cases, injuries can be boiled down to issues of
- Posture
- Biomechanics
- Mobility
- Muscle balance/tension relationships
When these aspects are compromised especially the limbs – ankles, knees, hips, wrists, elbows, shoulders – there is potential for clicking and popping to begin and potentially become malicious.
Let’s look at the knees for a specific example since it is the most common source of clicking (shoulder coming in at a close second). In particular the knee is special in that it has two extra pieces of articular cartilage, the menisci, in between the femur and tibia clicking is fairly common in many cases. It is not always insidious however.
In most cases the neural factors of posture and movement biomechanics contribute heavily to the deficiencies that develop in mobility and many muscle imbalances that arise. It is the development of such imbalances or limitations in mobility that have the potential to cause clicking within the knee to devolve into painful wear on the cartilage.
For example, we discuss in Shoes, Sitting, and Lower Body Dysfunctions that there is often the development of a very quad dominant and very hamstring weak individual.
Such imbalances give rise to problems with the articulation of the joint itself. When synovial joints move against each other they must simultaneously glide and roll to function correctly.
image from moon.ouhsc.edu – See here for more details
When mobility is limited by tight muscles and there are imbalances within antagonistic muscles, the biomechanics of the movement degrade.
Particularly with the knee if the hamstring do not engage correctly during walking or squatting motions, there is likely an excessive anterior glide of the femur on the tibia. This places a much larger torque on the patellofemoral complex. This is bad for multiple reasons:
- Excessive anterior gliding of the femur may start to impinge the anterior portions of both the medial and lateral menisci which cause clicking. This wears down the meniscus and articular cartilage faster contributing to osteoarthritis.
- Excessive anterior gliding of the femur puts more strain on the ligaments such as the ACL.
- The increased torque on the patellofemoral complex causes the quads to become much more active thus aggravating the imbalance of the quadriceps:hamstring strength ratio.
- The increased torque on the patellofemoral complex may lead to chondromalacia patellae or patellofemoral syndrome or other problems.
These problems are not just manifestations of the whole knee complex. Weakness and decreased mobility at the ankles and hips may also contribute to dysfunctions at the knee. Same with the shoulder, elbows, and wrists.
This is why teaching proper posture and biomechanics while improving mobility and imbalances is so important. For example, we can use box squatting — focusing on sitting back properly to engage the hamstrings and glutes — to help negate quad dominance. This occurs because sitting back shifts the weight distribution of the squat towards the heels will keep the shins upright thus decreasing the torque on the patellofemoral complex and the engagement of the hamstrings will help negate excessive anterior gliding of the femur. This should make the knee joint function properly, and it teaches perfect movement.
Earlier I listed the shoulder as the second most common site of clicking. While it does not have two extra pieces of cartilage as the knee, it has the most mobility and range of motion as any of the joints in the body. Thus, it is very easily destabilized by problems with posture, biomechanics, mobility and muscle imbalances.
In conclusion, if you know you are having onset clicking issues and you notice that you have problems with posture, biomechanics, mobility and muscle imbalances you may have an insidious onset of clicking that may devolve into worse problems.
In many cases correct the imbalances with proper strength and mobility work should improve the condition significant and even eliminating cartilage clicking. This may be the case even in people that have had clicking all their lives from loose joints.
Snapping sounds
If you have tissue that is rubbing and snapping over tissue. This signifies an injury condition.
This occurs in issues such as IT band snapping syndrome and triceps snapping syndrome along with other problems such as nerve and tendon snapping/popping.
In all of these cases, there is likely some problems related to posture, biomechanical, mobility and muscle imbalances. This is not unlike the clicking scenario.
The “quick” fix to eliminate the pain and snapping quickly is to loose up the tissues with soft tissue massage and anti-inflammatory drugs. However, to eliminate the problem entirely all of the factors that contribute to their development from the four attributes (posture, biomechanics, mobility and muscle imbalances) must be examined and corrected.
If you have no idea how to correctly evaluate yourself and perform correct soft tissue work after reading all of my articles then go see a health professional.
In conclusion
1. Joint cracking and popping does not cause increased incidence of arthritis.
2. If you have lax joints, however, you may want to avoid this just in case it may present problems later due to destabilization of the joint and also focus on increasing strength of the muscle/tendons that connect there. This is especially true if you notice the laxity is increasing over time.
3. Clicking without pain is in general fine, especially if it has been there all of the time.
4. Sometimes insidious onset of clicking may devolve into potential problems later on. Correct assessment of posture, biomechanics, mobility and muscle imbalances should be initiated through proper strength, mobility, and soft tissue work.
5. Snapping signifies injury conditions. Like clicking proper care must be undertaken.
I hope this has been helpful to people wondering whether they potentially had problems on their hands or not and the correct decisions to make regarding their health.
Steve — nice article.
However, you didn’t cover one “noise” I’ve occasionally experienced, and I’d like your thoughts on it. I’m referring to a “crunching” noise in the shoulder.
I’m 54yo, and 8 months getting into Crossfit workouts. Prior to this I had never done much shoulder strength work so I’ve had to increase my loading slowly.
Recently with heavy shoulder work, mostly “pressing” type of movements (shoulder press, bench press, etc) my right shoulder has been giving loud crunching noises as I go through the movement. Not painful, and ROM doesn’t seem to be affected, but I do feel some un-smoothness in the movement, and usually back off a little (in alarm!) No noise after an occurrance of this with the shoulder unloaded, and no joint pain. I have had some bouts of muscle soreness and spasming (rear deltoid, middle traps) that massage has helped with.
Any thoughts?
-Paul
Crunching noises, even without pain, aren’t good. It’s pretty much a worse form of detrimental clicking.
As you have explained you do actually have some orthopedic problems with the spasming and soreness. I’d likely guess you’re getting some impingement (crunching) on the labrum.
In most cases, pain in pressing movements is due to postural problems, and imbalances in strength.
I would avoid all pressing movements from now and get the area to calm down with massage, fish oil, ice, etc. Then start working on alleviating the strength imbalances with external rotator cuff work and horizontal pulling / LYTPs for now.
Hi Chris,
Great articles from you and Steve. You mentioned at the end of the article to see a health professional if we did not understand how to correct muscle imbalances from your previous articles. Which article are you refferring to specifically for muscle imbalances? If there are none yet, can you point me to some good resources, Ive done so much for my shoulder that this is the only thing that I have left to try. (Although I think the scoliosis is always going to throw me off since my right side has always been lower then my left).
Thanks,
albert
Shoes, sitting, and lower body dysfunctions was written for the lower body.
Unfortunately, I have yet to write the one for the shoulders. However, the Neanderthal No More series by Cressey and Robertson on T-nation covers this extensively as well. Check that out for now.
Hi Steven,
great article,my knees click loudly on nearly every squat,whether,air squats,or heavy 1 rep max,even if i’ve been squatting for over an hour,with no pain,though lately they are starting to ache,have recently been changing from low bar b/s to h/b and obviously with the olympic style the knees travel forward as the hips drop straight down to accomadate the upright position needed for the snatch and cln and jrk,which is then causing the anterior gliding of the femur that you mention earlier in the article,how then would you suggest that an oly lifter correct this ?as it is necessary to squat this way for oly lifting .I have been doing a mixture of both low bar ,hips back style and now high bar,hips dropping down to improve my positions for oly lifting.Personally i prefer the low bar style as it’s much easier and i can feel so much more power in the hips,but i need to do the high bar style for oly lifting. Thanks for any suggestions ,
Peter.
Much more quad soft tissue work and stretching. Unfortunately, knees extremely forward is needed for Oly however it can be mitigated a bit by proper lifting shoes (which I assume you do have some).
Do some specific work for the hammies though. Glute-ham raises and RDLs are good ones. Maybe some barbell hip thrusts as well. Don’t necessarily need to do LBBS.
Wow,
What a great resource at:
the Neanderthal No More series by Cressey and Robertson at tnation. This article had the detailed explanations and analysis I was looking for in regard to my shoulder pain. It also had a case study looking at slightly scoliotic individual. Thanks Steven!
Steve generally has good recommendations
Chris
Hey,
On both of my legs, my knee caps point outwards. Does this mean I’m very quad-dominant and I have femur gliding, or is it something totally different? My knees don’t click, but they do “pop” very quietly when squatting.
Thanks.
The pop is likely articulation within the knee probably the meniscus. This is actually fairly common. Nothing to be worried about as long as it doesn’t hurt. May signify strength imbalance between the quads/hammies though. Worth looking at if your quad development is big, and hamstrings are small in comparison.
What do you mean the patella points out though? It should track directly over the toes (well, the knees do). It’s possible you may have an oddly shaped patella, but that shouldn’t be anything to worry about.
If it was tracking laterally that would be a problem, and you’d likely feel it because of the patellofemoral articulation that is rubbing together. That would be patellofemoral syndrome.
It usually doesn’t hurt, but there are times when it does. I should probably clarify: I dislocated my left knee a couple of years ago. I can’t remember what sort of dislocation it was; basically, I was doing a squat and my knee bent inwards (so.. the Q-angle increased a lot?). When it dislocated my tibia and femur felt like they were side by side almost. Any ideas what would cause such a weakness?
Thanks.
Ah, usually weak abductors and weak (or tight) adductors.
Gotta focus on keeping the knees out over the toes and not allow them to collapse in during squatting. Strengthen everything basically if you can, especially glutes, hammies, abductors. Stretch your adductors and strengthen them if you need to.
I talk about a lot of these issues in this. If you haven’t read it before you should read it now:
http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/
OK, thanks for your help. Yeah, I skimmed that article. Was doing other things at the time so a lot didn’t go in – need to read it again!
This is a great article – the best I’ve found. My 14 year old son had a mild MCL sprain one year ago on his left knee; treated and no problems since. But today he came home from football practice (no injuries, no big tackles or hits, no soreness). All was fine; he had dinner, took a warm bath, and AFTER all that his knee started making clicking sounds when he bends it and then again when he straightens it. No pain, no restricted movement, no swelling. We gave him ibuprofen for lack of any better ideas… Should we see a doctor for this? Wait a couple days and see if it goes away? He has football practice every day – should we skip practice until this resolves? Don’t want to risk any knee injuries in someone so young. Thank you!!
Doesn’t sound like anything serious albeit if you’re that worried you should see a doc. There’s no pain involved and just clicking of the meniscus at end range which is fairly common.
The fact that it started after a practice probably just means there’s a bit of inflammation in the joint, but that’s normal with a lot of practice.
If his knee feels stable and strong I wouldn’t worry about it. If there’s any instability or locking or something like that then that’s a big warning sign. Likely nothing to worry about though.
Thank you so much! So glad to have found your site.
Hi buddy would it be ok if we used some info from here to use on one of my websites? cheers mate
If you link our site on any quotes you use. Please don’t full quote articles either…
Hi Mr. Low, very interesting article, thanks for sharing your knowledge! I’ve got a question of my own though, about a problem that’s just surfaced with my knees.
I’ve had joint problems as long as I can remember and I’m only 19. As a child I had problems with walking pigeon-toed, which led to physical therapy where I was told that my hips were messed up (and that I have the foot joints of a 60 year old). I’ve mainly corrected my gait since then, but just recently I started swimming and noticed that the inner sides of each of my knees pop when I do the breaststroke kick, with pain arriving at a higher intensity. You wrote something about a hamstring-quad imbalance that I’m afraid I didn’t fully understand, but I’ve noticed that both my quads look strange from the front–the inner side of the quad muscle protrudes significantly. When I bend my knee, the muscle mass on the inside of my leg makes my kneecap look like it’s off center (I hope that makes sense). Could that have anything to do with the imbalance that you’re talking about? Thanks for your help!
Sounds like patellofemoral syndrome, except you may have overdeveloped medial quads instead of overdeveloped lateral side like most people get.
This likely isn’t an issue of quad/hamstring imbalance but rather an issue of medial/lateral balance of the quads itself. It’s a bit different.
Proper squats forcing the knees out, and specific abductor work should help. If medial aspect is overdeveloped, you want to focus on developing the vastus lateralis, and also correcting imbalances at the hip — likely strengthening abductors and external rotators there.
If you need help beyond that depending on the severity it may be a good idea to see a physical therapist in your area who can deal with your case specifically though.
Thanks for the quick reply! I already do squats as part of my lifting routine, but what would be some good exercises to target the vastus lateralis?
The knee can be tilted inwardly and extended with the hands on the VL to cue it to fire.
As much as I would say stay away from leg press machines for example you can use them to great effect with this since you can put your hands and press into your VL while you contract/extend the legs.
That should get you started.
Thanks for the help, I actually just went to see a physical therapist and he seemed to think the popping was just subluxation. He also confirmed that my medial quads are overdeveloped and said that I had the tightest hamstrings of anybody he’s ever worked with (score!). Also, apparently my super-pronated feet (that I haven’t been wearing orthotics for in a while) are linked to my knee issues, which are linked to my tight hamstrings, which are linked to my poor posture/slouching, which is linked to some shoulder problems I’ve been having. If it wasn’t my body having all these issues, I’d actually think it was pretty cool how interconnected everything is!
Just to clarify though, when you say tilt the knees inwardly, does that mean tilting them towards each other? And do I exert pressure all along the vastus lateralis with my entire hand, or is there a certain region I should be aiming for? Thanks!
Max,
Yes, medial rotation of the hip.
Exert pressure on all of the VL works or you can do it closer to the patella. Whatever works for you.
Also, if you are seeing a PT get their advice for some more VL specific exercises to help bring that back into balance.
I would suggest reading the shoes, sitting, lower body dysfunctions topic too.
Max, I had a similar problem, when doing squats try putting your heels up on a small black.step a, inch or two high, and have your toes on the ground. This seemed to help me and take the pressure off my knees.