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This is a question I hear almost daily from my patients. So what causes it?

We all know someone who has the ability to click and crack their knuckles, neck or back at any given time of the day…. When I was younger there was always a rumour flying around that suggested this may cause arthritis or damage the joint in some way. 

The good news is that this is not true. The majority of clicking that goes on in the body is not something to be concerned about. There are three main causes of ‘clicking’:

1) Bursting of gas bubbles within the joint
In our joints, we all have some fluid which sits in and around the joint space. Within this fluid, there are small gas bubbles, which build up as we are still and then, as we move, they can shift rapidly depending on the pressures within the joint. If this occurs quick enough, there can be an audible ‘pop’. This is termed a cavitation. 

Some people find they naturally have very ‘clicky’ joints. Whilst it may be annoying or understandably cause some concern, as long as clicking is pain free, we are not normally concerned about this. 

It can sometimes increase following an injury. One potential explanation may be that an injury causes inflammation, which in turn causes an increase of fluid to the joint. Usually once the injury has healed, the clicking can reduce over time. 

Some therapists and practitioners use this cavitation technique for therapeutic effect e.g. Osteopaths, Chiropractors and some Physiotherapists. In this instance, the position you are stretched into increases the space between the joints surfaces. This reduces the pressure within the joint space and some of the gas bubbles leave the area, creating a bubble or a ‘cavity’. The collapse or pop of this bubble is what causes the ‘crack’ you will often hear or feel. The gas is thought to be mainly made up of carbon dioxide and nitrogen. Over time, the gas bubbles will return and begin to build up in the joint once again. 

2) Restriction in tendons and muscles
Sometimes in the gym or when doing exercises, people may notice a soft ‘snapping’ or ‘clicking’ in certain parts of the body. 
As we move, our joints change position and this can also influence the tendon position within a joint. 

The clicking is thought to be the tendon quickly moving back into it’s original position after a certain movement at the joint. It does not mean that there is damage to the tendon but it may indicate a bio-mechanical issue relating to muscle strength, flexibility or technique. 
An example is “snapping hip syndrome” – thought to be due to some muscles around the hip joint sliding over the ball of the ball and socket joint, causing a ‘snap’ sound. 

If this seems to be happening to you repetitively when you try certain exercises in the gym e.g. squat, let us know as we will be able to suggest the right type of exercises to do to try and reduce this sensation. 

3) Arthritis or other joint related changes
This usually presents differently from the above two as it is normally associated with pain and/or swelling. If people are noticing painful cracking when moving a joint or trying to exercise, this may be a sign of injury or arthritic changes.

The sound that is heard can sometimes be more of a ‘grind’ or ‘creaking’, rather than a clean ‘click’ as we may see in the above two cases. 
This usually indicates that the friction free cartilage is reducing within the joint and as a result, the bones thicken and become sore over time and this can lead to some painful noises. 

If you find that your knee, ankles, hip etc are experiencing painful clicking, it would be an indication to have an assessment to determine the best kind of exercises/advice. 

Often, this can improve significantly with exercise. This means that we can keep you doing all the things you enjoy!



As always, thanks for reading. 

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Our clinic is based at 5 Upper Wimpole Street in Marylebone and we can be reached on 0207 935 7344 weekdays from 8am - 6pm.

Wimpole Street Physiotherapy Clinic

5 Upper Wimpole Street
Marylebone, London
W1G 6BP

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