Joint cracking is the manipulation of joints to produce a sound and related "popping" sensation. It is sometimes performed by physical therapists, chiropractors, and osteopaths [1] pursuing a variety of outcomes.
The cracking of joints, especially knuckles, was long believed to lead to arthritis and other joint problems. However, this is not supported by medical research. [2] [3]
The cracking mechanism and the resulting sound is caused by dissolved gas (nitrogen gas) cavitation bubbles suddenly collapsing inside the joints. This happens when the joint cavity is stretched beyond its normal size. The pressure inside the joint cavity drops and the dissolved gas suddenly comes out of solution and takes gaseous form which makes a distinct popping noise. To be able to crack the same knuckle again requires waiting about 20 minutes before the bubbles dissolve back into the synovial fluid and will be able to form again. [4]
It is possible for voluntary joint cracking by an individual to be considered as part of the obsessive–compulsive disorders spectrum. [5] [6]
For many decades, the physical mechanism that causes the cracking sound as a result of bending, twisting, or compressing joints was uncertain. Suggested causes included:
There were several hypotheses to explain the cracking of joints. Synovial fluid cavitation has some evidence to support it. [11] When a spinal manipulation is performed, the applied force separates the articular surfaces of a fully encapsulated synovial joint, which in turn creates a reduction in pressure within the joint cavity. In this low-pressure environment, some of the gases that are dissolved in the synovial fluid (which are naturally found in all bodily fluids) leave the solution, making a bubble, or cavity (tribonucleation), which rapidly collapses upon itself, resulting in a "clicking" sound. [12] The contents of the resultant gas bubble are thought to be mainly carbon dioxide, oxygen and nitrogen. [13] The effects of this process will remain for a period of time known as the "refractory period", during which the joint cannot be "re-cracked", which lasts about 20 minutes, while the gases are slowly reabsorbed into the synovial fluid. There is some evidence that ligament laxity may be associated with an increased tendency to cavitate. [14]
In 2015, research showed that bubbles remained in the fluid after cracking, suggesting that the cracking sound was produced when the bubble within the joint was formed, not when it collapsed. [10] In 2018, a team in France created a mathematical simulation of what happens in a joint just before it cracks. The team concluded that the sound is caused by bubbles' collapse, and bubbles observed in the fluid are the result of a partial collapse. Due to the theoretical basis and lack of physical experimentation, the scientific community is still not fully convinced of this conclusion. [4] [15] [16]
The snapping of tendons or scar tissue over a prominence (as in snapping hip syndrome) can also generate a loud snapping or popping sound. [9]
The common old wives' tale that cracking one's knuckles causes arthritis is without scientific evidence. [17] A study published in 2011 examined the hand radiographs of 215 people (aged 50 to 89). It compared the joints of those who regularly cracked their knuckles to those who did not. [18] The study concluded that knuckle-cracking did not cause hand osteoarthritis, no matter how many years or how often a person cracked their knuckles. [18] This early study has been criticized for not taking into consideration the possibility of confounding factors, such as whether the ability to crack one's knuckles is associated with impaired hand functioning rather than being a cause of it. [19]
The medical doctor Donald Unger cracked the knuckles of his left hand every day for more than sixty years, but he did not crack the knuckles of his right hand. No arthritis or other ailments formed in either hand, and for this, he was awarded 2009's satirical Ig Nobel Prize in Medicine. [20]
Cavitation in fluid mechanics and engineering normally refers to the phenomenon in which the static pressure of a liquid reduces to below the liquid's vapour pressure, leading to the formation of small vapor-filled cavities in the liquid. When subjected to higher pressure, these cavities, called "bubbles" or "voids", collapse and can generate shock waves that may damage machinery. These shock waves are strong when they are very close to the imploded bubble, but rapidly weaken as they propagate away from the implosion. Cavitation is a significant cause of wear in some engineering contexts. Collapsing voids that implode near to a metal surface cause cyclic stress through repeated implosion. This results in surface fatigue of the metal, causing a type of wear also called "cavitation". The most common examples of this kind of wear are to pump impellers, and bends where a sudden change in the direction of liquid occurs. Cavitation is usually divided into two classes of behavior: inertial cavitation and non-inertial cavitation.
Sonoluminescence is the emission of light from imploding bubbles in a liquid when excited by sound.
In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the condylar process of mandible below; it is from these bones that its name is derived. The joints are unique in their bilateral function, being connected via the mandible.
A joint or articulation is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole. They are constructed to allow for different degrees and types of movement. Some joints, such as the knee, elbow, and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit very little movement in order to protect the brain and the sense organs. The connection between a tooth and the jawbone is also called a joint, and is described as a fibrous joint known as a gomphosis. Joints are classified both structurally and functionally.
The synovial membrane is a specialized connective tissue that lines the inner surface of capsules of synovial joints, tendon sheaths, and synovial bursas. It makes direct contact with the fibrous membrane on the outside surface and with the synovial fluid lubricant on the inside surface. In contact with the synovial fluid at the tissue surface are many rounded macrophage-like synovial cells and also type B cells, which are also known as fibroblast-like synoviocytes (FLS). Type A cells maintain the synovial fluid by removing wear-and-tear debris. As for the FLS, they produce hyaluronan, as well as other extracellular components in the synovial fluid.
Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.
A synovial joint, also known as diarthrosis, join bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articulating surfaces. This joint unites long bones and permits free bone movement and greater mobility. The synovial cavity/joint is filled with synovial fluid. The joint capsule is made up of an outer layer of fibrous membrane, which keeps the bones together structurally, and an inner layer, the synovial membrane, which seals in the synovial fluid.
Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.
Hyaline cartilage is the glass-like (hyaline) and translucent cartilage found on many joint surfaces. It is also most commonly found in the ribs, nose, larynx, and trachea. Hyaline cartilage is pearl-gray in color, with a firm consistency and has a considerable amount of collagen. It contains no nerves or blood vessels, and its structure is relatively simple.
Crepitus is "a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone".
Spinal manipulation is an intervention performed on synovial joints of the spine, including the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. It is typically applied with therapeutic intent, most commonly for the treatment of low back pain.
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. The knee joint is most commonly affected. The disease is metabolic in origin and its treatment remains symptomatic.
Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.
The knuckles are the joints of the fingers. The word is cognate to similar words in other Germanic languages, such as the Dutch "knokkel" (knuckle) or German "Knöchel" (ankle), i.e., Knöchlein, the diminutive of the German word for bone (Knochen). Anatomically, it is said that the knuckles consist of the metacarpophalangeal (MCP) and interphalangeal (IP) joints of the finger. The knuckles at the base of the fingers may be referred to as the 1st or major knuckles while the knuckles at the midfinger are known as the 2nd and 3rd, or minor, knuckles. However, the ordinal terms are used inconsistently and may refer to any of the knuckles.
A bubble is a globule of a gas substance in a liquid. In the opposite case, a globule of a liquid in a gas, is called a drop. Due to the Marangoni effect, bubbles may remain intact when they reach the surface of the immersive substance.
The facet joints are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment and each facet joint is innervated by the recurrent meningeal nerves.
Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.
Synovectomy is the surgical removal of the synovial tissue surrounding a joint. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If arthritis is not controlled, it can lead to irreversible joint damage. The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.
Proteoglycan 4 or lubricin is a proteoglycan that in humans is encoded by the PRG4 gene. It acts as a joint/boundary lubricant.
Tribonucleation is a mechanism that creates small gas bubbles by the action of making and breaking contact between solid surfaces immersed in a liquid containing dissolved gas. These small bubbles may then act as nuclei for the growth of bubbles when the pressure is reduced. As the formation of the nuclei occurs quite easily, the effect may occur in a human body engaged in light exercise, yet produce no symptoms. However tribonucleation may be a source of growing bubbles affecting scuba divers when ascending to the surface and is a potential cause of decompression sickness. The process has also been described as the basis for the cracking sound produced by the manipulation of human synovial joints.
One study published in 1990 found that among 74 people who regularly cracked their knuckles, their average grip strength was lower and there were more instances of hand swelling than among 226 people who did not crack their knuckles. However, the incidence of arthritis was the same in both groups.