PT on the Net Research

Crepitus "Cracking" in Joints


Question:

My client has clicking in one or more of his joints. What should I do?

Answer:

Clicking in one's joints has been an age old question of what to do and why it is happening. I am glad you asked the question. I have a couple of answers that may help. The first answer to clicking or popping is called crepitus. Crepitus is the releasing of gas at a joint that occurs occasionally, and there is no pain involved. It happens quite often at the knee when the patella rubs against the femoral condyles. It also often happens at the shoulder. In any case, it is fairly natural and most would say, if there is no pain involved, there is no reason for concern. The distinction between crepitus and other issues is that crepitus will only happen once in awhile and should not continue for each rep of each set. If this noise continues throughout the set, we need to delve into another possible explanation.

Each joint is surrounded in muscle tissue. There are muscles that create movement in each direction and muscles that allow each movement to occur. For example, when the biceps is creating elbow flexion, the triceps is allowing the movement to happen. In some cases, the length/tension relationship between the agonist and antagonist is dysfunctional. This can cause unnecessary stress on the joint capsule and cause the bone to rub against either another bone or irregular cartilage surfaces. This rubbing can cause a cracking or popping sound. If this situation is not remedied, inflammation can result, which can in turn lead to more popping and the cycle will continue. To combat this problem, we as trainers need to recognize imbalances in the structure and create proper corrective exercise programs that will regain functionally efficient length/tension relationships at each joint. For example, when the IT band becomes adaptively shortened, it can cause a clicking noise at the knee joint. The clicking noise is due to mal-tracking at the patella femoral joint. Some therapists have recommended strengthening the vastus medialis to help with the tracking issues. This can be a futile effort because the strength of the vastus medialis cannot overcome the adaptive shortening of the IT band. If we look at our functional anatomy, we will see that through the kinetic chain, the IT band becomes shortened because the gluteus medius is underactive, which in turn causes the tensor fascia latae to become dominant. This will create an adaptive shortening of the IT band, which will cause the clicking at the knee. (I left out a few of the steps to keep the answer brief.) This can all be avoided by using the assessment forms supplied by PTontheNet.com (under Programs & Assessments section) and looking at the kinetic chain as a whole. By doing an overhead squat assessment, you can determine what joints are receiving undue stress and try to alleviate the situation by creative productive corrective exercise programs.