OsteoBlog: Addicted to crack........
We all have times when we feel like our joints just need a good crack and it is very satisfying when you hear that sound and everything feels much better.
Maybe you arched back over a chair and your upper back popped or you twisted your foot in a certain way and heard a loud cracking sound followed by a relief of pain.......
But how long does that feeling last before you feel the need to do it again?
As osteopaths, we manipulate joints and we very often get a nice good cracking sound, indicating how good our skills are and how deft we are at our jobs...... right?
What is a manipulation? Why do we do it? Why do we need it done more than once sometimes?
Most of your joints are of the synovial type - they are bathed in synovial lubricating fluid and surrounded by a joint capsule of thick, fibrous, mildly stretchy collagen material.
Joints are noisy sometimes and move a lot by their very nature. Sometimes the noise is heard more internally and other times there is a loud audible crack your neighbours would worry about!
The most recent school of thought regarding the sound of popping within joints is that when the capsule is stretched, gas within the synovial fluid is quickly escaping, forming bubbles of oxygen, nitrogen or carbon dioxide.
After about 20 minutes, the gas will reabsorb and the joint may be cracked again. Case in point - try cracking your knuckles twice in quick succession and it won't often happen.
Old wives tale alert - cracking your knuckles will cause arthritis. There is no evidence to support this claim but lets be sensible and cautious - if cracking a joint results in pain and swelling then there is something mechanically wrong and we would advise you not to continue.
Loud cracks during movement or exercise can be indicative of damage such as fracture, ligament or tendon tears or dislocation, so make sure you get medical assistance in these cases and rest the injured part until then.
Snapping can occur when a tendon moves out of position at a bony prominence, and then snaps back over into place - such as in the front of the hip. This can sometimes cause pain and will require some muscle lengthening to remedy.
An arthritic joint has rough surfaces of degeneration and bony outgrowth or spurs and these can sometimes cause a creaking or rubbing sound within a joint. This is almost always painful and tends to be worse on weight bearing.
When a joint pops (cavitates) the stretch on the capsule causes a relaxation of muscles surrounding the joint, via the stimulation of mechanoreceptors within the joint. Osteopaths take advantage of this phenomenon by manipulating stiff joints in order to effect a better range of movement - commonly in spinal joints. There are also neuromuscular effects which serve to relax the area.
A popping sound is not essential, however, as osteopaths will use articulation and massage techniques to relax the joint - its just not as quick or efficient.
A 2011 Cochrane review (Rubinstein et al 2011) of 26 clinical trials looked at the effectiveness of different treatments, including spinal manipulation, for chronic low-back pain. The authors concluded that spinal manipulation is as effective as other interventions for reducing pain and improving function. Simply, it helps to restore normal pain free motion.
The use of spinal manipulation as part of treatment for low back pain is therefore recommended by several clinical practice guidelines, including the recently published NICE guidelines (2016).
So, in essence, the sound that joints make on their own or whilst being manipulated should not be associated with negative outcomes unless you have pain, stiffness and swelling. If you are in any doubt about your joints, your noises, or anything else please visit your osteopath.
This is the last blog of 2017 so all there is left to say is have a very Merry Christmas and a happy and healthy New Year.
As usual, for osteopathy in High Wycombe and beyond, call Lucy or Ebony from OsteoFusion on 07833 321604 or email firstname.lastname@example.org
Thanks for reading.
Rubinstein, S.M., van Middelkoop, M., Assendelft, W.J., de Boer, M.R., van Tulder, M.W. (2011) ‘Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review’. Spine, 36, 825-846.
National Institute of Clinical Excellence guidelines. Low Back Pain: [Online] available from: http://www.nice.org.uk/nicemedia/pdf/CG88QuickRefGuide.pdf (Nov 2016).