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The elbow is a complex joint with three bones: the humerus, radius, and ulna. Each of the bones has cartilage on its ends, surrounded by ligaments that form the joint capsule. The joint capsule is a fluid-filled sac that both protects the joint and lubricates it.
In addition to the bones, your elbow is a connection point for the muscles and tendons that support arm function. Your forearm muscles, for example, run across the elbow joint and connect to the humerus via the lateral and medial epicondyle. These tendons are the most common areas of tendinitis, which can cause pain and elbow popping.
Additional muscles attached to the elbow joint via tendons and ligaments include the biceps and triceps on the front and back of your upper arm. The radial, ulnar, and median nerves also travel past the elbow and may be affected by a joint injury.
As we age, the cartilage at the end of the arm bones wears away, keeping the bones from moving smoothly and causing more sounds. Again, these sounds are common unless you have pain, stiffness, or limited range of motion and should not cause concern.
Elbow popping and cracking noises can also be due to a buildup of gas inside the joint. Nitrogen gas naturally builds up in the spaces inside your joint, and when you move, it causes cavitation that pushes the gas out. It is the same process that causes the snapping sound when you crack your knuckles.
Overuse can also cause joint sounds like elbow clicking. When you repeatedly bend your elbow, such as when lifting weights, a clicking or grinding sound could indicate that your muscles are tight and need more stretching. Sometimes, the sound comes from tendons sliding over the bone, which can also be alleviated by proper stretching.
However, if the noise worsens and you experience swelling and persistent pain, make an appointment to see an orthopedic specialist. Depending on the condition of your joint, treatment will likely include a combination of rest, immobilization, medications, cold therapy, and physical therapy. Surgery may be necessary in extreme cases but is typically only recommended when less invasive treatments are ineffective.
Important: Shoulders are prone to injury, with 50% of adults 55 years or older having a detectable shoulder muscle tear. If you are experiencing pain along with clicking, popping, and cracking in your shoulder, we suggest you stop reading and book a physiotherapy assessment, as this could be a symptom of a more serious condition or injury.
If your shoulder suddenly started clicking, popping, or cracking in the past few months, you may have injured the muscle and altered its shape or the track on which it runs. The sudden onset of these sounds may indicate that further shoulder damage is occurring, and treatment is likely required.
A cracking joint can be as loud as 83 decibels - about the same as a running garbage disposal. How is that possible? Chiropractor Andrew Bang returns to the Health Essentials podcast to answer that question and more.
Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host. You hear snaps, cracks and pops whenever you get out of a chair. I know I do. Those noises from my knees, ankles and other joints seem to be getting louder and more frequent as time passes. So, here's the question: Is that normal and is it a reason to worry? That's what we're going to find out today from chiropractor Andrew Bang, one of our regular guests on the podcast.
Dr. Bang is one of the many trusted experts at Cleveland Clinic who chats with us every week to help us better understand how our bodies work. Now, let's learn the reason behind all those creaky sounds we've been hearing whenever we move around. Dr. Bang, welcome back to the podcast. I always know we're in for an enjoyable chat when you're joining us.
We definitely do. So today, in researching this, we're talking about cracking joints. I always love oddball facts, and I actually found where they said, "Cracking joints could get as loud as 83 decibels, which is the equivalent of a garbage disposal or a diesel truck rolling along at 40 miles per hour." Have you ever heard them that loud?
Probably. I think the novelty of it wears off a bit, as I've been working on so many patients over the years. But yes, when it's your first time, it can be a little scary, and we do try to warn patients, but there are sometimes a few gasps in the office when the patient doesn't realize that it's going to be that loud. I wonder how they measure that because it seems when you're the patient receiving that, it sounds way louder than garbage disposal. Especially when it's in your neck because it's so close to your ears compared to you or I who might be listening to that patient get work done.
Well, the good thing is, it's safe. Let me start with that. So, the noise you're hearing is safe, and it helps restore a range of motion. It helps decrease pain and all that good stuff. And essentially, there's like three kind of things that are happening, potentially making that sound. So, the first one is the one we're most interested in that we want to, that most people talk about when you YouTube: "OK, what is all the cracking sound I'm hearing?"
Well, usually the joints we manipulate on a patient are synovial joints. That's where we have two kinds of joint bones, that soft and very smooth cartilage where they meet together, and there's a joint capsule that goes around this joint. And inside of that there's synovial fluid and that synovial fluid helps - it's like motor oil essentially for our joints, right? Lots of lubrication, so things are slick and move nicely so your joint, it's freely moving, and you can do what you want to do.
Well, when we move that joint where it's restricted, there creates a negative pressure inside this capsule, and then when you pull it apart, it makes that cracking sound because you're creating a negative pressure inside of that synovial joint space. So, you get that sound.
That's part of it, too. Elbows, knees and joints - those are all synovial joints. Also, some of the joints inside of our spine are that same kind of makeup. Some of our finger joints, and these are here, those are those kinds of joints based where they meet together. So, manipulation can occur in lots of different areas inside of our body.
We have ligaments, right? Ligaments are bands of connective tissue. We also have tendons. Tendons are connective tissue that are really strong. And tendons, where it comes from turn from a muscle into that hard white-like ligament, connective tissue, very strong that attaches to a bone. And ligaments are just that white, hard connective tissue that attaches bone to bone. Well, these ligaments and tendons can roll over each other.
I always give the example of patients where, if I was to take my fingers and do this, it sounds like a crack you might hear in a chiropractic office. The thing is, that's not the joint, that's the ligaments flipping over each other. That happens when we're moving and doing different things. You may feel a lot when you're moving your ankle and you hear a crack or your knee when you go to stand up, that's usually a ligament passing over another ligament, all right?
So, you'll hear cracks now. And then, there's a third way. We have different layers of tissue, right? We have our skin, and then below that we have what we usually call the fascial layer. That's a bunch of really soft connective tissue that forms in a protective layer and a lubrication layer between skin, fascia, muscle because we want things to glide over each other.
Well, if I was to, let's say, stretch my skin kind of like this on an area around where you could grab a lot of skin - your back is usually an area this happens at - and I was to lift quickly, you'll actually hear a popping sound, and that's not your joints or ligaments. It's the skin separating from the fascia that is connected to the muscle layer, and you'll hear a pop. And it's similar in the fact of the synovial joint where you're creating this negative pressure inside of a tightly sealed kind of area, and you hear this pop sound.
So that's kind of why I try to explain to patients when they come to the office, "Hey, it could be one of three things." The good thing is typically all three of, the reason we do the manipulation is beneficial, even in all three of those situations. So, when I get, let's say a patient who has low back pain, I'm stretching through those synovial joints of their lumbar spine. I might hear some cracking, or we stretch, and we do some adjustments. We increase the range of motion. They feel the relief that comes from the adjustment, but they're still experiencing pain in the muscle.
I realized that they were working out or doing something very strenuous and their back muscles are so tight, I can then do another manipulation with their skin in that fascia layer. They'll hear more clicking and popping and be like, "Whoa, you're cracking the same spot." "No, no, it's totally new. It's a totally different area." But it's all to restore range of motion, that's usually our number one goal. Because as we've talked before lots of times, pain and range of motion are like a teeter totter, all right?
If I go up, you go down. So, pain and range of motion are similar. If pain goes up, range of motion goes down, which means you're stiff. But if the range of motion goes up or you get more flexible, usually pain goes down. And that's why we're trying to do this cracking and popping. We want more range of motion. We want our range of motion to go up and our pain to go down.
What a great way to explain it. So now, I do have to say, when I was younger, I remember my joints cracking a little bit. I'd do it when I was sitting in Mr. Troupe's social studies class, I'd crack some knuckles and things like that. But I'm getting older and I'm adding more birthday candles and I just seem to be snapping and popping and cracking every time I move. Is that just a gift that comes with the years?
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