Joint cracking explained

Joint cracking is the manipulation of joints to produce a sound and related "popping" sensation. It is sometimes performed by physical therapists, chiropractors, 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]

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.^[3]

It is possible for voluntary joint cracking by an individual to be considered as part of the obsessive–compulsive disorders spectrum.^{[4] [5]}

Causes

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:

• Cavitation within the joint—small cavities of partial vacuum form in the synovial fluid and then rapidly collapse, producing a sharp sound.^{[6] [7]}
• Rapid stretching of ligaments.
• Intra-articular (within-joint) adhesions being broken.
• Formation of bubbles of joint air as the joint is expanded.^[8]

There were several hypotheses to explain the cracking of joints. Synovial fluid cavitation has some evidence to support it.^[9] 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.^[10] The contents of the resultant gas bubble are thought to be mainly carbon dioxide, oxygen and nitrogen.^[11] 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.^[12]

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. 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.^{[13] [14]}

The snapping of tendons or scar tissue over a prominence (as in snapping hip syndrome) can also generate a loud snapping or popping sound.^[15]

Relation to arthritis

The common old wives' tale that cracking one's knuckles causes arthritis is without scientific evidence.^[16] 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.^[17] The study concluded that knuckle-cracking did not cause hand osteoarthritis, no matter how many years or how often a person cracked their knuckles.^[17] 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.^[18]

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.^[19]

See also

• Crepitus—sounds made by joint

Notes and References

1. Richard Boggs, Hammaming in the Sham: A Journey Through the Turkish Baths of Damascus, Aleppo and Beyond, 2012,, p. 161
2. Web site: 2018-05-14. Knuckle cracking: Annoying & harmful, or just annoying?. Robert H.. Shmerling. How do we know that knuckle cracking is harmless?. health.harvard.edu. 2019-07-19. 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..
3. News: Simulation May Finally Explain Why Knuckle Cracking Makes That Awful Sound. Dvorsky. George. Gizmodo. 2018-03-30. en-US.
4. Abouhendy. Wa-il. Jawad. Sudad. Compulsive Joint Clicking on the Obsessive-Compulsive Spectrum: A Case Report. The Primary Care Companion for CNS Disorders . 4 July 2013. 15 . 4 . PCC.13l01513 . 10.4088/PCC.13l01513 . 24392256 . 3869608 .
5. Johnson. A.. Linse. A.. Novoa. K. C.. A Tough Case to Crack: Diagnostic, Ethical, and Legal Considerations in Treating Compulsive Neck Cracking . Cureus. 6 April 2022. 14 . 4 . e23875 . 10.7759/cureus.23875 . free . 35530890 . 9076044 .
6. News: Why knuckle cracking makes a popping sound, and why it might be beneficial. Knapton. Sarah. 15 April 2015. The Daily Telegraph. 17 December 2016. London.
7. Web site: Cracked it! Scientists solve puzzle of why knuckles pop when pulled. Ian. Sample. 15 April 2015 . 20 September 2016. The Guardian . London.
8. Gregory N. Kawchuk. Jerome Fryer. Jacob L. Jaremko. Hongbo Zeng. Lindsay Rowe. Richard Thompson. 2015. Real-Time Visualization of Joint Cavitation. PLOS ONE. 10. 6. 384–390. 2015PLoSO..1019470K. 10.1371/journal.pone.0119470. 4398549. 25875374. free.
9. Brodeur R. . The audible release associated with joint manipulation . J Manipulative Physiol Ther . 18 . 3 . 155–64 . 1995 . 7790795.
10. Maigne. Jean-Yves. Vautravers. Philippe. Mechanism of action of spinal manipulative therapy. Joint Bone Spine. September 2003. 70. 5. 336–341. 10.1016/S1297-319X(03)00074-5. 14563460.
11. Unsworth A, Dowson D, Wright V. 1971. 'Cracking joints'. A bioengineering study of cavitation in the metacarpophalangeal joint.. Ann Rheum Dis. 30. 4. 348–58. 10.1136/ard.30.4.348. 1005793. 5557778. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005793/pdf/annrheumd00004-0008.pdf
12. Fryer, Gary . Jacob Mudge . McLaughlin, Patrick . amp . 2002 . The Effect of Talocrural Joint Manipulation on Range of Motion at the Ankle . . 6 . 384–390 . 12183696 . 10.1067/mmt.2002.126129 . 25. https://web.archive.org/web/20170921215401/http://vuir.vu.edu.au/504/1/Ankle_manipulation_-_revised.pdf . 2017-09-21 . live .
13. Why Does Cracking Your Knuckles Make So Much Noise? Science Finally Has an Answer. Time. en. 2018-03-30.
14. Chandran Suja. V.. Barakat. A. I.. 2018-03-29. A Mathematical Model for the Sounds Produced by Knuckle Cracking. Scientific Reports. En. 8. 1. 4600. 10.1038/s41598-018-22664-4. 29599511. 5876406. 2045-2322. 2018NatSR...8.4600C.
15. Protopapas M, Cymet T, Protapapas M . Joint cracking and popping: understanding noises that accompany articular release. . J Am Osteopath Assoc . 102 . 5 . 283–7 . 1 May 2002 . 12033758 . 2 March 2007 . https://web.archive.org/web/20070927214025/http://www.jaoa.org/cgi/reprint/102/5/283 . 27 September 2007 . dead .
16. Rizvi. Asad. Loukas. Marios. Oskouian. Rod J.. Tubbs. R. Shane. August 2018. Let's get a hand on this: Review of the clinical anatomy of "knuckle cracking". Clinical Anatomy. en. 31. 6. 942–945. 10.1002/ca.23243. 30080300. 51920825. 0897-3806.
17. Deweber K, Olszewski M, Ortolano R . Knuckle cracking and hand osteoarthritis . J Am Board Fam Med . 169–174 . 2011 . 10.3122/jabfm.2011.02.100156. 24 . 21383216 . 2. free .
18. Simkin. Peter. Habitual knuckle cracking and hand function.. Annals of the Rheumatic Diseases. November 1990 . 49 . 11 . 957 . 10.1136/ard.49.11.957-b. 2256753. 1004281.
19. Web site: 2009 Winners of the Ig® Nobel Prize. August 2006. 27 November 2011.