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The First Ever Video of a Cracking Joint

This article appeared recently in RealClearScience Journal Club by Ross Pomeroy.

For all those Osteopathic patients asking what the popping sound is when manipulating joints.

Scientists based out of the University of Alberta have — for the first time — imaged a joint cracking in real time, effectively putting to rest a decades-long debate in the process. They revealed their success in the journal PLoS ONE.

Doubtless you’ve experienced the physiological wonder that is a cracking knuckle. The audible pop it makes can sometimes be heard across an entire room, making many bystanders wince. But they probably have nothing to cringe about. While joint cracking may sound painful, it’s not associated with any adverse health effects — arthritis, for example.

Everyone knows that bending or stretching a joint is what causes it to crack, but what’s going on under the skin? First off, a joint is where two bones meet. At the ends of each bone is soft, cushioning cartilage. Connecting the cartilage — and thus the bones — is a synovial membrane that’s filled with a thick, lubricating fluid. Bending the joint can cause the membrane to stretch, which in turn causes the pressure inside it to drop and a bubble of dissolved gas to form within the fluid. The whole process is called tribonucleation.

Original article and video link

“It’s a little bit like forming a vacuum,” says Professor Greg Kawchuk, the lead researcher. “As the joint surfaces suddenly separate, there is no more fluid available to fill the increasing joint volume, so a cavity is created…”

For decades, prevailing wisdom has held that the popping noise is tied to these bubbles, but scientists have debated whether the sound is caused by the bubble’s formation or its collapse.

Thanks to Kawchuk and his team, we now know it’s the former. When they watched a volunteer’s knuckles crack inside an MRI machine in real time, the pop clearly occurred when the bubble formed. Moreover, the bubble persisted well after the sound was heard.

“This work provides the first in-vivo demonstration of tribonucleation on a macroscopic scale and as such, provides a new theoretical framework to investigate health outcomes associated with joint cracking,” the researchers say.

Source: Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R (2015) Real-Time Visualization of Joint Cavitation. PLoS ONE 10(4): e0119470. doi:10.1371/journal.pone.0119470

The health and safety executive estimate that in 2013/14 there were 526,000 cases of work related musculoskeletal disorders (MSDs) – about 42% of all work related illnesses. Repetetive Strain Injuries (RSI’s) are classic examples causing problems in Hands, wrists, elbows, Neck, Headaches, low back pain and many others.

MSDs are the second biggest cause of absence from work, effecting over 1m people at a cost to the economy (estimated in 2007) of £7bn.

If you are self-employed, taking time off work with musculoskeletal problem can have a devastating effect on you and your family’s financial security, so getting back to work as quickly as possible is essential. That can seem impossible when you’re in pain and unable to complete your usual daily activities, but movement really helps.

The Work Foundation recommend that you work with your employers and healthcare professionals if effected by MSDs to find ways of returning to work as soon as possible using a combination of treatment, lifestyle changes and adjustment to working conditions. They also suggest that early intervention is key to recovery, hastening your return to a normal, healthy lifestyle and limiting the negative psychological effects of an extended period of sick leave.

How osteopaths can help;

• Fast access – our osteopaths are usually able to see you within a couple of days of seeking an appointment. As osteopaths are primary healthcare professionals you don’t need to be referred by a GP unless you are seeking NHS funded treatment or your health insurance provider insists that you see a GP first.

• Treatment and advice – once they have assessed your condition an osteopath will usually begin treatment straight away. They can also provide advice on how to avoid making the condition worse or re-injuring yourself.

• Inexpensive treatment – Many MSDs can be treated by osteopaths over a few visits. Treatment costs just [insert your fee] per session, which compared to loss of earnings or productivity is a worthwhile investment to help you return to work promptly.

• Fit notes – A fit note provides your employer with advice on what they can do to help an employee return safely to work. This may include adjustments to working conditions, such as reduced hours, a different work station set up, or recommending avoiding activities that may prevent or slow recovery, heavy lifting for example. Osteopaths are able to issue fit notes which will give employers this expert advice.

• Onward referral – With your permission, we are/ I am able to share information about your health with other healthcare professionals, such as your GP. If your condition requires the intervention of another expert, we/I can provide a letter of referral detailing the diagnosis and any treatment that we/I have been able to provide, which may help you more rapidly get the help you need to return to health.