‘Click!’ ‘Clunk!’ ‘Grind!’ What does it mean when joints talk?

As a physiotherapist, I get lots of questions online and from my patients, friends and family about clicking joints, most commonly, but not exclusively, backs, necks, shoulders, knees, hips and ankles. Some people are worried that it is the early signs of arthritis or that it is the bones bashing against each other. They often report to the physiothat it is the symptom that causes them most concern, sometimes even more than pain.

The good news is that as long as you have not had a fall or a traumatic accident, and/or you don’t have any pain or other symptoms, research indicates that noisy joints do not indicate current damage nor do they indicate potential future damage. This includes arthritis. There is no indication that clicking joints might increase the risk of arthritis in future and this has not been shown to be the case.

So, what are the potential reasons for the clicking? The first one is bones making contact. In this case the clicking is extremely painful and debilitating and there are normally other signs and symptoms like swelling and bony deformity. If this is the case, you need to seek medical help immediately. The parts of bone where they join each other are covered with cartilage. For bones to touch each other this cartilage needs to wear away completely. This process is long and painful and the individual will normally seek help well before the audible grinding stage. To be honest the only time I have ever seen it was on elderly care wards in cases of neglect, very sad indeed.

There are far more common reasons for noisy joints. The first is ‘loose bodies’ in the joint – the strangest sounding medical term, I know! These are basically bits of tissue floating around in the fluid within the joint that can make a bit of a grinding sound when they are sloshed around. They may be temporary or permanent but either way having them removed is NOT advisable because the risks outweigh the advantages.

Then there are tendons popping over prominent bits of bone which is most common in the hip joint, the sound is more of a deep clunking sound. If you have no other symptoms then you can try to ignore this.as, again, it is not an indicator of current or future damage. You will probably find that the clunking comes and goes but if it is persistent and irritating you then a physiotherapist can give you exercises to adjust the alignment and strengthen the stability muscles of your hips and pelvis and, from my experience this can get rid of the clicking.

The most common one is, wait for it, air bubbles popping in the joint. This sounds ridiculous but they can make some very echoey loud noises. When a joint gains more movement than it is used to – for example when you get out of bed in the morning, or do something that you haven’t done for a while, or during a joint manipulation, the tiny air bubbles in the joints accumulate and burst making the hollow clicking sound that can be very audible. The more movement in the joint the more clicking there will be and the more uncontrolled the movement the more clicking there will be. That is why people with hypermobility (bendy joints) often have very clicky joints. Repetitive uncontrolled movement puts unnecessary forces though the joints which could logically therefore lead to increased wear and tear in the joints. Therefore, if your clicking joints are combined with excessive movement there could be some argument for seeing a physiotherapist to show you exercises to stabilise the joints and reduce unnecessary movement. However, bear in mind that clicking itself is not an indicator for future damage.

I hope that helps you. If you have any pain or other symptoms in addition to the clicking, then I would recommend a physiotherapy assessment. However, if it is just clicking then it is more of a grey area and it is up to you whether you whether you get it checked out.

I look forward to your questions.

Lucy

Lucy Macdonald
Chartered Physiotherapist

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Lucy has 14 years’ experience as a physiotherapist getting rid of pain and treating the cause of injuries in professional, amateur and non-sports people including members of the GB ski team. Lucy specialises in treating complex conditions and injuries, and regularly gets patients better who have been unsuccessfully treated elsewhere. This includes groin pain, knee pain, low back pain, shoulder pain, inflammatory conditions and hypermobility syndromes.

Lucy is equally happiest skiing in deep powder, at the opera or simply hanging out with her family, which recently gained a new member – a little boy. She enjoys world music, a good political debate, dancing, yoga, walking up mountains and is embarrassingly addicted to Zumba