I have been asked on quite a few occasions whether cracking knuckles is a bad thing or not, so I thought I’d write a short piece about this.

The answer is no.

But there is a twist (it would be my shortest post to-date otherwise really). Few things are bad in themselves. Water is good for you but drinking 3 gallons of the stuff in one day will kill you. Exercise is good for you, but running a marathon when the furthest distance you’ve ever run is to the back of you garden and back again (assuming you’re not proud owner of a 500 acre estate) is likely going to result in inflammation of knees, tendons and muscles… The point is that cracking your knuckles in itself is not bad for you but there are certain situations and certain methods of doing it which will result in damage. The main reason though, is not likely to be the reason most people think (“my nan says it causes arthritis”) and it is not the cracking noise it makes or even the process of causing the cracking which is the contemptious point , but rather the way in which you move your fingers to ellicit the crack.

Exhibit 1:

Here you can witness the anatomy of a human knuckle. It is classified as a “synovial” joint, officially synovial diarthrosis, which means that it has fluid between the two contacting surfaces (which is where it gets its name from as that fluid is called, you guessed it, synovial fluid) and a capsule around the whole lot to keep the fluid contained. The diarthrosis bit means that it can freely move. There are other types of joints with very fancy names, but you might find it an interesting pub-quizz factoid that the tooth and tooth-socket is also classified as a joint (a fibrous synarthrosis in fact, referring to the fact that it is a fibrous (ie. no fluid inside it) joint and synarthrosis means no movement is available from it).

End of anatomy lesson. Now physics. A fluid has certain properties which mean that its molecules, when at room temperature and under normal atmospheric pressure, remain fluid. Water is a fluid but when you reduce its temperature or increase the atmospheric pressure it will turn into a solid. On the other hand when you heat it up or decrease the atmospheric pressure it will become gasseous.

When you crack your knuckle you are effectively increasing teh space between the two joint surfaces whilst not increasing the amount of fluid within in. That way you are reducing the resting pressure on the synovial fluid causing it to turn (at least in part) into gas. This process is called “cavitation”.

So if you ever wondered why bubbles rise from the water when you look at a propeller moving around rapidly in the water, you now know that by moving rapidly, the propeller separates the individual molecules, creating space between them, which causes the water to turn into a gas which then rises to towards the surface.

So it’s a bubble that forms inside the joint, which when that happens it just so happens to (as a side effect) be making a popping noise. Nothing snaps, breaks, tears or any other things your nan may have told you. She was right about one thing though… it COULD contribute to causing arthritis, BUT only in so far that ANY abnormal or excessive movement can contribute to the development of arthritis. There are other contributing factors; genetic predisposition to arthritis, poor bloodsupply, smoking, poor diet, etc. So if we look at it in this context, it is POSSIBLE that when joined by other contributing factors, moving your joints abnormally and against the way they normaly move, which COULD on occasion be accentuated by the sound of cavitation, MAY contribute to the deterioration of the joint. So in that sense, I guess cracking your knuckles could harm your joints…

This is a little aside discussion which I found myself have with a few people recently, and thought it was worthwhile putting down in writing. The topic has come about by patients and colleagues asking me why, when it is so clear and obvious in their own experience, that chiroporactic care is still so very misunderstood. I figured there were a number of reasons; lack of information, shortage of “hard scientific evidence” (post soon to come), natural distrust to all things unconventional (that’ll be another post…). Critically I would like to discuss in these post just one of the problems at a time and this one is about the magical, quasi voodoo-esque qualities that are attributed to this “strange practice of cracking bones” (it’s not the bones cracking by the way, just the joints, and no it’s not bad for you… see “Cracking Knuckles” on the blog). The strangeness of it all comes down to two main points:

1. it’s not what we usually do

2. it’s a seemingly strange solution to a very common problem.

In fact, when I actually think about what happens in my own clinic in Warwick on a daily basis, then I come to the conclusion that it really just is a process of finding solutions to problems. The issue that is at the root of these two things which may make chiropractic care seem strange, is really that as a treatment method it offers unusual answers to common problems. Now, make no mistake, back problems are extremely common (in fact over 40% of the population currently suffers with back trouble), and most of them resolve quite naturally within 4 to 6 weeks, without anyone having to do anything. A small percentage of problems has more trouble recovering because there are “contributing factors” which obstruct the normal recovery. Sometimes these “obstructions” are so potent that they make it impossible for the person to recover, resulting in chronic back pain or adaptation. So, when we’re looking at the weird and wonderful world of chiropractic we are actually looking at  a percentage of people who are limited in their ability to recover and the answers may not be the most obvious,… In fact the main complaint I hear about the conventional healthcare approach (and it is a complaint I swiftly rectify their views on, I hasten to add) is that these answers so obvious in my clinic answers are often not assessed, are overlooked or are even missed in other clinics. The reason such harsh words to the address of conventional medicine are in my view not fair, is simply that they represent a rather small percentage of cases seen in GP practice and that it would take a lot of training and even financial investment to deal with this, relatively speaking, rather small group of people.

Chiropractors specialise in managing that relatively small group of people and do it quite successfully. But it creates confusion due to the lack of a much needed distinction and classification: I don’t treat back pain. I treat people with back problems which don’t go away in the way you would expect from someone with a normal, healthy back. The chiropractic approach as I practice it in my clinic boils down to this: if things work well, they don’t hurt, and if things hurt, and continue to do so for longer than 4 to 6 weeks, then it’s usually because they don’t work well. Although this may sound a little simplistic at first, you need to bear in mind that nature obeys only very few rules and one of those is that all things must have cause. That in itself is simple enough. What makes things so much more complex is that the concept of cause is a very flexible idea: if you suffered a fracture in a car accident, then one could argue that the cause was the car accident. In fact it was because you were in that car doing what you were doing, at that time whilst another car was doing what it was doing when you were both doing what you were doing, in a world where all else was doing what it was doing which ultimately resulted in the cars colliding and your leg hitting the dashboard in such a fashion so as to cause it to fracture in the way it did… how to say something simple in a thousand words…

The issue is that in any form of problem solving (and healthcare certainly is that!) requires you to acquire as many “contributing factors” as you possibly can. The more such factors are known, the fewer variables there are, the fewer variables there, the more certainty there is… so if you knew what all the cars on the road were doing, and how the weather could be impacting on your driving, you would be less likely to have a car accident, but if you also knew what all the other drivers were doing, you’d be less likely still, and if you could have known about that stray bird hitting your windscreen it was getting rather unlikely you’d ever have had that crash in the first place. Ultimately it wasn’t the bird hitting the windscreen that caused your fracture.  It was your crashing into the other car in the lane next to you which did, but the fact that you’d had lots of coffee and developed a phobia after watching Hitchcock’s “Birds” certainly did nothing to help either.

My job, as a chiropractor is to find the contributing factors (to the reason why you’re not recovering naturally) decide whether it/they can be removed and if so what the likely outcome will be. If the outcome is likely to be beneficial to you, you will be offered treatment. If not, you won’t.

So, back to the preposterous title of this blog: It’s meant as a little personal joke (my wife thinks my humour is quite doubtful too). Magic is something you don’t understand. Once you understand it, it stops being magical and becomes a “trick”. The problem is, and I encounter this quite frequently when interacting with sceptics, that lots of people still think of chiropractic, osteopathy, acupuncture etc as some hocus-pocus. Why? Mostly because of the assertions made by the people who practice it reflects either their lack of understanding of whne and why their treatment works or their inability to convey their understanding in a way that makes sense. Some people seem to think that I makes sense, so I took to writing a blog on my site and talk about my views on chiropractic. That said, I hope you found it helpful and interesting, and please don’t hesitate to post thoughts, comments or questions.

Stefaan Vossen, Clinic Director, The Chiropractic Network, Warwick

This is probably the top one question no-one ever asks but really should.

Firstly it should be very clear that chiropractic care is not the same as manipulation. This is one misunderstanding that is rife even in the media. Chiropractors frequently use manipulation of joints as a way to free up movement within those joints and really only do that because it is a very good way to achieve great results.

So what is it all about then? It is quite simple really and comes down to thinking about pain as the result of malfunction. In the same way as your car tyres wear out more rapidly if the steering isn’t adjusted correctly, your joints, muscles, tendons and discs wear out when you are not using them correctly, ultimately and eventually causing pain. Of course there are complicating factors: some people have stronger bodies than others and that may be due to genetic factors as well as life-style factors and it is only when the actual rate at which you are damaging yourself exceeds the rate at which you can repair yourself that the pain will become noticeable. One more aspect which makes matters even more complicated is that pain is perceived differently by different people and there are some well-known pain syndromes like ME or Fibro-Myalgia which exemplify this.

So then what does a chiropractor do? We look to find out what it is about the way you move that is abnormal and then help you correct it. If at the same time there are things that are making you less able to heal then we will guide you in those matters too.  And that guidance combined with any necessary treatment is what chiropractic care is!

I hope this helped, i fyou have any questions, don’t hesitate to post!

Stefaan

Warwick Chiropractors