Cracking or popping sounds that result from joint manipulation are mostly considered harmless. However, medical help must be sought if the noise is accompanied by pain. The spine, which is commonly referred to as the backbone, is an important part of the human skeletal system. It comprises twenty four vertebrae that are separated by intervertebral discs.
The lumbar spine, which is commonly referred to as the lower back, is the lowest section of the spine. Just below the lumbar spine, lies the weight-bearing joint known as sacroiliac joint. Problems are most likely to arise, if the lumbar vertebrae or the sacroiliac joint are strained beyond tolerable limits.
Popping or clicking sounds could sometimes be a sign of excessive strain on the lumbar region.
What Causes the Back to Crack or Pop?
It is believed that cracking or popping in the back arises when the gas that is trapped within the synovial fluid in the joint is released. This fluid is present between the joints in the body and acts as a lubricant and shock absorber, surrounding the vulnerable edges of our bones. The synovial fluid prevents the bones from rubbing against each other because increased friction between bones may lead to degeneration of the bones, a condition called arthritis.
The noise is also heard when the tendon that has moved slightly out of place returns to its original position.
Such sounds may arise due to strain to the joints or supporting structures such as the ligaments, tendons, or cartilage. These supporting structures work in tandem, in order to provide maximum range of motion of a joint. For instance, the cartilage, which is the connective tissue that covers the ends of the bones, prevents friction between bones.
Certain degenerative conditions could also be responsible for causing misalignment of the bony segments of the spine, which in turn may cause clicking noises in the lumbar region. Osteoarthritis is a medical condition that is associated with the degeneration of the cartilage. Clicking sounds may arise if the cartilage gets worn out, called crepitus. As a result, the bones start rubbing against each other.
What is Crepitus?
Crepitus describes any grinding, creaking, cracking, grating, crunching, or popping that occurs when moving a joint. People can experience crepitus at any age, but it becomes more common as people get older.
When a joint’s cartilage degenerates, the joint is no longer adequately protected against friction and impacts. In addition, the loss of cartilage can alter the joint’s biomechanics and cause bones to grind against one another. These changes can result in crepitus.
Common causes of crepitus include:
- Air bubbles popping inside the joint. This popping does not cause pain.
- Tendons or ligaments snapping over the joint’s bony structures. This snapping sometimes causes pain.
- Osteoarthritis which causes a joint’s articular cartilage to degenerate. Osteoarthritis often results in pain.
Although the sound can be alarming, crepitus itself is not something to be too concerned about. It’s pretty normal for a person’s back to sound like it is cracking and popping. However, one should be concerned if this comes with pain. When pain becomes unbearable or begins to impact daily activity, it is time to consult with a medical professional.
Causes of Osteoarthritis in the Lower Back
Osteoarthritis of the spine usually occurs due to internal damage to the facet joints. The surfaces of the facet joints are lined with smooth cartilage to allow for movement as the two sides of the joint rub against one another. However, the joint can become painful through the following process:
- The cartilage on one side of the facet joint gets damaged. Every time the spine moves the injured cartilage rubs against its neighbor, causing friction and further injury to both sides.
- The joint damage and friction leads to inflammation.
- The swollen facet joints transmit this pain signal through a single nerve (the medial branch) that travels through the facet joint.
- This signal then causes the back muscles to go into spasm.
- The combination of the muscle spasm and inflammation of the joints causes low back pain.
The spinal facet joints in the lower back are prone to developing osteoarthritis. The joints are quite small compared to the amount of body weight they bear. The resulting stress and strain makes them susceptible to damage to the cartilage and injury. The accumulation of injuries over a lifetime causes the joints to break down, or degenerate.
Facet joint breakdown also comes as a result of torn discs. Discs act as shock absorbers for the spine. They have a tough outer layer and a soft inside. The soft inner part absorbs the shock. The hard outer layer can tear due to degeneration or even injury. The torn discs don’t absorb stress and strain very well, which leads to excessive force being transmitted to the facet joints.
The degenerative process is similar to what happens in a car. If the shocks go out and aren’t replaced, the next thing that happens is the springs break. In the lower back, once the torn disc stops absorbing the stresses and strain of everyday life, the facet joints go out next. Once the facet joints are injured they become inflamed, swell, cause muscle spasm, and the back pain cycle continues.
Symptoms of Osteoarthritis
Osteoarthritis symptoms such as back pain and stiffness tend to progress gradually. Many people initially attribute these symptoms to lack of exercise or getting older. Others may dismiss early arthritis symptoms as muscle pain until the pain worsens and interrupts their enjoyment of everyday activities.
Common signs and symptoms of spinal osteoarthritis include:
- Back popping or crunching: Feeling a crunching or hearing a popping sound when bending or arching the back are signs that cartilage may have worn away and is not protecting the facet joints from friction.
- Back pain: Arthritis-related back pain depends on many variables, including how much joint degeneration has occurred and where it has developed on the spine. People with arthritis in the lumbar spine (lower back) often have pain in the lower back as well as the buttocks, groin, and back of the thigh.
- Back stiffness: Bone friction and swelling in the facet joints may make the spine stiff and less flexible, particularly after sleeping or sitting for a long period of time. Some people notice it is difficult to maintain good posture.
- Tingling, numbness, or weakness in limbs: Osteoarthritis can stimulate muscle spasms, the growth of bone spurs, or other degenerative changes that cause the spinal cord or its nerve roots to become compressed. When the spinal cord or a nerve root is squeezed, the entire area it travels to can be affected. This is called spinal stenosis. Lumbar spinal stenosis occurs in the lower back. A person may experience tingling, weakness, or numbness that radiates from the low back into the buttocks, thighs, or groin.
- Swelling: When the cartilage of the facet joints wears away, the bones can rub together, resulting in irritation and swelling. This swelling can be mild and go undetected by patients.
In most but not all cases, the symptoms of spinal osteoarthritis come and go, becoming worse and more frequent over months or years. Early recognition of symptoms and appropriate treatment can dramatically slow or eliminate progression of osteoarthritis symptoms.
How Is Osteoarthritis Diagnosed?
The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, and loss of motion involving the neck or lower back. If symptoms are suggestive, signs of nerve involvement may include weakness, reflex changes, or loss of sensation. A Magnetic resonance imaging (MRI) to show possible damage to discs may also be necessary.
The most effective step toward controlling the symptoms of osteoarthritis is obtaining an early diagnosis and starting treatment as soon as possible. Non-surgical treatments are often sufficient for the management of physical symptoms and the preservation of daily functioning.
Osteoarthritis treatment programs typically include a combination of medication and exercise therapy.
- Physical therapy. Physical therapy provides targeted exercises that help maintain the ability to perform everyday tasks such as walking, bathing, and dressing. Although rest is an important part of the healing process, it is important to keep up with moderate levels of activity to strengthen the muscles surrounding the damaged joint. Stronger muscles provide greater stability for the joint, which in turn helps reduce stress on the joint.
- Steroid injections. These are often performed if pain is moderate to severe and especially if the pain symptoms limit the patient’s ability to participate with exercises. When combined with physical therapy, steroid injections can offer a very important “window of opportunity” during which the patient may more fully participate with therapy because the pain is resolved or at least better controlled. By allowing the patient to participate with therapy, the patient may stretch and strengthen important muscles around the affected joint(s) and thereby decrease the load experienced by the joint(s) so that the inflammation and pain do not return.
- Regenerative medicine. Osteoarthritis is associated with the degeneration of the cartilage. Regenerative medicine can potentially reverse the cartilage degeneration, leading the patient back to full health. Treatments such as Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy may be good options for healing damaged tissue.
Popping or cracking noises in the lower back are very common and can often heal itself over time. However, if pain is involved then it may be necessary to see a doctor. Some conditions that cause crepitus can be benign, but it is best to rule out a more serious condition such as osteoarthritis. With the right attention and treatment, the underlying back issue can be addressed.