Crepitus: The Truth About Noisy Joints

Ever hear a pop when you squat, a crack when you roll your neck, or a grind when you climb stairs? That’s crepitus — the medical term for the noises or sensations that sometimes come from your joints.

Crepitus is common, and in most cases, it’s nothing to worry about. But sometimes, it can signal that your joint mechanics aren’t working as smoothly as they should. Let’s break down why it happens, when it’s normal, and when it may be worth a closer look.

What Exactly Is Crepitus?

Crepitus refers to the popping, cracking, grating, or crunching sounds (or sensations) that occur during joint movement. It can show up in many areas of the body, including the knees, shoulders, hips, spine, and even the jaw.

It’s not a condition by itself, but more of a sign that something is happening in or around the joint. A lot of times, that “something” is completely benign. Other times, it’s a clue that the joint is under stress (Drum et al., 2023).

Why Do Joints Make Noise?

There are several reasons joints produce crepitus, most of which are harmless:

• Gas bubble formation (cavitation): Joints are lubricated by synovial fluid. When pressure inside the joint changes quickly, gas can form or collapse in the fluid, creating a distinct popping sound (Kawchuk et al., 2015; Fryer et al., 2017).

• Tendons or ligaments snapping over bone: Soft tissues sometimes shift slightly during movement and then snap back into place, creating a click.

• Surface changes in cartilage: If the smooth joint surfaces become uneven (such as in arthritis), movement can cause grinding or crackling noises.

• Internal tissue catching: Soft tissue folds inside the joint, such as plica or meniscal edges, can occasionally cause popping or clicking (Drum et al., 2023).
  
  

How Common Is Crepitus?

You’re not alone if your joints make noise — crepitus is widespread, even in healthy people.

• About 41% of knees in the general population show crepitus.

• Even among people with no knee pain, roughly one-third still experience it.

• In individuals with osteoarthritis, the numbers are higher — up to 81% report crepitus (Couch et al., 2025).

The takeaway? Joint noise is very common, and by itself, it doesn’t necessarily mean damage.

When Crepitus Is Harmless

Most of the time, crepitus is simply a mechanical quirk of how your joints move. It’s usually not a concern if:

• The noise occurs without pain.

• There’s no swelling, stiffness, or loss of motion.

• It hasn’t been getting worse over time.

In these cases, there’s no reason to avoid movement — in fact, staying active can keep your joints healthier.

When Crepitus Might Signal a Problem

Crepitus deserves more attention when it’s paired with other symptoms. You may want to consult a physical therapist or physician if you notice:

• Pain with movement or weight-bearing

• Swelling, warmth, or stiffness in the joint

• Locking, catching, or instability

• Persistent or worsening grinding

• Loss of function or activity limitations

In some cases, more intense crepitus has been linked with weaker surrounding muscles (like the quadriceps in the knee). This muscle imbalance can place more stress on the joint, making symptoms worse (Jakovacz et al., 2024).

Importantly, while crepitus is more common in people with osteoarthritis, studies show that crepitus alone does not reliably predict disease progression or need for joint replacement (Pazzinatto et al., 2018).

What You Can Do About Crepitus

If your crepitus is painless:

• Keep moving. Regular activity nourishes cartilage and prevents stiffness.

• Strengthen muscles. For example, strong quadriceps and hamstrings help reduce stress on the knee.

• Stretch and mobilize. Increased flexibility can improve tendon and ligament function.
  
  
  

Simple Tools to Keep Your Joints Moving Smoothly

Crepitus can often be eased with tools that promote muscle relaxation and joint mobility. The Hypervolt massage gun with its heated attachment helps improve circulation, reduce muscle tension, and warm up tissues around the joints. Pairing it with gentle movements using an exercise ball encourages controlled mobility and improved joint function.

If your crepitus is painful or comes with swelling or dysfunction:

• Check in with a physical therapist. They can identify whether the crepitus is harmless or potentially linked to a condition like arthritis, tendon overload, or a fibrocartilage injury (meniscus, labrum).

• Follow a guided plan. Targeted exercises, joint protection strategies, and activity modifications can help reduce pain and restore confidence in movement.

Bottom Line

Joint noise by itself, even if it sounds dramatic, is usually nothing to worry about. But if crepitus shows up alongside pain, swelling, or loss of function, it’s your body’s way of telling you to pay closer attention.

The good news? Most causes of crepitus respond well to exercise, physical therapy, and healthy movement habits. So the next time your joints crack, remember: noise without pain is normal; noise with pain deserves attention.

References

• Couch, T. A., Hall, M., Hussain, S. M., Teichtahl, A. J., Wluka, A. E., & Wang, Y. (2025). Knee crepitus: A systematic review of prevalence, incidence, and associations with knee osteoarthritis. Osteoarthritis and Cartilage Open, 7(1), 100471.

• Drum, E. E., Jauregui, J. J., Probasco, S. K., et al. (2023). Knee crepitus: Current evidence and clinical relevance. Musculoskeletal Care, 21(3), 442–449.

• Fryer, G., Pearce, A. J., & Herbert, J. J. (2017). Cavitation onset in the metacarpophalangeal joint: A physiological explanation of joint cracking. PLoS ONE, 12(4), e0174190.

• Jakovacz, N., Mészáros, Z., & Farkas, J. (2024). Relationship between knee crepitus intensity and quadriceps muscle thickness. Manual Therapy, 66, 107102.

• Kawchuk, G. N., Fryer, J., Jaremko, J. L., Zeng, H., Rowe, L., & Thompson, R. (2015). Real-time visualization of joint cavitation. PLoS ONE, 10(4), e0119470.

• Pazzinatto, M. F., de Oliveira Silva, D., Azevedo, F. M., & Barton, C. J. (2018). Association between crepitus and progression of knee osteoarthritis: A longitudinal cohort study. Arthritis Care & Research, 70(3), 420–427.

Massage Vs. Physical Therapy: Choosing The Right Path

If you've ever pulled a muscle, twisted your knee, or found yourself dealing with persistent aches and pains, you might have wondered: Should I go see a massage therapist or book an appointment with a physical therapist?

It’s a common question—and a good one. While both massage and physical therapy (PT) are both key for treating pain and promoting recovery, they also serve different purposes and are often most effective when used together.

Let’s explore how each one works, when to choose one over the other, and why the smartest choice might be both.

Massage Therapy: A First Line of Care

Massage therapy is often a great place to start after an injury or when you're experiencing pain, tension, or swelling. Think of it as the “first responder” for soft tissue issues—like muscle strains, tension headaches, or post-exercise soreness.

Massage therapy works by:

• Reducing pain and muscle guarding through stimulation of pressure receptors and pain-modulating pathways (Moraska et al., 2021).

• Decreasing swelling by improving lymphatic flow and local circulation.

• Increasing blood flow to promote tissue healing and deliver nutrients to damaged areas.

• Improving tissue quality, including flexibility and pliability of muscles and fascia.
  

This makes massage especially useful in the acute phase of healing—when inflammation is high, movement is painful, and the goal is simply to help the body settle and start repairing itself.

In many ways, massage prepares the body for what comes next: more active rehabilitation.

Massage also activates the parasympathetic nervous system, promoting relaxation and reducing the body's stress response—an often-overlooked but critical part of healing (Field, 2014). This calming effect can make it easier for patients to move, breathe, and rest, all of which are essential for recovery.

Physical Therapy: Building Long-Term Resilience

While massage is excellent for reducing symptoms, physical therapy focuses on correcting the underlying root causes of pain and dysfunction. Working with a PT becomes especially important when you’re ready to restore movement, rebuild strength, and prevent the problem from coming back.

Physical therapists are trained to:

• Perform functional and sport-specific movement analysis to identify dysfunctions or imbalances.

• Restore mobility and function through manual therapy to optimize biomechanics and movement.

• Strengthen weak or inhibited muscles that may be contributing to pain or poor alignment and limited function.

• Improve proprioception, which is your body's awareness of where it is in space—a crucial skill after injury or surgery (Han et al., 2016).

• Develop and implement customized exercise plans to retrain the body and improve athletic capacity.
  

While physical therapists utilize manual therapy techniques and modalities to treat swelling and pain, their primary goal is long-term functional recovery and return to sport. That means helping you move better—not just feel better.

PT helps you build the strength and coordination to stay healthy, not just get healthy.

For example, if you’ve sprained your ankle, massage may help with the initial swelling and stiffness. But PT will help you restore your balance, retrain your gait, and strengthen your ankle to reduce the chance of reinjury.

Better Together: How Massage and PT Complement Each Other

Rather than choosing between massage and physical therapy, the real secret is knowing how they work in tandem.

Massage can:

• Relax tight muscles before a PT session, allowing for better movement.

• Help reduce soreness and inflammation after exercise or manual therapy.

• Improve tissue extensibility, making stretching and strengthening more effective.
  

Physical therapy can:

• Address the biomechanical issues causing pain or tightness in the first place.

• Reinforce the gains made through massage with strengthening and motor control exercises.

• Guide patients through functional movements to improve long-term outcomes.
  

Research supports this complementary approach. A 2016 study found that combining manual therapy (including massage techniques) with exercise led to better outcomes for low back pain compared to either intervention alone (Wegner et al., 2013). In other words, you get more value from both when they’re used together.

Final Thoughts: Two Tools, One Goal—Your Recovery

When you're in pain or recovering from an injury, it’s easy to look for one solution. But healing is rarely a straight line—and no single approach has all the answers.

Massage therapy and physical therapy each bring unique strengths to the table. Massage helps soothe the body, reduce pain, and restore tissue health. Physical therapy helps correct movement, build strength, and prevent future problems.

Used together, they offer a more complete path to healing. So if you’re wondering whether to book that massage or start PT, the answer might be: both—at the right time, in the right order, and with the right goals.

References

• Field, T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice, 20(4), 224–229.

• Han, J., Waddington, G., Adams, R., Anson, J., & Liu, Y. (2016). Assessing proprioception: A critical review of methods. Journal of Sport and Health Science, 5(1), 80–90.

• Moraska, A. F., Chandler, C., Edmiston-Schaetzel, A., Franklin, G., Calenda, E. L., & Rice, K. (2021). Massage therapy for pain and function in patients with chronic low back pain: A systematic review and meta-analysis. Pain Medicine, 22(4), 842–854.

• Wegner, A., Widyahening, I. S., van Tulder, M. W., Blomberg, S., de Vet, H. C. W., & Brønfort, G. (2013). Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews, (8).

The Science of Stretching

Stretching has been a go-to practice for athletes, fitness enthusiasts, and physical therapy patients alike. But what’s really happening inside your body when you stretch? More importantly, is stretching as beneficial as we’ve been told?

For years, the idea was simple: stretch to improve flexibility, prevent injuries, and enhance performance. However, modern research paints a more nuanced picture. While stretching does have benefits, how, when, and why you stretch matters. In this post, we’ll explore the science behind stretching, the differences between dynamic and static stretching, and how to make your stretching routine more effective.

What Happens at the Cellular Level?

When you stretch, your muscles don’t just "loosen up"—a series of complex physiological reactions occur at the cellular level.

1. Muscle Fibers and Fascia Adapt

Muscle fibers (sarcomeres) temporarily elongate during stretching, but lasting flexibility gains occur when connective tissues, like fascia, gradually adapt over time. This aligns with Davis’s law, which states that soft tissues remodel in response to consistent mechanical stress. Research also shows that fascia is dynamic and can adapt to mechanical forces, influencing long-term flexibility (Schleip et al., 2019).

2. Neuromuscular Inhibition (Stretch Reflex)

The stretch reflex protects muscles from overstretching by triggering a contraction when a muscle is rapidly lengthened. However, consistent stretching can reduce this reflex's excitability, allowing for greater flexibility. A study found that repeated stretching, especially when muscles remain relaxed, can attenuate stretch reflex activity, supporting the idea that long-term stretching helps muscles tolerate greater lengthening without resistance (Ogawa et al., 2022).

3. Increased Blood Flow and Tissue Elasticity

Stretching improves blood circulation, which brings oxygen and nutrients to the muscles. This can enhance recovery, reduce muscle stiffness, and even contribute to long-term joint health.

Has Science Proven That Stretching is Beneficial?

Yes and no. While stretching can improve flexibility, studies show that static stretching before exercise doesn’t significantly reduce injury risk or enhance performance (Behm et al., 2016). However, dynamic stretching and long-term flexibility training have been shown to improve range of motion, recovery, and even reduce chronic pain when done correctly (Oppert & Babault, 2018).

Dynamic vs. Static Stretching: How to Use Each Effectively

Not all stretching is created equal. The type of stretching you do should match your goal:

Dynamic Stretching:
Best Before Activity

Dynamic stretching involves active movements that take your joints through their full range of motion. Instead of holding a stretch, you move fluidly through it—mimicking the movements you’re about to perform.

Benefits:

• Increases blood flow and muscle temperature

• Activates the nervous system for movement

• Improves range of motion without reducing muscle power

EXAMPLES:

• Leg Swings – Swing your leg forward and backward to activate hip flexors and hamstrings.

• Lunges with a Twist – Engage core, hips, and spine before running or sports.

• Arm Circles – Increase mobility in the shoulders before upper-body activities.

Bottom Line: Use dynamic stretching before workouts to prepare your muscles for activity without reducing power output.

Static Stretching:
Best After Activity

Static stretching involves holding a position for an extended period (15–60 seconds), allowing muscles to relax and lengthen.

Benefits:

• Improves long-term flexibility

• Helps muscles recover and reduces post-exercise stiffness

• Promotes relaxation and stress relief

EXAMPLES:

• Hamstring Stretch – While lying on your back, use a strap to anchor around your foot and pull your leg up towards the ceiling, feeling a stretch in the back of your leg

• Chest Opener – While sitting, clasp hands behind your head and open your chest to counteract hunching, opening your elbows out and away from you

• Quad Stretch – While standing, grab one ankle behind you to stretch the front of your thigh.

Bottom Line: Use static stretching after workouts or as part of a flexibility routine to improve long-term mobility.

When to Stretch
(And When Not To)

When You Should Stretch:

✔ Before a workout? – Yes, but only dynamic stretching.
✔ After a workout? – Yes, static stretching can aid in recovery.
✔ To improve flexibility? – Yes, but hold stretches for 15-60 seconds & perform them regularly.
✔ To address muscle imbalances? – Yes, targeted stretching can help correct asymmetries.

When You Should Avoid Stretching:

❌ When muscles are cold – Jumping into static stretching without warming up can lead to injury.
❌ If you're experiencing sharp pain – Stretching shouldn’t cause pain; if it does, you may have an underlying issue.
❌ If you suspect a sprain or strain – these types of injuries involve the tearing of ligaments or muscles/tendons, respectively (sometimes these tears are minimal). If there’s any torn tissue, stretching is not advised
❌ When you have a history of dislocation or subluxation – joints that are likely to pop out of place are not suited for stretching

TOOLS FOR OPTIMIZING YOUR STRETCHING ROUTINE

A stretching strap promotes better alignment and controlled muscle lengthening, while a yoga mat provides joint support and stability—both enhancing safety and effectiveness through improved biomechanics.

Addressing Muscle Imbalances: Focusing on the Tighter Side

If you notice one side of your body is significantly tighter than the other, this could indicate:

• An imbalance in muscle strength

• A previous injury that caused compensatory patterns

• Postural habits affecting mobility

How to Fix It:

• During warmups, spend extra time dynamically stretching the tighter side.

• During cooldowns, hold static stretches longer on the less flexible side.

• If asymmetry persists, consider working with a physical therapist to address underlying issues.

Conclusion: Smarter Stretching for Better Movement

Stretching isn’t just about flexibility—it’s about training your nervous system and connective tissues to function optimally. Keep in mind that your body needs time to adapt to a new stretching routine, so start slow and don’t stretch more than once a day.

Here’s what to remember:

✔ Dynamic stretching before workouts prepares muscles for movement.
✔ Static stretching after workouts improves flexibility and recovery.
✔ Stretching should be intentional—focusing on imbalances and avoiding overdoing it.
✔ Flexibility is a long-term process—consistency is key.

Rather than mindlessly holding stretches, use stretching as a tool to enhance movement, prevent injury, and improve overall mobility. If you’re struggling with flexibility issues, a structured stretching routine (or a visit to a physical therapist) could make all the difference.

References

• Schleip, R., Gabbiani, G., Wilke, J., Naylor, I. L., Hinz, B., Zorn, A., Jäger, H., & Klingler, W. (2019). Fascia is able to actively contract and may thereby influence musculoskeletal dynamics: A histochemical and mechanographic investigation. Frontiers in Physiology, 10, 336.

• Ogawa, Y., Hasegawa, N., Nakazawa, K., Akai, M., & Murayama, M. (2022). Effect of repeated fast stretches on stretch reflex excitability in individuals post-stroke. Frontiers in Neurology, 13, 764650.

• Behm, D. G., Blazevich, A. J., Kay, A. D., & McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Applied Physiology, Nutrition, and Metabolism, 41(1), 1–11.

• Opplert, J., & Babault, N. (2018). Acute effects of dynamic stretching on muscle flexibility and performance: An analysis of the current literature. Sports Medicine, 48(2), 299–325.

Maintaining Cardiovascular Fitness with an Overuse Injury

Clinicians often recommend limiting time and intensity of workouts to allow for greater recovery time, decreased tissue stress and improved healing. By overloading a injured area either too soon, or too often, the athlete can see regressions in function, pain and dysfunctional mechanics. Yet, for the avid athlete, being told to decrease workout volume can feel disorienting. Aqua jogging can be a safe alternative for many athletes in this predicament, including those recovering from:

• Stress-related bone injuries: stress response, stress reaction or stress fracture

• Tendinopathies of the leg, including gluteal, hamstring and achilles tendinopathy

• Surgical repair of a major injury, including FAI, labral, ACL or a meniscus repair

Aqua jogging can also be a great accessory workout for those with a very high training volume to allow for a effective cardio workout at a decreased level of impact. For many, access to a pool is more convenient than an anti-gravity treadmill! By adding a reduced load workout to your routine, you can decrease your risk of injury.

In all cases, talk to your medical team to ensure you are ready to begin an aquatic rehab program.

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Pro tips for a successful aqua jogging workout:

1) Choose the right equipment

Wear a minimally buoyant belt to allow for moderate challenge throughout your workout. Avoid ones that are bulky, ill-fitting or feel like an inner tube. Click the images below to view our recommendations.

2) It’s aqua jogging, not swimming

Stay upright, keeping your hips under your shoulders. Resist the urge to go horizontal as with swimming; this will be less effective when wearing a floatation belt.

3) You’re in water, not on land

Don't focus on moving forward, as this will happen naturally. Instead, pay attention to the level of effort you’re exerting, regardless of how quickly you traverse the pool. 

4) Adjust your training volume to match

When cross-training specifically for distance running, a general rule of thumb is that you need to do 50% more in the pool to get the same cardio benefit as running on land. In other words, 45 minutes in the pool = 30 minutes of running.

To increase the challenge:

Intervals, intervals, intervals!

Just like with non-water workouts, varying the speed and intensity of your effort in waves can provide increased benefits. Using a timer or landmarks within the pool, challenge yourself to pick up the pace for a measurable interval. Based on your overall health, choose an appropriate recovery window. This can be time-based, for example resting the same, twice as much or half as much time it took you complete the challenging interval, or it can be biometrical, waiting for your heart rate to return to its pre-interval baseline.

Get a resistance band.

Select a band like this one and attach yourself to the wall, you can do "sprints" by creating more resistance than the water naturally provides.

Resistance bands can also be used if the pool is not deep enough throughout to do laps, you can do a stationary workout with this band by anchoring yourself to the wall or pool deck.

Remove the belt!

We recommend waiting until you feel confident with aqua jogging form is before taking this step. Taking it off too soon, even if you are a proficient swimming, will impact the overall quality of your workout.

Understanding the Role of Myofascial Decompression in Sports Rehab

Cupping massage, an ancient practice rooted in traditional Chinese medicine, has grown in popularity for its potential health benefits. In this therapy, suction cups are applied to the skin to create a vacuum, which pulls skin and underlying tissue upward. In western medicine, this technique is more commonly referred to as myofascial decompression. In both systems, similar tools are used- cups can be made of glass, plastic, or silicone and can be applied to the skin in a variety of strategies. The technique is often used to promote blood flow, relieve pain, and support recovery from muscle tension or injury.

If you haven’t experienced this technique first-hand, you may be wondering: what are the distinctive marks left by cupping, what does science reveal about one of its most frequently touted benefits, and is this right for me? Let’s dive into the details!

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Myth #1: Cupping Marks aren’t Bruises

The short answer: Yes, actually they are.

Many sources try to claim that cupping marks are not bruises. Most notably, they will cite that bruises are defined as both painful and a result of blunt force—two characteristics that are notably lacking in cupping application. But these flat-out denials seem to conflate the definitions of bruise and contusion.

For starters, bruise is mostly synonymous with a medical term: ecchymosis. Ecchymosis can be defined simply as bleeding under the skin due to broken capillaries. Whether these tiny blood vessels leak due to blunt force or suction is irrelevant, as the end result is the same. On the other hand, contusion is most commonly defined as ecchymosis due to blunt force, usually accompanied by pain and damage to underlying tissue.

As the purplish mark left behind by cupping therapy is a result of broken capillaries, this mark is technically a bruise. However, since the mode of achieving this bruise is suction instead of blunt force trauma, a cupping mark is not a contusion.

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Myth #2: Creating damage actually helps healing

While the idea of intentionally breaking capillaries might sound counterintuitive, it can have a therapeutic effect. Cupping increases blood flow to the area, triggering the body’s inflammatory response—a natural healing mechanism.

Studies suggest that cupping may stimulate the release of cytokines and other inflammatory mediators, which help repair tissues and reduce pain (Kim et al., 2018). Moreover, the pooling of blood and interstitial fluid under the skin can encourage lymphatic drainage and reduce swelling, further promoting recovery (Al-Bedah et al., 2019).

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Myth #3: Cupping releases Toxins

One of the most debated claims about cupping is whether it helps the body detoxify. To better understand the evidence, it’s important to first distinguish between wet and dry cupping. Wet cupping, an ancient form of bloodletting, involves making small incisions on the skin to draw out blood. This practice is NOT common in the United States and is not part of treatment offered at Physical TheraPT. In contrast, the more widely practiced dry cupping involves applying suction cups to unbroken skin.

Some studies suggest that wet cupping may help lower levels of uric acid and cholesterol in the body (Sutriyono et al., 2014). Current research has not shown a significant connection between dry cupping and toxin removal. The enduring association between cupping and detoxification may be attributed to the specific effects of wet cupping rather than the dry cupping methods commonly used today.

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The Takeaway

Despite the lack of evidence for the detoxifying effects of dry cupping, other benefits of this modality tend to be a larger focus in physical therapy. The lifting of the skin due to suction draws blood into the area, bringing oxygen and nutrients to tissues. The mechanical stretching and lifting of the skin can help to release fascia, also known as myofascial decompression, helping to release tension surrounding muscles. And, while cupping does cause microscopic injury, targeted application of it can help us bring your body’s attention to the areas that need extra care by jump-starting the inflammatory process.

If you’re considering cupping, talk to your practitioner to see how it can fit into your recovery or wellness plan.

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To learn more, check out these resources:

Al-Bedah, A. M., Elsubai, I. S., Qureshi, N. A., et al. (2019). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine, 9(2), 90–97.

Kim, J., Lee, H., & Lee, M. (2018). Effects of cupping therapy on chronic back pain: A systematic review and meta-analysis. Complementary Therapies in Medicine, 41, 129–137.

Sutriyono, S., Robbina, M. R., & Ndii, M. Z. (2019). The effects of wet cupping therapy on blood pressure, glucose, uric acid, and total cholesterol levels. Biology, Medicine, & Natural Product Chemistry, 8(2), 33–36.