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.

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.

What is an Athletic Trainer

While both are casually referred to as “trainers”, personal trainer and athletic trainers are two very different roles. Personal trainers generally work in gyms and health clubs, helping the general public improve their level of fitness; Athletic trainers are most often found at colleges, hospitals, clinics and with professional sporting or performance organizations, helping patients or athletes recuperate from injuries and safely continue to participate in sports and physically demanding professions. Below, we’ll dive into the two professions in greater detail:

Personal Trainers

Personal trainers evaluate a person’s fitness level and then design with an exercise program to improve the individual’s health, cardiovascular endurance and body composition. They teach clients how to perform exercises properly, while creating an atmosphere of accountability. Personal trainers with additional credentialing can also education clients on how to live a healthier lifestyle, coaching them on nutrition basics and recovery strategies.

While there is no governing body for personal training, it’s highly recommended to select a personal trainer who has completed a certification program; there are several institutions that offer certifications in personal training, including the American Council on Exercise (ACE) and the National Academy of Sports Medicine (NASM). However, some people may prefer to work with a coach who has learned personal experience in fitness such as a former athlete, rather than someone who has completed a certification program. In any arrangement, it is important to start smart-

1. Check with your doctor before beginning a new fitness program

2. Opt for simple movement patterns at low to moderate weights while you are still learning to limit your risk of injury

3. Stay hydrated and take rest breaks as needed

4. Stop exercising if you feel dizzy, lightheaded, nauseated, experience chest pain, or have an unexpectedly difficult time breathing

5. Don’t do anything you’re not comfortable with

Athletic Trainers

Athletic trainers are clinicians who provide injury preventative services, emergency care, clinical diagnosis of injuries, therapeutic intervention and rehabilitation of both injuries and medical conditions. Athletic training is recognized by the American Medical Association (AMA), Health Resources Services Administration (HRSA) and the Department of Health and Human Services (HHS) as an allied health care profession. As a part of the healthcare system, athletic trainers work under the direction of a physician, and work collaboratively with physical therapists, massage therapists, and chiropractors. As part of an athletic department, they partner with the coaching and strength and conditioning staff, as well as nutrition and sport psychology teams to promote the overall health of the athlete.

Athletic trainers undergo rigorous academic and clinical training, supervised by the Commission on Accreditation of Athletic Training Education (CAATE). The current minimum entry point into the profession of athletic training is at the master’s level. Upon completion of a CAATE-accredited athletic training education program, students become eligible for national certification by successfully completing the Board of Certification, Inc. (BOC) examination. Once certified, athletic trainers are required to complete several hours of continuing education every year in an effort to ensure all professions remain current on the latest recommendations within sports medicine.

Comprehensive Care

There’s not a lot of crossover between the two occupations. This isn’t to say the roles can’t go hand in hand. After working with an athletic trainer to rehabilitate a sprained ankle, for example, an athlete may choose to enlist the help of a personal trainer to return his strength and endurance to the levels they were before the injury.

Physical TheraPT is a multi-faceted clinic, centered on patient success. By placing the individual at the hub of the system, instead of siloing by speciality, we’re able to streamline a truly comprehensive recovery. Our athletes are able to seamlessly work with the professionals they need- physical therapists, athletic trainers, massage therapists, and strength coaches- all in one place. Our athletic trainer offers:

• Urgent Injury Assessment: Streamline your recovery by seeing an athletic trainer first. With extensive orthopedic education, athletic trainers are able to quickly determine the severity of an injury, determine next-steps and make referrals to local physicians, and provide you with home care instructions

• Rehab: Apply the same proven approaches used with elite athletes to your unique situation and goals. Our expertise includes post-operative rehab, as well as rehab for both chronic and acute injuries and conditions.

• Return-to-Play Training: We offer evidence-based programs, utilizing technology like force plates, dynamometer testing, blood flow restriction training (BFR), biofeedback and motion analysis to formulate your plan. Following a comprehensive evaluation, we can problem-solve with you to optimize your movement potential.

• Injury Prevention: By using similar tools as detailed above, we are able to assess athletes and individuals before an injury occurs. Underlying movement compensations and imbalances are often evident even in healthy athletes. By prescribing corrective exercise strategies, and customized strength and conditioning programming, these vulernabilities can be targeted.

To learn more, check out these resources:

1. American Counsel on Exercise

2. National Athletic Trainers’ Association

3. National Academy of Sports Medicine

4. CT.gov

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Reactive vs Proactive Athletic Wellness

Depending on where you are in the country, preseason is underway for fall sports. No matter what level, most teams require some form of pre-participation exam. These annual appointments are designed “to screen for injuries or medical conditions that may place an athlete at risk for safe participation."¹ Regrettably, there is not a standardized exam in the US, resulting in a wide range of effectiveness. The National Athletic Trainers' Association Position Statement includes the following guidelines for designing an exam:

• Medical and Family Health History

• General Health Screening

• Cardiovascular Screening

• Neurological Screening

• Orthopedic Screening

• General Medical Screening

• Review of Medication Use

• Nutrition Assessment

• Heat- and Hydration-Related Illness Risk Factors

Considering all the areas assessed, it is important a medical physician (MDs or DOs) supervise these exams. Missing from that list however, is a Functional Movement Assessment. Both ATCs and PTs can be instrumental in helping you establish an athletic baseline.²

By evaluating basic movement patterns, any strength imbalances or compensatory strategies can quickly be identified. Check out our instagram post on the functional assessment I used with the Warriors Dance Team for the 2021-2022 preseason screens!

Your provider can review any significant findings with you, helping you understand how they may be impacting your performance. But if the findings from your assessment don’t correspond with pain, should you still address them?

Short answer: It depends. 

As clinicians, it is important to take the whole athlete and their goals into account. Understanding the demands of the sport and the anticipated load throughout the season is one piece of the puzzle. A rising high school freshman basketball player with lower extremity strength imbalance may have been fine playing at the middle school level 3-4 times per week. However, once introduced to the demands of a varsity squad- weight lifting, practices 5 times a week, and a heavier competition schedule- may no longer thrive. It is reasonable to anticipate that they will begin to experience lower extremity joint pain at some point during the season. By providing them a short home exercise protocol that addresses the imbalance, they may be able to avoid the scenario altogether.

A semi-professional golfer will expectedly present with a strength imbalance dominant to non-dominant side rotation due to the demands of their sport. Assuming their regular strength and conditioning includes bilateral rotational power and deceleration work, minimal changes may need to be made.

Ultimately, we believe that sports medicine should be proactive not reactive. While it is impossible to avoid injury in sports entirely, athletes can train more effectively based on their individual strengths and demands.

To learn more, check out these articles:

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clin J Sport Med 2004; 14(3):109-122.

2. Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training 2014;49(1):102–120.

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Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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