Many of us creek and crack, with some of us even describing ourselves as “crispy.” Most of these are simply caused by slight wear and tear on the joints, bones, muscles and ligaments and is nothing to worry about. While uncomfortable and while it sounds very weird to click with certain movements, it is not life threatening, nor does it mean that you need to be operated on to be fitted with a new hip, knee or shoulder. However, sometimes, it can be a sign of cartilage having worn out, which can be a more serious problem. So when should you seek help, and when should you just learn to plod on?
When It’s Osteoarthritis
One problem that is caused by worn cartilage is osteoarthritis. In most cases, this is coupled with severe pain that gets worse over time. One location where some people get osteoarthritis is in the elbow.
Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is damaged or becomes worn. This can happen because of a previous injury such as elbow dislocation or fracture. It may also be the result of degeneration of the joint cartilage from age.
While the elbow is one of the rarer places to get osteoarthritis, it does happen and it is incredibly uncomfortable, as it is in any other part of the body. In most cases, sufferers will be prescribed corticosteroid injections, or hyaluronic acid. Coupled with physiotherapy, most people find significant relief. However, in some cases, surgery may be needed, either to replace the joint or to remove some of the worn cartilage and thereby reduce the stress placed on it. Unsurprisingly, physiotherapists try to avoid this as much as possible. One of the reasons for this is that it is not a permanent solution and most people see a return of their problem a few years after surgery. What a physiotherapist will try to achieve is to retrain the muscles of the affected area, as well as the brain, so that the body can still experience the full range of motion, but using other muscles instead.
When It’s Chondromalacia
Chondromalacia is a medical condition that affects the cartilage of the knee cap.
Chondromalacia occurs when the cartilage of the knee cap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. Chondromalacia can develop if a blow to the knee cap tears off a piece of cartilage or a piece of cartilage containing a bone fragment.
As with osteoarthritis, the first possible treatment would be physiotherapy. It is very important to do this as, with chondromalacia, there is an increased likelihood of a tear in the meniscus. The size of the tear will determine how bad the injury actually is and what sort of treatment is required. However, physiotherapists hope that most people will be diagnosed with chondromalacia before a meniscus tear happens, and are offered specialized treatment. Besides regular physiotherapy exercises, electric stimulation may also be beneficial. Steroid injections are less common, although it may be used as a last resort before having to opt for surgery.
When It’s Not Osteoarthritis or Chondromalacia
Many people present to their family doctor with aches and pains, and complain about cracking and clicking noises when they move their different joints. In almost all cases, the doctor will assume that this is caused by arthritis, which really is general wear and tear and almost inevitable. However, patients are recommended to insist to have an x-ray.
On x-ray, cartilage damage is seen as narrowing of the joint space between the bones that form the joint. In the knee, loss of articular cartilage typically correlates with loss of meniscal cartilage.
Research has shown that, in many cases, patients have accepted their physician’s arthritis diagnosis without questioning this any further and they then go through the rest of their life assuming that the pain, discomfort and clicks they feel are caused by arthritis and cannot be resolved. However, the reality is that in many cases, arthritis is not the actual problem. Physicians do not have x-ray vision and they will assume someone is suffering from arthritis when they present with certain problems, when the real issue could simply be a weakness of the muscles.
Physiotherapists are coming together to try and address this common misconception. They have explained that, very often, people suffer minor injuries, often without realizing it. However, the body then tells the muscles near where the injury has occurred to overcompensate, which is how someone will not even notice the injury. Unfortunately, the brain frequently forgets to then tell the muscles to move back into normal position after the injury has healed. As a result, the different joints in the body are not actually going through the range of motion they should go through, which leads to clicking, grinding, discomfort and pain. An x-ray will clearly show whether this is the case or not. Hence, if you do receive an arthritis diagnosis, it is better to have this checked out and confirmed through an x-ray.
Joint Replacement Surgery
In some cases, joint replacement surgery is the only remaining option to resolve issues with worn cartilage. This should be avoided as much as possible due to the associated risks with the surgery and because, as previously stated, it is not always a permanent solution. Furthermore, replacing a joint often leads to significant rehabilitation. If your physician does feel that joint replacement surgery is the only remaining option, you should make sure you are fully informed as to the how and why of these procedures.
Physical therapy can begin the day after surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. If you have your shoulder joint replaced, you can usually begin exercising the same day of your surgery! A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital, your therapist will show you how to use a pulley device to help bend and extend your arm.