Is it bad to crack your knuckles – Update

A number of years ago i wrote a post looking into the research of whether or not there is any harm in cracking your knuckles.  An update on the subject is needed since knowledge can change over 6 years.

Chronic Cracking of your Knuckles and Arthritis

There isn’t much more research in chronic knuckle cracking and arthritis since I last posted. Two new papers were found during my search on this topic.

The Consequences of Habitual Knuckle Cracking (1975)

This study took 28 people who could recall whether or not they had or had not cracked their knuckles when they were younger. X-rays were taken of the hand. 28 school children were surveyed to determine the prevalence of knuckle cracking in children. One of the 15 knuckle crackers had radiographic signs of arthritis where as 5 of the 13 non-knuckle crackers had signs of arthritis. “The chief morbid consequence of knuckle cracking would appear to be its annoying effect on the observer.”

Effect of habitual knuckle cracking on hand function (1990)

This study took 300 people 74 of which were admitted knuckle crackers (amount of cracking per day was not indicated) for 18 to 60 years and 226 non-knuckle crackers. Six-four (64%) percent of knuckle crackers had an increase in hand swelling where as 5.75% had hand swelling (this was statistically significant). Comparing grip strength, the habitual knuckle crackers’ strength was significantly less than the non-knuckle crackers ( 210 (50) mmHg v 280 mmHg). The knuckle crackers were also more often manual labourers with higher incomes who frequently smoked, drank alcohol, and bit their nails. The signs of osteoarthritis (Heberden and Bouchard’s nodes) were similar between the groups.

Knuckle Cracking and Hand Osteoarthritis (2011)

In this study the authors sent out questionnaires to 319 participants. The questionnaires asked which fingers were cracked, how frequently, for how many years they cracked their knuckles, if there were any other risk factors for osteoarthritis and if they worked in manual labour for over 5 years. They received 215 surveys. Based on these questionnaires they determined there were no differences between controls and those with osteoarthritis based on number of years they cracked their knuckles, the frequency of cracking or working manual labour. They concluded, that there is no association between knuckle cracking and the prevalence of osteoarthritis of the hand.

“Knuckle Cracking”: Can Blinded Observers Detect Changes with Physical Examination and Sonography? (2017)

When compared with subjects who are not habitual knuckle crackers, do habitual knuckle crackers have greater QuickDASH scores (a questionnaire for disability of the arm, shoulder and hand), swelling, weakness, joint laxity, or range of motion? The authors found there are no differences in QuickDASH scores, laxity and grip strength Range of motion comparisons between subjects with a history of habitual knuckle cracking versus subjects without such a history only yielded increased ROM in joints that cracked during manipulation.

Effects of habitual knuckle cracking on metacarpal cartilage thickness and grip strength (2017)

Thirty-five habitual knuckle crackers (cracking their joints ≥5 times/day) Cartilage thickness was measured with ultrasound and grip strength was measured. Grip strength was similar between groups Habitual knuckle crackers had thicker cartilage. Increased thickness may be an indication of edema of the cartilage which may be an early stage of OA.

Download the in depth summary  on knuckle cracking from the link below.

Dr Notley – Does Cracking your Knuckles Lead to Arthritis

Conclusion

The evidence hasn’t changed much. Currently there is no difference in the degree of arthritis and being a chronic knuckle cracker. Cartilage damage could be occurring in those who chronically crack their knuckles but more research is needed.

 

Breathing problems and lower back pain: Systematic Review

If you have ever been to my office you will have been given exercises to help out with whatever ails you. For low back sufferers, breathing exercises are given. Recently, I was curious to see what kind of connection there was between breathing and lower back pain. I discovered this paper, The presence of respiratory disorders in individuals with low back pain: A systematic review. This review discovered that there is an association between having back pain and having a respiratory disorder such as difficulty breathing (dyspnea), asthma, some allergies and respiratory infections.

Explanations, by the authors for the association of breathing problems and back pain

  1. Pro-inflammatory effects of allergies and asthma
  2. Altered breathing patterns may weaken the diaphragm or alter its activity. Altered diaphragm activity has been associated with back pain.
  3. Having a breathing problem can result in enhanced anxiety, stress and hyper-vigilance towards bodily sensations. Also, pain and difficulty breathing share the same emotion-related place in the brain.
  4. Socio-economic reasons.

 

Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache

If you have headaches then spinal manipulation or chiropractic adjustments can be an appropriate form of treatment for you.  In the following research paper you will see that spinal manipulation was more effective for reducing headaches than mobilization.  You should also note that a long course of treatment was not necessary.  Six to eight visits were performed to show significant effects.Dr Notley - upper cervical thoracic manipulation and headaches

Exercises were not performed by those who received manipulation. You should note that there are other papers that indicate that manipulation and exercise is more effective than with manipulation alone.

Here is the abstract. You can find the full version through the link.

Source: Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized c… – PubMed – NCBI

BACKGROUND:

Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.

METHODS:

One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.

RESULTS:

The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).

CONCLUSIONS:

Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.

 

Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. – PubMed – NCBI

Dr Notley DC and Dose response Chronic lower back pain-

 

I strive to treat my patients effectively.  Sometimes I feel as though I may under treat my patients.  In my experience, 6 to 8 visits is a reasonable amount of time to see improvements in a person’s condition.  Based on the following study, at least for chronic lower back pain, 12 visits seems to be reasonable about number of visits.

Source: Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. – PubMed – NCBI

BACKGROUND CONTEXT:

There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation.

PURPOSE:

To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control.

STUDY DESIGN/SETTING:

Practice-based randomized controlled trial.

PATIENT SAMPLE:

Four hundred participants with cLBP.

OUTCOME MEASURES:

The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status.

METHODS:

One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks.

RESULTS:

For the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025).

CONCLUSIONS:

The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.