If your joints make cracking, popping, or grinding noise during a Thai massage, it’s not a cause for concern in itself. In most cases, these sounds occur because either air bubbles form and collapse in the joint cavity, or strained tendons and ligaments slide over the bony surfaces. When done by a professionally trained therapist, this type of joint popping is harmless and usually followed by some increase in range of motion, release of built-up tension, and a resulting feeling of satisfaction.
However, if your joint cracking is accompanied by significant pain, as well as a significant decrease in mobility, numbness, dizziness, or lightheadedness, you should ask to stop treating this area. There is likely an underlying condition affecting your bones, joints, or soft tissues, that requires medical attention.
Traditional Thai massage is known for being a little firm, compared to typical Western modalities. It involves stretching, rocking, and compressing the receiver’s body, which may be stepped on, kneed, elbowed, and placed into strenuous and constantly shifting positions. These body manipulations are particularly aimed at relieving tension in muscles and joints and improving their ability to move through a wide range of motion.
During so intense massage, the receiver’s joints often make noises that can be described as popping, clicking, snapping, catching, grinding, grating, clunking, and even “snow crunching” or “crumpling of a newspaper”. It is noted that joint noise is less apparent in young, fit, and healthy people.
When massage clients hear this noise, some of them suggest it indicates the joint adjustment where the bones move back into their proper place. Contrary to popular belief, this is not the case. Others become worried as they think it’s the sound of tissue tearing, blood vessels breaking, or a similar injury. With the rarest exceptions, this is not the case either.
Let’s cover what is actually happening in your joint when a massage practitioner twists your back or bends your leg to the extent that you hear it click or pop. A bit of anatomy to begin with.
What makes up a movable joint?
Most of the joints in the body provide a wide range of motion because they have space between adjacent bones that are filled with lubricating fluid. These are the joints of the knees, shoulders, hips, elbows, wrists, fingers, and upper neck, where flexibility is critical. The bones in such a non-rigid connection are supported by ligaments and tendons on the outside of the joint.
On the contrary, the joints of the trunk must provide more stability and less flexibility, so the bones located here – the ribs and vertebrae – are only slightly movable being connected by resilient cartilage.
In fact, each vertebra is connected to the neighboring one by three joints: the main structure, called the vertebral disc, consists of cartilaginous tissue and plays the role of a shock absorber, and the other two, called facet joints, are filled with lubricant and work as hinges. This intricate design keeps the vertebral column stable and strong while allowing it to twist, or bend to the front, back, or side.
Four reasons why joints can make noise (in order of increasing danger):
1. Air bubbles form and collapse
If a client’s joints make noise during a massage, it is most often a faint sizzling sound, similar to the sound of opening a soda can. As is known, soda water fizzes out and bubbles after opening because of the carbon dioxide gas that is dissolved in the liquid under pressure. With a sharp decrease in pressure, the liquefied gas is re-vaporized forming bursting bubbles.
Likewise, nitrogen gas is dissolved under pressure in the joint cavity fluid. If the cavity expands sharply, the pressure therein quickly drops, and the gas is also released in the form of bubbles. When the joint is stretched far enough, the pressure in the cavity falls so low that these bubbles burst, producing a sizzling sound. After some time, the bones, tendons, and ligaments return to their natural position, restoring the previous pressure in the cavity – so that in about 20-30 minutes nitrogen gas is completely dissolved in the joint fluid again.
This can happen to any movable joint in the body, but the intensity of the “boiling” process depends on the capability of the joint to stretch rapidly beyond its normal limits. The joints of fingers are the easiest ones to crack, and we’ve probably all cracked our knuckles at one time or another.
Cavitation itself does not bring any harm or benefit. The sizzling sound when manipulating joints does not indicate anything to the massage therapist, except that these joints have good elasticity.
2. Tendons or ligaments slide around a bone
In turn, the ability of a joint to stretch depends on the elasticity of the surrounding ligaments and tendons, which hold the joint in place allowing the bones to move in the proper direction. Like a rubber bandage, these structures tend to return the joint to the normal position.
If a joint remains in a still or uncomfortable position for a long time, this causes the associated tissues to stiffen, decrease in size and strength, and become inflexible. When the joint begins to move, strained tendons and ligaments might slide over the bony surfaces with a snapping sound. After a warm-up or change of posture, they usually loosen up, giving a feeling of relief and pleasure.
Most often, built-up tension happens in the soft tissues of the neck, shoulder, and upper back. That’s why it’s so satisfying to bend our spine or neck with a good crackle after being stuck in an awkward posture while sleeping, sitting at the computer, or driving. Contrary to popular belief, back or neck cracking has nothing to do with bones being put back into place.
The noise of strained tissues rubbing against bone is not easy to distinguish from one of bursting bubbles, but an experienced massage therapist will always feel that the muscles, ligaments, and tendons surrounding the joint are excessively tight. To avoid injury, the practitioner should first release tension in the soft tissues and then massage the joint using slow stretching rather than rapid twisting movements.
3. Bones grinding together
If a clicking sound is accompanied by pain, discomfort, and a limited range of motion, the practitioner should stop any manipulation of the affected joint. Most likely, this sound is made by bones rubbing against each other. In that case, only gentle stretches and acupressure of the muscles and connective tissues surrounding the joint are possible.
A painful grinding sensation in the joint can indicate that its cartilage cushioning is thinned or damaged, causing misalignment of the bony segments. Degeneration of this protective structure on the endings of the bones is most often a result of wear and tear associated with aging. This medical condition is called osteoarthritis and primarily affects the knees, hips, spine, and hands.
There are also more than 100 other types of arthritis – for example, rheumatoid arthritis which is an immune disorder causing damage mainly to wrists, hands, and feet. To maintain padding between the bones, the body usually responds to the arthritis disease by increasing the volume of joint fluid, causing joints to swell and the cavities to stretch… but this hardly ever prevents the bones from painful direct contact!
4. Spinal disc is damaged
Spinal discs are stronger and can withstand more severe stress than the mobile joints of the body, but they also tend to deteriorate due to wear and tear with aging. This increases the risk of disc bulge when the discs’ soft material protrudes into the spinal canal, irritating the nerves and causing pain, numbness, or weakness.
Improper massage technique, especially repetitive flexion and rotation of the trunk, and exerting too much force and pressure may exacerbate these symptoms. But, fortunately, such disc injuries are usually minor and heal on their own within a few days or weeks unless the disc had been previously badly damaged or heavily worn out.
Despite horrifying rumors of people having their backs broken during a Thai massage, there is no known case in Thailand where a spinal disc has been badly damaged while being massaged. Thai hospitals are required to report serious injuries to regulatory authorities, and such a case would have gone public.
Nevertheless, in the most unfortunate case, this can happen. Should this occur, the popping sound of disc rupture will be accompanied by sharp throbbing pain and inability to move. This trauma will require immediate medical attention, right up to surgery!
The bottom line
The noise associated with cracking a joint is usually completely normal and not a cause for concern unless the cracking comes with pain, swelling, or other symptoms.