In a recent conversation with a client, they brought up a “click” in their shoulder. It happens occasionally with certain movements at home, and when exercising. They described the click as non-painful and as only happening with very specific movements and exercises. Based on these factors and a few others, we decided that the shoulder click is not something for them to be concerned about at this time. At that point, they asked a great question. Clicking joints, or cracking our neck/knuckles/etc., are commonly thought of as being bad, so it was surprising to them that I would suggest not to worry about the sound. They asked: “When would a ‘click’ or ‘cracking’ in a joint be something to be concerned about?”. I told them there are three main occasions where someone should be more concerned about a click.
If the click began suddenly, or after a traumatic injury.
We all have natural sounds that our body makes based on our own biomechanics. In this case, most sounds are likely normal. But, after an injury, new clicking might mean damage. If we injure a joint, muscle, or ligament, new clicking, popping, or snapping might indicate new injury. More specifically, there is a chance that something which was once healthy and moving well, is now moving abnormally, or is detached. An example is following a twist/fall while playing a sport, new “snapping” in the knee might mean a torn meniscus. In this case, it is very likely that the click would be associated with pain. That brings me to the next point.
If the click is associated with pain.
This statement extends beyond pain associated with an injury. More generally, when we experience any pain that is associated with clicking, it also might indicate damage. Sharp pain within the joint might be associated with conditions like damaged cartilage, or osteoarthritis. Dull pain surrounding a joint or tendon might indicate a slow build-up of tendinitis. All of these things can be accompanied by clicking. If a particular click causes pain in the moment, or dull pain that lingers, it is likely worth further investigation.
If the joint/area that is clicking ever feels unstable.
Finally, if the area where you hear clicking ever experiences instability, it is generally of greater concern. Instability might be described as “giving out” or losing all strength at once. Clicking and instability might not happen concurrently, but if a joint has become unstable, clicking tends to be more common. For example, in someone who has previously experienced shoulder dislocation, shoulder clicking, and instability, can be a common long-term side effect. In this case, strengthening and stability training is very important, with some cases requiring surgery. If you’ve had this feeling in your shoulder or another joint, it may mean something more significant and is worth investigation.
“I don’t have any of those, now what?”
For the most part, shoulder clicking (or any joint clicking, for that matter) is normal. Having sounds associated with certain movements occurs in many of us based on our unique structure. In some cases, these harmless clicks can still be corrected with manual therapy and proper home exercise. But overall, they are usually not alarming. The above list includes a few reasons why a new click or sound might be more alarming, therefore indicating further evaluation. Even if those reasons aren’t present, it is still normal to be curious about a certain click or crack in our body. If you’re ever unsure about a shoulder click (or other clicking joint), it is always a safe bet to contact your physiotherapist. They’re your best resource for understanding your body thoroughly and discussing next steps.
Stay safe and take care,
Daniel Sedran
Registered Physiotherapist
Owner of First Line Physiotherapy