Snap, Crackle, Pop: Interpreting Body Sounds
by Dr. Jim Brown
"I felt like something had hit the back of my leg just above the heel and it sounded like a muted rifle shot." This is how Philadelphia orthopedic surgeon Angela Smith described the feeling and the sound when she ruptured her Achilles tendon. "I knew it had to be one of two things. Either my tennis shoes had split or I had torn my Achilles tendon. The pain told me it wasn't my shoes."
The kind of sound and intense pain that Smith heard and felt is very specific to a torn Achilles tendon. There are few injury-related sounds that are as noticeable and as significant as the one heard with her injury. Another is when the anterior cruciate ligament is torn or completely ruptured. That crackling sound is made by the damage to the ligament that connects the ends of the thighbone (femur) and shinbone (tibia). But the sound made when a tendon or ligament is ruptured is different from the creaking, grinding, cracking sounds that most athletes hear every day.
Painless Noise Not Bad
"Don't make too much out of sounds made by movement around a joint," warns Andrew Cosgarea, M.D., an orthopedic surgeon at Johns Hopkins. "Painless noise is normal. It could be caused by irregular surfaces rubbing against each other, pressure changes around a joint, or two ligaments coming into contact. The only time to worry about it is when the sound is accompanied by pain."
The creaking/cracking sound with which most of us are familiar is called crepitus. The noise usually goes away or is not as noticeable with exercise. But there are musculoskeletal conditions in which noise may be one of several symptoms to be considered. It is important to remember Cosgarea's warning and not to assume that the sound is synonymous with an injury.
With tendinitis in any part of the body the person may hear a sound.
Flexor and extensor tendinitis in the foot, for example, means that there is an inflammation of the tendons running from the muscles of the lower leg to the top of the foot. These tendons allow extension and flexion of the toes. In severe cases, a creaking sensation is felt or heard when the toes are straightened or bent. This is especially noticeable when running. Says Cosgarea, "It is true that a sound may be one of the symptoms, but only in some cases." Other examples include a creaking sensation with Achilles tendinitis and a crackling sound that can accompany tendinitis of the wrist.