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PATHOLOGY PERSPECTIVES WHAT HAPPENS WHEN YOU POP YOUR JOINTS? We've all heard it, and some of us do it habitually: pop and snap our joints. We do it to our knuckles, our jaw, even our back and neck, and it can feel so good. But what really makes that characteristic sound when we stretch our joints? Interestingly, we're not completely sure. Most experts agree that it is probably the sound of the gases suspended in synovial fluid. In essence, when we stretch an airtight joint capsule, we create a vacuum. The nitrogen that was dissolved in the joint fluid coalesces to fill the vacuum with a "pop!" noise. research on chronic joint cracking has not revealed that it will inevitably lead to swollen, arthritic knuckles (despite what your mother or massage teacher might have said). However, some chiropractors suggest that if a joint, especially a spinal joint, feels "out" in such a way that a person self-adjusts frequently (that is, several times a day), then ligament laxity combined with inefficient muscle tension may be a problem. clearly, massage has a role here, as a person works to reset muscle tension in a way that doesn't exacerbate irritating subluxations in the spine. sprained or ruptured; nearby tendons and muscles may be torn; and nerves, blood vessels, bursae, and other structures may also be compromised. All this makes the healing process complicated, as scar tissue can penetrate multiple structures, severely limiting both range and ease of motion. This is why it is essential to heal in movement: joints should be used, within pain tolerance, as soon, and as fully, as possible after the acute stage of inflammation has passed. This helps new collagen fibers, which knit damaged structures back together, to lay down in alignment with the directions of force instead of in a knotted-up jumble. The ligaments around joints are strong, but they have poor rebound capacity. This means that once they have been stretched by trauma, the joints they are meant to protect have an increased risk of repeat events with much less force. These spontaneous dislocations can be reduced, or put back into alignment, without much force as well, but they indicate lack of stability, which significantly raises the risk for osteoarthritis at the affected joints. In addition, the muscles that cross the affected joints may become hypertonic as they attempt to stabilize the nearby structures. This can lead to pain, trigger points, and limited range of motion. CONGENITAL DYSPLASIA The acetabulum of a newborn baby is naturally shallow. It slowly closes in around the head of the femur as the infant grows and begins to crawl. Sometimes, however, the contours of the acetabulum don't correlate to the femur, or the femoral head is misshapen. Either way, the hip socket doesn't work and the femur can easily subluxate or dislocate. This situation is called congenital dysplasia. Hip dysplasia can be identified early in infancy. If it affects only one side, the consequences are especially serious: unequal leg length and significant problems with walking are inevitable. Interestingly, if the dysplasia is bilateral, the consequences are much less obvious. While the risk of subluxation or dislocation are still high, it is possible to delay or avoid surgery altogether to correct this situation. SUBLUXATION In a subluxation, bones are out of optimal alignment, but the joint capsule is intact. The joint is functional, but it lacks a full range of motion. This can occur when a joint is jarred or has a minor injury, but it is frequently not tied to any specific event. Joints that commonly subluxate include the intervertebral facet joints, the patellofemoral joint, and the radial head when it slips out of the annular ligament; a subluxation here is sometimes called nursemaid's elbow, because it is associated with dangling a child by his or her forearm. Subluxations can be painful, but often—especially at the spine—they involve low-level dysfunction that is chronic and progressive. When they occur at the vertebrae (this is sometimes referred to as vertebral subluxation complex), experts suggest that in addition to interfering with freedom of movement, the displacement can also put mechanical tension on nerve roots and dura mater, leading to referred pain and other symptoms, 104 massage & bodywork march/april 2011