Ep 280: Should I worry about noisy joints? With Dr Danilo De Oliveira Silva

[00:00:00] The most anticipated course in orthopedic physical therapy is coming back. Updated, expanded, and better than ever. Current Concepts of Orthopedic Physical Therapy, 6th Edition, arrives fall 2026. And if you haven't taken it yet, there's never been a better time. This is APTA Orthopedics' most popular course for a reason. 12 comprehensive sections covering every major joint and body region, from head to toe, all grounded in the latest evidence.

[00:00:28] Each section walks you through anatomy, examination, diagnosis, and intervention, and wraps up with real-world case scenarios to sharpen your clinical reasoning. Whether you're preparing for the OCS or simply want the most current evidence-based resource in orthopedic PT, this course delivers. Visit orthopt.org to explore the current edition and be the first to know when the 6th edition opens for registration. Dr Danilo De Oliveira Silva, JOSPT Insights

[00:00:57] Because one of the biggest frustrations of patients when they ask about that sign is that people say, oh well, I'm not really sure. The most common complaint is that, oh, I talked to my clinician, and I get nothing. And then they go to the internet, they get nothing. Hello and welcome to JOSPT Insights, the podcast that aims to help you translate quality research

[00:01:24] to quality practice. I'm Claire Ardern, the Editor-in-Chief of the Journal of Orthopedic and Sports Physical Therapy. It's great to have you listening today. Hipcrepitus, what does it mean? Is it an issue? And how do we talk about it with our patients? Today, we're going to dive deep into this with none other than Dr. Danilo de Oliveira Silva. Dr. Danilo is an Associate Professor and NHMRC Emerging Leadership Fellow at La Trobe University

[00:01:52] in Melbourne, Australia. Dr. Danilo is not only a physiotherapist, but also a PhD, and his research focuses on biomechanics, psychological, and pain characteristics of people with musculoskeletal conditions across the lifespan. Today, we will be discussing his recent publication in JOSPT Open entitled Self-Reported Hip Crepitus is prevalent in football players with hip and groin pain, but is it associated with early hip osteoarthritis structural features? My name is Dan Chapman, owner of Summit Physical Therapy and Performance in Baltimore, Maryland.

[00:02:21] I'm Martise Santa Rice. I'm a doctor of physical therapy in Baltimore, Maryland at Summit Physical Therapy and Performance. Dr. Danilo, thank you so much for taking the time to join us. It's my pleasure. Thanks for having me. So let's just jump into it. Can you give our listeners a little bit of background into what inspired this study and what you were expecting when you were really first getting into it? This story is really interesting on how it all started. It actually started with

[00:02:46] knee creptus. I was one day in my lab doing my PhD back in Brazil, and my main area of research is patellofemoral pain. And I was reading a paper about patellofemoral pain from Claire Robertson from the UK, and she did a qualitative study in knee creptus. And I was just like reading all the

[00:03:09] quotes and everything about knee creptus. And one quote really stood out to me. One of the participants of the study said, oh, I loved doing yoga, but then I had to stop because my joint was too loud and people were making fun of me. And like, if you really reflect on that, that is huge. Someone

[00:03:35] stopped doing the activity that they love. They were being physically active, going out, doing physical, because of the noise in their joints. And that sent us, we should do something about it, that there is something in there. And then I started a side hustle, a line of research looking into knee creptus. And I've done like multiple studies about knee creptus. And going to the gym

[00:04:00] and talk to people, they said, oh, my hip also clicks when I do some lunges, some exercises. And then I said, oh, maybe there's something on the hip as well. People could change the way they do things about the hip. And then I had a PhD student just starting with me, Fernanda Sirigeli. And I said to her, well, what about we explore and dive deep into this hip creptus world to try to

[00:04:26] understand that a little bit better? And I'm lucky enough to work at La Trobe University in Melbourne, which is in a research center led by Kay Crowley. And she had a big cohort here with football players with FAI syndrome, so femoral acetylular impingement. And then we had access to this very large database to explore and answer some research questions. And then we started from there. But that's what inspired the study.

[00:04:53] So as somebody that treats a wide variety of adults over the age of 50, I'm very much looking forward to hearing what you have to say about creptus because we get those questions all the time, every day. So I am curious, what were your expectations as you were kind of delving into this research? What did you think was going to come about?

[00:05:15] Look, a bit inspired by what we found in the knee, which was pretty much, look, the joint, in young people at least, they make some noise, but they don't mean much in terms of relationship with symptoms, relationship with structure. In young people, there's no much correlation. New other people is a bit different. But I thought we wouldn't find many associations regarding the

[00:05:43] hip. But if we take a step back and try to understand creptus a little bit, because that's the problem of creptus. Many clinicians say that to me, like, I don't know what that means. And patients as well. I think we don't know much about the different types of creptus as well, because there are people that click, there are people that make the grinding sound. So it's all different. For this study in particular, we are looking to self-reported creptus. So people that say,

[00:06:12] oh, my hip joint clicks. So we are going from there. It's a self-reported. In the knee, we can put our hand there and feel it. But in the hip, we can't because it's such a deep joint. So we rely on self-reported. So from this study, we are assuming that all creptus are the same. And when we start discussing more about that, I will try to prove to you that it's not without a lot of evidence.

[00:06:38] But we can chat and make some assumptions here. My hypothesis was, I think hip creptus won't have any relationship with anything in the hip. I started like that. But then we did find a few things in there. Hip creptus, knee creptus, it's definitely something that we hear very often from our patients. And I don't know if it's the association with, hey, my car makes this noise, there must be something

[00:07:04] wrong with it. And it's like, my hip is making this noise, there must be something wrong with it too. So it's definitely something that people come to us very often, and they have questions and concerns with this, and it can even create fear. In this study, can you walk us through a little bit of what you guys ended up finding? And were there any results that kind of stood out to you or perhaps challenged what you expected when you were going into the study?

[00:07:28] So this was the first study of Fernandez's PhD. So we needed to start somewhere. And we had to ask the first question, is hip creptus common? That was the first question. And our cohort was footballers. So we had the symptomatic group, 178 participants, and the healthy control group, asymptomatic people, some football players, 60 people. And what we found was that creptus was

[00:07:58] five times more common in people with symptoms. That doesn't tell a lot, but it is an important information. So this clinical sign is more common in people that have hip pain. And then we said, let's look for some things to explain from where that noise or sensation is coming from. And the obvious thing, you think about anatomy, you think about the structure of the joint.

[00:08:25] So that was where we went first. All this cohort, they had x-rays and MRIs. So we had to explore the association between the presence of creptus and also the severity of creptus, how severe those noise and sensations are, again, all self-reported. What we found was no association with x-ray variables. If we think about like alpha angle, lateral center edge angle, so no association

[00:08:53] with that. But then MRI is a bit more sensitive to show those early signs of osteoarthritis. So we looked at cartilage defects, we looked at labral tears and explored things in a different way. Like the presence of cartilage defects, the worst part of cartilage defects and the number of sub-regions affected by those defects as well. So we explored the joint a little bit.

[00:09:18] And what we found there was that creptus wasn't association with labral tears whatsoever in any variable, but there was an association between the presence of creptus with the number of cartilage sub-regions affected. And what that tells me, if we make an analogy, let's say you are driving your car in a road and that road, it's very inconsistent. There are a lot of holes in that road.

[00:09:48] So it's very bumpy. That's associated with creptus, the bumpiness, the number of holes in that road. But if there's only one big hole in there and your car just goes through, it's not associated. So if you have one sub-region really bad, that's not association with the presence of creptus. But if you have many, even if with the small defects, because then you create that friction

[00:10:16] environment that is just and that's associated, but we didn't find an association with the severity of creptus. But then we said, okay, this is cross-sectional. A moment in time, a photography there. Let's look to how it is associated with how the structure progresses over time. So we got the MRI after two years in the same footballers and we explored association and we didn't find an association

[00:10:45] anymore, but there is a catch in there. And without going too deep in stats and things, we didn't find an association with the number of sub-regions, with the change in number of sub-regions. But when we look to the number, the strength of the association that we found in that cross-sectional, in that photography analysis,

[00:11:08] it was the same that we found with the change, but it wasn't significant because we had less people in the follow-up. We lost a few on the way. So our analysis was not that powerful to detect the significant association. But the association is pretty much the same. The one that is with the number of sub-regions

[00:11:31] and with the change in cartilage defects, but it's not a strong association. So we need to take those findings with a grain of salt. If I'm understanding you correctly, it seems like if you're an athlete, if you have hip pain, we're more likely to have hip creptus. But that is not essentially correlated to degeneration or defects in the joint or in some of the surrounding capsule, labrum,

[00:12:01] but it is associated with a number of regions affected for the sub-chondral regions affected. Yep. How should clinicians kind of reconcile some of those differences? Yeah, we have hip pain. We're likely to have more hip creptus, but it maybe is not associated with any long-term or at least some kind of sub-short-term

[00:12:29] changes over the next couple of years. How should clinicians kind of reconcile that? If we stick to the paper, if we don't go any broader than the paper itself, the main take-home message here is that, okay, creptus is common, but it's not explained or it's not too much associated with the structure in the joint. Even though if we found some associations, they're not that strong. So

[00:12:57] someone with creptus would be two times more likely to have this association with the number of cartilage sub-origines, which is not a big association. So the information for the patients here is, hey, you are all right. There are some noises, there are some sensations in there, but it doesn't mean your joint is worse than someone that doesn't have those sensations. I think that's the take-home message

[00:13:22] if we go by the paper itself. But we need to go a bit broader than that. And we need to consider, again, that we are asking creptus in a self-reported way. We are not doing a deeper clinical exam. I'm saying that because we did a qualitative study in Fernandez's PhD. And we went to those athletes with hip creptus and asked them, like, how do you feel? What do you think you have it? And

[00:13:51] we explored everything about their knowledge, beliefs, and how they perceive themselves with those, that clinical sign. And we found two clear, distinct subgroups. One, with people that had some clicking in their hip and a tightness association with that clicking. And another group that they had pain in their hip

[00:14:18] associated with a grinding sensation. So all of them, they would have clicked. Yes, I do have noise or clicks or a creptus sensation. So we got those two big subgroups and we lumped them together in this paper that we are discussing today. And for me, they're completely different. One has like this bad experience and sensation with grinding and pain. The other one, ah, just clicks. I change the way

[00:14:45] I move here and there and I fix this clicking. But the others, they struggle and they consider surgery because it's so annoying. So it's a bit more complex than a blank state. It doesn't matter. And do we have any further information on those subgroups in terms of like those who reported painful grinding and what their hip looked like under imaging versus those who had maybe like an inconvenient

[00:15:09] click, but no real symptoms related with it? That's an amazing question. And no, we don't have any information because the participants from that qualitative study, they are not the same participants as this study here that we are discussing today. And it was just a qualitative study. We didn't do an MRI on them, but that's my next research question. Like we need to explore the different types of creptus because some of them, they may matter. They may be associated with symptoms.

[00:15:38] I'm going to be on the lookout for that paper because we do have those different subgroups present in the clinic quite often. The person who says, yeah, I can like squat down and pick something up. My knees are really loud. And the follow-up question from us is obviously, hey, do you have pain with that sound? Right? And the answer is no. And then you also have that other subgroup that come into the clinic and they're like, yeah, ow, every time I hear or feel that grinding, that's what hurts. Right? So I'm excited to see that come out. How would you say that this paper should really

[00:16:08] influence the conversations that we have about hip joint creptus with our patients? I think for now, it's just having a information to discuss with them. Because one of the biggest frustrations of patients when they ask about that sign is that people say, oh, well, I'm not really sure. The most common complaint is that, oh, I talked to my clinician and I get nothing. And then they go to

[00:16:34] the internet. They get nothing. We did a study on that. The information is bad. Well, what is out there? Shocking. So now we have something to start the conversation. Look, they have done this study. More than 200 participants. So you can really trust that data. It seems there is no clear association with how your joint actually is. So let's try to keep yourself active. Let's focus

[00:17:01] on your symptoms and getting yourself out there doing exercise. Don't worry too much about this at the moment. So I think that paper helps with that, helps with the information. And if there was a very clear big association, we would have seen in this data to explore it a bit further. So it's nothing clear. It doesn't mean if you have creptus, your joint is terrible. So we can start the

[00:17:27] conversation with that. It's a powerful tool to discuss with patients. Yeah, I think it is extremely powerful, especially to just be able to resolve people's worries and to be able to resolve people's fears. Because I know that that's a big part about this. We even kind of mentioned that, hey, when you have pain somewhere, you're likely going to be more vigilant to maybe some of the sounds that we kind of hear. So being able to give them a little bit of ease is certainly very, very helpful.

[00:17:54] From a clinical perspective, how should these findings kind of change the way that we as physical therapists, athletic trainers, anyone who is evaluating someone who has hip creptus, how should this change how we evaluate and manage them? And how does this change the examination process and how we kind of lead or guide an athlete through their plan of care? I think creptus is not something that we think about straight away when we are assessing a patient.

[00:18:21] So I think this paper also shows, hey, it's very common. So maybe we should assess that. For the hip, we don't have a specific clinical test to assess it. But we could even start making the question, hey, does our hip make any noise and sound when we do some type of exercise? Do you do something about it just to understand where they are coming from and if that happens? So I would say it changes by

[00:18:48] saying that we should perhaps consider and asking the questions to the patient and including that as part of our assessment. And when I say assessment, it's not like perhaps formally assessing, but part of the conversation because that creates an opportunity for you to educate and reassure them about that. So I think that's a big way to change, to consider it when it's not something that's

[00:19:13] really considered in the heat. I would say in my past, I've kind of let the patient bring that up to me if it was something that was bothering them. But after reading your paper, it's something that I'm going to be more proactive in saying, hey, does your hip make noise? Oh, it does. How does that make you feel? What are your thoughts on that? And kind of bring that conversation up front so that we can talk about it and make sure that I'm not avoiding or not having a conversation that could actually be

[00:19:40] really, you know, freeing or helpful for the patient. I've found this paper very, very valuable, especially when it comes to the patient education aspect, which is such a crucial part of our evaluation and the whole plan of care all the way through it. Is there anything that we haven't covered that you really want to make sure our listeners take away? We covered the paper really well. It's just that this is one piece of study. We need more to understand craptozinomar broader way.

[00:20:10] That's why we discussed more studies. And it was funny that you mentioned, I'll bring that up, because if you don't, the internet will, a family member will, a friend will, and maybe not in a nice way. They will make joke of them and they will feel bad about it because others' perceptions maybe doesn't bother them, but others will say, hey, like, you're such an old person with these

[00:20:35] cracky joints. I spoke with my physio, it doesn't matter. It doesn't mean I have crappy joints. So then it becomes like more light. Like you said, it's like not avoid the conversation, just go and explain about it. I think we should make it a positive thing that some people are just more musical than others. Dr. Danilo, thank you so much for all of the work that you and your team have done

[00:20:59] on this paper. Thank you for your time. Big thanks for the opportunity to discuss. I love your work, guys. I'm a listener of the podcast. So thanks a lot for bringing fun to the boring scientific articles. And thank you. And we will absolutely be having you back if you dive further into those subgroups. We are, I know our listeners are going to be very, very excited to learn more about this line of research. So we're looking forward to having you back in the future.

[00:21:29] Sounds great. Thank you. We want to thank Dr. Danilo de Oliveira-Silver one last time all the way over in Australia. I do believe it was beyond 11 p.m. his time when we finished recording. So thank you so much for all the time and effort you put into this paper and for staying up late to share it with all of us here on the show. As always, we want to thank you for listening to JOSPT Insights. Thanks for listening to this episode of JOSPT Insights. For more discussion of the issues in

[00:21:59] musculoskeletal rehabilitation that are relevant to your practice, subscribe to JOSPT Insights on Apple Podcasts, Spotify, TuneIn, Stitcher, Google, or your favorite podcast app. If you like JOSPT Insights, help others find us. Tell your friends and colleagues and rate and review us. To keep up to date with all the latest JOSPT content, be sure to follow us on Twitter, we're at JOSPT, and Facebook, we're JOSPTOfficial. Talk with you next time.