Cartilage is a connective tissue found in many parts of the body. Although it is a tough and flexible material, it is relatively easy to damage. This fine, rubbery tissue acts as a cushion between the bones of joints. People with cartilage damage commonly experience joint pain, stiffness, and inflammation (swelling).

Cartilage can be damaged or injured in several ways:

•Direct blow - if a joint receives a heavy impact, perhaps during a bad fall or a car accident, the cartilage may be damaged. Sportspeople have a higher risk of suffering from articular damage, especially those involved in high impact sports like football, rugby, and wrestling.

Trauma to the area can cause micro-fractures to the cartilage, reducing its resilience and damaging the smooth service, speeding up normal wear and tear.

•Wear and tear - a joint that experiences a long period of stress can become damaged. Obese individuals are more likely to damage their knee over a 20-year period than a person of normal weight, simply because the body is under a much higher degree of physical stress. Inflammation, breakdown, and eventual loss of cartilage in the joints is known as osteoarthritis, or more correctly, degenerative joint disease or DJD.

•Lack of movement - the joints need to move regularly to remain healthy. Long periods of inactivity or immobility increase the risk of damage to the cartilage as the means by which the cartilage gets it’s nutrients (via diffusion from synovial fluid) is reduced.

So what can we do? There are several steps we can take to reduce the damage we inevitably do to our joints and things we can do to reduce the impact of that damage.

►Get moving. If you’re overweight or inactive, losing weight will take some pressure off your joints, and movement is important to compress and release cartilage enabling diffusion of nutrients. If you’re really struggling in this area due to pain or restriction, opt for low or no impact activity like swimming, cross-training, bike riding or pilates. At Lilydale Osteopathy we have a Nutritionist who may be able to assist with dietary or weight loss concerns, and our skilled practitioners can advise you what exercises might be best for you.

►Seek advice sooner rather than later. The accepted first aid for a strain or a sprain to a joint has long been ice. There is evidence that ice slows the healing process by way of reducing blood flow to the injured area, however can still be a useful tool if the pain is unbearable. Whether you decide to use ice or not, heat is definitely NOT advisable in the first 72 hours. Some gentle movement of the joint can be beneficial, again to improve blood supply and healing factors to the injured tissues.

After a few days or a week, if you’re still in pain, please seek medical advice, or book an appointment to see one of our osteopaths. We can not only assess the joint and advise if imaging or further medical attention is necessary, but we can check to see if other biomechanics have been disrupted as a result.

For example, if you sprain your ankle, it’s quite likely your knee took some of the brunt and your altered gait is having an adverse effect. Treating these biomechanical compensations can not only prevent further irritation to the secondary joint, but help with healing the primary injury. Joint traction (and even joint pumping) helps to encourage synovial fluid production and aid joint fluid dynamics to help with nutrient diffusion into articular cartilage. Some of these techniques are easily performed at home. Please ask your therapist to show you some exercises and techniques you can do at home.

►What about medications and supplements? Certainly the responsible use of over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) such as Nurofen or Voltaren can be helpful in the initial stages of an acute injury, but long term use like in the treatment of DJD, is considerably detrimental to your gut, blood pressure and liver function. Natural anti-inflammatory alternatives such as omega 3 (as found in fish oil) and turmeric can be of significant benefit in treating the symptoms of osteoarthritis. Blackmore’s Lyprinol and BioCeuticals TherActive Triple (containing 180mg of the active ingredient curcumen) are particular favourites of the clinic.

In cases of severe pain, cortisone (steroid) injections may be advised. Please keep in mind that cortisone is known to be chondroclastic - that is, it breaks down cartilage. So although it is an excellent anti-inflammatory, and can certainly be beneficial in episodes of bursitis (where no joint is involved) and other tendon and ligament issues, it has the long-term effect of speeding up destruction of the cartilage. If you’re considering joint replacement surgery, and cortisone injections have been recommended, obviously cartilage destruction is less of an issue if it’s going to be replaced with an artificial joint, but outside of these circumstances, please carefully consider this intervention.

►What about Glucosamine? Glucosamine is an amino-sugar produced naturally in the body, made from glucose and the amino acid glutamine but its production slows with aging--when people need it the most. It plays an important role in the formation, maintenance, and repair of cartilage and other body tissues. It stimulates the production of the molecules glycosaminoglycans (GAGs) and proteoglycans. These substances are the foundation of cartilage, tendons, ligaments, collagen, synovial fluid in the joints and other tissues.

Studies examining the effects of glucosamine on joint health are inconclusive. Some studies show a reduction in the likelihood of knee replacement by 50% compared to those of the placebo group, but other studies show little to no difference compared to placebo.

What we do know is that glucosamine is a safe supplement to take, with few side effects. 1500mg is the optimum level required to elicit a clinically identifiable change. It’s understood that glucosamine’s role is to stimulate chondroblasts to make cartilage, and there’s only so much “stimulation” the

chondroblasts can take, meaning more than 1500mg (or saturation point) is believed to be “wasted”.

Some patients report improvement in their symptoms with levels higher than 1500mg, however this is believed to be as a result of a low-grade anti-inflammatory effect, which can be better achieved with specialist supplements such as those listed above.

Next week: understanding fish oil.

Cartilage!

Joints need cartilage to function properly. Up to eight times more slippery than ice, and with the ability to soak up and push out water as easily as a sponge, cartilage is perfectly designed to permit seamless motion between bones, while at the same time providing ideal shock-absorbing capacity. In the world of joints, cartilage is a true superhero. Scientists have put men on the moon, eradicated polio, made flying an everyday event, and decoded DNA, but they haven't yet been able to create a substance that is better suited for joints than the body's own healthy cartilage.

Cartilage is made of collagen, proteoglycans (core proteins that are attached to carbohydrate chains), chondrocytes (cells that make cartilage), and up to 80 percent water. When you are at rest and your joints are not bearing weight, cartilage stores synovial fluid and water within it. When a joint is loaded with a force, the fluid stored in the cartilage is redistributed to the joint. In other words, when you stand from a seated position, the weight you put on your knee pushes the synovial fluid and water out of the cartilage in your knee, much as it would push the water out of a wet sponge inside your knee. The fluid pushed into the joint space helps to cushion your weight and also nourishes and lubricates the joint. It moves back into the cartilage when you sit down.

In addition to this sponge-like property, cartilage has another cushioning advantage -- it is filled with negatively charged chondroitin molecules. Negative particles resist touching each other with astounding atomic force. When the joint is made to bear weight, these chondroitin molecules are pushed together, but their negative charges resist. Pushing two negatively charged chondroitin molecules together is like trying to force two negatively charged magnets together. The closer they come to touching, the stronger they repel each other.

Cartilage doesn’t have a direct blood supply, which makes injury healing sluggish. The same goes for ligaments and tendons. When you have a direct blood supply to tissues, nutrients and reparative cells like fibroblasts can get there fast. With no blood supply, the injured tissue has to rely on absorption or other means to get nutrients in.

This is why joints, whose main structures are cartilage, ligaments and tendons, take so long to heal when injured and often require surgery. Once you hurt it, it can take months, even years before it fully heals, if it does at all.

Find out next week about the causes of injury and what we can do to help with pain and recovery.

What are shin splints?

Shin splints, the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), are the bane of many athletes. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, adding a sudden increase in the frequency, duration and/or intensity of activity, or switching from running on flat surfaces to hills. Runners with flat feet and those running in poor shoes or with poor form are also more likely to develop shin splints, otherwise known as Medial Tibial Stress Syndrome.

However shin pain doesn't always mean you have shin splints. It might be a sign of some other problem.

Two conditions that are sometimes mistakenly diagnosed as shin splints are:

Compartment Syndrome. Swelling or hypertrophy of muscles within a closed compartment creates pressure and is characterised by pain on the anterior (outside) part of the lower leg. To diagnose this condition, special techniques are used to measure the amount of pressure. Sometimes surgical "decompression" is required. The symptoms of compartment syndrome include leg pain, unusual nerve sensations, and eventually muscle weakness.

Stress Fractures. This is an incomplete crack in the bone, and is a far more serious injury than shin splints, but may also accompany them. The pain of shin splints is more generalized than that of a stress fracture. Press your fingertips along your shin, and if you can find a definite spot of sharp pain, it's a sign of a stress fracture. Additionally, stress fractures often feel better in the morning because the bone has rested all night whereas shin splints often feel worse in the morning because the soft tissue tightens overnight. Shin splints are also irritated when you flex your ankle up or down, depending on which muscles are aggravated. A bone scan or MRI is the definitive tool for diagnosing a stress fracture. However, there are clues you can look for that will signal whether or not you should get further imaging and your Osteopath can help with this diagnosis.

What are the causes?

The cause of shin splints can be summarised as “too much, too soon”. MTSS most often occurs in athletes who increase their mileage too quickly, the intensity or duration of their training; or change their running surface too dramatically and/or too abruptly.

Other common causes are worn-out footwear, running on hard or uneven surfaces, and even excessive stress placed on one side of the body from running on cambered roads or always in the same direction on a track.

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What can I do to prevent them?

Getting help and guidance before embarking on a new training regime is always helpful. A detailed examination and evaluation by your Osteopath before you change your routine or start something new, is always a good idea. But here are a few things that can help along the way.

Choose the right shoes. Wear footwear that suits your sport. If you’re a runner, replace your shoes about every 400 to 600 kilometers. Get fitted by trained fitters like those found at Complete Feet and Active Feet. Preferred brands are Asics, Brooks and New Balance.Consider arch supports. Arch supports can help prevent the pain of shin splints, especially if you have flat arches.Lessen the impact. But this doesn’t necessarily mean softer ground. Cross-train with a sport that places less impact on your shins, such as swimming, walking or cycling. Your legs will adapt to the surface you’re running on - softer ground means stiffer legs! In fact, there is even some evidence that running in thinner shoes on a harder surface might be a better idea.Add flexibility and strength training to your workout. A strong core, gluts,calves and shins will all help stabilise your body and allow you to run more efficiently with less strain on your shins. You must remember to stretch after every strengthening workout - this is how muscles repair and get stronger.STRETCH stretch after activity. This is paramount. The general rule of thumb is ‘the larger the muscle - the longer the stretch’. The largest muscles in your body require a good 30-40secs each to achieve optimal stretch. The smallest muscles about 10-15secs. Your calves sit in about the middle.Check your running form. Pay attention to how your foot hits the ground - you want to aim for a mid-foot landing, not a heavy heel-strike. You can inspect your footwear and look for how it wears to get an indication as to whether you hit the ground hard with your heel, or even if you tend to be an over-pronator. Increasing your stride frequency (aim for about 180 steps or more per minute) will markedly decrease the amount of force your tibia has to absorb when you hit the ground.

But how do I get rid of my pain?!

The basic treatment for shin splints is no different from most other soft-tissue injuries - RICER!

For shin splints in particular, stretching is the next very important step. Releasing off the calf and shin muscles is vital to take the irritation off the tibia. Once the calf muscles have lengthened sufficiently, you should begin to strengthen your ankles, calves, gluteal muscles and core.

See below for six easy stretches that will be a great start to your recovery.

Watch the video below to see how effective this stretch on the foam roller can be.