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Cartilage Damage & Osteoarthritis

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.

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