Cartilage
There are 3 primary types of cartilage within our bodies.
Elastic Cartilage is the flexible connective tissue that makes up the shape and structure of our ears.
Articular Cartilage consists of a very smooth connective tissue that lines the ends of the bones in many of our joints, and provides cushioning and a smooth sliding surface for those joints to move.
Fibrocartilage consists of a rough and tough surface, and is the connective tissue that makes up intervertebral discs, the knee meniscus, and shoulder and hip labrum. Fibrocartilage of the intervertebral discs and knee menisci work well to provide additional cushioning, shock absorption, and load distribution, while the fibrocartilage of the shoulder and hip labrum provide additional covering for stability.
On this page, we will specifically discuss articular cartilage, which will be referred to simply as “cartilage” for the remainder of this article.
Just like bone and muscle, cartilage plays a significant role in comfortable daily movement.
But unlike bones and muscles, cartilage has significantly less blood supply, which is a major factor in its ability to heal. Tissues with reduced blood supply have a reduced ability to naturally regenerate and heal.
Therefore, although it is possible for cartilage to show some signs of regeneration and healing, it is unfortunately of very little amount and occurs at a much slower pace than other tissues such as bone, muscle, tendon, and ligament.
In addition, bones, muscles, tendons, and ligaments have a much greater nerve supply as compared to cartilage.
That is why you generally experience pain immediately upon initial injury to those structures, while you tend to not experience cartilage damage until a significant amount of it has occurred and the bone underneath the cartilage begins to become irritated.
Therefore, prevention is really the best approach to avoiding significant cartilage damage. The information included within this article will help you better understand cartilage, and allow you to help take the proper steps necessary to avoid significant pain.
Cartilage Stressors
There are normal and abnormal stressors that result in different outcomes on the cartilage. Cartilage is most commonly stressed with repetitive activity that involves weight or load bearing through the joints.
The ways by which cartilage adapts to stressors are dependent on the nature of the stressor, as well as the recovery process post stressor.
Please remember, challenging obstacles from which you are able to fully recover result in a good stress known as Eustress. On the other hand, obstacles deemed threatening and/or obstacles from which you are unable to fully recover will result in a negative stress known as Distress.
Distress: A Dangerous Threat to Cartilage
Negative and potentially painful stress may occur when stressors placed on the cartilage exceed that of what the cartilage can handle.
Increased cartilage damage may accompany excessive and repetitive load-bearing activities, particularly involving joints that are not appropriately stabilized or that have excessive and uncontrolled motion and movement.
Furthermore, other injuries that may destabilize a joint, such as ligament injuries, may result in excessive movement within the joint space leading to increased “wear and tear.”
The condition most commonly associated with impaired articular cartilage includes Osteoarthritis.
Resolve What's Holding You Back: Restoration and Recovery
Please recall that cartilage has limited blood supply, and therefore is limited in its ability to heal. Nonetheless, there is still plenty you can do to help the condition.
Treatment and/or prevention of cartilage damage are based on the following:
- A clear understanding of what appropriate and healthy loading of articular cartilage entails
- The fact that synovial fluid is the primary nutrition source for cartilage
- A clear understanding of the mechanism by which cartilage damage occurs
First, treatment must focus on preventing further damage to the cartilage. As previously described, cartilage damage is primarily present with excessive and repetitive load-bearing forces through a joint that has poor stability. Poor stability involves excessive movement of the bones at a joint.
This may be due to a previous injury of a joint stabilizing structure such as a ligament. Or, the joint may naturally have high amounts of mobility without sufficient enough muscular control to stabilize the joint.
Therefore, particular attention must be placed on reducing excessive and repetitive weight bearing forces while simultaneously improving muscular strength and movement mechanics. This will effectively work to reduce any excessive and repetitive motion that may be occurring at the joint.
At this point I ask that you please allow me to explain why it is absolutely crucial that you do not stop moving the joint. Unless of course the pain is just too great.
We cannot stop moving the joint because of the understanding that synovial fluid is the primary nutrition source for the cartilage, and synovial fluid can only be formed with natural movement of the joint.
Synovial fluid helps the remaining cartilage stay healthy, and also works by providing additional lubrication between the joint surfaces for improved and smoother joint motion despite any cartilage damage that has already occurred.
Finally, all of this is achieved with appropriate loading of the remaining cartilage in a healthy manner. This is accomplished by allowing the joints to undergo load-bearing and/or non-load-bearing activity through moderate to full ranges of the available motion. But remember, it is critical that the motion is performed in a controlled and stable manner that is not beyond the forces that the cartilage can handle.
Eustress: A Healthy Challenge for Cartilage
Cartilage is stressed appropriately and in a healthy manner when joints undergo repetitive load-bearing and/or non-load-bearing activity, through moderate to full range of motion, in a controlled and stable manner that is not beyond the forces that the cartilage can handle.
Joints are meant to move, and the joints of your lower body and spine are designed to bear weight and load.
Furthermore, normal stressors will actually improve the health of your cartilage. That is because the primary nutrition source for cartilage is through a substance known as synovial fluid. Synovial fluid is necessary to maintain healthy cartilage and is primarily released during joint motion.
As an added bonus, synovial fluid in-and-of itself provides lubrication and allows for smoother joint movement, thereby assisting the cartilage in reducing bone friction and stress.
Time to Move Forward: Preparation and Fitness
Improving fitness is among the most effective approaches addressing the ‘preparation’ aspect of performance enhancement. Preparing for maximal performance through fitness involves optimizing the balance between movement quality, strength, endurance, and speed.
Focusing on movement quality prepares you to: 1) Maintain synovial fluid-promoting mobility 2) Perform activities in a manner that avoids excessive joint movement and instability 3) Perform activities in a manner that reduces impact and load through the joint.
Focusing on strength prepares your muscles to handle more stress and ultimately support your joints.
Focusing on endurance improves synovial fluid and blood flow to the cartilage and remaining joint structures, thereby improving joint nutrition and health.
Focusing on speed improves how quickly your body is able to react to outside stressors and maintain optimal movement quality.
TAKE ACTION!
- If you believe you have undergone a cartilage-related injury, or are experiencing cartilage-related pain, be sure to consult with a licensed healthcare provider specializing in this field in order to receive a definitive diagnosis rather than attempting to “guess and test.”
- Make sure to keep the affected joints moving in a way that is tolerable. As long as the pain is not too severe and you do not have other restrictions preventing you from doing so, it is actually recommended to allow your joints to undergo various activity through moderate to full ranges of the available motion. If pain is present, make sure to find a specialist that can guide you through the appropriate motions.
- It is time to begin the ‘preparation’ aspect of performance enhancement as soon as sufficient restoration of any cartilage-related distress has occurred. When ready, begin implementing the information presented in this article, as well as the remainder of the content within the “Convergent Path to Performance,” in order to maximize Eustress while minimizing Distress.
Summary
Cartilage plays a significant role within your body, and therefore undergoes a multitude of stressors throughout the day. The key is to remember that you hold a large influence over the health of your cartilage. By understanding how cartilage is stressed and how it recovers, you will have the tools necessary to maximize positive adaptation while reducing the occurrence of distress and injury.
Dr. Eugene Ketselman PT, DPT, Cert. MDT, CSCS
Dr. Eugene Ketselman is a licensed Physical Therapist, Certified Strength and Conditioning Specialist, Performance Coach, and owner of Convergent Movement and Performance; Home of where Physical Therapy, fitness, and performance training converge! Dr. Ketselman's mission is to help motivated athletes and active adults excel in their passions by maximizing physical performance and reducing setbacks from pain and injury.
Here at Convergent Movement and Performance, we practice what we preach. You know we are a good match for one another as soon as you find yourself relating to the content we provide. Be sure to click below to learn more.
Do you have specific questions that aren’t answered on this website?
Click below
Does pain, weakness, or exhaustion prevent you from reaching your FULL potential while performing the activities you love?
Click below
Do you love what you’re seeing, but still aren’t sure if you can make the commitment?
Click below
Contact Us
Convergent Movement and Performance serves out of Northern – Central New Jersey, conveniently located to those that live, work, and travel in the nearby towns of Warren, Bridgewater, Martinsville, Watchung Hills, Bedminster, Basking Ridge, Bernardsville, Chatham, Westfield, and Piscataway within Somerset, Morris, Union, and Middlesex counties, NJ.