Hyaline Cartilage

(Keywords: Hyaline Cartilage, cartilage hyaline, foot pain, ankle pain, arthritis pain in knee )

Cartilage is subject to serious degenerative changes in joints because it has no blood supply. It's the very hard substance that lines the bones in a joint - the material that takes the strain in working joints.

This is what a normal hip looks like. See how super-smooth the cartilage is?


Cartilage is what we call a connective tissue. It can be very flexible and soft as in the ear lobe, or flexible and tough as in a ligament or tendon. And what really interests us today, is the cartilage that lines the bones in our joints: Hyaline cartilage.



It's very hard and slippery, enabling us to bend our knees, move our toes, take a great deal of weight in the hip, and flex and extend our spines, all with minimal friction between the opposing joint faces. Our finger joints ... virtually all our joints with a few exceptions.

Take particular note of the little white arrows. They show the movement of nutrients from the synovial fluid as it sloshes about in the joint, not literally! to the hyaline cartilage on the ends of bones.

Without that flow of fluid, carrying nutrients and oxygen, the hyaline cartilage soon begins to degenerate.



What is critical about cartilage is that, unlike other connective tissues like bone, it has no blood supply. It is utterly dependent on the synovial fluid within the joint for its nutrition. No rich, healthy sloshing fluid bathing the hyaline cartilage, and it will degenerate and die. And hurt. Pain. Put simply, damaged cartilage has far more limited ability to regenerate than bone does. Bone is flooded with blood. Cartilage not.

Chondroitin sulphate. Does that say anything to you? Seen on the label of bottles in your health food store? The gelatinous ground substance of cartilage is make up largely of chondroitin sulphate, into which are embedded collagen and elastic fibres made of protein: hence you will see that chondroitin often comes with glucosamine, the precursor of proteoglycans, substances found in cartilage.

They make cartilage flexible and very resistant to compression - it's that property that interests us with the hyaline cartilage on the ends of bones. As articular cartilage, hyaline is found covering the articular surfaces of bones in synovial joints. It reduces friction, more slippery than ice, literally, and acts as a shock absorbing tissue.



As the cartilage in your knee degenerates it causes discomfort and ultimately severe pain as a hole wears right through the cartilage to the underlying bone. Bits of the cartilage break off forming 'joint mice' that get stuck in the knee causing severe pain on straightening the knee.

Cartilage is produced by cells called chondroblasts which are found along the vulnerable edge of the cartilage end plate. This is the place where new cartilage growth occurs.

In HC the protein collagen fibers that are imbedded in the chondroitin matrix are very uniform giving cartilage its hard, uniform and slippery-white appearance. Typically, perichondrium is found around hyaline cartilage.

Fibrocartilage


On the other hand the disc between vertebrae in your back is made up of two parts,

  1. The so-called "nucleus pulposis", a bubble of gelatine made up of substances called "glycosaminoglycans", made from the substrate glucosamine sulphate. Healthy glucosaminoglycans are able to bind water, and water is incompressible. This gives the disc its shock-absorbing properties.
  2. The outer ring of the disc is called the "annulus fibrosus". It is made from fibrocartilage, powerful collagen fibres arranged in a criss-cross ring, and attached deep into the endplate of the bone by very strong roots called Sharpey's fibres. Healthy cartilage is able to stretch outwards.

When you lift something heavy, the nucleus bulges into the annulus and, being a liquid and thus incompressible, it also presses back against the vertebrae, pushing them apart. Healthy annular cartilage contains this bubble of water-rich, gelatinous gel (it looks a bit like egg-white) as it bulges.

But diseased cartilage, particularly if you twist as the same time as bending and lifting, may rip, allow the gel to leak out. That is what chiropractic is all about! Getting the gel back where it belongs, without the use of drugs and surgery.

In a normal knee, for example, there is a space between the two hyaline cartilage  plates, one femur, one tibia. In obesity, these bones are forced against each other and, because the growing part of the cartilage is at the surface, the pressure damages the growing chondrocytes. Obese woman are particularly vulnerable, but men are certainly not exempt. Pain! 


Before subjecting your grinding, painful knee to arthroscopy knee surgery consider a consultation with your local Chiropractor. This mind-blowing medical research indicates that a sham treatment, or placebo, was more effective than arthroscopy.

The cartilage under the kneecap is particularly responsive to gentle chiropractic mobilisation of the patella. The condition, patello femoral pain syndrome.



CARTILAGE ENEMIES

1. OBESITY


Orthopaedic researchers in the Netherlands have designed a nifty device which draws the bones of the knee apart, whilst allowing them to keep moving. Preliminary results are very encouraging. By wearing the device for two months, simply by taking the weight off the damaged cartilage, MRI studies have confirmed that KNEE JOINT DISTRACTION allows for a 50% increase in cartilage volume ...

Dr Lafeber's rationale for his Knee Joint Distraction technique for advanced osteoarthritis in the younger patient is that osteoarthritic cartilage is capable of self-repair if ... read more.

2. SMOKING

All living tissue needs oxygen. Nerve tissue, denied oxygen, dies within minutes. Cartilage takes a little long, but the process is essentially the same: starved of oxygen, cartilage ages much faster, and the chances of restoration are much less.

In back surgery it is well recognised that smoking is the biggest risk factor. Put differently, it is the greatest single factor likely to put the patient into what is known as FBS. Failed Back Surgery. The healing tissues simply don't get enough oxygen.

Ask any Chiropractor, and s/he will confirm that in the treatment of acute low back pain with Chiropractic adjustments, that smoking with us too makes recovery more difficult. It takes longer, and the chances that you won't respond as well to chiropractic are much greater.

ATHEROSCLEROSIS SYMPTOMS Low Back Pain research indicates there is a close association between vascular disease and Lumbar Disc Degeneration. Read more


Glamorous - and DEADLY.


KNEE ARTHRITIS

Arthritis pain in knee is a complex condition of degeneration of the hyaline cartilage lining the ends of the femur and tibia - major weight bearing bones. It usually comes after injury to the knee (such as torn ligaments), excessive weight and poor diet.

There is no magic formula and no treatment works really well. Chiropractic Help certainly has a contribution to make, confirmed by the number of patients we treat with knee arthritis.

Research shows the most effective treatment is... also the most difficult... weight loss. These Free weight loss programs have much to offer.


3. POOR DIET

As in all disease, lack of the proper nutrients and vitamins, food rich in glucosamine and chondroitin and gelatine, the chances of the cartilage in your neck or back, knee or ankle, healing are much lower. There is now quite strong research from Harvard Medical School confirming that a rich bouillon made from bones does indeed help restore cartilage:

For strong healthy bones, the body needs adequate amounts of a group of fatty acids called omega-3. They are found mainly in fatty fish, nuts such as walnuts and pecans and freshly ground flaxseed. The big plus is that omega-3 simultaneously has powerful anti inflammatory properties, as well as benefits for the heart and mind.

So too the B vitamins are essential for healthy bones and nerves, keeping a toxic substance called homocysteine down...

All in all, if you are suffering from degenerative arthritis take a good long look at your diet. Healthy Living Tips ...


4. IMMOBILISATION

There is now oddles of research confirming that joints that aren't moving normally become arthritic. Or, to put it differently, cartilage starved of fresh synovial fluid sloshing about the joint, layering the cartilage with a substance called Hyaluronic acid, rapidly loses it glistening white slippery properties. It's called Immobilisation Arthritis. The cartilage starts to die ... degeneration and pain ...

Add to this the waste products of cartilage metabolism that are not quickly removed ... that is why Chiropractic subluxlations are a disaster waiting to happen.


SUMMARY

Cartilage lacks a blood supply and is restored far more slowly than other living tissues. But, given the right environment, your aging hyaline cartilage, and other types of cartilages as in the intervertebral disc, can heal, BUT it requires a diet rich in the necessary ingredients, plenty of oxygen, and plenty of movement.

  1. Take the pressure off
  2. Adequate nutrition
  3. Oxygen
  4. Movement, both at macro level (the whole body), and the microlevel - at the level of individual joints.
  5. Removal of waste products of hyaline cartilage metabolism, otherwise they start to irritate the nerve in the foramen which is located right between the joints in the spine.

And that is exactly what Chiropractic is all about!



ORANGE JUICE FACTS

Because bioflavonoids increase tissue permeability and collagen synthesis, something as simple as drinking a glass of freshly squeezed orange juice will contribute to the healing of hyaline cartilage. ORANGE JUICE FACTS ...

OJ I'm afraid just isn't the same thing. Think whole, freshly prepared foods.


FOOT PAIN AND ANKLE PAIN

It hardly seems possible, but almost as many patients at the Chiropractic Coalface are complaining of foot and ankle pain as low back pain. In fact, truth be told, a painful foot that makes you limp is probably the underlying cause of your lower back pain.

Take this letter received this morning from a reader. Think she might soon be suffering from low back pain?


I sprained my ankle nearly twelve months ago, and it's still swollen and the ankle is burning and tingling.

I had a scan four months ago. No broken bones were found.

The bridge of my foot is very painful whilst walking, and really it's not improving.

Orthotics have not helped in the slightest.

Do you have any advice for me?

Fixated joints in the foot and ankle lead unerringly to immobilisation arthritis and chronic foot pain.


IMPORTANT CONSIDERATIONS



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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


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