Hyaline Cartilage

Hyaline cartilage is the vital substance lining the bones in your joints.

Connective tissue 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 the working parts.

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.

But what really interests us today, is the hyaline cartilage that lines the bones in our joints.

I had a photograph here of the ball from the hip of a pig, brought courtesy of a butcher patient. Alas, Google calls it shocking content, so I've had to remove it.

Hyaline Cartilage

Hyaline cartilage is vulnerable because it has no blood supply; it is utterly dependent on the continuous supply of fresh synovial fluid to provide nutrients and oxygen, and remove waste products.

Hyaline cartilage on the ends of a long bone showing the flow of synovial fluid.

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.

That would include our fingers and 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 to the living hyaline cartilage, it would soon lose the ability to heal itself and begin 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 embedded in the chondroitin matrix are very uniform giving cartilage its hard, uniform and slippery-white appearance. Typically, perichondrium is found around hyaline cartilage.

Degenerate hyaline cartilage on the ends of long bones.


The discs in our spines are made from fibrocartilage.

Normal cartilage in disc anatomy.

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

It's as well to acknowledge cartilage enemies; they will cause us a lot of pain and, worse, disability. You don't mess with hyaline cartilage; it bites back.


Obesity is the number one enemy of hyaline cartilage; increased pressure, in the knees for example, makes us lose our independence; pain is an aside, in my experience, in comparison with disability.

This obese man using a walker will clearly have worn hyaline cartilage.

Arthritis pain in knee

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 for those suffering from arthritis pain in knee.

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 the weight is taken off.

Obesity and arthritis go hand in hand.


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; smoking is public enemy number one.

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.

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

Read more about atherosclerosis symptoms and low back pain

Particularly in women, smoking is one of the chief causes of osteoporosis as well as affecting the hyaline cartilage.

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; cutting out all the refined carbohydrate with a moderate increase in the healthy fats like olive oil and avocados is the way to control the dreaded feeling of being famished.

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.

Anti inflammatory omega 3 is part of the solution to angry joints and muscles.

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

Folate benefits

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 subluxations are a disaster waiting to happen.

Fixated joints that reduce the flow of synovial fluid succumb to immobilisation arthritis.


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 explains why OJ just isn't the same thing; think whole, freshly prepared foods.


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.

Ankle joint pain and the hyaline cartilage are intimately linked.


These mackerel recipes are rich in omega-3.

› Hyaline cartilage

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

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.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.