Is it true that painful knee joint cartilage can heal?
Even if you have a bone-on-bone knee joint situation?
Absolutely yes, knee cartilage can heal.
And in this video today I'll be explaining exactly how that works.
My name is Dr. David Middaugh.
And I'm a specialist the physical therapist at El Paso Manual Physical Therapy.
And this channel is dedicated to helping people stay healthy, active and mobile,
while avoiding unnecessary injections, surgeries and pain medications. Please subscribe to
our channel so that you don't miss out on any of the helpful videos that we post every
single week.
Now if you have a bone-on-bone knee joint situation you've probably visited the doctor
had some x-rays, and had been diagnosed by a doctor with arthritis or a meniscus tear
of some sort. You'll probably feel a lot of stiffness pain achiness in your knee joint.
And this tends to be worst in the morning when you get up out of bed.
Or if you've been sitting for a while, like say you've been watching TV, you're watching
a movie or you've been in the car for a while, and then you get up to go move around those
first few steps, those first moments when you have to move your knee and put weight
through your leg in a walk are dreadful.
And that's a sign that you do have some cartilage damage, you probably have crunchy sounds that
happen in your knee too.
And then maybe you in swelling associated with this problem.
And you've gone to your doctor for help with the pain and the mobility to see if it's getting
any worse or if there's a chance at making it better.
And they'll take x-rays at the doctor's office.
And if you take a look at this x ray right here, it will show you that there's more pressure
on one side of the knee joint and less pressure on the other side of the knee joint because
the bones are closer together on one side and farther apart.
On the other side, where the bones are closer together, you obviously get compression of
all the tissues in there with x rays don't show his cartilage or the meniscus in there,
or muscles or tendons, they just show bones.
And you can kind of see a little bit of other stuff.
But it's really hard to tell you need an MRI or a CT scan to see more information on your
knee joint.
But the X-ray is good.
It's telling of decreased joint space on that side of the thigh bone in the shin bone or
meeting up closer together, then your doctor may tell you that this is age related that
you're getting older,
and this just happens with age.
And they'll probably tell you too, that you might need surgery sometimes sooner sometimes
later, just depending on how severe your knee problem is at this time.
Now what your doctor may not know to tell you just because of their training, they're
trained in medicine, and surgery, not necessarily rehabilitating cartilage.
That's not what most doctors do.
So what they forget to tell you is that the extra they took of your knee that they use
to diagnose your knee problem is a picture in time it's an image of your knee at the
time that you had the X ray taken.
And what you've got to realize is that in your knee joint, it has the ability to move
around.
And as you can see right here, this space between the knee when I move it around, it
changes.
So it could be that the position that your knee joint is currently in or was when you
took the picture was in such a position that the knee joint was coming together on one
end more than the other could have been outside or inside.
Now what pulls us in those directions is of course, just the position that you lie in,
but also the muscles, there's tons of muscles in the front of the thigh that quad muscles,
there's muscles on the outside of the thigh and the back and on the inside.
And if you've got an imbalance of those muscles, meaning they're too strong on one side and
not strong enough on the other, it changes the forces at the knee and pulls the joint
into a certain position which can compress the cartilage and the meniscus in the area,
causing that apparent bone on bone position.
And here's the key that doctors don't know about typically it's not their specialty,
you can alter the muscle balance around your knee joint through exercise and normalize
the position of the knee joint, which means that you're taking pressure off the cartilage
in the meniscus in the area.
And if you take the pressure off for long enough, the cartilage the meniscus can heal.
Now just a side note there's a difference between regeneration and healing.
regeneration means you put down brand new cells that are exactly like the ones that
you were born with.
There's a whole field of medicine called regenerative medicine that's focused on doing that.
And that's not what I'm talking about here.
I'm talking about healing.
Healing in the body the way it normally occurs, means you put down scar tissue Now we all
know about scar tissue you probably have scars on your skin that you've gotten in you remember
how you got them you injured yourself somehow you scraped yourself banged yourself.
Maybe you got some Road Rash, we scraped your knee, that kind of thing.
Well if you find a scar in your body and remember how you got it in the process, That you went
through to heal and get that scar, you had to bleed initially, then you scabbed over,
then the stab healed, and probably fell off.
And then under that scab is a brand-new scar.
Now think about that scar, it doesn't hurt, right?
It shouldn't hurt, not a normal scar should not hurt.
And it looks a little bit different than the skin around it.
The reason why it looks different is because it is not the original tissue that was there.
It's not the original skin cells that were there.
It's scar tissue.
The cool thing about scar tissue is it's typically 70 to 80% as strong as the original tissue.
The same thing happens inside our joints, the lining on the ends of the bones of cartilage.
And the meniscus itself can heal given the decreased pressure that's been on them that
has caused a problem if you take that pressure off, and then you put them in a great healing
environment.
And you can fill in the spots that are bothered with scar tissue.
It takes time to because cartilage and meniscus tissue, which is a type of cartilage just
heal slower than skin is one of the fastest healing tissues in the body it has to be watertight,
so it doesn't let the wrong things in or the wrong things out.
But cartilage, we all know that it has a decreased blood supply, which means that it just has
a lower metabolism, which means things just happen a lot slower in that tissue.
But that's how it's designed so that it can endure the forces that it does the body weight
that you put through it.
But if you put it in the right healing environment, which means taking the pressures off of the
cartilage tissue, then it can begin to go through the healing process and scar up the
way that it should be.
And another side note that I need to mention here is scar tissue isn't a bad thing in the
medical community in the health care industry, scar tissue has developed a bad reputation
because of extra scar tissue or excessive scar tissue.
And it really is rarely a thing.
And when we talk about excessive scar tissue, it tends to be related to surgery situations
because a surgeon is really injuring you, it's a controlled injury with the hopes that
everything's going to heal better than the situation that you were in before you had
the surgery.
But when they cut you open and make big incisions like that, you have to heal in the body and
actually puts down scar tissue.
But when there's a ton of damage to the area, you put a ton of scar tissue down, that's
when you have the potential for having excessive scar tissue, which can change the way things
move.
But if you have a little injury inside your knee joint, even though might be very painful
and seem big to you, relative to a surgery, it's a little injury, the amount of scar tissue
needed to heal that is pretty small.
And that scar tissue is incredibly important.
I mean, if you just think of any sort of skin injury that you have, like for instance, I
had a burn, right there was on my daughter's birthday, she's seven years old now, that's
seven years old, and that burn was big, it was at least double the size of the scar that
I have now.
And everything's fine.
Same thing happens inside the body, when you damage your cartilage, it can heal given the
right pressures.
So going back to the snapshot of the knee joint in the X ray, you probably had your
knees straight, which means that's the position that you stand in.
And when you put pressure through your leg, if you don't accept the pressures, right,
because you have muscle imbalances, that means your knee joints going to slightly collapse
one way or the other and apply more pressure on either the outside of the inside of the
knee.
The most common is on the outside of the knee.
Although it happens all the time again, so the knee as well.
When you fix the muscle imbalances, then you can change suddenly the alignment of the knee
and take pressures off.
Now when you bend your knee like so you also change the pressure that's on the knee and
the position of the cartilage relative to each other.
In other words, the cartilage that's on this surface of the knee is off versus when you
straighten your knee.
Now it's more on the shin bone here.
So there's different surfaces of the knee joints that make contact with each other.
And so there's different points in the knee joint that can develop a bone on bone or worn
down cartilage areas.
Let me show you what I mean in a picture that I've drawn for you.
So here's the thigh bone, here's the shin bone.
He drew a dotted line for the kneecap here and all the blue area right there is a cartilage
that's on the end of the thigh bone.
And this purple stuff right here is the meniscus so those sit on each other right there.
And this is typically the spot relative to the size of the model that I've drawn here
that is affected where the cartilage is worn down and you have a bone-on-bone situation.
It just so happens that when your knee straightens up, that's the position that you accept the
most forces and that's where you're most likely to wear down the knee joint.
But if you were to open up your knee joint, you'd have all this other healthy cartilage
tissue, you really don't lose all your cartilage you typically wear down the cartilage in one
spot where there's extra pressure.
And then once you fix the muscle imbalances, then you can offload that spot and allow the
cartilage in that area to heal so long as you can sustain that offloaded cartilage there,
you can take the pressure off for the long term, which goes back to the concept of these
muscle imbalances you have to fix the muscle imbalances.
without addressing the muscle imbalances, you will not take the pressure off long enough
to allow the cartilage to heal.
I've got separate videos to talk about which exercises to do and the concepts behind offloading
your knee joint cartilage so that you can heal your bone-on-bone joint situation.
These videos are linked in the description below.
There's our playlist on knee joint help knee joint advice and exercises is a wealth of
information.
It's a library of tips and exercises that you can start to do to heal your knee joint.
Go check that out everything's like the description below.
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Bye bye.