Our joints are covered by a layer of hyaline joint cartilage, which facilitates the sliding of the two joint partners against each other. Hyaline cartilage is a cartilaginous connective tissue with a very high water content. It serves as a shock absorber.
There are no nerve endings in the cartilage, which means it is not sensitive to pain. In case of cartilage injuries, degenerative diseases such as arthrosis (knee arthrosis is often present) or inflammatory diseases such as spondylarthritis, the quality and also the mass of the cartilage decreases. Abrasion products may be released, which cause irritation.
When the joint cartilage is lost, bone rubs against bone, which is supplied with nerves and causes pain. For the most part, cartilage is not supplied with blood vessels, but is supplied with nutrients via the synovial fluid. Movement is important for this.
Painful restrictions in movement can also lead to a reduced supply of nutrients to the cartilage. Cartilage is not reproducible. If areas of cartilage are injured or worn out, new cartilage cannot develop.
The addition of hyaluronic acid or indentations in the joint attempts to stimulate cartilage growth. Exercises for the joint cartilage are designed to keep the joint surfaces mobile and to supply the cartilage with nutrients through pressure and tensile load. Movement in the joint causes the cartilage surfaces to move above each other and synovial fluid is produced.
Exercises can also help to relieve the cartilage. Support exercises are ideal for this purpose. In everyday life, we often support ourselves in a way that strains our passive structures such as cartilage, bones and ligaments.
Targeted support exercises can help the musculature relieve a large part of the load. Strengthening the muscles surrounding the joints is just as much a part of the exercise program as stretching shortened muscles. If possible, the physiological body axes should be maintained in order to optimally load the joint cartilage.
Our knee is one of the joints most prone to cartilage damage. Sports injuries cause damage to the ligaments or the menisci, which often affects the joint cartilage. Osteochondrosis dissecans is a disease that occurs in adolescence and leads to the loss of a small area of cartilage and bone.
Depending on the treatment options, this can lead to later cartilage damage in the knee joint. Another cause of cartilage damage in the knee joint is axial malalignment such as knock-knees (genu valgum) or bow legs (genu varum). The malalignment results in a constant additional load on one side of the joint cartilage, which promotes wear and tear and may lead to patellar pain.
In order to prevent damage to the cartilage of the knee, the leg axis should be trained to compensate muscularly for malpositions as early as possible. This can be done with the help of Thera bands, with self-correction in front of a mirror and simple exercises such as knee bends and lunges. 1. knee bends with the Theraband This exercise should be performed by those with an X-B adjustment.
Tie a Theraband around your knees so that the Theraband presses you more into the knock-knee. You should now press both knees outwards against the pull of the Theraband, so that a straight leg axis exists. Now push your buttocks backwards while your upper body bends forward and the knee joints bend up to 100°.
The weight is now increased on the heels. Slowly bend your knees (up to 5 seconds) and return to normal knee and hip extension (eccentricity). During the execution the knee joints must not point over the tips of the feet.
If this is the case, bend the knees with the upper body straight and not bent forward. Do these exercises only if there is no pain. Method: 3 x 15 whl.
2. knee bend with a ball This exercise should be performed by people with an O-position. The execution is the same as for the knee bend with a Theraband, only that no Theraband is tied around the knees but a ball (pillow, blanket etc.) is put between the knee joints.
The ball pushes the knees outwards and should be pushed inwards by the user during the exercise to maintain a straight leg axis during the exercise. Do these exercises only if there is no pain. Method: 3 x 15 whl.
3. lunge step forward From a standing position make a long step forward.Catch your weight slowly and go max. 90° with the front knee into the flexion. The step should be set so far forward that the knee does not protrude over the tip of the foot.
Both feet point in viewing direction, the leg axis remains straight/stable during flexion. You can support yourself with your hands on the front thigh during the flexion. The upper body remains upright during the exercise.
Also for this exercise it is recommended to bend slowly and stretch faster. Perform these exercises only if there is no pain. Method: 3 x 15 whl.
per side. 4. step to the side Also here you start from a standing position. Now you put one foot far out to the side and bend your knee joint also here to max.
90°. The feet point in the direction of vision, the upper part of the body leans slightly forward, the buttocks push slightly backwards. You can support yourself on the bent knee.
From this position press yourself strongly back into the standing position. Do these exercises only if there is no pain. Method: 3 x 15 whl.
per side. After sports injuries or other traumas it is important to rebuild the musculature in order to avoid consequential damage and to ensure muscular stability, which relieves the cartilage. Coordination training is ideal for this purpose.
Knee bends on different surfaces, lunges in different directions, standing on one leg and much more are part of the training in the consolidation phase after the injury has healed. The therapy can be supplemented by treatment of the soft tissues, stretching and physical therapy. Tape bandages can relieve structures or support their healing.
Cycling and swimming are good sports that can be performed in case of cartilage damage in the knee joint, as the knee joint is hardly stressed by pressure from the body weight. If the joint cartilage is severely damaged, surgery is usually performed. Arthroscopic reprocessing of the joint surfaces is performed.
Depending on age, an endoprosthetic joint replacement can be performed. Further exercises for the knee can be found in the article Physiotherapy for knee arthrosis and exercises for knee arthrosis. The hip joint is a ball and socket joint in which the thigh articulates with the pelvis.
Cartilage damage in the hip joint is usually caused by arthrosis. In the hip joint, too, axial malpositions can lead to overloading of the cartilage. Typical axial malalignments are the coxa valga or the coxa vara.
This causes a change in the angle of the neck of the femur (valga – steeper angle – vara, flatter angle) and unilateral loading of certain areas of cartilage. Other causes can be hip dysplasia – a lack of roofing over the head of the femur, or Perthes disease – a childhood disease in which there is a short-term shortage of supply to the femoral head with the loss of cartilage/bone tissue. The femoral head can deform, which leads to permanent cartilage damage or promotes later arthrosis.
The hip joint can be easily mobilized by taking large, wide steps in which the pelvis rotates above the femoral head. Here, too, swimming and cycling are suitable in order not to put additional strain on the femoral head due to body weight. It is also important to maintain the mobility of the hip joint.
One-sided postures, such as sitting all the time, cause the joint to lose mobility. Especially the extension is often lost. Stretching exercises for the hip flexor muscles are ideal for this, but strengthening exercises for the hip extensors are also important.
1. hip extension with the Theraband Tie a Theraband tightly around both ankle joints. Stand upright and lead one leg stretched approx. 15° backwards without tilting the upper body forward.
Afterwards you lead your stretched leg slowly forward again. You can also do the exercise in prone position on the floor without Theraband. One leg is stretched completely upwards.
The view is directed vertically downwards. Method: 3 x 15 whl. 2. hip abduction with the Theraband Tie a Theraband tightly around both ankle joints.
You stand upright and lead one leg stretched approx. 35° to the side without tilting the upper body. Afterwards you lead your stretched leg slowly to the middle again.
You can also do the exercise on the floor in side position with or without Theraband. The leg lying on top is spread out. Method: 3 x 15 whl.
3. hip adduction with the Theraband Put a Theraband around your ankle and a fixed counter bearing (table leg etc. ).They stand upright and lead one leg stretched approx. 20° inwards, so that they pass the supporting leg without tilting the upper body.
Then they slowly lead their stretched leg back to the starting position. You can also do the exercise on the floor in a lateral position without Theraband. In this case the upper leg is directed forward, so that the lower leg is free.
This is now lifted. Method: 3 x 15 whl. In physiotherapy additional traction techniques can be used to relieve the joint surfaces.
By pulling on the joint, the cartilage surfaces are slightly separated from each other and thus relieved. Furthermore, painful tense muscles can be loosened by soft tissue treatment. Trigger point therapy and passive stretching round off the therapy for cartilage damage in the hip.
Further exercises can be found in the article physiotherapy exercises hip. Our shoulder joint is only slightly secured by bones. But the joint surface is secured by a cartilage lip, the labrum, glenoidal.
Injuries to the shoulder, such as a dislocation, often result in tears of this cartilage lip. Even with instability, the joint cartilage of the shoulder is overstressed and can wear out. This results in painful restrictions of movement, acute irritation and inflammatory conditions that promote shoulder arthrosis.
The mobility of the shoulder should be maintained as far as possible. To this end, it is important to identify and eliminate any protective mechanisms that may occur. Usually, when pain in the shoulder joint occurs, the entire shoulder girdle is moved and the head of humerus is hardly moved at all in the socket.
Although this relieves the pain, it leads to the joint cartilage being poorly nourished and the joint surfaces and surrounding structures becoming sticky. Therefore, provided that the cartilage damage is no longer acute and no longer requires immobilization, the shoulder joint should be mobilized gently and with a reduction in the weight of the arm. Pendulum exercises in which the upper body is tilted forward so that the arm hangs freely in space are ideal for this purpose.
Further mobilization exercises can be found in the article physiotherapy mobilization exercises. If the cartilage is capable of bearing weight, the active support should also be exercised. Since this can relieve the joint in everyday life.
We often support ourselves in our passive structures without tensing the muscles. In this case, the joint cartilage is subjected to a great deal of stress. The patient should learn to support himself in his musculature and to actively support himself.
In this way the joint is stabilized and the joint surfaces are relieved. 1. support on the wall You stand upright about half a meter in front of a wall and now let yourself fall against it. You support your weight with both hands at shoulder height.
Fix your shoulder blades by pulling them together and guiding them slightly down. The elbows are bent. Hold this position just before you push yourself away from the wall again.
Perform these exercises up to 3 sets of 15 whl. each. 2. support on the floor Do a push-up.
The arms remain fixed in a slightly bent position. Your entire body is under tension and completely straight. If you have the strength, you can turn the support into a push-up.
If you cannot hold the stretched position, support yourself with your entire lower leg and not just your feet. Hold this exercise for about 20 seconds. Small rocking movements can be performed.
Further exercises can be found in the article Exercises for the rotator cuff. In the case of acute inflammation due to cartilage damage, the joint should be immobilized completely for a short time if necessary. Orthoses or splints (usually prescribed by a doctor) are suitable for this purpose.
Shoulder gymnastics or aquagynastics are also often offered for shoulder patients, where the mobility of the shoulder is trained in a group. Here, too, therapy should be supplemented by physiotherapeutic soft tissue treatment or manual therapy. It is not uncommon for cartilage damage to occur behind the kneecap (patella).
This is called retropatellar cartilage damage. People who work a lot on their knees or athletes who put a lot of strain on their knees (weight lifting, running) are particularly often affected. The kneecap is a sesamoid bone in the insertion tendon of the knee extensor, the musculus quadriceps.
The kneecap can be pressed into its sliding bearing on the thigh (condyle) by placing heavy strain on the quadriceps. Increased pressure puts a strain on the cartilage surfaces and can lead to long-term cartilage damage.Anatomically, the patella is stabilized by a ligamentous apparatus laterally in the sliding bearing. It is possible that one (usually lateral) side pulls on the patella more than the other, resulting in unilateral abrasion of the joint surfaces, which promotes cartilage damage.
The imbalance can be so severe that habitual dislocations (dislocations) of the patella can occur, which is a strong risk factor for retropatellar cartilage damage. Traumatic injuries such as fractures of the patella or dislocations due to trauma are also strong risk factors for cartilage damage behind the patella. Pain usually also affects the patellar tendon later in life.
This leads to patellar tip syndrome. First the knee should be relieved, then the cause should be eliminated. If the quadriceps has problems with its attachment, it should be stretched and relieved.
In the case of axial malpositions and lateralized patella (pulled outwards), these should be corrected as far as possible by compensating for the muscular imbalances. 1st Thekla This exercise trains the back of the thigh (hamstring). You support yourself from the long seat on the floor with both hands and one foot upwards.
One leg is not on the floor but stretched and parallel to the floor in the air. The hip is pressed upwards and held. You now feel a pull in the hamstrings of the supporting leg.
Increase this pull by making small circular movements with the stretched leg in and out of the hip, clockwise and counterclockwise. It is important to always stretch the hip upwards. Hold this position for about 15 seconds.
2. knee bend In hip-widened position bend your knees to approx. 100°. The buttocks push backwards and the upper body bends forward.
The pressure on the heels increases. The flexion should take up to 5 seconds, while the extension to the starting position takes 1 second. You train eccentrically in this way.
If necessary, an operation in which the outer ligamentous apparatus is surgically loosened so that the patella can slide further medially (inwards) in its slide bearing is helpful. An operation in which the external ligamentous apparatus is surgically loosened so that the patella can slide further medially (inwards) in its slide bearing may be helpful. In the case of cartilage damage, no matter in which joint, a diagnosis should first be made to clarify the cause of the overloading of the cartilage.
Systemic causes such as arthritis or bacterial inflammation etc. must be excluded. Subsequently, an exercise program should be developed with the patient, which he/she should carry out regularly at home.
The correctness of the execution of the exercises is of utmost importance. Incorrectly performed exercises can further damage the cartilage. If the pain is severe, a complementary drug therapy should be considered.
If necessary, an operation in late stages may be considered. After acute injuries and traumas where cartilage damage has occurred, the joint must usually be relieved and immobilized before a rehabilitative therapy can be started. Heat or cold applications can be pleasant in the acute stage. Exercise and a balanced interplay of loading and unloading are essential for healthy joints with healthy joint cartilage. Most cartilage damage is degenerative and can be completely healed, if at all.
