Cartilage Injuries refer to a broad range of traumatic, age-related, autoimmune and disease-related conditions in which the cartilage in joints is worn down, degraded or damaged. Cartilage is an essential component of nearly all the moving joints in your body, from the small bones in your toes to the long bones in your arms and thighs, the working surfaces of the joints have a coating of cartilage to minimise shock to the bone, aid in weightbearing, improve the mechanical advantage of the limbs and make movements easier. Cartilage-covered surfaces are involved in almost all major and minor movement of the body, so they are constantly under strain during daily life. Cartilage is also present in the body in structures like the labrum of the shoulder, the acetabulum of the hip, and the meniscus of the knee. These cartilage structures are reinforcers of their joints; they change the way the bones work together to increase stability, smoothen movement, hold the joint together, and help it last longer. 

With so many places in the body being made up of cartilage, there are many common cartilaginous injuries that can occur. Two common ones are explored below.

Meniscus Injuries:

The meniscus is a structure inside the knee that attaches to the top of the tibia, which you may know as your shinbone. The knee is made up of the articulation between the thigh, the kneecap, and the shinbone. The end of the thighbone is rounded, and the top of the tibia is flat. Because it's difficult to stabilise a round object on a flat plane, the knee joint is well-reinforced by ligaments, the tendons of muscles crossing over the joint, the joint capsule itself, and the meniscus. The meniscus is a double-crescent shaped cartilaginous structure that is thicker at the front of the knee and thinner towards the middle. It is attached to the top of the shinbone and acts to center and seat the rounded end of the thighbone while the knee is being used for standing, bending, and weightbearing. The rounded heads of the thighbone are kept in place regardless of light or heavy movement, and so the meniscus is usually under continuous strain.

The meniscus can be injured in the same way the ligaments of the knee can be injured. During twisting, shock loading, awkward landing or external trauma, the thin cartilage of the meniscus can become torn and begin flapping about inside the knee joint itself. Excessive loading of the knee can also result in the degradation of the meniscus and separation of the structure without a traumatic cause. The meniscus is also degraded over time as a result of ageing, and in severe cases of arthritis, its loss can result in bone-on-bone contact of the thigh on the top of the shinbone which can be quite painful. 

Meniscus injuries can be managed with exercise and manual therapy, as well as with surgery. Regardless of the course of management, if you currently suffer from or have experienced a meniscus injury in the past, you will be encouraged to seek input from a physiotherapist. The work you do will focus on building muscular strength and stabilising the joint through basic and then complex movements, as well as planning a return to sport if that is something important to you.

Labral Tears:

Your arms and your legs attach to your body at the shoulderblades and the hips, respectively. At the shoulder, the rounded head of the humerus interacts with the shallow cup of the shoulderblade to seat the arm, and the shoulder joint is then stabilised by the capsule of that joint as well as the complex mesh of muscles that flow over, under, in front of and behind the joint. The hip has a deeper cup to accommodate the head of the femur, and so relies less on supporting muscles and more on the actual shape of the bones comprising those joints. Both the arm and the hip are made up of rounded bone heads fitting into socket-like spaces, so they are called ball-and-socket joints. The fit of a bone into a joint is called its congruence, and like fitting jigsaw pieces together, a more congruent joint is a more stable joint. 

Both the hip and the shoulder have a cartilaginous labrum. A labrum is a cup-shaped rim of cartilage that reinforces a ball-and-socket joint by increasing its depth and increasing the amount of surface area that the rounded bone head can interact with. This is particularly important in the case of the shoulder, whose range of motion is so significant that it is highly prone to dislocation if jarred or struck in the wrong way. The labrum of the shoulder joint acts to minimise the likelihood that the joint will be dislocated, but in the case of traumatic injury, the labrum may be torn. The labrum of the hip can also be worn down over time due to occupational, recreational, or anatomical factors such as hip dysplasia, and the result can be quite painful and debilitating.

Labral Tears can be managed with exercise and manual therapy, as well as with surgery. Regardless of the course of management, if you currently suffer from or have experienced a labral tear in the past, you will be encouraged to seek input from a physiotherapist. The work you do will focus on building muscular strength and stabilising the joint through basic and then complex movements, as well as planning a return to sport if that is something important to you.

Management of your discomfort depends on its causative factors, how it feels and changes during the day, what makes it better and worse, and the length of time you have been experiencing that pain. All of these factors will be addressed in your initial assessment, which is the first step toward managing and minimising any pain or discomfort. The treatment you receive will be tailored to address the specific cause of your discomfort, and will focus on minimising pain, maximising your ability to move pain-free, and developing a plan to minimise the risk of a flare-up in the future.

At Atlas Physio, we will provide you with education, structured management, and ongoing monitoring of your pain both in-clinic and out. Contact us to arrange an assessment, and to take the first step on a course of corrective care today.