Articular Cartilage Injuries

articular cartilage injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interessted in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Definition

Articular cartilage is difficult to understand because there are 3 types of cartilages in the body : articular of hyaline cartilage (covers joint surfaces), fibrocartilage (knee meniscus, vertebral disk) and elastic cartilage (outer ear). These cartilage’s types differ in their structure, elasticity and strength.

Articular cartilage is a complex element, it’s a living tissue that is on the joint’s surface. The function is to provide a low friction surface to allow the joint to withstand weight loads through the range of motion needed to perform activity of daily living. To put it simply, articular cartilage is a very thin shock absorber. It’s built in 5 distinct layers and each layer has a structural and biochemical difference.

Injury

articular cartilage injury

Articular cartilage injury may be due to trauma or progressive degeneration (wear and tear). This can be mechanical destruction, a direct blow or other trauma. The healing of articular cartilage cells depends on the severity of the damage and the location of the lesion. Articular cartilage has no direct blood supply so it has very little ability to repair itself. It the lesion penetrates the bone under the cartilage, the bone provides blood in the area which improves the chances of healing.

Mechanical degeneration (wear and tear) of articular cartilage occurs with progressive loss of normal cartilage structure and function. This loss begins with the softening of the cartilage, then progresses to fragmentation. As the loss of articular cartilage lining continue, the underlying bone no longer has any protections against normal wear and tear of daily life and begins to get damaged leading to osteoarthritis.

In many cases, a patient experiences knee swelling and vague pain. At this stage, continuous physical activity isn’t possible. If a loose body is present, words such as « locking » or « catching » might be used to explain the problem. With wear and tear , the patient often experiences stiffness, decreased range of motion, joint pain and/or swelling.

Diagnostic

The physician examines the knee to look for a decrease in range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the joint’s bones, and ligament or meniscal injury.

Cartilage lesions are difficult to diagnose and it’s possible that the use of magnetic resonance imaging (MRI) or arthroscopy may be necessary. Plain X- rays don’t usually diagnose articular cartilage problems but they used to rule out other abnormalities.

Treatment

articular cartilage injury treatment

 

Articular cartilage injury that doesn’t penetrate the bone doesn’t repair itself. A lesion that penetrates the bone can heal but the type of cartilage created is structurally unorganized and doesn’t work as well as the original cartilage.

Lesion less than 2 cm have the best prognosis and the best treatment options. These options are arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone (drilling, pick procedure or microfracture ).

For smaller lesion of articular cartilage surgery is not required.

For larger lesion, it’s necessary to transplant the articular cartilage from another area of the body. Talk to your doctor or specialist to have more information about the decision to have a surgical operation.

For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (for example reducing activity), bracing, supportive devices, oral and injection drugs (like non-steroidal inflammatory drugs, cartilage protective drugs) and medical management.

Surgical options depend on the severity of osteoarthritis and may provide a reduction in symptoms that are usually short-lived. Total osteoarthritis may relieve the symptom of advanced osteoarthritis but this usually requires a change in the lifestyle and/or level of activity of the patient.

Statistics

Based on published studies, the overall prevalence of articular cartilage injury in the knee is 36% among all athlete and 59% among asymptomatic basketball players and runners.

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-Steph

Adapt Your Training To Your Morphology (Part 2)

anatomy body squat morphology knee big belly

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

If you didn’t read Part 1, click here.

Legs

Improve your squat position

anatomy body squat morphology knee big belly

To reduce the lower back’s effort and limit the hamstrings tension, it’s possible to do like powerlifters by putting the barbell on posterior deltoids.

This technique decreases the cantilever and increases the power of lifting from the back. This allows you to lift heavier weights.

By using powerlifter of weightlifting shoes (solid raised heel) or a wedge under the heels, this reduces the cantilever by having the buttocks not too back by the advancing knees. This allows for greater amplitudes with the thighs flexion.

With that, we feel better the quadriceps work by limiting the torso’s inclinaison and the work of the gluteus maximus and spinal erectors.

The low barbell and raised heel combination allows you to lift heavier weights. This technique is recommended for rangy people and people with stiff ankles to correct their positioning at squat.

Front squat to target quadriceps

anatomy body squat morphology knee big belly

Front squat limits the torso’s inclinaison. This has the effect of reducing the work of the lower back, decrease the tension of hamstrings muscles and adductor magnus muscle.

On the other hand, front squat increases the cantilever, which forces quadriceps to make more effort to extend the thigh on the leg.

Which means it’s the perfect squat for thighs. But it’s not possible to lift heavyweights like the classic squat and it’s recommended to do it with heels elevated for better stability.

For rangy people, front squat is very hard to do. The torso of rangy people is more inclined, which make it more difficult to hold the barbell which may fall forward during the execution of the movement.

Spread the legs to less incline the torso

anatomy body squat morphology knee big belly

There is a squat’s technique to limit the torso’s inclination. This involves spreading the legs with the feet outward. Some powerlifters do this technique with the legs almost wide apart. With the legs apart, this limits the legs flexion.

To be able to squat with the legs apart, it’s necessary to have an adequate bone conformation of the hip joint and to be flexible of the thighs adductor muscle. Which means, it’s a technique that can’t be used by everyone.

The advantage of the big belly

anatomy body squat morphology knee big belly

Having a big belly for squat and deadlift allow to compress it against the thighs. This helps to limit the inclination of the torso and the back’s rounding. This has the effect of protecting the lower back and limiting the risk of herniated disc.

It’s for this reason that we can see a lot of heavyweight champion of powerlifting or weightlifting with a big belly. They take care to keep their belly fat with an excessively rich diet.

Different forms of knees

anatomy body squat morphology knee big belly

In bodybuilding, it’s important to take into account the different morphologies of the individual and especially for the knees.

Arched legs (genu varum) are not more risky than normal legs. For people with X legs (genu varum) or people who can overly extend the thighs (genu recurvatum), it’s often recommanded to not do leg exercises with very heavy weights.

Cases of genu valgum are often :

  • In people who were overweight during their youth when leg bones weren’t fully developed and still « malleable ». Legs are deformed because of the overload. Now, they have this X shape.

  • In women. The fact that women have wider hips to have children, this influences the femurs direction which are generally more inclined.

For people with genu valgum. If the genu valgum is to excessive, the joint would be overused. The medial collateral ligament would be extremely tense. The lateral meniscus, the articular surfaces coated with cartilage of the external condyle of the femur, and the external lateral tuberosity of the tibia would be subjected to excessive friction, which would cause pathologies of wear.

For people with genu recurvatum. These are people who are essentially very flexible named hyperlaxes or women whose muscular and ligamentous hyperlaxity is related to reproductive function.

Rarely pathological, knees with genu recurvatum can sometimes have some problems like the meniscus pinching. This can happen when the knees are rapidly expanding and the meniscus haven’t had enough time to slip, or during an exercise with a heavy weight that has forced the hyperextension of the thigh.

It’s for this reason that it’s recommended to people suffering from a genu recuvatum pathological never to totally block the knees at the end of extension to the squat or to the leg press.

Note

For 2 people who are the same size, it’s important to consider the torso-leg ratio.

anatomy body squat morphology knee big belly

Type A :

People with proportionally long legs and a short torso will have trouble doing a proper squat without tilting their torso excessively forward.

On the other hand, the short torso (which limits the cantilever) facilitates the execution of the good-morning, classic deadlift and Romanian deadlift.

Type B :

People with proportionally short legs and a long torso will have the facility to squat safety without tilting their torso excessively forward. It’s for this reason that the great champions of powerlifting squat specialist have this type of morphology.

Share this article if you think it can help someone you know. Thank you.

-Steph