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

Hanging Leg Raises

hanging leg raises

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Suspended on a chin-up bar :

  • Inhale and back up your knees as high as possible by approaching your knees to your torso.

  • Exhale at the end of the movement

This exercise works :

  • The iliopsoas, rectus femoris, tensor fasciae latae when you raise your legs.

  • The rectus abdominis and a little less obliques work when you move your knees to your torso.

To target the work on abs, it’s advisable to make small oscillations of thighs without never having the knees below the horizontal.

Attention

Rotations of the torso to the machine are proscribed for people suffering from low back or having already had a herniated disc.

Variant

hanging leg raises variant

By raising your knees on the side alternately to the right and to the left, obliques work more intensely.

Abdominal lumbar balance

It’s necessary to work in a balanced way the abdominal’s muscles and the back’s muscles (erector spinae). A lack of tone of hypertonicity of one of these two muscle groups can create a bad posture, and over time, create pathologies.

Example

Hypertonicity of the lower part of the erector spinae (sacro lumbar mass) with a hypotonicity of the muscles of the abdomen, will create a hyperlordosis with an abdominal ptosis. This postural defect can sometimes (if it is taken in time) be diminished by exercises of reinforcement of the abdominal muscles.

Conversely, hypertonicity of the abdominal muscles with loosening (hypotonicity) of the erectors spinae, especially in the upper part (multifidus spinae, longissimus, iliocostalis), will create a kyphosis (rounding back ) with loss of lumbar vertebral arch. This postural defect can sometimes (if it taken in time) be diminished by exercises of reinforcement of erectors spinae muscles.

Hypertonicity erector spinae muscles lumbar vertebral arch Hypotonicity abdominal ptosis

Kyphosis Hypotonicity erector spinae muscles lumbar vertebral arch Hypertonicity abdomen

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-Steph

Good Position For Abs

Action on lumbar curvature of the psoas muscle

Psoas muscles have other functions than to be powerful flexors of hip. They put the lumbar spine in lordosis, which increases the arch.

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

Abs exercises (especially for rectus abdominis) must work with the round back (round your spine). It’s the opposite of other exercises.

For vertebral coil exercises, the mechanicals stresses on vertebral joints aren’t the same as for exercises such as squat, deadlift and other exercises with weight. For example, for squat, the spine isn’t arched at the lumbar level. The vertical pressure with the spine’s rounding pushes the nucleus pulposus intervertebral disc backwards, which can compress nerve elements and create sciatic herniated disc.

For abs exercises, it’s the opposite. If during the abs execution you forget to round your back with an intense contraction of abs and obliques, the powerful flexors of hips (psoas major) will increase the lumbar arch. This will move the intervertebral discs forward as they aren’t stabilized by the vertical pressure. Then an excess of pressure at the back of the lumbar vertebral joints can create lumbago or more serious, joints damage by compression and shear.

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-Steph

Should You Arch Your Back ?

exercise arching back

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

Audio file:

For people who don’t have vertebral pathology, arching their back during an exercise isn’t a problem. Arching a little bit the back for exercises such deadlift or squat is necessary because the spine is rounded so arching a little bit the back helps avoid injuries.

But for some people, arching the back during an exercise can be very dangerous :

  • This concerns people suffering from congenital spondylolysis (absence of welding of the vertebral arch). The lumbar spine’s extension may cause the vertebrae to slide (spondyloystesis), which can seriously compress the nervous elements and cause sciatica.

    spondyloystesis

  • This concerns people who have demineralization due to age (osteoporosis) or people who haven’t yet completed their growth. The lumbar spine’s extension may cause spondylolysis by fracture of the vertebral arch. This fracture which has broken the posterior attachement system of a vertebrae can slide and seriously compress the nervous elements and cause sciatica.

    osteoporosis

spondyloystesis

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

-Steph

Shoulder Injury (Part 2)

shoulder

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

Dumbbell bench press with elbows along the body to continue training with a shouler injury

Dumbbell bench press with elbows along the body

It’s one of rare exercice to do when you have a shoulders injury, subacromial bursitis

Do dumbbell bench press with elbows along the body work, the anterior bundles of the deltoid and, a little bit, its middle portion to avoid an excessive friction at the front of the shoulders.

Do it regularly, it allows you to keep shoulders voluminious and tonic in spite of a local pathology. And it can use as a rehabilitation movement after a tear of pectoralis major muscle. Keep elbows along the body reduces stretching of pectoral major muscle limiting the risk of tearing of the injured area.

Exercice execution  :

Lying on a bench, your chest out and your back slightly arched. Your elbows flexed and along your body with a dumbbell in each hand :

  • Inhale and push your arms vertically

  • Exhale at the end of the movement

  • Return to the initial position by controlling the movement

Influence of bone morphology on back press

It’s important to take into account the individual differences in morphology when you’re training shoulders with back press.

Arm size

Arms lenght and especially forearms, plays a fundamental role in the execution of the exercice.

People with proportionately long forearms will descend their elbows much lower than those with proportionately short forearms.

This excessive elbow descent has the effect of streching the deltoid strongly, placing it in an unfavorable position that doesn’t allow the muscle to recruit the maximum amount of fiber to start the push powerfully.

Clavicles width

Clavicles width has a influence on the possibility of correctly lowering the barbell behind the neck.

Short clavicles invariably bring the two shoulder blades towards the vertebral axis. It follows that during the back press, when the two shoulder blades tilt towards the inside of the back, their displacement is substantially reduced by the compression of the trapezius and rhomboid muscle which fill the middle of the back, which limits at the same time the possibility of descendent correctly elbows to well feel deltoids work.

In addition, it’s important to note that more you have big muscles in the center of the back, the less the shoulder blades will be able to get closer and the lower the barbell behind the neck will be limited.

Note : Indivuduals with long forearms and narrow clavicles should have an interest in avoiding the back press to properly work deltoids.

back press anatomy

Attention

Too much space between the glenohumeral joint and the acromio caraoidal osteo ligamentary vault can lead to excessive friction when the humerus is raised in external rotation. With time, risk to damage, even tear, the supra-spinous tendon. With back press, it’s therefore important with the slightest sensation of discomfort in shoulders, accompanied by pain, to change movement in order to avoid a degenerative rotator cuff’s tendinitis.

A too small space between the gleohumeral joint and the acromio caraoidal osteo ligamentary vault can cause, during the arms elevation – when the humerus is carried this time in internal rotation (as with dumbbell lateral raise), excessive rubbing which may damage the infraspinatus tendon.

-Steph

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