yogabook / pathologie / cartilage damage in the knee joint

cartilage damage in the knee joint

Definition of

There is a wide-ranging debate about the relationship between cartilage damage and exercise, particularly sporting activity. It is clear that a regular, healthy amount of exercise is essential for the supply of cartilage, and this also applies to osteoarthritis patients. Immobilization, on the other hand, is bound to damage the cartilage over time due to insufficient supply and also leads to an increased deposition of fat on the joint surfaces. It is assumed that even competitive athletes and top athletes do not have a greater risk of osteoarthritis if there are no disruptive factors such as axial misalignments, foot deformities or muscular imbalances in the musculoskeletal system and the knee is not exposed to trauma. Disorders of the cartilage due tooveruse often occur on the basis of risk factors such as varusor valgus position of the knee, meniscus damage, which can be traumatic or degenerative in nature, instability of joints of the lower extremity or other pathological changes, in particular foot malalignment and hip damage. The extent of the cartilage damage depends on the level, duration, repetition of the load, the regeneration times and the extent of the disorder posing a risk. Cartilage damage is classified into four grades, as is well known. The ICRS score is used for this purpose. It is known that shock loads and load impulses promote cartilage wear. This must be taken into account when choosing the type of sport in the event of existing damage. Training must not extend into the area where the non-muscular structures of the knee become painful. Training under pain medication is prohibited. NSAIDs, for example, but also intra-articular injections with analgesics are used against pain. There are wide-ranging discussions about cartilage-nourishing substances as supplements. There is a positive study situation for the intra-articular injection of hyaluronic acid, but not for other substances, and even less for oral administration.

Cause

1. Overuse, especially in the case of abnormalities of the musculoskeletal system (lower extremities and hip joints)

Predisposing

1. Axial misalignments
2. Foot deformities
3. muscular imbalances
4. Non-axial movements (rotational movements during extension or flexion movements)
5. Pre-existing meniscus damage

Diagnosis

1. MRI

Symptoms

1. Exercise-induced pain

Complications

1. Osteoarthritis

Therapy

1. Unclear effectiveness: supplementation
2. Intra-articular injections (risk of infection!)
3. Movement therapy
4. Adaptation of sporting behavior
5. Therapy of the causes (predisposing factors)

Asana practice and movement therapy

In the case of cartilage damage, a controlled, moderate amount of movement is important. This should involve wide areas of joint movement so that the cartilage is exposed to changing pressure conditions as completely as possible. Excessive pressure or force is not necessary here. Regular alternation of the load is also more important here than static loading. Cyclical movements are therefore ideal. Here, however, one should think beyond the well-known cyclical movements such as walking, running, cycling and swimming. Furthermore, depending on the extent of the cartilage damage, the movements should be as low-impact as possible. In the case of severe cartilage damage, running, for example, may be strictly contraindicated or only tolerated to a limited extent. The preference for cyclical movements does not mean that an attempt should not be made to correct flexibility deficits and muscular imbalances with static postures, but this is an – albeit possibly very important – accompanying measure and not the actual „causal treatment therapy“. However, it is extremely important as an accompanying measure if unphysiological stresses, joint positions, pressure conditions or pathogenic movement patterns were the cause or co-factors in the development of the disorder. Exercise therapy is designed for the long term, as articular cartilage is the last of all bradytrophic tissues in terms of turn over.

Another aspect of movement therapy is the systemic approach. The most commonly affected joints do not stand alone, but must be considered as a link in a chain of force-conducting joints and muscles. Disorders in neighboring joints or in the muscles that cover the affected or neighboring joints can be important cofactors in the genesis of the disorder. Therefore, muscular disorders, muscular imbalances, restricted flexibility or pathogenic movement patterns must be investigated everywhere. In the lower extremity in particular, the gait pattern, shoe alignment, foot misalignments and deviations of the knee from the Mikulicz line of the shoes must also be considered.