This month we’ll cover the most common cartilage injuries in the knee.Last month we discussed the two most common ligament injuries in the knee – the ACL and MCL tears. This month we’ll cover the most common cartilage injuries in the knee. While the ligaments keep the bones connected together, the cartilage serves to provide cushioning and allows for smooth movement to occur in the knee and other joints in the body. If it wasn’t for the soft shock absorbing properties of cartilage, impact sports like Muay Thai boxing and judo would be extremely painful. Over time, degeneration of the cartilage in the knee can lead to joint problems including arthritis and injuries to the meniscus. Arthritis, otherwise known as degenerative joint disease or osteoarthritis, is the result of repetitive trauma, overuse, and excessive force placed on joints. Most of us think of arthritis as a bone problem the older population has to deal with. While this is true to a certain extent, this is not always the case. Certain factors like genetics, exercise habits, being overweight, and poor nutritional habits also play a role. I tell patients with arthritis that gravity always wins in the end. The knees take a tremendous amount of compressive force, and the longer a person has been alive the more cumulative traumas, injuries, and wear and tear their knees have seen through the years. Arthritis can affect any weight-bearing joint in the body, but the knees are especially prone to degeneration in grappling sports and MMA. Repeated traumas from throwing knee strikes, kicking Thai pads, and resisting single leg take downs or knee bars can accelerate the degeneration that occurs in the knees. The most common symptoms of arthritis in the knee are pain, stiffness, and limited range of motion. It’s often common to experience some grinding or “crunching” sounds with knee flexion and extension. An arthritic knee joint is typically not swollen or hot, but ice and anti-inflammatory medication can often make arthritis pain more manageable. A good stretching program and flexibility exercises for the hips, thighs and legs is essential for full range of motion and minimizing any progression of the arthritis. One thing to keep in mind is that once you have arthritis, it’s there to stay. You can’t undo the effects which is why prevention is vitally important. Taking supplements like glucosamine and chrondroitin sulfate may help improve joint health so it’s worth trying if you already have arthritis in the knees. If you have persistent locking or giving way of the knee, chances are you probably have some meniscus damage. The meniscus is a C-shaped piece of cartilage in the knee joint that provides cushioning and “cups” the thigh bone so the knee can bend and extend smoothly. There is medial and lateral meniscus in each knee. Just as repetitive traumas can cause degeneration in the cartilage that lines the ends of the bones, it can also wear away and damage the meniscus. Most acute meniscus injuries occur when the foot is planted and the knee is quickly rotated in one direction (i.e. twisting out of a single leg take down). A torn meniscus can make squatting motions difficult and painful. Any torquing motions of the knee can also be painful making submissions like the triangle and omoplata your least favorite ones to attempt. Rubber guard work can also be uncomfortable to do with a torn meniscus. With severe tears it can be difficult to extend the knee without it locking, and it’s also common for the knees to give out while walking. As far as treatment goes for a torn meniscus, there isn’t a whole lot you can do once the damage is done. Smaller tears in the outer edge of the meniscus may heal, but larger tears closer to the inside have little chance for healing. Arthroscopic surgery to clean out torn pieces of the meniscus can decrease pain and make bending and squatting less painful. Sutures can be used to repair larger tears. Recovery time varies depending on how large the tear is and whether the meniscus was removed or repaired. One thing to keep in mind is that once it’s removed, it’s gone forever so I advise patients to hold out on surgery unless the tear is causing moderate to severe pain, and it significantly limits the range of motion in the knee. As always, a good rehab program is necessary post surgery. Gentle range of motion exercises followed by non-weight bearing exercises, which are then progressed to weight bearing strengthening exercises are recommended. Stretching is also necessary post surgery to ensure full range of motion at the knee without any limitations. At our clinic we always do lots of manual therapy including cross friction massage, myofascial release and ART (Active Release Techniques) treatments to minimize adhesions and abnormal scar tissue formation. For more information on knee injuries and how to manage arthritic or post-surgical knees you can e-mail or contact Dr. Park at the address below.
Contact info: Dr. John H. Park, D.C., C.S.C.S.Progressive Spinal & Sports Rehab10076 Darnestown Road Suite 200Rockville, MD 20850www.ProSpineRehab.comwww.yourMMAdoctor.comPhone: (301) 294-5101
Dr. Park is a chiropractor specializing in sports medicine and physical therapy. He is a BJJ blue belt under Mike Moses/Lloyd Irvin (www.evolveacademy.com) and continues to train and compete in BJJ.