Exercise Helps Cartilage Recovery
30/09/2022
Hello readers! Following on from our blog earlier this month about osteoarthritis, I thought it would be helpful to follow-up on the topic of exercise and how it can assist with the recovery when there is injury to cartilage. Before we dive into that topic though, I would like to wish Aisling Decapitani, one of our Physiotherapists a Bon Voyage on her travels to see the world! All of us at Castletroy Physiotherapy Clinic are sad to see you leave, none more so than all the patients who you’ve helped immensely over the past 4 years! We wish you the best of luck for the future!
I think the best place to start when talking about how exercise can help the recovery from cartilage injury is to outline the medical professions understanding of the healing process. Quite simply, we looked at the different types of tissues in the body (skin, muscle, bone, tendon, ligament and cartilage to name but a few) and determined their healing capacity based on their blood supply. This is altogether sensible given how clearly we can track the healing of the skin with knowledge of the abundant blood supply it has. Other tissues, particularly ligament and cartilage are different with poor to no blood supply. This has generally lead to the wide assumption that their recovery capacity is limited or at least very slow. The research does however support the fact that these tissues do heal.
In 2009, a research paper outlined how these tissues with poorer blood supply recover through a process termed “Mechanotherapy”. Essentially what the authors describe is how a mechanical stimulus i.e. movement, causes the effected tissues to respond at a cellular level which results in adaptation. This adaptation means the tissue can better respond to the stimulus the next time it is received. In explaining this to people I would often liken it to leaving a plant near a window but not directly in sunlight. You will notice that the plant grows towards light source. The stimulus is the light and the response is the growth towards it to obtain more sunlight.
What does this all mean for cartilage healing? It tells us that if we perform the right types of movements (exercise) with the correct dosage (reps/sets/weight etc.) and over time make it gradually more demanding the cartilage will adapt to the stimulus and be better able to tolerate future demands. The “chondrocytes” which are cartilage cells, receive the mechanical pressures from the exercise and this encourages the production of more chondrocytes. It seems quite simple, however the challenge for us as Physiotherapists is ensuring we prescribe the right type and dosage of exercise. This does depend on the individual circumstances of the person, and therefore it is difficult to suggest a one size fits all set and dosage of exercise.
One last point to make on this topic is regarding the ongoing debate around the use of arthroscopy (keyhole surgery) versus exercise. Recent research has consistently shown that arthroscopy is no better than exercise in the short-term (3-6 months) or long-term (2 years plus), and in fact carries some additional risks, such as an increased likelihood of needing joint replacement in the future. Exercise on the other hand not only has the benefit of improving the condition of the cartilage, the joint tissues and muscles, it is also very beneficial for our general health.
I hope that has given you some helpful “food for thought”.
Till our next blog, stay active and stay well!
Lonan Hughes
Chartered Physiotherapist