Regenexx patients often ask what they can do to help their cartilage. Understanding the causes of cartilage loss in the first place is helpful.

obesity, mechanical. Being heavier places more wear and tear forces on cartilage.

solution: lose weight. This one is simple, but often tough to accomplish and maintain.

obesity, biochemical. Metabolic syndrome occurs when obesity not only breaks down cartilage by wear and tear, but also causes changes in the patient’s insulin response system. The syndrome itself has been shown to dramatically destabilize the chemical structure of cartilage.

solution: In addition to losing weight, reduce your carbohydrate and sugar load to reduce spikes in blood sugar and insulin release. If you have the genes that create the risk for metabolic syndrome, you need a strict low glycemic diet. (Signs of genetic predisposition include middle-aged paunch, muffin top, or belly). A low glycemic diet excludes sodas, sugar, fruit drinks, and baked goods, limits whole grains, and excludes caffeine, which will spike blood sugar. Low glycemic diets include Zone, Atkins, and South Beach.

trauma. Injuring the cartilage surface in a sudden traumatic event can lead to a weak spot that can cause that area of cartilage to break down more easily under normal conditions. Think of a strong fabric with a tear. The damage may be small, but the fabric will wear faster due to the tear.

solution: Consider cell-based solutions for cartilage repair before the problem becomes bigger. These might include injections of platelet-rich plasma or stem cells.

joint instability. Think of ligaments as pieces of duct tape that hold a joint together. An unstable joint means that ligaments have been injured, which will cause the joint to move around too much. All of this extra motion can slowly further injure the cartilage. Signs of instability include soreness or swelling after activity. If the instability is severe, you might notice sudden shifting, popping, or cracking.

solution: Clinical experience shows that injections such as prolotherapy, platelet-rich plasma, and stem cells can help reduce instability. If the instability is more severe, you may need to have it surgically corrected.

nutrition. You are what you eat.

solution: Add nutritional supplements and nutrient-dense foods to your diet. Taking 1,500 mg of glucosamine a day has been shown to protect cartilage. The same cartilage protection holds true for 1,200 mg of chondroitin a day, and vitamin C also has a protective effect. Resveratrol seems to help stabilize cartilage breakdown caused by metabolic syndrome. Vitamin E may be able to protect against premature cell death due to excessive wear and tear or due to chemical damage caused by medications.

medications. The most common medications injected into arthritic joints also have been shown to be the most toxic to cartilage. Local anesthetics and steroid medications cause cartilage cell death (called apoptosis). Local anesthetics that contain epinephrine are even more toxic due to their low pH and the presence of a preservative used to prolong the shelf life of the medication. Commonly used NSAID medications such as Ibuprofen (Motrin, Alleve), Naproxen (Naprosyn), and Celebrex (Celecoxib) have been shown to have an adverse impact on normal cartilage cells. In one study, Celebrex lowered the body’s production of chemicals that protect cartilage cells and increased the production of harmful chemicals. Although some drug-company-sponsored trials have suggested NSAID’s might protect cartilage, recent real-world patient studies show no such protective effect.

solution: Stay away from cortisone shots and consider taking natural anti-inflammatory supplements such as fish oil.

hormonal changes.  The most important hormone related to cartilage breakdown is leptin, which acts as a hormonal switch to tell your body when you’re full. Patients who chronically overeat produce an excess of leptin causing the body to lose its sensitivity to the hormone. Metabolic syndrome then sets in. A lack of response to leptin has been linked to an increase in arthritis symptoms.

solution: Eat smaller portions. You can reset your leptin switch to better turn off your impulse to eat by fasting or by a steep reduction in food intake for day or two.

repetitive trauma. If your joints are normal, then running should help your cartilage. If you’ve had joint surgery, then activities such as running or other impact sports can worsen cartilage loss. Moderate loading activities, like walking, tend to protect cartilage, while higher levels of loading, like running, may break down cartilage.

solution: If you have cartilage loss, switching from high-impact to mid- or low-impact activities may help protect your existing cartilage. If you have normal joints, keep running. It seems to help protect joints from damage.

poor alignment and biomechanics. We all accept the idea that if our car alignment is off, our car’s tires will wear unevenly. The same laws of physics apply to the human body. If you have asymmetrical cartilage loss (one knee and not the other), you may have a body-alignment problem that’s wearing down certain joints faster.

solution: Best to see the alignment section in the Regenexx book Orthopedics 2.0, which recommends different approaches to repairing alignment issues.

age and genes. Older patients seem to have less cartilage, and certain people have genes for weaker cartilage.

solution: There may not be anything you can do about this one, which is why it’s last on the list.

“Top 10 Causes of Cartilage Loss” first appeared as a post on the Regenexx blog.

Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.

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