This is How Knee Cartilage Can Heal (Even Bone-On-Bone!)

Is it true that painful knee joint cartilage can heal even if you have a bone on bone knee joint situation? Absolutely yes, knee cartilage can heal. And in this video today, I'll be explaining exactly how that works.

My name is Dr. David Midoff and I'm a specialist physical therapist at El Paso Manual Physical Therapy and this channel is dedicated to helping people stay healthy, active and mobile while avoiding unnecessary injections, surgeries and pain medications.

Please subscribe to our channel so that you don't miss out on any of the helpful videos that we post every single week. Now, if you have a bone on bone knee joint situation, you've probably visited the doctor, had some x-rays and have been diagnosed by your doctor with arthritis or a meniscus tear of some sort.

You'll probably feel a lot of stiffness, pain, achiness in your knee joint. And this tends to be worst in the morning when you get up out of bed or if you've been sitting for a while, like say you've been watching TV, you're watching a movie or you've been in the car for a while and then you get up to go move around. Those first few steps, those first moments when you have to move your knee and put weight through your leg in a walk are...

are dreadful and that's a sign that you do have some cartilage damage. You probably have crunchy sounds that happen in your knee too and there may be even swelling associated with this problem. And you've gone to your doctor for help with the pain and the mobility to see if it's getting any worse or if there's a chance at making it better.

And they'll take x-rays at the doctor's office. And if you take a look at this x-ray right here, it will show you that there's more pressure on one side of the knee joint and less pressure on the other side of the knee joint because the bones are closer together on one side and farther apart on the other side.

Where the bones are closer together, you obviously get compression of all the tissues in there. What x-rays don't show is cartilage or the meniscus in there or muscles or tendons. They just show bones. And you can kind of see a little bit of other stuff, but it's really hard to tell. You need an MRI or a CT scan to see more information on your knee joint. But the x-ray is good. It's telling of decreased joint space on that side where the thigh bone and the shin bone are meeting up closer together.

Then your doctor may tell you that this is age related, that you're getting older and this just happens with age. And they'll probably tell you too that you might need surgery sometimes sooner, sometimes later, just depending on how severe your knee problem is at this time. Now what your doctor may not know to tell you just because of their training, they're trained in medicine and surgery, not necessarily rehabilitating cartilage. That's not what most doctors do.

So what they forget to tell you is that the x-ray they took of your knee that they use to diagnose your knee problem is a picture in time. It's an image of your knee at the time that you had the x-ray taken. And what you've got to realize is that in your knee joint, it has the ability to move around. And as you can see right here, the space between the knee when I move it around, it changes.

So it could be that the position that your knee joint is currently in or was when you took the picture was in such a position that the knee joint was coming together on one end more than the other. Could have been outside or inside.

Now, what pulls us in those directions is, of course, just the position that you lie in, but also the muscles. There's tons of muscles in the front of the thigh, the quad muscles. There's muscles on the outside of the thigh, in the back, and on the inside. And if you've got an imbalance of those muscles, meaning

they're too strong on one side and not strong enough on the other, it changes the forces at the knee and pulls the joint into a certain position, which can compress the cartilage and the meniscus in the area, causing that apparent bone on bone position. And here's the key that doctors don't know about typically, it's not their specialty. You can alter the muscle balance around your knee joint through exercise,

and normalize the position of the knee joint, which means that you're taking pressure off the cartilage and the meniscus in the area. And if you take the pressure off for long enough, the cartilage, the meniscus can heal. Now, just a side note, there's a difference between regeneration and healing.

Regeneration means you put down brand new cells that are exactly like the ones that you were born with. There's a whole field of medicine called regenerative medicine that's focused on doing that. And that's not what I'm talking about here. I'm talking about healing.

Healing in the body the way it normally occurs means you put down scar tissue. Now, we all know about scar tissue. You probably have scars on your skin that you've gotten and you remember how you got them. You've injured yourself somehow. You scraped yourself, banged yourself. Maybe you got some road rash. You scraped your knee, that kind of thing. Well, if you find a scar on your body and remember how you got it and the process that you went through to heal and get that scar,

You had to bleed initially, then you scabbed over, then the scab healed and probably fell off and then under that scab is a brand new scar. Now think about that scar. It doesn't hurt, right? It shouldn't hurt. A normal scar should not hurt.

and it looks a little bit different than the skin around it. The reason why it looks different is because it is not the original tissue that was there. It's not the original skin cells that were there. It's scar tissue. The cool thing about scar tissue is it's typically 70 to 80% as strong as the original tissue.

The same thing happens inside our joints. The lining on the ends of the bones, the cartilage and the meniscus itself can heal given the decreased pressure that's been on them that has caused the problem. If you take that pressure off, then you put them in a great healing environment and you can fill in the spots that are bothered with scar tissue. It takes time because cartilage and meniscus tissue, which is a type of cartilage,

just heal slower than skin. Skin is one of the fastest healing tissues in the body. It has to be. It has to be watertight so it doesn't let the wrong things in or the wrong things out.

But cartilage, we all know that it has a decreased blood supply, which means that it just has a lower metabolism, which means things just happen a lot slower in that tissue. But that's how it's designed, so that it can endure the forces that it does, the body weight that you put through it. But if you put it in the right healing environment, which means taking the pressures off of the cartilage tissue, then it can begin to go through the healing process and scar up the way that it should be.

And another side note that I need to mention here is scar tissue isn't a bad thing. In the medical community, in the healthcare industry,

Scar tissue has developed a bad reputation because of extra scar tissue or excessive scar tissue. And it really is rarely a thing. And when we talk about excessive scar tissue, it tends to be related to surgery situations because a surgeon is really injuring you. It's a controlled injury with the hopes that everything's going to heal better than the situation that you were in before you had the surgery.

But when they cut you open and make big incisions like that, you have to heal and the body naturally puts down scar tissue. But when there's a ton of damage to the area, you put a ton of scar tissue down. That's when you have the potential for having excessive scar tissue, which can change the way things move.

But if you have a little injury inside your knee joint, even though it might be very painful and seem big to you, relative to a surgery, it's a little injury. The amount of scar tissue needed to heal that is pretty small. And that scar tissue is incredibly important. I mean, if you just think of any sort of skin injury that you had, like for instance, I had a burn recently.

right there, it was on my daughter's birthday, she's seven years old now. That's seven years old and that burn was big. It was at least double the size of the scar that I have now.

And everything's fine. Same thing happens inside the body. When you damage your cartilage, it can heal given the right pressures. Part of the interruption, I want to tell you about our knee arthritis recovery program. This program is completely focused on fixing the root problem that's putting too much pressure through your knee joint and setting up osteoarthritis.

There's three components to this program. The first is a curriculum. It's me walking you through the four phases of recovery. In the first one, that's when you're really stiff and painful and you maybe can't get around very well. All the way to the last phase where you're doing maintenance work and you're feeling fantastic, able to get around and potentially even exercise.

That's a big section of the program. A second section of the program is weekly live group coaching where me and my staff are on Zoom talking to you, answering questions so that you're never stuck. And then the third component is a private community where you can ask questions and my team is getting to you throughout the week as well as learn from others and see their questions and their wins so you can get encouragement along the way.

Go check out the program. Back to the video. Going back to the snapshot of the knee joint in the x-ray, you probably had your knees straight, which means that's the position that you stand in. And when you put pressure through your leg, if you don't accept the pressures right, because you have muscle imbalances, that means your knee joint is going to slightly collapse one way or the other and apply more pressure on either the outside or the inside of the knee. The most common is on the outside of the knee, although it happens all the time on the inside of the knee as well.

When you fix the muscle imbalances, then you can change subtly the alignment of the knee and take pressures off. Now, when you bend your knee like so, you also change the pressure that's on the knee and the position of the cartilage relative to each other. In other words, the cartilage that's on this surface of the knee

is off versus when you straighten your knee now it's more on the shin bone here. So there's different surfaces of the knee joint that make contact with each other and so there's different points in the knee joint that can develop a bone on bone or worn down cartilage areas. Let me show you what I mean in a picture that I've drawn for you.

So here's the thigh bone, here's the shin bone. I drew a dotted line for the kneecap here and all the blue area right there is the cartilage that's on the end of the thigh bone and this purple stuff right here is the meniscus. So those sit on each other right there.

And this red dot is typically the spot relative to the size of the model that I've drawn here that is affected where the cartilage is worn down and you have a bone on bone situation. It just so happens that when your knee straightens up, that's the position that you accept the most forces in. That's where you're most likely to wear down the knee joints. But if you were to open up your knee joint, you'd have all this other healthy cartilage tissue. You really don't lose all your

cartilage, you typically wear down the cartilage in a one spot where there's extra pressure. And then once you fix the muscle imbalances, then you can offload that spot

and allow the cartilage in that area to heal so long as you can sustain that offloaded cartilage there. You can take the pressure off for the long term, which goes back to the concept of these muscle imbalances. You have to fix the muscle imbalances. Without addressing the muscle imbalances, you will not take the pressure off long enough to allow the cartilage to heal.

I've got separate videos that talk about which exercises to do and the concepts behind offloading your knee joint cartilage so that you can heal your bone on bone joint situation. These videos are linked in the description below. There's a playlist on knee joint help, knee joint advice and exercises is a wealth of information. It's a library of tips and exercises that you can start to do to heal your knee joint.

Go check that out. Everything's linked in the description below. If you thought this video was helpful for you, please give us a thumbs up and don't forget to subscribe so you don't miss out on any of our helpful videos that we post every single week. We'll see you soon. Bye-bye.