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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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November 29, 2016

How to Feed, Train and Care for Your Cartilage

By Mark Sisson
30 Comments

Inline_Cartilage_TrainingMost health and fitness writers don’t spend a lot of time on cartilage. As tissues go, it’s fairly isolated. It doesn’t contain blood vessels, so we can’t deliver blood-borne nutrients to heal and grow it. Cartilage has no nerve cells, so we can’t “feel” what’s going on. Doctors usually consider it to be functionally inert, a sort of passive lubricant for our joints. If it breaks down, you’re out of luck, they say.

But that’s what people used to think about bone, body fat, and other “structural” tissues: that they are inert rather than metabolically active. The truth is that bone is incredibly plastic, responding to activity and nutrition, and that body fat is an endocrine organ in its own right, secreting hormones and shaping the way our metabolism works. What about cartilage? Can we do anything to improve its strength and function?

Absolutely.

Cartilage is made of water, collagen, and proteoglycans, a protein-polysaccharide bond that provides elasticity. Right there we see one avenue for altering cartilage health—hydration.

Stay hydrated.

Go down to the pet store and look at the dehydrated tendons. They’re dry, stiff, and completely unmanageable. Go down to the Asian market and check out the fresh beef tendons. They’re slippery, pliable, and still tough as nails. Now consider that cartilage and tendon are made of very similar stuff. Without hydration, cartilage doesn’t slide as easily. It can’t do its job.

And once you have cartilage damage, hydration is even more important because damaged cartilage is harder to hydrate. In one study, researchers dehydrated and then rehydrated damaged pig cartilage and intact pig cartilage, finding that the damaged cartilage absorbed far less water than the intact cartilage.

Eat extra collagen/gelatin.

Our need for and collective failure to obtain adequate dietary glycine underpins the growing bone broth/supplemental collagen industry. The reason why drinking broth and eating collagen makes so many people feel better is that we are providing a fundamental nutrient: glycine. See, our bodies need about 10 grams of glycine each day to maintain basic metabolic functions. We only make 3 grams, so 7 grams must come from the diet. A major function of glycine is to maintain and repair cartilage. If you’re training hard or trying to recover from existing damage, your glycine needs skyrocket.

Conclusive studies showing collagen rebuilding or buttressing cartilage are lacking, but we have hints. One study found that supplementary collagen improves joint pain in athletes who complain about their knees. And more recently, a study found that giving dietary collagen alongside Tylenol to patients with osteoarthritis improved joint pain and function over Tylenol alone.

My favorite ways to get collagen include bone broth, adding gelatin to pan sauces, and eating Primal collagen bars.

Move around a lot.

Motion is lotion. You need to walk. You should develop a daily movement practice, even if it’s just bodyweight squats while brushing your teeth and waiting for the train, your favorite VitaMoves routines while watching TV, or a good old fashioned rajio taiso.

Be sure to include mobility work, too, like the aforementioned VitaMoves, KStarr’s MobilityWOD, or MDA writings on joint mobility, foam rolling, and stretchingMany joint injuries occur because the tissues surrounding them—your muscles, your fascia, your major movers—are restricted, placing undo stress on the joint itself.

Walk over varied terrain.

Walking through civilization isn’t the same as ambling across a wild landscape strewn with stones and dips and fallen branches and slippery leaves, inclines and declines and slants. The former is linear and predictable. You just walk without having to think or react. It’s rote.

Walking across varied terrain exposes your cartilage to different positions and different loading patterns.

Go barefoot.

It starts with the foot’s connection to the ground. If you’ve got a big thick slab of rubber blocking the millions of nerves in your feet from sensing the ground, everything up the kinetic chain suffers.

Do so gradually, though. Going barefoot after a lifetime in protective shoes can be a shock. You don’t want to get injured; being sedentary is terrible for cartilage (and everything else).

Travel back in time and quit the soccer team.

If you have kids, don’t force them to specialize. Playing a variety of sports and activities early on and waiting to specialize until later adolescence is better for future athleticism and safer for the joints. Let them be kids. Let them play and cavort and explore multiple sports. Or no sports, just movement, if that’s what they want.

“Chronic repetitive loading” of the joints associated with intense sport practice reliably produces cartilage damage in adults, too. We can’t travel back in time, but we can eliminate any chronic repetitive loading our joints are still subject to. 

Join an adult sports league, but don’t get obsessed. Keep doing other stuff, too.

Load.

Osteoblasts are to bone as chondrocytes are to cartilage. Just like an osteoblast responds to load by increasing bone mineral density, chondrocytes respond to load by increasing cartilage growth and repair. You have to load it or lose it. Studies in cows find that cartilage is most robust in joints that actually receive loading

Research finds that high-load, low-volume back extensions can stimulate healing of damaged intervertebral dics, the pucks of cartilage that line your spinal column.

Use full range of motion on your lifts.

Full range of motion is correct range of motion. It’s what the cartilage is “meant” to handle and respond to. Deep squats, for example, are easier on the joints and make the knee more resilient than half or quarter squats.

Full range of motion is relative, of course. If you can’t squat below parallel without topping forward, don’t force the issue.

Get outside into nature.

Spending time in nature offers many benefits to your cartilage:

You’re more likely to be active, thus subjecting your joints to the loading and multivariate articulations they require to be healthy.

You’ll get more sunlight, which has been linked to better cartilage health in older adults. Curiously, vitamin D supplementation has no effect, so it’s probably the sun.

You’ll lower cortisol and improve your immune response. Elevated cortisol has been shown to impede cartilage repair, and some types of arthritis are autoimmune in nature.

Eat omega-3s and limit excess omega-6s.

Eat wild-caught and fatty fish, like wild salmon or sardines. The omega-3s have been shown to improve arthritis symptoms and even slow degradation of cartilage, and in rats, a balanced omega-3/omega-6 intake inhibits expression of MMP13, a gene involved in the progression of cartilage degeneration.

Don’t worry about nuts or avocados or other whole foods containing omega-6s. Don’t go crazy on them, either. Focus on avoiding high-PUFA seed oils, the densest sources of omega-6 in our diets.

Sleep.

Endogenous growth factors like human growth hormone play major roles in cartilage repair. And absent pharmacological assistance, we get the largest bolus of growth hormone at night, during sleep. Whether we’re recovering from the microdamage caused by smart training and regular loading or the degenerative damage caused by poor mechanics and outright injuries, sleep is where most of the repair happens.

Get your sleep hygiene in order.

Get a slackline.

Read my post from a couple years back on slacklining. I still have the same one set up in my backyard, and I still take frequent breaks to hop on and balance and walk.

Slacklining forces your body to make micro corrections constantly. That’s why a first timer putting foot to slack line will wobble uncontrollably and feel like they don’t know their own body: they’re placing enormous demands on a neuromuscular system that’s never encountered so unstable and dynamic an environment. It takes a while to get their bearings. And all the while, the knees, hips, and ankles are facing very unique loading patterns.

Plus—and this isn’t “scientific” or cited, just personal instinct—anything that puts a smile on your face while it forces a training adaptation will be more effective than one that makes you grimace. Teach your cartilage that work is fun.

Lose excess weight.

There can be too much load. We want the application of loading to be acute and intermittent. We want to control it. So, workouts, hikes, jumping, squatting, climbing, running and other short term activities generally improve cartilage health, particularly when using proper technique and allowing for ample recovery. But carrying 20-30 extra pounds is chronic loading because it never goes away. You can’t take that pack off.

Research shows that weight loss can really improve cartilage health. In one study, obese people with arthritis who lost a large amount of weight (5-10% of their bodyweight) greatly reduced cartilage degeneration. For many of them, it stopped entirely. If weight loss has that big of an effect on existing cartilage damage, imagine how it would affect healthy cartilage.

Those are 13 practices I find most useful in buttressing cartilage against damage and degeneration.

What do you got?

Thanks for reading, all!

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30 Comments on "How to Feed, Train and Care for Your Cartilage"

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Richard
Richard
6 months 29 days ago

Mark, what about people who are missing cartilage. I am missing 75% of the meniscus in my right knee (ACL repaired) and 25% of the meniscus in my left knee.

Time Traveler
Time Traveler
6 months 29 days ago

Richard, I lost my wrist cartilage following a complication due to mountain biking accident, arising from negligent treatment. Thus I suffer on a daily basis and it’s effecting my load bearing workout and day do day activities. While there’s no cure for missing cartilage at the wrist, progress is being made at regenerating it at the knee. There’s lot’s of info on line but here’s one that I came across while searching for a “cure”. Good Luck! [https://www.hss.edu/newsroom_knee-cartilage-repair-outcomes-regeneration.asp]

Frank
Frank
3 months 2 days ago

My doctor says prolotherapy will regenerate my worn away wrist cartilage. Have you tried that already?

Time Traveler
Time Traveler
3 months 1 day ago

Thanks. I just looked it up and it looks promising. My surgeon who is in charge of the hand department at my hospital, said that nothing can be done since there is no Cartledge left. Meanwhile, I’m in pain and weight bearing exercises puts a load on it.

Beth
Beth
6 months 29 days ago

Mark – wondering if a whole body vibration plate qualifies for unpredictable movement? I’m finding it useful for balance and rattling my lymph system loose, any impact on cartilage and tendons?

eatsleepswim
eatsleepswim
6 months 29 days ago

Not on topic but clearly in the Primal universe, read about the oldest human being who eats raw eggs and raw steak everyday.
http://www.cbsnews.com/news/emma-morano-worlds-oldest-likely-last-living-person-born-in-1800s-celebrates-117th-birthday/

Jen
Jen
6 months 29 days ago

Pardon my ignorance, but can anyone please explain what he means by “high-load, low-volume back extensions?” What does that look like? I don’t often understand the technical jargon. Is it just a yoga back bend like the Cobra position or is it something else? Thanks so much.

paul
paul
6 months 29 days ago

Heavy deadliifts 2-3 sets of 3-5 reps.

Juli
Juli
6 months 29 days ago
Is jello an appropriate food for glycine? I know, it’s not primal, but I’m looking for some quick fixes! Also – I have a lot of knee cartilage problems, and found hope through the likes of Doug Kelsey and Richard Bedard (http://savingmyknees.blogspot.com) . They believe that cartilage can be rebuilt, but that it takes an awfully long time with a lot of dedication. In a nutshell, they recommend a lot of movement with no weight, so minimal effort on a stationary bike. The key is to get a lot of movement in the knee area, but keep it free from… Read more »
Shary
Shary
6 months 29 days ago

Juli, I don’t know about Jell-O. It’s probably too high in sugars to be a very good idea. You could try Great Lakes gelatin. Something else that might help is low level laser treatment (also known as cold laser), which is known to promote deep healing in hard-to-heal places. It’s still not readily available but more and more chiropractors are offering treatment packages of six or more sessions at a reasonable price.

Clay
Clay
6 months 29 days ago

I second Great Lakes. I use the hydrolysate version. Odorless, tasteless and dissolves in hot or cold liquid easily.

Mary Shaw
6 months 28 days ago

+1 for low-level laser. I’ve had two arthroscopic surgeries on my left knee and didn’t think there was any meniscus left to tear, but got re-injured at the end of August. Low level laser /chiropractic and lots of stationary bike riding helped me get back in action faster than any standard orthopedic treatment.

Juli
Juli
6 months 28 days ago

I would go with sugar free (I drink Diet Coke too so am not overly concerned about the artificial sweeteners, or at least I consider it to be my primary Primal Vice).

wildgrok
wildgrok
6 months 29 days ago

Slackline!

I do it twice a week, I remember the wobbling uncontrollably when I started.
Now I can walk the whole line (15 meters) and my current goal is to walk it sideways , can do several steps and to do the turn back: reverse the way without stepping down (this one is proving to be very difficult)

The good thing is that you do not have to spend lots of time on it to get better,

Peter Estermannn
6 months 29 days ago

Vitamin C?

Elizabeth Resnick
6 months 29 days ago

So the same things that are good for our overall health are good for our cartilage, which makes perfect sense. Funny, I never really even thought about cartilage until reading this. I remember having a knee injury when running track in high school, and they said I had worn away a lot of cartilage. The knee doesn’t bother me at all anymore, and I’m very active. Is it possible the cartilage rebuilt itself?

Juli
Juli
6 months 28 days ago

Yes, but the cartilage that has grown back is not the same as the original cartilage. But hey – whatever works!

Andy
6 months 29 days ago
Any thoughts on people who suffer from fluoroquinolone toxicity? The antibiotics Cipro, Levaquin, Avelox, etc, have the well known side effects of dissolving human tendons and connective tissue over time, even without the tendons being loaded or used. People report their achilles tendon snapping in the middle of the night, or while standing still, or while doing mild stretches. And these tendon issues can happen up to years *after* stopping the drugs. I’ve been loading up on homemade bone broth but that doesn’t address the many underlying chemical insults to the body that these drugs leave for months, years and… Read more »
K D
K D
6 months 28 days ago

You might be interested in this article about knee pain: http://www.drbookspan.com/KneePainArticle.html

Joey
6 months 28 days ago

Looking to keep my knees in good shape … thanks for the tips!

Melanie
Melanie
6 months 28 days ago

I have torn cartlidge in my hip. Would the collagen still help since there is no blood flow to that area? It has been 2 years and it is still bothering me. Considering surgery because I don’t see another way for it to heal.

charles
charles
4 months 26 days ago

Google prolotherapy for hip. Has been used for almost 50 years in Europe for helping to regenerate joints.

Sandy
6 months 28 days ago

Very interesting. Thank you for the information. I also add curcumin/tumeric, ginger, and coconut oil to my meals and drinks daily.

Savage warrior
Savage warrior
6 months 26 days ago

Any thoughts on ozone, PRP, and stem cell therapies for cartilage regeneration?

Animanarchy
Animanarchy
6 months 25 days ago
Gristle! Eat gristle! If you don’t like gristle, I am sorry to say, you better suck it up,. (maybe eat real jello?). Plus some vit. C. Maybe this has been mentioned, I just quickly skimmed the first paragraph, thinking, “yeah, right, pfft.” Then onto the second: You mischievous charlatan! Ah, I got like a few minutes on this computer in a charitable “youth” center. (They didn’t ask me my age, nice (26) ) They had fresh veggies for me to munch even. I so miss this website. Custody (for stuff I wasn’t guilty of, or that was exaggerated or only… Read more »
Daniel
Daniel
6 months 24 days ago

Gelatin is great in bulletproof/blender coffee too.

I’ve posted about this in mda comments before, but the easiest way to supplement with glycine is…glycine. You can find it for $10/lb on Amazon. The Bulk Supplements brand is probably the easiest. It’s very sweet, about 70% as sweet as sucrose. 1 tsp is 4 g of glycine. I make a “soda” with it by dissolving 2-3 tsp in a couple tbs of hot water, add the juice of half a lime and lemon, 8-10 oz sparkling water and ice. It delicious, like drinking limonata San pelligrino, but good for you.

Mark Sanders
Mark Sanders
6 months 24 days ago

Over the years I’ve noticed that all my friends and acquaintances who were big on running/jogging usually stopped those activities sometime in their 50s because of knee pain. All of them did their running on sidewalks or streets, in other words om hard surfaces. I suspect if they did some kind of cross country running (on a variety of surfaces like grass or sandy beaches), they would have lasted longer.

Lily
Lily
6 months 21 days ago

I like how you said walk barefoot 🙂 that makes me happy because i never though about that. Yes when i walk around barefoot outside on the grass it feel so natural and primitive lol also the grounding is good 🙂

Florence
6 months 6 days ago

Another great blog post. Thank you so much!

Cindy Locher
5 months 21 days ago

This is an issue for me too. Numerous running injuries to both knees. I have one of those wobble boards (not sure what you call it) and that has really helped strengthen and stabilize my knees.

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