Disclaimer: I am not a trained medical professional. I am not a medical doctor. The therapy described in this article is to be used at your own risk. “Always make the transition to any alternate/supplemental therapy gradually. Always monitor your health signs diligently through your doctor whenever doing any alternative therapy, and stop if there is any pain or discomfort. I am not responsible for any adverse reactions or side effects.
This article is for those who are suffering from complete loss of articular cartilage and meniscus cartilage and wish to avoid surgery.
Started writing this when I found out my mom suffering from this on her left knee. As a result, the femur and tibia at the knee joint are grinding against each other causing inflammation and lot of pain even when at rest such as when she is sitting or laying down. I’ve put together a comprehensive plan to help restore the cartilage.
I always believe in the body’s tremendous capacity to heal itself, if we give it the proper rest, exercise, and nutrition it needs. So I wasn’t too surprised to find many authors (most of them athletes) have written books on how they rejuvenated their knee cartilage without surgery despite doctors having told them the the cartilage is totally gone and there is no chance of it growing back, and that the only option is surgery. These people have had the same symptoms, almost all of them tell about how they’d wake up in the middle of the night almost crying in pain, but after going through a regiment, they cured it without surgery.
In order for this therapy to be successful one has to go on war-footing, like preparing for a battle. Everything has to be followed strict discipline.
Why not surgery?
When a non-surgical solution exists, why go for surgery? If something can be fixed by the body, then why not give a chance for the body fix it? I prefer surgery only in conditions where the body cannot repair itself or in matters of emergency.
There is a chance of post-surgery complications such as infections, sepsis, pinched nerve, etc… which can be more terrible than the knee pain.
Without a statistical database, I’d rather side with the consumer than with the person/hospital that is trying to sell you something. There is a significant number of cases where people opt for surgery to fix something, but only to make matters worse. The statistics highlighted in the book “Death by Medicine” of the number of people killed due to medical negligence including drug side effects is staggering. This is more so in countries like India where there is no accountability.
- Majority of the doctors and hospitals in India almost never get sued. As a result, the level of precautions and safety checks they take is much less than those countries where there is severe accountability.
- Many doctors not only prescribe drugs before even diagnosing the patient, they prescribe drugs that are banned elsewhere, and rarely determine the medical parameters and case history of patient before prescribing the drug.
- A very significant cause of complications and death come from medical negligence and bad practices from poorly trained assistants. For example, a leading cause of post-operative complications and death in India is sepsis due to utter disregard for hygiene protocols, such as when handling sterile tools.
In the USA, Johnson and Johnson is being sued for $1 billion for health damages caused by their hip implants. Metal from the hip implant over the years leached into the blood, causing metallosis, which in turns causes numerous body ailments. So that is another concern to keep in mind.
When the patient is 70+, one has to be very careful about anesthesia, especially in a country where there is no accountability. The nature and amount of anesthesia administered is critical, and if done wrongly can put in a person in coma. This is especially so for elderly patients. This is why anesthesiologists are among the highest paid in the medical profession. The doctor at Meenakshi Mission hospital was very forthcoming when he replied to my question of the success rate of the surgery for my mom (70+). He said that the only concern he had was not in the success rate, but in anesthesia. Having said, that he said they would do very comprehensive tests to determine amount of anesthesia.
About the Knee
Cartilage is the cushioning material between bone joints made up of collagen fiber.
- The articular cartilage surrounds the rounded end of the top bone (femur) and rounded end of the bottom bone (tibia). It serves primarily to reduce friction between the joints.
- The meniscal cartilage is sandwiched between the two bones. It serves primarily as cushion.
An X-ray of a healthy knee joint will show a gap in the knee joint. The “gap” is essentially cartilage. In a severely damaged cartilage that gap will be very thin.
For my mom the cartilage was paper-thin, literally almost invisible in the X-ray. In normal knee it is around 6mm thick.
Take a moment to identify the articular cartilage, femur, tibia, and quadriceps in the image below:
Take a moment to identify the meniscus in the side view of knee below.
Collagen is the protein which makes up the collagen fiber that constitutes the cartilage in joints.
- 30% of the protein in the body is collagen, this includes skin, hair, cartilage.
- There 16 types of collagen in our body, of which 90% of the collagen are of three types: Type 1, 2, or 3.
- Joint cartilage is primarily composed of Type 2 collagen.
- The collagen protein is a triple-helix structure which gives it its tough yet resilient/cushioning mechanical characteristics.
Causes of Knee Injury
Once you cross into your 40’s the number one cause of knee pain is damage to the articular cartilage (more common) and meniscal cartilage (less common). In case of osteoarthritis it can be damage to both cartilage.
One can wear out the cartilage due to a number of reasons:
- Age: From age 30 you lose approximately 1%-2% of collagen yearly. By 40 you’ll have lost 10-20% of collagen. In conditions of disease or stress injury you may even lose over 50% of collagen in the affected area.
- Osteoarthritis: This is the number one cause of knee pain for those above 50. Usually it affects both knees.
- Obesity: Obesity can cause great stress not only on knee but also on the back. It also puts one at risk for cardiovascular disease, diabetes, and cancer. Being obese is like carrying around two sacks of potatoes throughout the day, causing constant pressure and crushing of the cartilage of the knees and discs in your spinal vertebrae. It is essential to reduce weight/obesity by eliminated all forms of processed foods such as processed wheat flour (maida), white rice, trans-fats (this includes no more frying in highly heated oil, as when oil begins to smoke it becomes trans-fat, which is one of the biggest contributers to cardiovascular disease).
- Cholesterol: Cholesterol has little effect in blockage of smaller blood vessels and capillaries. Mainly effects blood flow in larger arteries. Nevertheless, cartilage and ligaments have very little blood flow, and it would be prudent to get as much blood flowing to it as possible. In this regard cardio exercise is also essential in getting blood circulating.
- Stress injury:
- Running without warm-up exercises is a leading cause of various leg injuries in beginners (joints, torn ligaments, inflamed tendons, sprained/damaged muscles, hairline fractures, etc).
- Running after a long break (such as couple of months of winter) for long distance (i.e. without gradually building up your distance over couple of weeks).
- Standing or walking for prolonged periods and ignoring that your body/legs are signaling you to rest. Even more so if you are obese.
- Carrying lot of weight (such as a fully loaded shoulder bag). Even more so if you are obese.
- Repetitive motion injury, such as repeatedly bending without giving enough time to recovery.
- Improper walking, such as stomping your feet instead of gracefully landing your feet when walking.
- Bad food habits such as excess sugars can not only destroy collagen but reduce collagen production.
Source of Pain
The articular cartilage is normally at least 6mm thick. When it is severely deteriorated it is paper-thin.
In such severe case it is not uncommon to experience severe pain throughout the day, even when at rest (sitting or laying down). Even more so at night, since it is at night when the blood vessels dilate, causing swelling, causing inflammation. People have been known to wake up in the middle of the night with unbearable pain in knee joint.
The reason for pain is because without the cartilage, the bone at the knee joint is grinding against each other, including damaging whatever muscle and nerves that were originally surrounding that gap (note: cartilage itself does not have much nerve nor blood vessels). This can cause lot of inflammation and pain.
The grinding of the bones can also cause bone deformities called bone spurs. Instead of the bone ends being smooth, it will be rough or jagged. So even with cartilage regrowth, it will be may not be 100% back to normal as the bone ends are no longer smooth, causing friction that can tear into the cartilage, instead of smoothly gliding over each other. The longer you have been suffering and putting up with joint pain, the more damaged the bone ends become causing bone spurs, and the more difficult to get back to 100% normal.
The following regiment is required for the cartilage to rebuild itself:
You’ll need at least 100 days for the cartilage to grow to 5mm (typical articular cartilage is 6mm thick). This means the cartilage grows by only 5mm/100 = 0.05mm/day (or 0.1mm every second day).
Rest is the single most important requirement for rejuvenating the cartilage. It is critical to rest over 80% of the day. For every hour, rest at least 45min, and be on your feet for no more than 15min. Preferably split the 15min across the hour instead of a continuous 15min on your feet. Just that 20-30 minutes of continuous standing is enough to crush that growth of 0.05mm of cartilage and undo any progress. You will be constantly undoing whatever growth there is. No matter what food, diet, massage, medicine, your cartilage will not grow back.
Therefore, for the next 3-4 months make preparations to be mostly seated in chair/sofa or laying in bed. This may seem like a big hassle, but the payoff is that your cartilage will start regrowing, and once it reaches of critical mass of a few mm thickness, you won’t have to rest as much.
If you want the cartilage to grow back, there needs to be absolutely no pressure nor inflammation on the joints. When you have your entire half of your body weight on the knee joint crushing the paper-thin cartilage that is left, it will not have a chance to recover, and whatever paper-thin cartilage that is left will be gone.
Also, since people tend to put all their weight on the good leg, this can very rapidly accelerate the damage to the cartilage on the good leg as well, rendering you incapacitated or wheelchair-bound. If you don’t have the discipline to take rest, you will be forced to rest.
An inflamed cartilage is as bad as not resting enough — both cause pressure on the cartilage preventing it from growing. In addition to rest, it is an absolute must to keep it from getting inflammed. Taking rest and taking anti-inflammatory drugs are the top two advices that physicians stress. Just these two can help the body repair itself. Else no amount of diet, medicine, etc will have any effect — you will be just wasing your time and money on supplements and diet.
Applying cold pack / ice compress at least 3 times a day. Do not apply it so much that it freezes the knee. Do not wait for pain to appear before putting the ice pack. By the time you experience pain, it indicates the area is already damaged/inflamed. Pain is always an last resort symptom, where the body is signaling it has gone beyond its ability to handle it.
Ice therapy is one of the most underestimated and yet highly effective healing properties. It is widely used by athletes for recovery from various injuries.
In fact the common mantra for reducing knee pain and inflammation is RICE: Rest, Ice, Compression, Exercise.
Note: do not apply ice after massaging the knee area. The idea of massage is to increase circulation to deliver nutrients and awaken the healing process. See Massage section. You may apply ice before the massage if the area is inflamed.
You may also take anti-inflammatory supplements, natural or western medicine. See in Diet section for natural anti-inflammatories.
If taking anti-inflammatory western medicine, avoid steroids.
One can also take pain killers, as the stress due to constant pain can also cause inflammation. Usually anti-inflammatory drugs are combined with pain killers. But beware that pain killers may give you the illusion that your knees are fine, and you might start walking more, causing it to be damaged even more, causing you to take even more pain killers.
Air Conditioned Room
As much as possible stay in an air-conditioned room. Avoid hot and humid climates. Even more so when sleeping make it a must to sleep in a cooled room. If you are not accustomed to air-conditioned rooms, you may cover the upper body, but leave the knee area exposed. Something as simple as an AC room or ice-therapy will greatly help in reducing inflammation.
The smallest amount of inflammation is very bad and when will undo all your efforts. Rest and Ice are so important that without both of these all your dietary and medicinal supplemants will go to waste.
The following are the list of dietary requirements in order of importance for production of collagen.
We need to increase intake of the amino acids that make the collagen protein. But just taking amino acid supplements is not enough. We need to also increase the intake of vitamins and minerals that are needed to take the collagen protein and produce the collagen fiber that makes up the cartilage.
All th ecollagen protein sources are non-vegetarian. However, the body can synthesize its own collagen if you provide it all the raw materials (see section on Raw Materials).
|Collagen||Cartilage is made of collagen protein.||– Gelatin (most gelatin is made from boiled skin and sinew from cow and pig). – Bone broth from cow or chicken bones. – Egg whites. Fish (cod and salmon).|
Collagen Repair Supplement
The following are the top 3 key ingredients in almost every joint repair supplment.
|Glucosamine||The byproducts of glucosamine acting with collagen are needed for cartilage repair. Glucosamine contributes to the synovial fluid which is the slippery lubrication in joints. Glucosamine is synthesized by chondrocyte cells. Commonly marketed forms are glucosamine sulfate or glucosomine hydrochloride. Even though Glucosomine HCL is more organically synthesized by the body, the Glucosamine Sulfate when taken has more bio-availability. If taking the Glucosomine HCL it would beneficial to take foods with high sulfur content.|
|MSM||MSM (methylsulfonylmethane), also known as DMSO2, is the oxidized form of DMSO. In essence it provides biologically active sulfur which helps reduce inflammation and pain intensity in joints. MSM has been hailed as the “miracle supplement” for joint pain and inflammation relief.|
|Chondroitin||Helps build cartilage. It works by retaining water in the joints, thereby increasing lubrication of joints. It is often used to treat pain from osteoarthritis. Chondroitin is naturally present in Type 2 Collagen.|
When I first spotted the word “DMSO“, brings back memories of my dad, as he had plenty of publications in leading scientific journals on DMSO back in the 1990’s.
I advise against taking supplements. Instead take food that has the amino acid profile of collagen (and supporting amino acids) in large quantities (not small nibbles or once in awhile). If you can’t do that, then if you do take collagen supplements, make sure to take it on an empty stomach. Best time is before you go to bed. Take approx 1000-1500mg in one go. Don’t eat anything 2-3 hours after taking collagen. As per this article “How to Take Collagen Pills” this allows to collagen to pass through the stomach and into the intestines without getting broken down by the stomach.
The body can synthesize its own collagen if you provide it all the raw materials (all vegetarian).
|Glycine||One of 4 amino acids that are the building blocks of collagen.||Spirulina, hemp seeds, amaranth, quinoa, spinach, kale, cabbage, pumpkin, banana, kiwi. Spirulina is a superfood that contains all essential amino acids, vitamins and minerals, that are needed for collagen production. See blog article Spirulina.|
|Proline||One of 4 amino acids that are the building blocks of collagen.||Spirulina, eggs, avocados, garbanzo beans, peanuts, cucumbers, chives, wite mustard seeds.|
|Lysine||Amino acid needed for synthesize of Hydroxyproline and Hydroxylysine — two of 4 amino acids that are the building blocks of collagen.||Spirulina, eggs, kidney beans, black beans, pistachios, Parmesan cheese.|
|Arginine||Another important amino acid needed for collagen synthesis.||Spirulina, eggs, sesame seeds, coconut, yogurt.|
|Hyaluronic acid||Is a must for binding collagen and elastin fibers together to form collagen bundles. Hyaluronic is naturally present in Type 2 Collagen.||Seaweed, sweet potato, avocados, mango.|
|Vitamin C||Is a must for converting proline to hydroxyproline, and lysine to hydroxylysine. Hydroxyproline and hydroxylysine are two of 4 amino acids needed for the body to synthesize collagen fiber. In addition to being necessary for producing these two amino acids, it is also a powerful antioxidant that can scavenge free radicals that are known to damage collagen.||Amla/gooseberry, orange, lime, lemon, citron (naarthankai), papaya, hot chilli pepper, kale, beet greens, turnip greens, collard greens, mustard greens, okra, sweet potato.|
|Sulfur||Needed for collagen synthesis. Also prevents breakdown of collagen.||Garlic, chives, leeks, onions.|
|Vitamin A||Needed for collagen synthesis. Also prevents breakdown of collagen.||Spirulina, chlorella, cooked carrots.|
|Vitamin E||Prevents breakdown of collagen.||Avocados have been shown to increase the level of soluble collagen as well as provide vitamin E.|
|Zinc||Helps “activate the proteins needed for collagen synthesis” and slow down the breakdown of collagen.||Fish, nuts (esp. cashews), cocoa powder, pumpkin seeds, cooked chickpeas.|
|Manganese||Helps increase production of collagen and elastin by increasing the enzyme for proline formation.||Seaweed, nuts, pineapple, green leafy vegetables.|
|Copper||Helps increase production or utilization of collagen and elastin.||Nuts (esp. almonds), lentils, dark chocolate, apricots.|
|Omega 3||“Helps to create an ideal environment for collagen production”. Note, omega-3 is an essential fatty acid, but the body cannot produce it. It must get it from an external source.||Eggs, fish, or flax seeds (do not go for flax oil), and nuts such as almond, cashews, walnuts, pistachio, pumpkin seeds.|
The following are some of the top anti-inflammatory foods to help relieve knee joint swelling.
|Turmeric||Take 1/3 teaspoon with food, or in buttermilk or milk. Do not take alone or just only with water, as it can cause ulcer.|
|Ginger||Take fresh ginger tea. Do not take dried ginger. Though dried ginger is also very potent, it is has different medicinal properties for other uses, not for anti-inflammation.|
|Coconut MIlk or Coconut Oil||There are over 14,000 5-star reviews on just one coconut oil brand alone on Amazon.com (likely 20,000 reviews if you take all the coconut oils sold on Amazon). People have woken up to the enormous benefits of coconut oil. Coconut oil contains lauric acid which is a medium-chain fatty acid (MCFA). Coconut oil is the only oil where MCFA is found in abundance. It has numerous health benefits (see related blog article The Good Oils). For knee joint health one can consume a spoonful of coconut oil (or a 1/2 cup of coconut milk) as well massage the knee with coconut oil. In fact when you buy milk in the USA and you see the label “Important for brain development”, it is likely because it has been fortified with lauric acid derived from coconut oil. Even baby food in USA is fortified with coconut oil.|
|Fenugreek||Roast fenugreek seeds, grind into find powder. Mix two teaspoons with water and leave over night. Apply the paste to knee and leave on knee for few hours or overnight.|
Reminds me of a medicine that my dad made consisting of Spirulina, Amla/Gooseberry (high in Vitamin C), and Turmeric (super anti-oxidant and anti-inflammatory). Numerous people came all the way to our house from afar to thank him in person for the relief and healing of various diseases that no other medicine helped.
One must take these food items in large quantities, i.e. instead of 5 almonds take 10-15 almonds, instead of a pinch of turmeric take 1/3 spoon per day, instead of highly fried or boiled greens where most of the vital nutrition is destroyed, steam them.
You might say, but I’m already taking these foods. Most likely not. Most people are eating the wrong way. The right way to eat is to substitute, weight-for-weight, your main dish (often rice, wheat, or meat) with vegetables. That is, whole grains (like rice and wheat) should be your side dish (i.e. less than 1/4 of what you would typically consume) and these vegetables should be your main dish. Unless you are an athlete or doing heavy duty field work, the adult does not need that much carbohydrate in ones diet. Even as an active person if you need carbohydrates take millets and wild rice instead, as they digest slowly and have lower glycemic index.
Native Indian Herbs
The following are traditional healing herbs from plant-based medicinal systems in ancient Hindu traditions like Siddha and Ayurveda.
1. Pirandai (Cissus quadrangularis)
Pirandai (பிரண்டை) in Tamil. In Sanskrit it known as asthi-samharaka (अस्थि संहारक), meaning prevents destruction of bones (asthi – bone, samharaka – closing or drawing together).
Note that pirandai has oxalic acid in its nodes, which can cause kidney stones. Be sure to neutralize the oxalic acid the same way you neutralize the oxalic acid in saag (mustard greens spinach) – by adding lemon or lime juice. The oxalic acid can also be neutralized by calcium in diet, which binds to the oxalic acid to form calcium oxalate which gets flushed out of the digestive tract instead of going to the kidney.
2. Mudakathan Keerai (Cardiospermum halicababum)
Mudakathan Keerai (முடகத்தான் கீரை) Tamil, meaning relief of joints. In Sanskrit it is known as indravalli (ईन्द्रवल्लि).
3. Other Traditional Recommendations
The above video talks about the same dietary recommendations that Western medicine is advising: such as taking 10 of each almond, pistachio, cashews. He also talks about taking papaya. A very popular remedy among athlete easing joint pain is a smoothie made of oats, papaya, pineapple, and soaked almonds
Observe that when almond or pistachio is soaked, it takes on a texture that resembled cartilage. When soaked almond or pistachio is crushed it is creamy/milky texture, which gives insight to the healthy fat and protein needed for collagen. Almond and pistachio are very rich in protein. Since cartilage is primarily protein, it is very essential to take these. Not just a few, but a handful (10-15 of each) every day. Make sure to soak them overnight before taking.
Papaya and pineapple are recommended along with these protein-rich nuts likely because papaya and pineapple contain enzymes papain and bromelain respectively, that help digest the protein (in fact most of the processed red meat in the USA is injected with papain or bromelain to aid in digestion).
The above videos talks about taking garlic. Must be taken raw or briefly boiled in milk, as the beneficial sulfur components are in the raw aromatic oil which gets destroyed when garlic is oil fried.
The problem with the above youtube videos is that they focus only one particular nutrient (pirandai, garlic, almonds, etc). You not only need all the nutrients mentioned earlier, but need all the components of the therapy (Rest, Anti-Inflammation, Diet, Exercise, Massage).
All three of the below videos are essentially the very same exercises that was demonstrated by a physiotherapist at Meenakshi Mission Hospital for mom. To be done at lease 3 times a day.
These stretch exercises are important as they work on strengthening the quadriceps, hamstring, and calf muscles which help pull the knee joint apart to relieve the gap from being crushed, which helps the cartilage grow/repair.
Massaging the knee area, including well above and below the knee, is important, as there is very little blood circulation in cartilage. Meaning, very little transport of nutrients for regrowth of cartilage. This is why damaged cartilage can take long time to heal, often in months.
As with any message it not only improves circulation but also stimulates lymph to facilitate drainage. Improper drainage is indicated if back of knee is swollen or inflamed.
Again, to emphasize, all components of Knee Cartilage Repair Therapy is important: rest, anti-inflammatories, diet, exercise, massage.
The more you devote time and discipline to all components, the greater the chance of success. Even if you neglect one component, such as no rest, or no exercise, or no massage… you’re recovery will likely not work, you’ll be just wasting your time and money on supplements, exercise, and diet regiments. So make sure to rest the leg a lot and keep the inflammation low. Please re-read the section on Rest and Anti-Inflammatories.
But if I were to emphasize just a few items they would be:
- Rest/Breaks (absolutely no continuous standing walking for more than 45min at a stretch)
- Spirulina (one tablet with every meal) – supplies the necessary amino acids for collagen: glycine, proline , lysine, arginine, and Vitamin A.
- Amla/orange/lime/lemon/citron (naarthankaai) – provides the vitamin C which is important for collagen production. Just 1 amla provides equivalent vitamin C of 4 oranges. As one article said, “No vitamin C means no collagen”.
- Avocado – provides the hyaluronic acid, vitamin E, essential proteins.
- Almonds (soaked) and other nuts – provides the zinc, manganese, copper, omega-3, and essential proteins.
- Pirandai and Mudakathan Keerai – Just the meaning of Tamil/Sanskrit name itself for these plants show that they have been used traditionally for joint relief.
Just some bookmarks for my own reference.
Collagen Supplements (USA)
Collagen Supplements (India)