Repair and Regrow Joint Cartilage
Article by Stefan Burns - Updated June 2022. Join the Wild Free Organic email newsletter!
Cartilage is a unique human tissue with it’s own cellular physiology same as muscle, bone, brain, and organ tissues. Cartilage is the smooth but very strong protective tissue that caps the ends of bones, protecting bones from erosion as they move back each other during normal movement. When cartilage becomes damaged or eroded over time, the result can be terrible pain and a reduction in mobility. The human body caps bones with cartilage because cartilage is mostly friction-less and can regrow, whereas bone is rough and cannot regrow under normal circumstances. Once bone plates fuse in late adolescence, new bone growth stops.
Contrary to popular belief, which is that once cartilage or connective tissues are damaged then they are unable to heal, human physiological development itself provides the first clue that cartilage can be repaired and regrown. The reason for mistaken beliefs on the ability of cartilage to heal is because cartilage and connective tissues take a long time to heal and only do so under specific circumstances.
With consistency and patience, it is possible to reverse cartilage damage and heal connective tissues by modifying diet, using simple physical therapy techniques, and with intelligent supplementation.
To properly care for cartilage, it is important that equal attention is given to this unique tissue as would be given to muscle, skin, or heart tissue. Yet what we commonly see are people who work out for bigger muscles, or who devote tons of time on their skin care routines, or cardio fanatics who overdo it, but when it comes to the joints of the body, people throw up their hands and say fixing joint problems can’t be done, it’s impossible.
This is simple not true. Healing joints isn’t impossible, it’s just slow. Due to the cellular biology of cartilage, how it is created, and the chemistry of nutrient transport, it takes time to heal cartilage tissues. The methods described below are the fastest and most focused you can follow to repair your joints, but patience will be required.
Science of Cartilage Tissue
Cartilage is a smooth resilient elastic tissue found throughout the body. Where bones meet at joints, cartilage forms the protective cap which allows for smooth friction-less movement. Healthy cartilage is heavily hydrated (clue #2).
Chondrocytes in hyaline cartilage matrix. | CC3.0 - Emmanuelm at en.wikipedia
Cartilage is made up of cells called chondrocytes which are embedded in a cartilage matrix. This cartilage matrix is primarily made of type-II collagen and chondroitin sulfate.
It is the job of chondrocytes to produce a large amount of the collagenous extracellular matrix and ground substance of which they are embedded in. Ground substance is the gel-like material that contains the rest of the materials found in the cartilage matrix except the fibrous materials, providing lubrication for the collagen fibers that chondrocytes produce.
There are three types of cartilage: elastic cartilage, hyaline cartilage and fibrocartilage. Hyaline and fibrous cartilage are the types of cartilage found in joints, with elastic cartilage being what make up ear flaps and similar tissues.
The three types of cartilage, they differ in the ratio of chondrocytes to collagenous matrix | CC4.0 - Shiloh117981894 at en.wikipedia
The smooth, friction-less, and tough characteristics of cartilage are an expression of the unique proteins and molecules that make up cartilage. The main building blocks of cartilage are water, collagen, and chondroitin sulfate. For any cartilage repair and regrowth protocol, it is factors that required targeted therapy.
Just as important as cartilage is connective tissue. Connective tissue is found throughout the body, and it is an important component of overall joint structure. Very similar to chondrocytes, a fibroblast is a type of cell that synthesizes extracellular matrix and collagen. Fibroblasts create the structural framework that holds everything in the body together (1). Collectively this organ is known as fascia, and through the functions of fibroblasts, fascia exerts a huge influence throughout the body. Fascia is what holds all the organs and muscles and soft tissues of the body together and in place while still allowing for a degree of movement. Fascia is very important for posture, strength, and must be considered when healing any wound.
The same nutrients and physical therapy techniques that are effective in triggering cartilage repair and synthesis by chondrocytes are effective at stimulating fibroblasts to repair and regrow connective tissues.
Connective Tissues Require Certain Nutrients
In order to support the maintenance and creation of healthy cartilage tissues, a proper diet high in the right building blocks (fats and amino acids) is needed. You are what you eat, so the easiest way to eat a cartilage supporting diet is to eat cartilage. During digestion, animal cartilage is broken down and absorbed as amino acids, dipeptides, and tripeptides. The body transports these simple proteins to connective tissues where they can be resynthesized into the compounds required grow and repair. If following a vegan diet, then consuming the same amino acids found in collagen and at the same ratios will be similarly effective as eating cartilage. Since cartilage and connective tissues are highly hydrated tissues, drinking enough pure water every day is very important for these tissues to be healthy and function properly.
Collagen peptides are characterized by their high levels of specific amino acids glycine, hydroxyproline, proline, and alanine (2). Glycine is the main amino acid of collagen, making up nearly every third component in the collagen peptide chain. Glycine is a conditional amino acid, meaning that the body is able to produce it, but depending on diet and other factors, it might or might not be produced in sufficient quantities. The standard recommendation for glycine is to consume 10-15 grams per day. Under normal circumstances the body will get about 2 grams from a typical diet, and synthesize another 2 grams from the amino acids serine and threonine (3). That leaves 6+ grams of glycine everyday that the body would like to have for connective tissue and cartilage maintenance, but won’t synthesize at the expense of other metabolic processes and needs.
Glycine helps stabilize blood sugar levels, and conversely, with insulin resistance, glycine metabolism is impaired (4), producing a series of negative downstream effects. Cartilage and connective tissues won’t receive the nutrients they need, and other serious issues like arterial calcification and elevated cardiovascular risk are associated with glycine deficiency.
Having pain, degraded function, and reduced strength in joints is a sign that the body is stressed for glycine and not receiving adequate amounts in the diet, instead slowing breaking down connective tissues to receive the amino acids it needs for more important metabolic processes. In this way connective tissues and cartilage act as a storehouse of key amino acids, slow to fill up and faster to pull from.
To Repair Cartilage Go Plant-Based for Extra Glycine
Incorporating into your diet glycine rich foods consistently is the first and most important way you can positively benefit your joint health and reduce joint pain. This can be done by consuming animal products high in collagen, or better yet by incorporating plant-based foods high in glycine.
For the typical plant-based diet, most of the protein comes from pulses such as beans, lentils, and chickpeas, which contain three to four times as much glycine as methionine (another amino acid). Glycine deficiency is not typically a concern with plant-based diets. Methionine is an amino acid found in high percentages in muscle meat, and methionine consumption in excess depletes glycine. Considering most meat products now are muscle based and contain very little connective tissues or skin, an animal protein rich diet will provide little glycine to begin with and overtime will deplete the bodies stores of glycine due to excess methionine consumption.
I have personal experience with this. When I first started a vegetarian diet, coming off of eating a lot of meat, a couple weeks in I started to have joint pain in my knees, an exceedingly rare event for me. I had hydrolyzed collagen on hand, so rather than waste it, I took 20 grams and for the next week or so all knee pain vanished. I increased glycine concentrations in my body and the first signs of joint concern vanished. As I learned to incorporate more beans, lentils, and chickpeas into my diet, I no longer required the occasional collagen infusion to reduce joint point, instead my body was being provided ample glycine on a daily basis and at a balanced ratio with methionine.
If you’re an omnivore, incorperate collagen-rich animal products into you diet as well as plant-based sources of glycine. If you follow a carnivore diet, eat more collagen-rich animal products than you think you need, and if you’re vegetarian or vegan consistently eat plant-based sources rich in glycine. The following foods are notably rich in glycine:
Pulses
lentils, beans, chickpeas, peas
Nuts/Seeds
pumpkin, sunflower, almond
Vegetables
spinach, cabbage, asparagus, watercress, seaweed, spirulina
Fruits
bananas, appricots, oranges, avocado
Animal Products
bone broth
poultry skin
seafood
connective tissues
egg whites
Dairy
cheese, greek yoghurt, cottage cheese
Methods to Repair and Regrow Cartilage and Connective Tissue
Before any application of a systematic cartilage regrowth protocol, being mindful of your diet and making the changes necessary to provide yourself with enough glycine is the important first step that needs to be taken. Once diet is in check, then other variables which help with the repair and growth of connective tissues can be undertaken successfully. First up are a few known biological processes which improve cartilage repair.
Pressure Stimulates Cartilage Growth
Applying pressure has been shown to repair & regrow cartilage is pressure. Starting with simple truths, pressure is useful for healing wounds, from the basics of holding pressure on a wound to stop bleeding to pressures usefulness for healing longer term injuries such as muscle, bone, and joint damage. Pressure changes stimulate the circulatory system, bring oxygen-rich blood and fresh nutrients to the area. In addition to improving blood flow, pressure itself can stimulate changes in physiology, for example with pressure proteins can change their structure to more advanced forms.
Ace bandage wrap on the left, voodoo floss wrap on the right. Both can be used to safely apply temporary or longer lasting pressure to parts of the body.
For muscle tissue, pressure changes (contractions, pumps, etc) will carry nutrients to areas in need of repair and stimulatory growth, but in cartilage no blood vessels are carried into the tissue. Blood flow is limited in reaching cartilage due to the nature of cartilage.
Nutrients are still delivered from nearby blood vessels directly to the chondrocytes and fibroblasts of cartilage and connective tissues, only it happens through osmosis. Osmotic transfer is regulated through differences in concentrations of molecules across boundaries, and by applying pressure to a joint, the osmotic transfer of glycine, chondroitin sulfate, and other building blocks to chondrocytes and fibroblasts is sped up.
The easiest way pressure can be applied to joints or areas of pain is with elastic wraps like ace bandages or voodoo floss bands. For deeper tissues, hard objects can be used to direct pressure to specific areas and break up scar tissue. When scar tissue is broken up, an inflammation response starts, triggered by the fibroblasts, and cellular cleanup begins. If pressure through a wrap is applied to the area after scar tissue is broken up, then healing nutrients will reach the area sooner and the healing process will be more effective.
Functional Range Conditioning Improves Cartilage Health
Many of the same principles for muscle growth and strengthening can also be applied to joints. Productive stress applied to joints and connective tissues, through targeted methods like functional range conditioning (FRC) can stimulate the repair, growth, and strengthening of cartilage tissues. The proper application of strength training will also improve joint strength and function, and will tighten and strengthen the fascia. Yin yoga and hatha yoga are also especially good at improving joint health.
Any of these modalities done properly increases mobility, improves joint strength, and improves body control. By using performing joint healing movements consistently, there will be a reduction of pain and lower chance of injury, plus better body movement and control overall. FRC, strength training, and yoga are best learned from an experienced professional.
Heat Therapy Reduces Inflammation in Joints
Heat therapy has wide ranging health benefits such as improved healing and increased longevity. Heat therapy works on the cellular level by activating heat shock proteins and releasing growth hormone. Heat shock proteins elimate free radicals and heal damaged proteins, meanwhile growth hormone stimulates growth, cell reproduction, and cell regeneration.
You can do whole body heat therapy by using a sauna, steam room, or hot bath, and this will create a systemic full-body healing effect. Or you can apply heat therapy via a heat wrap to the specific joint or body part that requires attention. pairing pressure, heat therapy, and simple joint movements together is a very effective in breaking up scar tissue, cleaning up the resulting damage, and bringing in fresh blood and nutrients, returning joint function to normal.
Joint/Muscle Flossing Stimulates Cartilage Growth
Back to the beneficial application of pressure for healing connective tissues, voodoo floss bands are particularly effective in my experience. Voodoo floss bands are made of latex and can be wrapped around a body part or joint in order to improve performance, increase range of motion, or promote healing. Joint flossing effectively combines pressure and the FRC ideology, and is the single best thing outside of making changes to your diet that you can do to improve joint health. Watch the video below for more information and how to voodoo floss a knee.
Note - I prefer to skip wrapping the kneecap in order to let the knee glide more smoothly during movements. To see how to floss other joints do a search on YouTube.
Supplements For Cartilage and Connective Tissues
There are some well known dietary supplements and herbs which can with help heal cartilage and connective tissues.
Curcumin for Cartilage Pain and Inflammation
Turmeric is a bright orange root used in cooking well known for its potent anti-inflammatory and anti-oxidant effects. Curcumin, a type of curcuminoid, is the main phytochemical responsible for the health effects of turmeric. There are many different ways turmeric/curcumin supplements are formulated, and some formulations are more bioavailable than others.
Dosing - 1000 mg of curcumin with 10 mg of piperine every morning.
Effects - Reduced pain and inflammation.
Supplement Recommendation - Curcumin with Piperine by Nootropics Depot.
Omega-3 Fatty Acids for Cartilage Lubrication
Omega-3 fatty acids are a type of fat used throughout the body for a variety of important bodily processes, namely for the cardiovascular system and brain. Omega-3 fatty acids have anti-inflammatory effects and work synergistically with curcumin. Omega-3 fatty acids come in three forms, ALA, DHA, or EPA. ALA is the plant version which requires conversion into DHA or EPA in the body, so it is best to supplement with DHA and EPA omega-3 fatty acids.
Dosing - 2-3 grams of DHA/EPA combo every morning. It is better to have a greater DHA/EPA ratio.
Effects - Reduced pain and inflammation
Supplement Recommendation - 70% DHA Omega-3 Fish Oil by Nootropics Depot.
Dietary Recommendation - Sardines are a super rich source of omega-3’s high in EPA and DHA. Walnuts, flaxseed, and chia seeds are good sources of ALA omega-3 fatty acids.
Sulforaphane for Joint Inflammation
Sulforaphane is a sulfur-rich naturally occurring compound found in cruciferous vegetables like broccoli, cabbage, and kale know for it’s potent anti-inflammatory health effects. A diet high in raw or lightly cooked cruciferous vegetables is best, and sulforaphane supplements are also available.
Dosing - 50-100 mg sulforaphane every night
Effects - Reduced pain and inflammation
Supplement Recommendation - BroccoMax by Jarrow Formulas
Glucosamine Sulfate for Joint Repair
Glucosamine sulfate is a chemical created naturally by the body for use in joint and connective tissues, and if levels in the body are deficient, supplementation may help. Glucosamine sulfate used in supplements is derived from shellfish shells. By supplementing with glucosamine sulfate you’ll ensure your body has enough available to repair cartilage and connective tissues.
Dosing - 1.5 grams every night
Effects - Reduced pain, improved function
Supplement Recommendation - Glucosamine Sulfate by Doctor’s Best
Hydrolyzed Collagen for Cartilage Building Blocks
Hydrolyzed collagen is derived from collagen-rich animal sources, and collagen is the main protein that makes up cartilage and connective tissues. Glycine is the dominant amino acid of collagen protein, and glycine has insulin, cardiovascular, cognitive, and sleep quality effects. By supplementing with collagen you’ll ensure your body has enough amino acids needed to repair cartilage and connective tissues.
Dosing - 20-40 grams every night
Effects - Reduced pain, improved function, better sleep.
Supplement Recommendation (animal) - Collagen Hydrolysate by Great Lakes Gelatin
Supplement Recommendation (plant) - Collagen Building Protein Peptides by Sunwarrior
Boswellia Serrata for Powerful Joint Repair
Boswellia serrata is a gum resin extracted from a tree, with the main active compounds being boswellic acids. Boswellia serrata can suppress pain and immobility from osteoarthritis in as little as a weeks time. Osteoarthritis is a joint disease that breaks down cartilage and connective tissues of joints, causing pain, stiffness, and loss of function.
Dosing - 1 gram three times a day, for a total of 3 grams every day
Effects, Increase in mobility, reduced pain, reduced stiffness/immobility
Supplement Recommendation - Boswellia Phytosome by Thorne Research
Boron for Bone and Connective Tissue Health
Boron is the fifth element of the periodic table, and trace amounts can be found in the Earth’s crust. Even though boron is a trace element, it is critical for plant and animal biology. Boron greatly improves wound healing by interacting with the fibroblasts of connective tissues. Boron has direct actions on specific enzymes found in fibroblasts, and making sure you are not boron deficient, as is common, is another way to make sure there are no weak links in the healing process.
Dosing - 10 mg per day
Effects - Improved healing time, stronger connective tissues
Supplement Recommendation - Pinch of borax by 20 Mule Team
Bonus - BPC-157
BPC-157 is a 15 amino-acid long protein peptide, with BPC short for body protection compound. BPC is found in stomach gastric fluids, and when injected into a problem area, reduces oxidative stress and speeds up wound and tissue healing. BPC-157 has also been shown to heal epithelial tight junctions in the gut. I haven’t used BPC-157 myself, but it’s effects are so powerful I included it as a jumping off point for your own research. BPC-157 is not used in this cartilage and connective tissue healing protocol.
Joint and Connective Tissue Healing Protocol
Using the methods, tools, and supplements above, and with a good diet already in place, a cartilage and connective tissue repair and regrowth protocol can be designed. This protocol will increase collagen protein synthesis using joint flossing, pressure and heat therapy, functional range conditioning, and intelligent supplementation. It’s also very important to better understand posture and how tension runs through the body in order to make a joint and connective tissue regeneration protocol most effective, and so future mistakes aren’t made that require this process to be done more than once. To read my article on the topic click the button below.
The protocol is a week long, and can be repeated as many times as needed until improvement or complete restoration of function. Weight training is recommended once joint health and pain have abated so lean tissue, bones, and connective tissues can strengthen. The general principles of the program are:
Daily stimulation of the collagen protein synthesis pathway for affected joints via joint/muscle flossing
Walking 1x a week for general movement and cardiovascular health. Walk more on your own too!
FRC 2x a week for targeted applications of overload (for strength and resiliency increases) and movement (for range of motion improvements)
Yin Yoga 1x a week for restorative movement, deep passive stretches, relaxation, fascial stretching, deep breathing, and overall tension release
Morning Supplements: 2-3 grams omega-3 fatty acids, 500-1000 mg turmeric/curcumin combination, 10 mg boron.
Evening Supplements: 50-100 mg sulforaphane, 1.5 grams glucosamine sulfate, 20 grams collagen.
Monday
Morning supplements
Joint flossing
Pressure with ace bandage and self myofascial release
Evening supplements
Friday
Morning supplements
Joint flossing
Pressure with ace bandage and self myofascial release
Evening supplements
Tuesday
Morning supplements
Joint flossing
Heat therapy
Evening supplements
Saturday
Morning supplements
Joint flossing
FRC exercises
Evening supplements
Wednesday
Morning supplements
Joint flossing
FRC practitioner visit
Evening supplements
Sunday
Morning supplements
Joint flossing
Heat therapy
Evening supplements
Thursday
Morning supplements
Joint flossing
30-60 minute walk
Evening supplements
All these techniques can be used more often than scheduled in the program, but I reduced their frequency in order to make the routine more realistically possible. If you are really determined to fix whatever joint problems you are experiencing, go all out and devote a lot of time towards these practices. Remember though, healing joints and connective tissues takes a long time due to the biology of it, so doing what you can consistently is best long term strategy to make progress.
The importance of diet can’t be understated. Other than acute injuries, it might have been diet that made these joint and connective tissue problems arise. Having a joint friendly diet is at least half the battle.
References:
Bordoni B, Zanier E. Understanding fibroblasts in order to comprehend the osteopathic treatment of the fascia. Evidence-Based Complementary and Alternative Medicine. 2015;2015:1-7.
Gauza-Włodarczyk M, Kubisz L, Włodarczyk D. Amino acid composition in determination of collagen origin and assessment of physical factors effects. International Journal of Biological Macromolecules. 2017;104:987-991.
KEGG PATHWAY: Glycine, serine and threonine metabolism - Reference pathway.
Adeva-Andany M, Souto-Adeva G, Ameneiros-Rodríguez E, Fernández-Fernández C, Donapetry-García C, Domínguez-Montero A. Insulin resistance and glycine metabolism in humans. Amino Acids. 2018;50(1):11-27.
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