- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
Spinecare Topics
Spinehealth and Disease
The Healing Spine
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The Healing Spine
The physical properties of cartilage are the result of two principal macromolecules that lie in the matrix surrounded by specialized cells in the cartilage called chondrocytes. The first of these macromolecules is collagen that forms the beam-like supportive infrastructure that helps to define the shape and tensile properties of the cartilage. The other large molecule is aggrecans that acts like a binding glue for the collagen. To facilitate the repair of cartilage resident chondrocytes make new collagen and aggrecans. In the adult chondrocytes are usually incapabable of successfully restoring optimal tissue relationships.
Due to the lack of direct blood supply and the limited number of cells in cartilage it subsequently has a very limited capacity to repair. The repair process is often characterized by fibrous tissue replacement (fibrous patch) rather than new cartilage. This leads to altered physical properties of the joint surface. The limited regenerative capacity of cartilage combined with the development of a fibrous repair process renders the injured cartilage more vulnerable to damage under load bearing stress.
Cyclical loading of joints is an important mechanical stimulus for chondrocytes to produce special chemicals that comprise the make up of cartilage. Excessive or prolonged focal loading of cartilage contributes to the development of partial and full thickness defects in the cartilage. Intermittent short duration compression/decompression of the cartilage helps moves fluids across the matrix of the cartilage. Loss of the functional lubricating system of cartilage leads to early and progressive breakdown of the cartilage as well as of the underlying bone.
When cartilage is compromised a repair process is initiated. The specialized cells within the cartilage begin to manufacture and secrete a new chemical matrix. The repair process often involves adjacent tissues that may have also been compromised such as the adjacent bone (subchondral bone). The repair of cartilage from the joint periphery generally consists of a cellular layer that extends over into the pre-existing cartilage. Factors that contribute to impaired capacity for cartilage to heal include immobilization that interferes with the nutritional delivery to articular cartilage. Abnormal loading compromises the lubrication and support system of cartilage. Immobilization of a joint has been shown to contribute to the development of fibrillation, flaking, fissuring, fibroproliferation and thinning of joint cartilage.
Synovial (Facet Joint) Lining
The fine internal cellular lining of joint capsules and tendon sheaths is referred to as the synovium. This very thin membrane is comprised of specialized cells that provide lubrication and nutritional support to the joint (articular) cartilage through the secretion of synovial (joint) fluid. The synovial fluid contains special chemicals that act as a lubricant to help reduce friction on the surface of the cartilage. The synovium has a very good blood supply. The synovial lining of a joint is also richly innervated with pain endings although there are not as many as the overlying joint capsule. The synovial lining has several important functions which includes the prevention of surface adhesions, the promotion of movement between adjacent tissues, reduced friction between joint surfaces, it provides a deformable packing which occupies physical space, it contains the primary blood supply for the cells of the cartilage (chondrocytes), it acts as a passive barrier to fluid dispersion (shifting) with joint movement and it regulates the volume and composition of the synovial fluid.
Due to the lack of direct blood supply and the limited number of cells in cartilage it subsequently has a very limited capacity to repair. The repair process is often characterized by fibrous tissue replacement (fibrous patch) rather than new cartilage. This leads to altered physical properties of the joint surface. The limited regenerative capacity of cartilage combined with the development of a fibrous repair process renders the injured cartilage more vulnerable to damage under load bearing stress.
Cyclical loading of joints is an important mechanical stimulus for chondrocytes to produce special chemicals that comprise the make up of cartilage. Excessive or prolonged focal loading of cartilage contributes to the development of partial and full thickness defects in the cartilage. Intermittent short duration compression/decompression of the cartilage helps moves fluids across the matrix of the cartilage. Loss of the functional lubricating system of cartilage leads to early and progressive breakdown of the cartilage as well as of the underlying bone.
When cartilage is compromised a repair process is initiated. The specialized cells within the cartilage begin to manufacture and secrete a new chemical matrix. The repair process often involves adjacent tissues that may have also been compromised such as the adjacent bone (subchondral bone). The repair of cartilage from the joint periphery generally consists of a cellular layer that extends over into the pre-existing cartilage. Factors that contribute to impaired capacity for cartilage to heal include immobilization that interferes with the nutritional delivery to articular cartilage. Abnormal loading compromises the lubrication and support system of cartilage. Immobilization of a joint has been shown to contribute to the development of fibrillation, flaking, fissuring, fibroproliferation and thinning of joint cartilage.
Synovial (Facet Joint) Lining
The fine internal cellular lining of joint capsules and tendon sheaths is referred to as the synovium. This very thin membrane is comprised of specialized cells that provide lubrication and nutritional support to the joint (articular) cartilage through the secretion of synovial (joint) fluid. The synovial fluid contains special chemicals that act as a lubricant to help reduce friction on the surface of the cartilage. The synovium has a very good blood supply. The synovial lining of a joint is also richly innervated with pain endings although there are not as many as the overlying joint capsule. The synovial lining has several important functions which includes the prevention of surface adhesions, the promotion of movement between adjacent tissues, reduced friction between joint surfaces, it provides a deformable packing which occupies physical space, it contains the primary blood supply for the cells of the cartilage (chondrocytes), it acts as a passive barrier to fluid dispersion (shifting) with joint movement and it regulates the volume and composition of the synovial fluid.
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