Osteoarthritis of the knee joint combines two processes: the destruction of cartilage and the growth of osteophytes or bone spurs.The stage of the process is determined by x-rays.Osteoarthritis is believed to be the destruction of knee joints with age, a natural process of aging.The reasons are weakening of the muscles and insufficient blood supply to the tissues.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.
Causes
The causes of osteoarthritis have not yet been determined by medicine,Only risk factors are named:age over 45 years, knee injuries and being overweight.Almost 50% of the adult population has complained about a knee joint.
In osteoarthritis, the cartilage that lines the edges of the bones wears away or is completely missing.Damaged tissue is not a source of pain because it has no receptors.Inflammation in nearby structures causes characteristic symptoms.
The body continues to regenerate damaged tissue, but the cartilage grows unevenly.As a result, irregularities form that harm other elements of the joint.The nature of osteophytes is explained by the compensation of smooth articular cartilage.Another version suggests that the expansion of the Spursassociated with the attempt to stabilize the joint medially or laterally due to weakening of the muscles.
What causes chronic osteoarthritis of the knee joint?Pain occurs in tendons and ligaments only when muscular forces no longer hold and control the bones.Therefore, the biomechanical causes of pain and arthrosis are distinguished:
- Against the backdrop of prolonged sittingCompression occurs between the inguinal ligament and the iliopsoas muscle of the femoral artery and nerve, which weakens the strength of the front of the thigh and leads to tension in the tendon - under the kneecap.
- Sitting for a long time strains the gluteal muscles, weakening them.Instead, the piriformis muscles begin to work, under which the sciatic nerve passes.When it is compressed, the biceps muscle weakens and the angle of rotation of the thigh and leg changes.The knee is injured.
- Walking in high heelscauses tension in the calf muscles, rotates the pelvis, and weakens the gluteus medius muscles.The femur rotates inward, the ligaments along the inside of the knee and the medial meniscus are loaded, and the osteophytes grow.
- Flat feet, associated with the use of uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outwards, which causes knee pain due to compromised biomechanics and the development of a Baker's cyst.
Pathological chains affecting the knee are associated with falls on the coccyx in childhood, scoliosis caused by diseases of internal organs.People with different shoulder heightsover time they start to complain about their knees, since the fascial chains along the front of the body include the extensor of this joint - the rectus femoris muscle.
Symptoms
The degenerative process impairs joint function, causing pain and stiffness.It is believed to bethe effect on muscles begins with cartilage and bone.Practice shows the opposite -knee joint pain occurs in the tendons– weakened muscle insertions of the knee extensors, flexors and stabilizers.
The main signs of the threat of cartilage wear:
- Occasional discomfort associated with walking, feeling of “putting your foot in the wrong place”.
- The appearance of pain with direct load on the joint and the muscles that flex and extend it - squatting, climbing stairs.
- Pain and stiffness in the knees after inactivity or prolonged rest, for example when getting out of bed in the morning, which is associated with stagnation of venous blood.
The main signs of osteoarthritis are caused by stress on weakened muscles:
- Knee pain when standing up is due to the fact that the gluteal and biceps hip extensor muscles do not work and the rectus femoris muscle is excessively stretched, causing discomfort in the knee.
- Pain when bending the joint is associated with weakness of the flexors - the biceps muscle and tension in the quadriceps tendon.
Swelling is caused by soft tissue injury, inflammation of the tendons and joint capsule.The appearance of heat in the knee area, swelling, indicates accumulation of inflammatory exudate -osteoarthritis is often accompanied by bursitis, synovitis and tendonitis.
A knee crisis can be painless or traumatic.Popping noises and other sounds do not indicate that the bones are worn out.Signs of knee instability -weakness of one of the muscles that controls movement.
Crepitus, caused by bone-to-bone friction, does not occur at the beginning and end of the range of motion, but in the middle,even with passive joint flexion.Joint locking is caused by wear and tear on the cartilage and tendons, which creates a feeling of being locked in place.Bones are controlled by muscles during any movement.Its premature contraction leads to a change in the direction of bone movement, blocking it.
1st degree
The degree of osteoarthritis is determined using an x-ray, revealing the participation of bone structures in the pathological process.Its change indicates that the muscular system has been out of balance for 5 to 10 years.As a rule, peopleI have been experiencing a dull pain for several years.
In the first stage of arthrosis, which is detected by chance, there is a slight growth of bone spurs.Growths appear in places where the joint is most unstable.Typically, patients rarely experience pain or discomfort during movement.
The weakness of some muscles is compensated by the function of others, without causing spasms and serious overload.Running and weight training trigger symptoms by putting pressure on weakened muscles.Weakness (hypotonia) of muscles is associated with impaired blood supply and innervation.
2 degrees
The second stage of osteoarthritis is considered mild.The x-ray reveals significant bone spurs, but the cartilage is not affected.The amount of synovial fluid decreases, but symptoms of pain appear after long walks and runs, joint stiffness and pain when bending and kneeling.
Early radiological signs of the second stage of knee osteoarthritis:
- sharp edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space on the medial surface;
- pointed edges of the condyles of the bones on the medial sides, less often on the sides - depending on the development of valgus or varus deformity of the joint.
For the second stage according to Larsencharacterized by a narrowing of the joint space by more than 50%, but this can only be verified in dynamics or comparison with an unaffected joint.
3 degrees
In the third stage of arthrosispain when bending and straightening the joint becomes constant.During an exacerbation, the joint turns red and swells, and the pain does not stop even at rest.Swelling and noticeable deformation of the contours of the joint appear around the knee.
Signs of moderate arthrosis of the knee joint in the third stage:
- the joint space is significantly reduced;
- the presence of subchondral sclerosis in loaded areas;
- numerous osteophytes on the margins;
- rare occurrence of subchondral cysts;
- synovitis, appearance of Baker's cyst under the knee;
- irregular surfaces of the femur and tibia, loss of joint congruity;
- change in the shape of the patella;
- foci of calcification and chondromalacia;
Rarely, the fourth stage is complemented by necrotic lesions.Why is osteoarthritis dangerous?The disease impairs the ability to move around and creates dependence on other people.
Diagnosis
The podiatrist examines for signs of swelling, palpates the joint for tenderness, and examines active and passive range of motion.Be sure to examine the lumbar spine, becauseThis is where the nerves that provide function to the thigh muscles pass.
The x-ray shows the presence of osteophytes, changes in the space between the femur and tibia, indicating loss of cartilage in the knee.X-rays of knee joints sometimes show significant signs of cartilage wear, but patients do not experience significant pain.On the contrary, first-stage osteoarthritis can impair knee function., since the cause of pain is hypotonic muscles.
If the x-ray does not show major changes, thenthe doctor prescribes an MRI of the knee joint and lower back.Diagnosis views ligaments, tendons and muscles, and menisci to look for other sources of pain.
Laboratory diagnosis is necessaryif you suspect a joint infection or gout.
Treatment
Arthrosis therapy should be comprehensivetargeted at the cause of the disease.For endocrine dysfunctions that can affect connective tissues, appropriate treatment is carried out.Overweight patients are recommendedswitch to proper nutrition.Exacerbations are relieved with the help of medication.
Drug treatment
Drug treatment for pain involvesprescription of anti-inflammatories.Nonsteroidal anti-inflammatory medications for long-term usenegatively affect gastric function.
The treatment regimen includes chondroprotectors, which help only when taken in long courses during3-6 months.Pharmacies offer a large number of medicines from this group.
It is believed that the components of these drugs help regenerate the cartilage structure and have an analgesic effect.
There are few controlled studies, and concerned complex treatments - arthroplasty, physiotherapy, diet.
Attention!Chondroprotectors are given in courses - you can take one course of one medicine and a second course of another and compare the effect.However, uncontrolled use of medications is not a good idea.Before starting to take medication, consult your doctor.
How and with what to relieve pain and swelling?Intra-articular injections are most popular:
- Steroid drugssuppress inflammatory reactions at the level of immune cells, relieving acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of the joint fluid, reducing friction of the joint surfaces.
Important!The effect of the medications lasts from 6 to 12 months, but the degenerative processes do not stop.
Surgical treatment
If medications are of low efficacy, patients receive arthroscopy– a minimally invasive procedure for removing bone growths and joint revision.If necessary, surgeons perform plastic surgery on ligaments and cartilage and remove areas of worn tissue.
Bone osteotomy aims to change the load axis in the joint.The doctor cuts the femur or tibia to change the point where the joint surfaces meet.The operation is often performed on young patients.
Total knee replacement or arthroplastynecessary for severe stages of arthrosis (third or fourth degree).Surgical treatment does not always solve the problem, as it requires diligent and daily muscle strengthening and rehabilitation.
Changes in the knee can be compensatory in relation to the pelvis, therefore, without restoring muscular balance, the hip joint is the next to suffer.
Physiotherapy treatment
In the physiotherapy environment, mud applications, phonophoresis and magnetic therapy are used.The action of external factors aimsstimulation of blood supply and tissue regeneration, relieving inflammation and swelling.
Treatment with traditional and non-traditional methods
Recipes for folk remedies for treating arthrosis of the knee joints at home are oftenintended to relieve swelling and eliminate pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed to make compresses.
Degeneration cannot be completely stopped.You can influence kidney metabolism by using celery juice.The kidneys are connected to the iliopsoas muscle, which is associated with hip pathology.Normalization of the function of the gallbladder and liver improves the condition of the knees.
Traditional medicine methods for treating the initial stage of knee arthrosis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortelle.Swabs made from dry mustard, sea salt and kerosene are used.Baths with magnesium salts and pine infusions are used.
Manual therapy and massage
Manual therapy for osteoarthritis of the knee joint helps, if the specialist understands imbalances in muscle tone.Muscle testing helps find weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source may be not only joint blockage in the lumbar region,but also dysfunctions in terms of blood supply, internal organs, endocrine and biochemical disorders.Therefore, a chiropractor must have skills in osteopathy and applied kinesiology to influence many factors.
Massage acts as an auxiliary tool in manual therapy and self-help.A patient with arthrosis of the knee joint can independently stretch the tendons of the muscles that control the movement of the limb:
- area around the gluteus maximus muscle;
- lines along the front surface of the thigh - from the pelvis to the patella;
- lateral surface of the thigh, from the greater trochanter to the femoral condyles;
- groin region along the inguinal ligament;
- the inner surface of the thigh (along the line of the adductor canal).
The massage is performed with acupressure, without much pressure.
Therapeutic gymnastics
The cause of osteoarthritis is the weakening of muscles caused by problems in the lower back, pelvis and abdominal cavity.Perform exercises to prevent arthritis and arthrosis of the knee joints in the elderlyCan be used to increase strength but not tone.
Without working on the factors that weaken them with the help of manual therapy, it is difficult to achieve complete restoration of biomechanics.Yoga further deprives joint stability.Among the treatment methods, it is better to preferPilates and Nordic walking.
Diet
Nutrition is adjusted mainly to combat excess weight.It is important to give up sugar and simple carbohydrates, add foods with fiber, magnesium, B vitamins and calcium for knee osteoarthritis, which are important for muscle activity.Try iteliminate dairy, as almost 80% of the population is lactose intolerant.
Prevention of osteoarthritis of the knee joints
Trying to strengthen your muscles with exercise doesn't always help., since innervation and blood supply have not been restored.The function of the thigh muscles depends on the lumbar plexus.
Changes in the lower back associated with weak abdominal muscles also affect the knees.Therefore, in men with a “beer belly” arthrosis is more common, as in women after polyhydramnios, multiple births with diastasis - weakening of the muscles of the abdominal wall.
Surgeries in the pelvic region and internal organs form adhesions that affect the lumbar vertebrae, interrupting the innervation of the muscles around the knee.
Which doctor should I see for osteoarthritis of the knee joint?An orthopedist will help make the diagnosis, who will insist on surgery.The best results are achieved by the work of multidisciplinary teams in rehabilitation centers.
The best thing you can do for your joints:eat well, control your weight, walk more, visit a massage therapist or osteopath once every three months.
Reviews about treatment
Positive reviews can only be provided by the comprehensive treatment of deforming arthrosis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections work temporarily, suppressing the natural inflammatory response.
Conclusion
The problem with arthrosis is that drug therapy temporarily eliminates only pain syndromes.The reasons remain unidentified and uninfluenced.Occupational therapists can help by teaching you how to live with knee osteoarthritis and how to use a cane correctly.But the service is only available in private rehabilitation clinics.