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 the knee joints with age, a natural aging process.The reasons are weakening of the muscles and poor blood supply to the tissues.How to treat yourself without surgery?Eliminates 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, knee injuries and overweight.Almost 50% of the adult population has ever complained of a knee joint.
With osteoarthritis, the cartilage that lines the edges of the bones wears away or is completely absent.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 cartilage grows unevenly.As a result, irregularities are formed that damage other elements of the joint.The nature of osteophytes is explained by the compensation of smooth articular cartilage.Another version suggests Spurs expansionassociated with attempting to stabilize the joint medially or laterally due to weakening of the muscles.
What are the causes of chronic osteoarthritis of the knee joint?Pain occurs in tendons and ligaments only when muscle forces no longer hold and control the bones.Therefore, the biomechanical causes of pain and arthrosis are distinguished:
- Against the background of a prolonged sessionCompression 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.
- Prolonged sitting strains the gluteal muscles, weakening them.Instead, the piriformis muscles, under which the sciatic nerve passes, begin to work.When compressed, the biceps muscle weakens and the rotation angle of the thigh and lower leg changes.The knee is injured.
- Walking in heelscauses tension in the calf muscles, rotates the pelvis and weakens the gluteal media muscles.The femur rotates inward, the ligaments along the inside of the knee and the medial meniscus are loaded, and osteophytes grow.
- Flat feet, associated with the use of uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outward, which leads to knee pain due to impaired biomechanics and the development of a Baker's cyst.
Pathological chains affecting the knee are associated with falling on the coccyx in childhood, with scoliosis caused by diseases of internal organs.People with different shoulder heightsover time they begin to complain about the knee, since the fascial chains along the front of the body include the extensor of this joint: the rectus femoris muscle.
Symptoms
The degenerative process compromises the function of the joint, causing pain and stiffness.It is believed to bethe effect on muscles begins with cartilage and bones.Practice proves the opposite:Knee joint pain occurs in the tendons– insertions of the weakened muscles of the knee extensors, flexors and stabilizers.
The main signs of a threat of wear and tear of the cartilage:
- 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 knee after prolonged inactivity or 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 is due to the glute and biceps hip extensor muscles not working and the rectus femoris muscle being overstretched, creating discomfort in the knee.
- Pain when flexing 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 the accumulation of inflammatory exudate -osteoarthritis is often accompanied by bursitis, synovitis and tendinitis.
A creaking knee can be painless or traumatic.Popping and other sounds do not indicate that the bones are wearing down.Signs of knee instability -weakness of one of the muscles that control movement.
Crepitus, caused by bone-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 the sensation of being stuck in place.Bones are controlled by muscles during any movement.Their 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.Their change indicates that the muscular system has been out of balance for 5-10 years.As a rule, peoplehave been suffering from nagging pain for several years.
In the first stage of arthrosis, which is detected by chance, a slight growth of bone spurs is noted.The 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 strong spasms and overloads.Running and weight training cause symptoms by putting strain on weakened muscles.Weakness (hypotonia) of the 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 walking and running, stiffness of the joint and pain when bending and kneeling.
First radiological signs of the second stage of knee osteoarthritis:
- pointed edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space on the medial side;
- pointed edges of the condyles of the bones on the medial sides, less often on the lateral ones, 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 greater than 50%, but this can only be verified in dynamics or in comparison with an unaffected joint.
3 degrees
At the third stage of arthrosispain when bending and straightening the joint becomes constant.During an exacerbation, the joint turns red and swells, and the aching pain does not stop even at rest.Swelling and notable deformation of the contours of the joint appear around the knee.
Signs of moderate arthrosis of the knee joint in the third stage:
- joint space is significantly reduced;
- the presence of subchondral sclerosis in the loaded areas;
- numerous osteophytes at the margins;
- rare presence of subchondral cysts;
- synovitis, appearance of a Baker's cyst below the knee;
- irregular surfaces of the femur and tibia, loss of joint congruency;
- change in the shape of the kneecap;
- foci of calcification and chondromalacia;
Rarely, the fourth stage is completed by necrotic lesions.Why is osteoarthritis dangerous?The disease impairs the ability to move and creates dependence on others.
Diagnostics
The podiatrist examines signs of swelling, palpates the joint for tenderness, and examines active and passive range of motion.Be sure to examine the lumbar spine, becauseThe nerves that provide function to the thigh muscles pass here.
An x-ray shows the presence of osteophytes, a change in the space between the femur and tibia, indicating loss of cartilage in the knee.Sometimes x-rays of the knee joints show significant signs of cartilage wear, but patients experience no significant pain.On the contrary, first-stage osteoarthritis can compromise the functionality of the knee, since the cause of pain is hypotonic muscles.
If the x-ray shows no major changes, thenthe doctor prescribes an MRI of the knee joint and lumbar region.Diagnostics visualize ligaments, tendons, muscles and menisci to look for other sources of pain.
Laboratory diagnosis is necessaryif you suspect a joint infection or gout.
Treatment
Therapy for osteoarthritis must be comprehensiveaimed at the cause of the disease.Appropriate treatment is carried out for endocrine dysfunctions that can affect the connective tissues.Overweight patients are recommendedswitch to proper nutrition.Flare-ups are relieved with the help of medications.
Pharmacological treatment
Drug treatment for pain involvesprescribe anti-inflammatory drugs.Nonsteroidal anti-inflammatory drugs for long-term usenegatively affect gastric function.
The treatment regimen includes chondroprotectors, which help only when taken in prolonged courses3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs help regenerate the structure of cartilage and have an analgesic effect.
There have been few controlled studies, and concerned complex treatments: arthroplasty, physiotherapy, diet.
Attention!Chondroprotectors are taken in courses: you can take one course of one drug and a second of another and compare the effect.However, uncontrolled use of medications is not a good idea.Before you start taking medications, consult your doctor.
How and with what to relieve pain and swelling?Intra-articular injections are most popular:
- Steroid drugsthey suppress inflammatory reactions at the level of immune cells, relieving acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of the joint fluid, reducing the friction of the joint surfaces.
Important!The effect of the drugs lasts 6-12 months, but the degenerative processes do not stop.
Surgical treatment
If drugs have little effectiveness, patients are offered arthroscopy– a minimally invasive procedure for the removal of bone growths and joint revision.If necessary, surgeons perform plastic surgery of the ligaments and cartilage and remove areas of worn tissue.
The bone osteotomy aims to change the axis of load on the joint.Your doctor cuts the femur or tibia to change where the joint surfaces meet.The operation is often performed on young patients.
Total knee replacement or arthroplastyrequired for severe stages of osteoarthritis (third or fourth degree).Surgical treatment does not always solve the problem, as it requires diligent, daily rehabilitation and muscle strengthening.
Changes in the knee can be compensatory to the pelvis, so without restoring muscle balance, the hip joint is next to suffer.
Physiotherapy treatment
In the physiotherapy environment, mud applications, phonophoresis and magnetotherapy are used.The action of external factors is targetedstimulation of blood supply and tissue regeneration, relieving inflammation and swelling.
Treatment with traditional and non-traditional methods
Usually they are recipes for folk remedies for the treatment of arthrosis of the knee joints at homeaimed at relieving swelling and eliminating pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed for compresses.
The degeneration cannot be completely stopped.You can influence the metabolism of the kidneys by using celery juice.The kidneys are connected to the iliopsoas muscle, which is associated with hip disorders.Normalizing 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.Rubs 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 arthrosis of the knee joint helps, if the specialist understands muscle tone imbalances.Muscle testing helps identify weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source may not only be joint blockage in the lumbar region,but also dysfunctions in the blood supply, internal organs, endocrine and biochemical disorders.Therefore, a chiropractor must have the skills of osteopathy and applied kinesiology to be able to influence many factors.
Massage serves as an auxiliary tool for 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 anterior surface of the thigh - from the pelvis to the kneecap;
- lateral surface of the thigh from the greater trochanter to the femoral condyles;
- inguinal area along the inguinal ligament;
- the internal surface of the thigh (along the line of the adductor canal).
The massage is performed with acupressure, without too 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 for older peopleIt can 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 robs your joints of stability.Among the treatment methods it is better to preferPilates and Nordic walking.
Diet
Nutrition is adapted 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.Trialeliminate dairy products, since almost 80% of the population is lactose intolerant.
Prevention of arthrosis of the knee joints
Trying to strengthen 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, several births with diastasis - weakening of the abdominal wall muscles.
Surgeries in the pelvic area and internal organs form adhesions that affect the lumbar vertebrae, interrupting the innervation of the muscles around the knee.
Which doctor should I consult for osteoarthritis of the knee joint?An orthopedist will help make the diagnosis, who will insist on surgery.The best results are achieved thanks to the work of multidisciplinary teams in rehabilitation centers.
The best thing you can do for your joints:eat well, watch your weight, walk more, visit a masseur or osteopath once every three months.
Treatment reviews
Positive reviews can be provided only by 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 the painful syndromes.The reasons remain unidentified and uninfluenced.Occupational therapists can help by teaching you how to live with knee osteoarthritis and how to properly use a cane.But the service is only available in private clinics that provide rehabilitation.