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.It is believed that arthrosis is the deterioration of the knee joints with advancing age, a natural process of aging.The causes are weakening of the muscles and poor blood supply to the tissues.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.
Reasons
The causes of arthrosis have not yet been determined by medical science,We only name the risk factors:Age over 45, knee injuries and overweight.Nearly 50% of the adult population has ever complained about knee joints.
In the case of arthrosis, the cartilage covering the edges of the bones wears out or is completely missing.Damaged tissue is not a source of pain because it has no receptors.Inflammation of nearby structures causes characteristic symptoms.
The body continues to regenerate the damaged tissue, but the 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 that the expansion of the Spursassociated with an attempt to stabilize the joint medially or laterally due to weakening of the muscles.
What causes chronic arthrosis of the knee joint?Pain in the tendons and ligaments only occurs when the muscle strength no longer supports and controls 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 hip 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 patella.
- Prolonged sitting puts strain on the gluteal muscles, weakens 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 lower leg changes.The knee is injured.
- Walking in heelsit causes tension in the calf muscles, rotates the pelvis and weakens the gluteal muscles.The femur rotates inward, the ligaments on the inside of the knee and the medial meniscus are stressed, and osteophytes grow.
- Flat feet, which is associated with wearing uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outward, which leads to knee pain due to damage to biomechanics and the formation of a Baker's cyst.
Pathological chains affecting the knee are related to falls on the coccyx during childhood and scoliosis caused by diseases of the 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 the function of the joint, leading to pain and stiffness.It is believed to bethe effect on the muscles starts with the cartilage and bones.Practice shows the opposite...pain in the knee joint appears in the tendons– fixation of the weakened muscles of the knee extensors, flexors and stabilizers.
The main signs of the risk of cartilage wear:
- Occasional discomfort with walking, the feeling of "putting your foot in the wrong place".
- The appearance of pain with direct load on the joint and the muscles that bend and extend it - squatting, climbing stairs.
- Knee pain and stiffness after prolonged inactivity or rest, such as when getting out of bed in the morning, due to stagnation of venous blood.
The main signs of arthrosis are caused by strain on weakened muscles:
- Knee pain when standing up is caused by the hip extensor muscles of the glutes and biceps not working, and the rectus femoris muscle being overstretched, causing discomfort in the knee.
- Pain when bending the joint is associated with weakness of the flexors - the biceps muscle and the tension of the quadriceps tendon.
Swelling is caused by injury to soft tissues, inflammation of tendons and joint capsule.The appearance of warmth in the knee area, swelling indicates the accumulation of inflammatory secretions -arthrosis is often accompanied by bursitis, arthritis and tendonitis.
Knee cracking can be painless or traumatic.Popping sounds and other sounds are not signs of bone wear.Signs of knee instability -weakness of one of the muscles that control movement.
Crepitus caused by bone-bone friction does not appear at the beginning and end of the range of motion, but in the middle,even with passive joint flexion.Joint locking is caused by the wear and tear of cartilage and tendons, creating a feeling of being locked in place.Bones are controlled by muscles during any movement.Their premature contraction leads to a change in the direction of bone movement and to blocking.
Grade 1
The degree of arthrosis is determined using X-rays, reveals the involvement 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 general rule, peoplehave been experiencing nagging pain for years.
In the first stage of arthrosis, which is detected by chance, there is a slight bone spur growth.Growths appear in places where the joint is most unstable.In general, patients rarely experience pain or discomfort during movement.
The weakness of some muscles is compensated by the action of others without causing severe spasms and overload.Running and weight training trigger symptoms by stressing weakened muscles.Weakness of the muscles (hypotonia) is associated with disturbances in blood supply and innervation.
2 degrees
The second stage of arthrosis is considered mild.X-rays reveal significant bone spurs, but the cartilages are not affected.The amount of synovial fluid decreases, but symptoms of pain, joint stiffness and pain when bending and kneeling appear after long walks and runs.
Early radiological signs of the second stage of knee arthrosis:
- the pointed edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space on the medial side;
- sharp edges of the condyles of the bones on the medial side, less often on the lateral side - depending on the development of valgus or varus deformity of the joint.
For the second stage, according to Larsencharacterized by more than 50% narrowing of the joint space, but this can only be checked in dynamics or in comparison with an unaffected joint.
3 degrees
In the third stage of arthrosispain during bending and straightening of the joint becomes constant.During an exacerbation, the joint becomes red and swollen, and the aching pain does not go away even at rest.Swelling around the knee and a noticeable deformation of the contours of the joint appear.
Signs of moderate arthrosis of the knee joint in the third stage:
- the joint space narrows significantly;
- the presence of subchondral sclerosis in the affected areas;
- numerous osteophytes on margins;
- rare occurrence of subchondral cysts;
- synovitis, the appearance of Baker's cyst under the knee;
- uneven surfaces of the femur and tibia, loss of joint alignment;
- a change in the shape of the patella;
- foci of calcification and chondromalacia;
Rarely, the fourth stage is complemented by necrotic lesions.Why is arthrosis dangerous?The disease impairs mobility and causes dependence on others.
Diagnostics
The podiatrist will check for signs of swelling, palpate the joint for tenderness, and examine active and passive range of motion.Be sure to examine the lumbar spine becauseThe nerves that provide function to the thigh muscles pass through here.
The x-ray shows the presence of osteophytes, a change in the space between the femur and the tibia, which indicates loss of cartilage in the knee.Sometimes X-rays of the knee joints show significant signs of cartilage wear, but patients do not experience significant pain.On the contrary, arthrosis of the first stage can impair the functioning of the knee, since the cause of the pain is hypotonic muscles.
If the X-ray shows no major changes, thenthe doctor prescribes an MRI of the knee joint and the lumbar region.Diagnostics visualizes the ligaments, tendons and muscles, as well as the menisci, to look for other sources of pain.
Laboratory diagnosis is requiredif you suspect a joint infection or gout.
Treatment
Therapy of arthrosis should be comprehensiveit is aimed at the cause of the disease.Adequate treatment must be carried out in case of endocrine dysfunctions affecting the connective tissues.Recommended for overweight patientsswitch to proper nutrition.Exacerbation is alleviated with the help of drugs.
Drug treatment
Pain medication includesprescription of anti-inflammatory drugs.Nonsteroidal anti-inflammatory drugs for long-term usenegatively affects the functioning of the stomach.
The regimen includes chondroprotectors, which only help if taken over long courses of treatment3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs promote the regeneration of the cartilage structure and have a pain-relieving effect.
Few controlled studies have been conducted, and involved complex treatment - joint surgery, physical therapy, diet.
Attention!Chondroprotectors are taken in courses - you can take one drug and another from another and compare the effect.However, uncontrolled drug use is not a good idea.Before you start taking the medicines, consult your doctor.
How and with what can pain and swelling be alleviated?Intra-articular injections are more popular:
- Steroid drugssuppresses inflammatory reactions at the level of immune cells, relieves acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of the synovial fluid, reduces the friction of the joint surfaces.
Important!The effect of the drugs lasts for 6-12 months, but the degenerative processes do not stop.
Surgical treatment
If drugs are ineffective, patients are offered arthroscopy– a minimally invasive procedure for the removal of bone growths and joint revision.If necessary, surgeons perform plastic surgery on the ligaments and cartilages and remove the worn tissue parts.
The purpose of bone osteotomy is to change the loading axis of the joint.The doctor cuts the femur or tibia to change where the joint surfaces meet.The surgery 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 rehabilitation and muscle strengthening.
Changes in the knee can have a compensatory effect compared to the pelvis, so without restoration of muscle balance, the hip joint suffers next.
Physiotherapy treatment
Mud treatment, phonophoresis and magnetic therapy are used in the physiotherapy environment.The influence of external factors is aimed at itstimulating blood supply and tissue regeneration, reducing inflammation and swelling.
Treatment with traditional and non-traditional methods
Folk remedy recipes for the home treatment of arthrosis of the knee joints in generalaims to reduce swelling and eliminate pain.Most often, horseradish leaves and mashed potatoes are used, sometimes honey and vodka are mixed to make a poultice.
Degeneration cannot be completely stopped.Celery juice can affect kidney metabolism.The kidneys are connected to the iliopsoas muscle, which is related to hip pathologies.Normalizing the functioning of the gallbladder and liver improves the condition of the knee.
Traditional medical methods for the treatment of the initial stage of knee arthrosis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortelle.Rubs made of dry mustard, sea salt and kerosene are used.Baths with magnesium salts and pine decoction are used.
Manual therapy and massage
Manual therapy for knee osteoarthritis helps, if the specialist understands the imbalance of muscle tone.Muscle tests help find the weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source can be not only the joint block of the lumbar region,but also blood supply, dysfunction of internal organs, endocrine and biochemical disorders.Therefore, a chiropractor must have knowledge of osteopathy and applied kinesiology to influence many factors.
Massage works as an aid to manual therapy and self-help.A patient suffering from arthrosis of the knee joint can independently stretch the tendons of the muscles that regulate the movement of the limb:
- the area around the gluteus maximus muscle;
- lines along the front surface of the thigh - from the pelvis to the kneecap;
- the lateral surface of the thigh from the greater trochanter to the femoral condyles;
- inguinal area along the inguinal ligament;
- the inner surface of the thigh (along the line of the adductor canal).
The massage is done with acupressure, without much pressure.
Therapeutic gymnastics
The cause of arthrosis is the weakening of the muscles caused by problems with the lower back, pelvis and abdominal cavity.Perform exercises for the prevention of arthritis and arthrosis of the knee joints for elderly peopleIt can be used to increase strength, but not tone.
Without treating the factors that weaken them with manual therapy, it is difficult to achieve a complete restoration of biomechanics.Yoga further destabilizes the joints.Among the treatment methods, it is better to give preferencePilates and Nordic walking.
Diet
Nutrition is primarily set up to overcome excess weight.It is important to give up sugar and simple carbohydrates, add foods containing fiber, magnesium, vitamin B and calcium, which are important for muscle activity, in case of knee arthrosis.Try it outskip dairy products, as nearly 80% of the population is lactose intolerant.
Prevention of arthrosis of the knee joints
Strengthening muscles through exercise does not always help., as innervation and blood supply were not 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, arthrosis is more common in men with a "beer belly" than in women after polyhydramnios, multiple births with diastasis - weakening of the muscles of the abdominal wall.
Surgeries in the pelvic area and internal organs form adhesions that affect the lumbar vertebrae, disrupting the innervation of the muscles around the knee.
Which doctor should I see for knee arthrosis?The orthopedist helps in establishing the diagnosis, who insists 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 right, watch your weight, walk more, visit a masseuse or osteopath once every three months.
Reviews of the treatment
Positive reviews can only be provided by comprehensive treatment of deforming arthrosis or gonarthrosis of the knee joint.Anesthesia and intra-articular injections work temporarily by suppressing the natural inflammatory response.
Conclusion
The problem with arthrosis is that drug therapy only temporarily eliminates pain syndromes.The causes remain unidentified and unaffected.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 at private rehabilitation clinics.