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 thought to be the destruction of the knee joints with age, a natural process of aging.The reasons 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 established by medicine,Only risk factors are indicated:age over 45, knee injuries and overweight.Almost 50% of the adult population has ever complained of a knee joint.
In arthrosis, the cartilage covering the ends 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 the damaged tissue, but the cartilage grows unevenly.As a result, irregularities are formed that injure 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 knee osteoarthritis?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 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 knee cap.
- Prolonged sitting puts strain on 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 angle of rotation 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 medius muscles.The femur rotates inwards, the ligaments on the inside of the knee and the medial meniscus are stressed, osteophytes grow.
- Flat feet, associated with wearing uncomfortable shoes, weakening of the adductors and increased lordosis, turns the tibia outward, leading to knee pain due to impaired biomechanics and development of Baker's cyst.
Pathological chains affecting the knee are associated with the fall of the coccyx in childhood, scoliosis caused by diseases of the internal organs.People with different shoulder heightsover time they begin to complain about their knee, because the fascial chains along the front of the body include the extensor of this joint - the rectus femoris muscle.
Symptoms
The degenerative process disrupts the function of the joint, leading to pain and stiffness.It is believed to be sothe effect on muscles begins with cartilage and bone.Practice shows the opposite -pain in the knee joint occurs in the tendons- attachments of weakened muscles of the extensors, flexors and stabilizers of the knee.
The main signs of the threat of cartilage wear:
- Occasional discomfort associated with walking, a feeling of "putting the foot in the wrong place".
- The appearance of pain when directly loading the joint and the muscles that bend and stretch it - squatting, climbing stairs.
- Pain and stiffness in the knees after prolonged inactivity or rest, such as when getting out of bed in the morning, which is associated with venous stasis.
The main signs of arthrosis are caused by stress on weakened muscles:
- Knee pain when standing up is due to the fact that the gluteus and biceps of the hip extensors are not functioning, and the rectus femoris is 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.
Edema 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 -arthrosis is often accompanied by bursitis, synovitis and tendinitis.
A crunch in the knee can be painless or traumatic.Cracking noises and other sounds do not mean that the bones are wearing out.Signs of knee instability -weakness of one of the muscles that control movement.
Crepitus caused by bone rubbing on bone 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 of the cartilage and tendons, creating a feeling of being locked in place.Bones are controlled by muscles during every movement.Their untimely contraction leads to a changed direction of movement of the bone, blocking.
1st degree
The degree of arthrosis is determined using an X-ray, revealing the involvement of bone structures in the pathological process.Their change indicates that the muscular system has been imbalanced for 5-10 years.As a rule, peoplehave been experiencing unpleasant pain for several years.
In the first stage of arthrosis, which is discovered incidentally, has a slight overgrowth of bone spurs.Growths appear in places where the joint is most unstable.Patients usually 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 provoke symptoms by stressing weakened muscles.Weakness (hypotonia) of the muscles is associated with impaired blood supply and innervation.
2 degrees
The second stage of arthrosis is considered mild.X-rays revealed significant bony spurs, but the cartilage was unaffected.The amount of synovial fluid decreases, but symptoms of pain after prolonged walking and running, stiffness in the joint, and pain when bending and kneeling appear.
Early X-ray signs of the second stage of knee arthrosis:
- pointed edges of the intercondylar tubercles of 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 sides - depending on the development of valgus or varus deformation of the joint.
For the second stage according to Larsencharacterized by narrowing of the joint space by more than 50%, but this can only be verified in dynamics or comparison with the unaffected joint.
3 degrees
In the third stage of arthrosispain when bending and straightening the joint becomes constant.During an exacerbation, the joint becomes red and swollen, and the aching pain does not stop even at rest.Swelling appears around the knee and noticeable deformation of the contours of the joint.
Signs of moderate arthrosis of the knee joint in the third stage:
- the joint space is significantly narrowed;
- the presence of subchondral sclerosis in stressed areas;
- multiple osteophytes along the edges;
- 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 congruence;
- change in the shape of the patella;
- foci of calcification and chondromalacia;
Rarely, the fourth stage is supplemented by necrotic lesions.Why is arthrosis dangerous?The disease impairs the ability to move and creates dependence on others.
Diagnosis
The orthopedist examines for signs of swelling, palpates the joint for tenderness, and examines active and passive range of motion.Do not forget to examine the lumbar spine, becauseThis is where the nerves pass that provide the function of the thigh muscles.
An X-ray shows the presence of osteophytes, a change in the space between the femur and tibia that indicates cartilage loss 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 in the first stage can disrupt the function of the knee, as the cause of the pain is hypotonic muscles.
If the X-ray does not show major changes, thenthe doctor prescribes an MRI of the knee joint and the lumbar region.Diagnostics visualizes ligaments, tendons and muscles, and the meniscus to look for other sources of pain.
Laboratory diagnosis is requiredif you suspect a joint infection or gout.
Treatment
Therapy for arthrosis must be comprehensivedirected at the cause of the disease.In case of endocrine dysfunctions that may affect the connective tissue, appropriate treatment is carried out.Recommended for overweight patientsswitch to proper nutrition.Exacerbations are relieved with the help of drugs.
Drug treatment
Drug treatment of pain includesprescribing anti-inflammatory drugs.Nonsteroidal anti-inflammatory drugs for long-term usenegatively affect gastric function.
The treatment regimen includes chondroprotectors, which help only with long courses3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs help to regenerate the cartilage structure and have an analgesic effect.
There are few controlled studies, and referred to complex treatment - endoprosthesis, physiotherapy, diet.
attention!Chondroprotectors are taken in courses - you can take one course of one drug and a second course of another and compare the effect.However, uncontrolled use of drugs is not a good idea.Before you start taking medication, consult your doctor.
How and with what to relieve pain and swelling?Intra-articular injections are more popular:
- Steroid drugssuppress inflammatory reactions at the level of immune cells, relieve acute pain, stiffness and swelling of the joints.
- 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 the drugs are of low effectiveness, patients are offered arthroscopy– a minimally invasive procedure for the removal of bone growths and joint revision.If necessary, surgeons perform plastic surgery on ligaments and cartilage and remove areas of worn tissue.
Bone osteotomy is aimed at changing the load axis of the joint.The 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 arthroplastynecessary in 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 be compensatory in relation to the pelvis, therefore, without restoration of muscle balance, the hip joint suffers next.
Physiotherapy treatment
Physiotherapy uses mud applications, phonophoresis and magnetotherapy.The action of external factors is aimed atstimulation of blood supply and regeneration of tissues, relief of inflammation and swelling.
Treatment with traditional and non-traditional methods
Recipes for folk remedies for the treatment of arthrosis of the knee joints at home are usuallyaimed at relieving swelling and eliminating pain.Most often, horseradish leaves and potato mash are used, sometimes honey and vodka are mixed for compresses.
Degeneration cannot be completely stopped.You can influence the metabolism in the kidneys by using celery juice.The kidneys are related to the iliopsoas muscle, which is related to the pathologies of the hip joint.Normalizing the function of the gallbladder and liver improves the condition of the knees.
The methods of traditional medicine for the treatment of the initial stage of knee arthrosis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortelle.Dry mustard, sea salt and kerosene rubs are used.Baths with magnesium salts and pine tinctures are used.
Manual therapy and massage
Manual therapy for osteoarthritis of the knee joint helps, if the specialist understands muscle tone imbalances.Muscle testing helps find weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source can be not only the joint block in the lumbar region,but also dysfunction at the level of blood supply, internal organs, endocrine and biochemical disturbances.Therefore, a chiropractor must have the skills in osteopathy and applied kinesiology to influence many factors.
Massage acts as an aid to 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 on the front surface of the thigh - from the pelvis to the patella;
- the lateral surface of the thigh from the greater trochanter to the femoral condyles;
- the groin area along the inguinal ligament;
- the inner surface of the thigh (along the line of the adductor canal).
The massage is performed point by point, without strong pressure.
Therapeutic gymnastics
The cause of arthrosis is the weakening of the muscles caused by problems in the lower back, pelvis and abdominal cavity.Do exercises to prevent arthritis and arthrosis of the knee joints for the elderlyIt 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 a complete restoration of biomechanics.Yoga further destabilizes the joints.Among the methods of treatment, it is better to preferPilates and Nordic walking.
diet
Diet is primarily adjusted to combat excess weight.It is important to give up sugar and simple carbohydrates, add foods with fiber, magnesium, B vitamins and calcium in knee osteoarthritis, which are important for muscle activity.Try iteliminate dairy products, as almost 80% of the population is lactose intolerant.
Prevention of arthrosis of the knee joints
Attempts to strengthen muscles with exercise do not always help., as innervation and blood supply are 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, in men with a "beer belly", arthrosis is more common, as in women after polyhydramnios, several births with diastasis - weakening of the muscles of the abdominal wall.
Surgeries in the area of the pelvis 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 osteoarthritis?The orthopedist will help you 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 right, watch your weight, walk more, visit a massage therapist or osteopath once every three months.
Treatment reviews
Positive examinations can be provided only by comprehensive treatment of deforming arthrosis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections work temporarily by suppressing the natural inflammatory response.
Conclusion
The problem with arthrosis is that drug therapy temporarily removes only the pain syndromes.The causes remain undetermined and unaffected.Occupational therapists can help by teaching you how to live with knee osteoarthritis and how to use a cane properly.But the service is offered only in private clinics providing rehabilitation.