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 knee joints with age, a natural process of aging.The reasons for this 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 the risk factors are cited:over 45 years old, knee injuries and overweight.Almost 50% of the adult population has already complained about a knee joint.
With osteoarthritis, the cartilage lining the edges of the bones wears away or is completely missing.Damaged tissues are not a source of pain because they do not have receptors.Inflammation of neighboring structures causes characteristic symptoms.
The body continues to regenerate damaged tissue, but cartilage develops unevenly.As a result, irregularities form and damage other elements of the joint.The nature of osteophytes is explained by the compensation of smooth articular cartilage.Another version suggests that Spurs expansionassociated with an attempt to stabilize the joint medially or laterally due to muscle weakening.
What are the causes of chronic osteoarthritis of the knee joint?Pain occurs in tendons and ligaments only when muscular forces no longer hold and control the bones.We therefore distinguish the biomechanical causes of pain and osteoarthritis:
- In the context 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 - below the kneecap.
- Prolonged sitting exercises the gluteal muscles, weakening them.Instead, the piriformis muscles, under which the sciatic nerve passes, begin to work.When compressed, the biceps muscle is weakened 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 gluteus medius muscles.The femur rotates inward, the ligaments on the inside of the knee and the medial meniscus are loaded, and osteophytes develop.
- Flat feet, combined with wearing uncomfortable shoes, weakening of the adductor muscles, and increased lordosis, rotates the tibia outward, leading to knee pain due to altered biomechanics and the development of a Baker's cyst.
Pathological chains affecting the knee are associated with falls on the tailbone in childhood, scoliosis caused by diseases of the internal organs.People with different shoulder heightsover time they start to complain about their knee, since the fascial chains located 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, causing pain and stiffness.We think it isthe effect on muscles begins with cartilage and bones.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 a 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.
- Knee pain and stiffness after inactivity or prolonged rest, for example when getting out of bed in the morning, associated with stagnation of venous blood.
The main signs of osteoarthritis are caused by stress on weakened muscles:
- Knee pain when standing is caused by the gluteal and biceps extensor muscles of the hip not working and the rectus femoris muscle being overstretched, creating discomfort in the knee.
- Pain when flexing the joint is associated with weakness in 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 cracked knee can be painless or traumatic.Popping noises and other sounds do not indicate worn bones.Signs of knee instability -weakness of one of the muscles that controls movement.
Crepitus, caused by bone-on-bone friction, does not occur at the beginning and end of the range of motion, but in the middle,even with passive joint flexion.Blocked joints are caused by wear and tear of cartilage and tendons, which creates a feeling of blockage.Bones are controlled by muscles during any movement.Their untimely contraction causes a change in direction of bone movement, a blockage.
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 to 10 years.Generally, peopleI have suffered from stubborn pain for several years.
In the first stage of osteoarthritis, which is detected by chance, there is a slight growth of bone spurs.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 spasms or serious overloads.Running and weight training cause symptoms by putting pressure on weakened muscles.Muscle weakness (hypotonia) is associated with impaired blood supply and innervation.
2 degrees
The second stage of osteoarthritis is considered mild.The x-ray reveals large 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 in the joint and pain when bending and kneeling.
Early 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;
- sharp edges of the condyles of the bones on the medial sides, less often on the lateral sides - depending on the development of valgus or varus deformity of the joint.
For the second stage according to Larsencharacterized by joint space narrowing of more than 50%, but this can only be verified dynamically or by comparison with an unaffected joint.
3 degrees
In the third stage of osteoarthritispain 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 noticeable deformation of the joint contours appear around the knee.
Signs of moderate osteoarthritis of the knee joint in the third stage:
- the joint space is significantly narrowed;
- the presence of subchondral sclerosis in loaded areas;
- numerous osteophytes on the margins;
- rare occurrence of subchondral cysts;
- synovitis, appearance of a Baker cyst below the knee;
- uneven surfaces of the femur and tibia, loss of joint congruence;
- 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 around and creates a dependence on others.
Diagnosis
The podiatrist examines the signs of swelling, palpates the joint for tenderness and examines the range of active and passive movements.Be sure to examine the lumbar spine, asThis is where the nerves that ensure the function of the thigh muscles pass.
An X-ray shows the presence of osteophytes, a change in the space between the femur and the tibia, indicating 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, early stage osteoarthritis can impair knee function., since 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 lumbar region.The diagnosis visualizes the ligaments, tendons, muscles and menisci to look for other sources of pain.
Laboratory diagnosis is necessaryif you suspect a joint infection or gout.
Treatment
Treatment of osteoarthritis must be comprehensiveaimed at the cause of the disease.For endocrine dysfunctions that can affect connective tissues, appropriate treatment is put in place.It is recommended for overweight patientsswitch to a good diet.Exacerbations are relieved with medication.
Drug treatment
Drug treatment of pain involvesprescribe anti-inflammatories.Nonsteroidal anti-inflammatories for long-term usenegatively affect gastric function.
The treatment regimen includes chondroprotectors, which help only when taken as a prolonged course.3-6 months.Pharmacies offer a large number of drugs from this group.
The components of these drugs are believed to help regenerate the cartilage structure and have an analgesic effect.
There have been few controlled studies, and they concerned complex treatments - joint replacement, 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 consumption of medications 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, thereby relieving acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of joint fluid, thereby reducing friction of joint surfaces.
Important!The effect of drugs lasts 6-12 months, but degenerative processes do not stop.
Surgical treatment
If the medications are not very effective, patients are offered arthroscopy.– a minimally invasive procedure for the removal of bone growths and revision of joints.If necessary, surgeons perform plastic surgery on ligaments and cartilage and remove areas of worn tissue.
Bone osteotomy aims to modify the axis of load on 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 arthroplastyrequired for severe stages of osteoarthritis (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 may be compensatory in relation to the pelvis.Therefore, without restoring muscular balance, the hip joint is the next to suffer.
Physiotherapeutic treatment
In the field of physiotherapy, mud applications, phonophoresis and magnetotherapy are used.The action of external factors is aimed atstimulation of blood supply and tissue regeneration, relieving inflammation and swelling.
Treatment with traditional and non-traditional methods
Recipes for folk remedies for the treatment of osteoarthritis of the knee joints at home are usuallyaimed at relieving swelling and eliminating pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed for compresses.
Degeneration cannot be completely stopped.You can influence kidney metabolism using celery juice.The kidneys are connected to the iliopsoas muscle, associated with hip pathologies.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 osteoarthritis include anti-inflammatory herbal decoctions:chamomile, St. John's wort, immortelle.Rubs based on 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 muscle tone imbalances.Muscle testing helps detect weakened muscles that stabilize the knee, determine the cause of the dysfunction and correct it.
The source may not only be joint block in the lumbar region,but also dysfunctions at the level of vascularization, internal organs, endocrine and biochemical disruptions.Thus, a chiropractor must have the skills of osteopathy and applied kinesiology in order to influence numerous factors.
Massage acts as an auxiliary tool for manual therapy and self-help.A patient suffering from osteoarthritis 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 patella;
- lateral aspect of the thigh from the greater trochanter to the femoral condyles;
- groin area along the inguinal ligament;
- the inner surface of the thigh (along the line of the adductor canal).
The massage is performed by acupressure, without too much pressure.
Therapeutic gymnastics
The cause of osteoarthritis is a weakening of muscles caused by problems in the lower back, pelvis and abdominal cavity.Performing exercises to prevent arthritis and osteoarthritis of the knee joints in older peopleCan be used to increase strength, but not tone.
Without working on the factors that weaken them using manual therapy, it is difficult to achieve complete restoration of biomechanics.Yoga also deprives the joints of stability.Among the treatment methods, it is better to preferPilates and Nordic walking.
Diet
Nutrition is mainly adapted to combat excess weight.It is important to give up sugar and simple carbohydrates, add foods containing fiber, magnesium, B vitamins and calcium for knee osteoarthritis, which are important for muscle activity.Tryeliminate dairy products, since almost 80% of the population is lactose intolerant.
Prevention of osteoarthritis 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” osteoarthritis is more common, as in women after polyhydramnios, multiple births with diastasis - weakening of the muscles of the abdominal wall.
Surgical interventions in the pelvic region and internal organs form adhesions that affect the lumbar vertebrae, disrupting the innervation of the muscles around the knee.
Which doctor should I consult if I have osteoarthritis of the knee joint?An orthopedist will help make the diagnosis, who will insist on surgery.The best results are achieved through the work of multidisciplinary teams in rehabilitation centers.
The best thing you can do for your joints:eat well, watch your weight, walk more, see a massage therapist or osteopath once every three months.
Comments on treatment
Positive reviews can only be provided by comprehensive treatment of deforming osteoarthritis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections act temporarily, suppressing the natural inflammatory response.
Conclusion
The problem with osteoarthritis is that drug treatment only temporarily eliminates pain syndromes.The reasons remain unidentified and uninfluenced.Occupational therapists can help you by teaching you how to live with knee osteoarthritis and how to use a cane correctly.But the service is only available in private clinics offering rehabilitation services.