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 a weakening of the muscles and poor blood circulation in the tissue.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.
Causes
The causes of osteoarthritis have not yet been medically clarified,The only risk factors mentioned are:Age over 45, knee injuries and overweight.Almost 50% of the adult population has complained about a knee joint.
In osteoarthritis, the cartilage on 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 surrounding structures causes characteristic symptoms.
The body continues to regenerate damaged tissue, but the cartilage grows unevenly.This creates irregularities that damage other joint elements.The nature of osteophytes is explained by the compensation of smooth articular cartilage.Another version suggests an expansion of Spursassociated with an attempt to stabilize the joint medially or laterally due to weakening of the muscles.
What causes chronic osteoarthritis of the knee joint?Pain in the tendons and ligaments only occurs when the muscle strength no longer holds and controls the bones.Therefore, biomechanical causes of pain and osteoarthritis are distinguished:
- Against the background of long sittingCompression occurs between the inguinal ligament and iliopsoas muscle of the femoral artery and the nerve, weakening the strength of the front of the thigh and causing tension in the tendon - under the kneecap.
- Sitting for long periods of time puts strain on the gluteal muscles, which weakens them.Instead, the piriformis muscles, under which the sciatic nerve passes, begin to work.During compression, the biceps muscle is weakened and the angle of rotation of the upper and lower leg changes.The knee is injured.
- Walking in high heelscauses tension in the calf muscles, rotates the pelvis and weakens the gluteus medius.The femur rotates inward, the ligaments on the inside of the knee and the medial meniscus are stressed, and osteophytes grow.
- Flat feet, associated with wearing uncomfortable shoes, weakening of the adductor muscles and increased lordosis, rotates the shinbone outward, leading to knee pain and the development of Baker's cyst due to impaired biomechanics.
Pathological chains affecting the knee are associated with a fall on the tailbone in childhood and scoliosis caused by diseases of the internal organs.People with different shoulder heightsOver time they begin to complain about their knee, as the fascial chains along the front of the body include the extensor muscle of this joint - the rectus femoris muscle.
Symptoms
The degenerative process affects the function of the joint and leads to pain and stiffness.This is believed to be the caseThe effect on the muscles begins with cartilage and bones.Practice shows the opposite -Pain in the knee joint occurs in the tendons– Adhesions of weakened muscles of the extensors, flexors and stabilizers of the knee.
The most important signs of impending cartilage wear:
- Occasional discomfort when walking, the feeling of “putting your foot in the wrong place.”
- The appearance of pain when there is direct stress on the joint and the muscles that flex and extend it - squatting, climbing stairs.
- Knee pain and stiffness after prolonged inactivity or rest, for example when getting up in the morning, which is accompanied by stagnation of venous blood.
The main symptoms of osteoarthritis are caused by strain on weakened muscles:
- Knee pain when standing up is due to the hip extensor muscles gluteus and biceps not working and the rectus femoris muscle being overly 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 injuries, inflammation of the tendons and joint capsule.The appearance of warmth in the knee area, swelling, indicates the accumulation of inflammatory exudate -Osteoarthritis is often accompanied by bursitis, synovitis and tendonitis.
A knee crunch can be painless or traumatic.Popping noises and other noises are not an indication that the bones are worn down.Signs of knee instability –Weakness of one of the muscles that controls movement.
Crepitus, caused by bone-on-bone friction, occurs not at the beginning and end of the range of motion, but in the middle.even with passive joint flexion.Joint blockages are caused by wear and tear on cartilage and tendons, creating a feeling of locking.Bones are controlled by muscles every time they move.Their premature contraction leads to a change in the direction of bone movement and blockage.
1st degree
The degree of osteoarthritis is determined using an X-ray, which reveals the involvement of bone structures in the pathological process.Their change indicates that the muscles have been out of balance for 5-10 years.Usually peopleI have been suffering from severe pain for several years.
In the first stage of osteoarthritis, which is discovered 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 with movement.
The weakness of some muscles is compensated for by the function of other muscles without causing severe cramps and overload.Running and strength training cause symptoms by putting strain on weakened muscles.Muscle weakness (hypotension) is accompanied by impaired blood supply and innervation.
2 degrees
The second stage of osteoarthritis is considered mild.X-rays clearly show bone spurs, but the cartilage is not affected.The amount of synovial fluid decreases, but after long walking and running, pain symptoms, stiffness in the joint and pain when bending and kneeling appear.
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 side;
- sharp edges of the bone condyles on the medial side, less often on the lateral side - depending on the development of a 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%However, this can only be checked in dynamics or in comparison with an unaffected joint.
3 degrees
In the third stage of osteoarthritisThe pain when flexing and extending the joint becomes constant.During an exacerbation, the joint becomes red and swollen, and the aching pain does not stop even at rest.In the knee area there is swelling and noticeable deformation of the joint contours.
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;
- numerous osteophytes at the edges;
- rare occurrence of subchondral cysts;
- synovitis, the appearance of a Baker's cyst under the knee;
- uneven surfaces of femur and tibia, loss of joint congruence;
- change in patella shape;
- foci of calcification and chondromalacia;
In rare cases, the fourth stage is supplemented by necrotic lesions.Why is osteoarthritis dangerous?The disease impairs the ability to move and leads to dependence on others.
diagnosis
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 ensure the function of the thigh muscles run 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 knee joints show clear signs of cartilage wear, but patients do not experience significant pain.On the contrary, osteoarthritis in the first stage can impair the function of the knee, since the cause of pain is hypotonic muscles.
If the x-ray doesn't show any major changes, thenThe doctor orders an MRI of the knee joint and lumbar spine.During the diagnosis, ligaments, tendons and muscles as well as menisci are made visible in order to look for other sources of pain.
Laboratory diagnostics are necessaryif you suspect a joint infection or gout.
Treatment
Therapy for osteoarthritis must be comprehensivetargets the cause of the disease.Appropriate treatment is provided for endocrine dysfunction that can affect the connective tissue.Overweight patients are recommendedswitch to proper nutrition.Exacerbations are relieved with the help of medication.
Drug treatment
Includes medication for pain treatmentPrescribing anti-inflammatory medications.Non-steroidal anti-inflammatory drugs for long-term usehave a negative effect on stomach function.
The treatment regimen includes chondroprotectors, which help only when taken for a long time3-6 months.Pharmacies offer a variety of medications from this group.
It is believed that the components of these drugs contribute to the regeneration of the cartilage structure and have an analgesic effect.
There are only a few controlled studies, and they concerned complex treatments – arthroplasty, 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 effects.However, uncontrolled medication intake is not a good idea.Before you start taking any medication, consult your doctor.
How and with what can pain and swelling be relieved?Intra-articular injections are more popular:
- Steroid medicationssuppress inflammatory reactions at the level of immune cells and relieve acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of the synovial fluid and reduces 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 effectiveness of the medication is low, patients are offered arthroscopy– a minimally invasive procedure for the removal of bone growths and joint revisions.If necessary, surgeons perform plastic surgery on ligaments and cartilage, removing worn-out tissue.
The aim of bone osteotomy is to change the stress axis of the joint.The doctor cuts the femur or tibia to change the place where the joint surfaces meet.The operation is often performed on young patients.
Total knee replacement or arthroplastyrequired in severe stages of osteoarthritis (third or fourth degree).Surgical treatment does not always solve the problem as it requires careful and daily rehabilitation and muscle strengthening.
Changes in the knee can have a compensatory effect in relation to the pelvis, so that if muscle balance is not restored, the hip joint suffers next.
Physiotherapeutic treatment
In the field of physiotherapy, mud treatments, phonophoresis and magnetic field therapy are used.The aim is to influence external factorsStimulating blood supply and tissue regeneration, relieving inflammation and swelling.
Treatment with traditional and non-traditional methods
As a rule, there are recipes for folk remedies for the treatment of arthrosis of the knee joints at homeaims to relieve swelling and eliminate pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed for compresses.
The degeneration cannot be stopped completely.You can influence kidney metabolism with celery juice.The kidneys are connected to the iliopsoas muscle, which is associated with hip pathologies.Normalization of the function of the gallbladder and liver improves the condition of the knees.
Traditional medicinal methods for treating the initial stages 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 helps with osteoarthritis of the knee joint, when the specialist understands imbalances in muscle tone.Muscle testing helps to find weakened muscles that stabilize the knee, determine the cause of the dysfunction and correct it.
The cause can not only be the joint blockage in the lumbar region,but also dysfunctions at the level of the blood supply, internal organs as well as 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 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 along the front of the thigh - from the pelvis to the kneecap;
- lateral surface of the thigh from the greater trochanter to the femoral condyles;
- groin 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 osteoarthritis is a weakening of the 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 to increase 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 also deprives the joints of their stability.Among the treatment methods it is better to give preferencePilates and Nordic walking.
diet
The diet is adjusted primarily to combat excess weight.It is important to avoid sugar and simple carbohydratesFor knee osteoarthritis, add foods containing fiber, magnesium, B vitamins and calcium, which are important for muscle activity.Try itAvoid dairy products, as almost 80% of the population is lactose intolerant.
Prevention of osteoarthritis of the knee joints
Trying to strengthen muscles through exercise doesn't always help., since innervation and blood supply are not restored.The function of the thigh muscles depends on the lumbar plexus.
Changes in the lower back that accompany weak abdominal muscles also affect the knees.Therefore, osteoarthritis occurs more often in men with a “beer belly”, as well as in women after polyhydramnios, multiple births with diastasis - a weakening of the abdominal wall muscles.
During operations in the pelvic area and internal organs, adhesions occur that affect the lumbar vertebrae and disrupt the innervation of the muscles around the knee.
Which doctor should I see if I have osteoarthritis of the knee joint?An orthopedist will help with 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 right, watch your weight, walk more, see a masseur or osteopath every three months.
Reviews about treatment
Positive reviews can only be given by comprehensive treatment of deforming arthrosis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections have a temporary effect and suppress the natural inflammatory response.
Conclusion
The problem with osteoarthritis is that drug therapy only temporarily eliminates the pain syndromes.The reasons remain unknown and unaffected.Occupational therapists can help you by teaching you how to deal with knee osteoarthritis and how to use a cane properly.However, the service is only available in private clinics that offer rehabilitation.