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 aging process.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.
Causes
The causes of osteoarthritis have not yet been determined by medicine.Only the risk factors are named:age over 45 years, knee injuries and overweight.Almost 50% of the adult population has at some point complained about a knee joint.
With osteoarthritis, the cartilage that lines the edges of the bones wears away or disappears completely.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 form 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 osteoarthritis of the knee joint?Pain occurs in tendons and ligaments only when muscle forces no longer support and control the bones.Therefore, the biomechanical causes of pain and osteoarthritis are distinguished:
- In the context of a long sessionCompression occurs between the inguinal ligament and the iliopsoas muscle of the femoral artery and nerve, weakening the strength of the front of the thigh and causing tension in the tendon below the kneecap.
- Sitting for a long time strains the gluteal muscles., weakening them.Instead, the piriformis muscles begin to work, under which the sciatic nerve passes.When compressed, the biceps muscle weakens and changes the angle of rotation of the thigh and lower leg.The knee is injured.
- Walking in heelsIt causes tightness in the calf muscles, rotates the pelvis, and weakens the gluteus medius muscles.The femur rotates inward, the ligaments along the inside of the knee and the medial meniscus become loaded, and osteophytes grow.
- flat feet, associated with wearing uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outward, causing 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 heights.Over time they begin to complain about their 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 impairs joint function, causing pain and stiffness.It is believed to beThe effect on muscles begins with cartilage and bone..Practice shows the opposite.Pain in the knee joint occurs in the tendons.– weakened muscle insertions of the knee extensors, flexors and stabilizers.
The main signs of threatened cartilage wear:
- Occasional discomfort associated with walking, feeling of “putting your foot in the wrong place.”
- The appearance of pain with direct loading 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 tension in weakened muscles:
- Knee pain when standing is due to the gluteus and biceps hip extensor muscles not working, and the rectus femoris muscle being stretched excessively, 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 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 usually accompanied by bursitis, synovitis and tendinitis.
A cracking knee can be painless or traumatic.Clicking and other sounds do not indicate that the bones are wearing down.Signs of knee instability -weakness of one of the muscles that controls movement.
Crepitus, caused by friction between bones, does not occur at the beginning or 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, which creates a feeling of being locked in place.The bones are controlled by muscles during any movement.Its untimely contraction causes a change in the direction of bone movement, blocking it.
1st grade
The degree of osteoarthritis is determined by x-ray., revealing the participation of bone structures in the pathological process.Its change indicates that the muscular system has been unbalanced for 5 to 10 years.As a general rule, peoplehave been experiencing persistent 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 overload.Running and weight training cause symptoms by putting pressure on weakened muscles.Weakness (hypotonia) of the muscles is associated with problems with 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 walking and running for a long time, 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 of the tibia, where the cruciate ligament attaches;
- 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 the 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%, but this can only be verified dynamically or by comparing it with an unaffected joint.
3 degrees
In the third stage of osteoarthritis.The pain when bending and straightening the joint becomes constant.During an exacerbation, the joint becomes red and swollen, and the pain does not stop even at rest.Swelling and noticeable deformation of the contours of the joint appear around the knee.
Signs of moderate osteoarthritis of the knee joint in the third stage:
- the joint space is significantly reduced;
- the presence of subchondral sclerosis in loaded areas;
- numerous osteophytes on margins;
- rare occurrence of subchondral cysts;
- synovitis, the appearance of a Baker's cyst below the knee;
- uneven surfaces of the femur and tibia, loss of joint congruity;
- change in the shape of the kneecap;
- foci of calcification and chondromalacia;
Rarely, the fourth stage is complemented by necrotic lesions..Why is osteoarthritis dangerous?The disease affects the ability to move and creates 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, becauseThis is where the nerves that provide function to the thigh muscles pass.
An x-ray shows the presence of osteophytes, a change in the space between the femur and 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.In contrast, early stage osteoarthritis can impair knee function., since the cause of the pain is hypotonic muscles.
If the x-ray does not show any major changes, thenthe doctor prescribes an MRI of the knee joint and lumbar region.The diagnosis visualizes ligaments, tendons, muscles and menisci to look for other sources of pain.
Laboratory diagnosis is necessary.if you suspect a joint infection or gout.
Treatment
Therapy for osteoarthritis must be comprehensive.directed at the cause of the disease.For endocrine dysfunctions that can affect the connective tissue, appropriate treatment is carried out.It is recommended for overweight patients.switch to proper nutrition.Exacerbations are relieved with the help of medications.
Pharmacological treatment
Pharmacological treatment for pain involvesprescribe anti-inflammatory medications.Nonsteroidal anti-inflammatory drugs for long-term use.negatively affect gastric function.
The treatment regimen includes chondroprotectors, which only help when taken in long cycles for3-6 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 have been few controlled studies., and they referred to 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 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 more popular:
- Steroid medicationssuppress 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 to 12 months, but the degenerative processes do not stop.
Surgical treatment
If medications have little effectiveness, patients are offered arthroscopy.– a minimally invasive procedure to remove bone growths and joint revision.If necessary, surgeons perform ligament and cartilage plastic surgery and remove areas of worn tissue.
Bone osteotomy aims to change the load axis in 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 can be compensatory in relation to the pelvis, so without restoring muscle 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 aimsstimulation 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 usuallyintended to relieve swelling and eliminate pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed to make compresses.
Degeneration cannot be stopped completely.You can influence kidney metabolism using 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 medicine methods for treating the initial stage of knee osteoarthritis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortelle.Dressings made with 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 find weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source may be not only joint blockage in the lumbar region,but also dysfunction at the level of blood supply, internal organs, endocrine and biochemical alterations..Therefore, a chiropractor must have osteopathy and applied kinesiology skills to be able to influence many factors.
Massage acts as an auxiliary tool for manual therapy and self-help.A patient with 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 front surface of the thigh, from the pelvis to the kneecap;
- lateral surface 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 with acupressure, without much pressure.
therapeutic gymnastics
The cause of osteoarthritis is the weakening of the muscles caused by problems in the lower back, pelvis and abdominal cavity.Perform exercises to prevent arthritis and osteoarthritis of the knee joints in older people.It can be used to increase strength, but not tone..
Without working on the weakening factors with the help of manual therapy, it is difficult to achieve a complete restoration of biomechanics.Yoga further deprives joints of stability.Among the treatment methods, it is better to prefer.Pilates and Nordic walking.
Diet
Nutrition is adjusted mainly to combat excess weight.It is important to give up sugar and simple carbohydrates., add foods with fiber, magnesium, vitamin B 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 abdominal muscle weakness also affect the knees.Therefore, in men with a "beer belly" osteoarthritis is more common, as well as in women after polyhydramnios, several 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, altering 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 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, visit a massage therapist or osteopath once every three months.
Comments on treatment.
Positive reviews can only be obtained through 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 therapy temporarily eliminates only pain syndromes.The reasons remain unidentified and uninfluenced.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 in private clinics that offer rehabilitation.