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 radiographs.It is believed that arthrosis is 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.
Causes
The causes of arthrosis have not yet been determined by medicine,Only risk factors are named:age over 45, knee injuries and overweight.Almost 50% of the adult population has ever complained of a knee joint.
With arthrosis, the cartilage lining the edges of the bones wears away or is completely absent.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 the cartilage grows unevenly.As a result, irregularities are formed that injure other elements of the joint.The nature of osteophytes is explained by 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 occurs in the tendons and ligaments only when muscle forces no longer hold and control the bones.Therefore, biomechanical causes of pain and arthrosis are distinguished:
- Against the backdrop 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 kneecap.
- Prolonged sitting strains the gluteal muscles, weakening them.Instead, the piriformis muscles begin to work, under which the sciatic nerve passes.When it is 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 gluteal medius muscles.The femur rotates inward, the ligaments along the inside of the knee and the medial meniscus are loaded, and osteophytes grow.
- Flat feet, associated with wearing uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outward, which leads to pain in the knee due to impaired biomechanics and the development of a Baker cyst.
Pathological chains affecting the knee are associated with falling on the tailbone in childhood, scoliosis caused by diseases of the internal organs.People with different shoulder heightsover 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 the function of the joint, leading to pain and stiffness.It is believed that it isthe effect on the 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 a threat of cartilage wear:
- Occasional discomfort associated with walking, a 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 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 arthrosis are caused by stress on weakened muscles:
- Knee pain when standing up is due to the fact that the gluteus and biceps hip extensor muscles do not function, and the rectus femoris muscle is excessively stretched, creating 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 warmth in the knee area, swelling, indicates the accumulation of inflammatory exudate -arthrosis is often accompanied by bursitis, synovitis, and tendonitis.
A crunch in the knee can be painless or traumatic.Popping noises and other sounds do not indicate that the bones are being worn out.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.Joint locking is caused by wear and tear on the cartilage and tendons, which creates a feeling of being locked in place.Bones are controlled by muscles during any movement.Their untimely contraction leads to a changed direction of bone movement, blocking.
1st degree
The degree of arthrosis 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 5-10 years.As a rule, peoplehave been experiencing nagging pain for several years.
At the first stage of arthrosis, 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 severe spasms and overloads.Running and weight training provoke symptoms by placing strain on weakened muscles.Weakness (hypotonia) of muscles is associated with impaired blood supply and innervation.
2 degrees
The second stage of arthrosis is considered mild.X-ray reveals significant 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 arthrosis:
- pointed edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space on the medial side;
- pointed edges of the condyles of bones on the medial sides, less often on the lateral - depending on the development of 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 checked in dynamics or comparison with an unaffected joint.
3 degrees
At the third stage of arthrosispain 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 contours of the joint appear around the knee.
Signs of moderate arthrosis of the knee joint at the third stage:
- the joint space is significantly narrowed;
- the presence of subchondral sclerosis in loaded areas;
- numerous osteophytes at the margins;
- rare occurrence of subchondral cysts;
- synovitis, the appearance of a 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.
Diagnostics
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 pass that provide function to the thigh muscles.
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 significant signs of cartilage wear, but patients do not experience significant pain.On the contrary, arthrosis of the first stage can impair the function of the knee, since the cause of 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.Diagnostics visualizes ligaments, tendons and muscles, and menisci to look for other sources of pain.
Laboratory diagnosis is necessaryif you suspect a joint infection or gout.
Treatment
Therapy for arthrosis must be comprehensiveaimed at the cause of the disease.For endocrine dysfunctions that can affect connective tissues, appropriate treatment is carried out.Overweight patients are recommendedswitch to proper nutrition.Exacerbations are relieved with the help of medications.
Drug treatment
Drug treatment for pain involvesprescribing anti-inflammatory drugs.Nonsteroidal anti-inflammatory drugs for long-term usenegatively affect gastric function.
The treatment regimen includes chondroprotectors, which help only when taken in long courses over3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs help regenerate the structure of cartilage and have an analgesic effect.
There have been few controlled studies, and they concerned complex treatment - 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 medication use 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 drugssuppress inflammatory reactions at the level of immune cells, relieving acute pain, joint stiffness and swelling.
- Hyaluronic acidincreases the viscosity of the joint fluid, reducing friction of the articular surfaces.
Important!The effect of the drugs lasts for 6-12 months, but the degenerative processes do not stop.
Surgical treatment
If the drugs are low in effectiveness, patients are offered arthroscopy– a minimally invasive procedure for removing bone growths and joint revision.If necessary, surgeons perform plastic surgery of ligaments and cartilage, and remove areas of worn tissue.
Bone osteotomy is aimed at changing 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 arthrosis (third or fourth degree).Surgical treatment does not always solve the problem, since it requires diligent and daily rehabilitation and muscle strengthening.
Changes in the knee can be compensatory in relation to the pelvis, therefore, without restoring muscle balance, the hip joint is the next to suffer.
Physiotherapeutic treatment
In the environment of physiotherapy, mud applications, phonophoresis and magnetic therapy 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 arthrosis 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, which is associated with hip pathologies.Normalizing the function of the gallbladder and liver improves the condition of the knees.
Traditional medicine methods for treating the initial stage 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 for osteoarthritis of the knee joint helps, if the specialist understands muscle tone imbalances.Muscle tests help 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 disruptions.Therefore, a chiropractor must have the skills of osteopathy and applied kinesiology in order to influence many factors.
Massage acts as an auxiliary tool for 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 surface of the thigh - from the pelvis to the patella;
- 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 arthrosis is weakening of muscles caused by problems in the lower back, pelvis, and abdominal cavity.Perform exercises to prevent arthritis and arthrosis of the knee joints for older peopleCan 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 complete restoration of biomechanics.Yoga further deprives joints of stability.Among the treatment methods, it is better to preferPilates and Nordic walking.
Diet
Nutrition is adjusted primarily to combat excess weight.It is important to give up sugar and simple carbohydrates, add foods with fiber, magnesium, B vitamins and calcium for knee arthrosis, which are important for muscle activity.Tryeliminate dairy products, since almost 80% of the population is lactose intolerant.
Prevention of arthrosis 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” arthrosis is more common, 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, disrupting the innervation of the muscles around the knee.
Which doctor should I consult for arthrosis of the knee joint?An orthopedist will help 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.
Reviews about the treatment
Positive reviews can only be provided by comprehensive treatment of deforming arthrosis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections act temporarily, suppressing the natural inflammatory response.
Conclusion
The problem with arthrosis 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 arthrosis and how to use a cane correctly.But the service is available only in private clinics providing rehabilitation.