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 joint with age, a natural aging process.The reason is muscle weakness and poor blood supply to the tissues.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.
Cause
The cause of arthrosis has not been determined by medicine,Only named risk factors:age over 45, knee injury and overweight.Almost 50% of the adult population has complained about the knee joint.
With arthrosis, the cartilage lining the edges of the bones wears away or disappears completely.Damaged tissue is not the cause 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, distortions 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 attempts to stabilize the joint medially or laterally due to muscle weakness.
What causes chronic arthrosis of the knee joint?Pain occurs in tendons and ligaments only when the muscle force no longer holds and controls the bone.Therefore, the causes of pain and biomechanical arthrosis are distinguished:
- Against the background of sitting for a long timeCompression occurs between the inguinal ligament and the iliopsoas muscle of the artery and the femoral 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, weaken them.Instead, the piriformis muscle begins to work, where the sciatic nerve passes.When it is compressed, the biceps muscle weakens, and the angle of rotation of the thigh and lower leg changes.Injured knee.
- Walk in heelscauses tension in the calf muscles, rotates the pelvis, and weakens the gluteal medius muscle.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 the adductor muscles and increased lordosis, making the tibia come out, which leads to pain in the knee due to impaired biomechanics and the development of Baker's cyst.
The chain of pathologies affecting the knee is associated with a fall on the coccyx in childhood, scoliosis caused by diseases of the internal organs.People with different shoulder heightsover time they start complaining about their knees, because the fascial chain along the front of the body includes the extensors of this joint - the rectus femoris muscle.
symptoms
The degenerative process affects joint function, causing pain and stiffness.It is believed that it isthe effect on muscles begins with cartilage and bone.Practice shows the opposite -Pain in the knee joint occurs in the tendons– poor muscle attachment to 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 your foot in the wrong place."
- The appearance of pain with direct load on the joints and muscles that flex and extend them - 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 venous stasis.
The main signs of arthrosis caused by pressure on weak muscles:
- Knee pain when standing is due to the fact that the hip extensor muscles gluteus and biceps do not work, and the rectus femoris muscle is overstretched, causing discomfort in the knee.
- Pain when bending the joint is associated with weakness of the flexors - biceps muscles and tension in the quadriceps tendon.
Swelling is caused by soft tissue injuries, inflammation of tendons and joint capsules.The appearance of warmth in the knee area, swelling, indicates the accumulation of inflammatory exudate -arthrosis is often accompanied by bursitis, synovitis, and tendonitis.
Irritation in the knee can be painless or traumatic.Popping sounds and other noises do not indicate that the bone is worn.Signs of knee instability -weakness of one of the muscles that control movement.
Crepitus, caused by bone-to-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.Premature contraction leads to a change in the direction of bone movement, restricting it.
first degree
The degree of arthrosis is determined using x-rays, revealed the participation of bone structures in the pathological process.Their changes indicate that the muscular system has been out of balance for 5-10 years.As a rule, peoplehad been suffering from intractable pain for several years.
In the first stage of arthrosis, which was detected by chance, there was a slight growth of bone spurs.Tumors appear in places where the joints are most unstable.Usually, 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 loads.Running and weight training exacerbate symptoms by placing tension on weakened muscles.Muscle weakness (hypotonia) is associated with impaired blood supply and conservation.
2 degrees
The second stage of arthrosis is considered mild.X-rays revealed significant bone spurs, but the cartilage was unaffected.The amount of synovial fluid decreases, but symptoms of pain appear after long walks and runs, joint stiffness and pain when bending and kneeling.
Early radiological signs of the second stage of knee arthrosis:
- the pointed edge of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space in the medial part;
- the pointed edge of the bone condyle in the medial part, less often on the side - depending on the development of valgus or varus deformation of the joint.
For the second stage according to Larsencharacterized by joint space narrowing of more than 50%, but this can only be checked in dynamics or comparison with an 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 pain does not stop even with rest.Significant swelling and deformation of the contour of the joint appears around the knee.
Signs of moderate arthrosis of the knee joint in the third stage:
- the joint space narrows significantly;
- the presence of subchondral sclerosis in the loaded area;
- many osteophytes at the periphery;
- rare occurrence of subchondral cysts;
- synovitis, the appearance of a Baker's cyst below the knee;
- uneven surface of the femur and tibia, loss of joint congruence;
- changes in the shape of the patella;
- calcification focus and chondromalacia;
Rarely, the fourth stage is accompanied by necrotic lesions.Why is arthrosis dangerous?This disease affects the ability to move and creates dependence on others.
Diagnostics
The podiatrist checks for signs of swelling, palpates the joint for tenderness, and checks active and passive range of motion.Be sure to check the lumbar spine, becauseThis is where the nerve pathways provide function to the thigh muscles.
X-ray shows the presence of osteophytes, changes in the space between the femur and tibia, indicating loss of cartilage in the knee.Sometimes the x-ray of the knee joint shows signs of significant cartilage wear, but the patient does not experience significant pain.On the other hand, first stage arthrosis can affect knee function, because the cause of pain is hypotonic muscles.
If the x-ray does not show major changes, thenthe doctor prescribed an MRI of the knee joint and lumbar region.Diagnostics visualizes ligaments, tendons and muscles, and the meniscus 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 dysfunction that can affect connective tissue, appropriate treatment is carried out.Overweight patients are recommendedswitch to proper nutrition.Exacerbations are relieved with the help of medicines.
Drug treatment
Drug treatment for pain involvesprescribe 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 a long course3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs help regenerate the cartilage structure and have an analgesic effect.
There are few controlled studies, and they concern complex treatment - arthroplasty, physiotherapy, diet.
Attention!Chondroprotectors are taken in courses - you can take one course of one drug, and the second course of another, and compare the effects.However, uncontrolled use of the drug is not a good idea.Before you start taking medicine, consult your doctor.
How and with what to relieve pain and swelling?Intra-articular injections are more popular:
- Steroid drugsblocking the inflammatory response at the immune cell level, relieving acute pain, joint stiffness and swelling.
- Hyaluronic acidincrease the viscosity of the joint fluid, reduce the friction of the articular surface.
Important!The effect of the drug lasts for 6-12 months, but the degenerative process does not stop.
Surgical treatment
If the drugs are ineffective, the patient is offered arthroscopy– minimally invasive procedures to remove bone growths and joint revisions.If necessary, the surgeon performs plastic surgery of ligaments and cartilage, and removes areas of worn tissue.
Bone osteotomy aims to change the axis of load on the joint.Doctors cut the femur or tibia to change where the joint surfaces meet.Surgery is often performed on young patients.
Total knee replacement or arthroplastyrequired for severe 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 restoring muscle balance, the hip joint is the next to suffer.
Physiotherapy treatment
In the physiotherapy environment, mud application, phonophoresis and magnetic therapy are used.The action of external factors is intended tostimulation of blood supply and tissue regeneration, relieves inflammation and swelling.
Treatment with traditional and non-traditional methods
Recipes for folk remedies for the treatment of arthrosis of the knee joint at home usuallyintended to relieve swelling and relieve pain.Most often, radish leaves and potato pulp are used, sometimes honey and vodka are mixed to compress.
Degeneration cannot be completely stopped.You can influence the metabolism of the kidneys using celery juice.The kidney is connected to the iliopsoas muscle, which is associated with hip pathology.Normalizing the function of the gallbladder and liver improves the condition of the knee.
Traditional medical methods for treating the early stages of knee arthrosis include anti-inflammatory herbal decoctions:chamomile, St. wortJohn, immortal.A rub made of dry mustard, sea salt and kerosene is used.Baths with magnesium salts and pine infusion are used.
Manual therapy and massage
Manual therapy for osteoarthritis of the knee joint helps, if the specialist understands the imbalance of muscle tone.Muscle testing helps find weak muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.
The source is not only the joint block in the lumbar region,but also dysfunction at the level of blood supply, internal organs, endocrine and biochemical disorders.Therefore, a chiropractor must have osteopathy and applied kinesiology skills to influence many factors.
Massage acts as an aid to manual therapy and self-help.Patients with arthrosis of the knee joint can freely stretch the tendons of the muscles that control the movement of the limbs:
- the area around the gluteus maximus muscle;
- a line 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 condyle;
- groin area along the inguinal ligament;
- 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 arthrosis is muscle weakness caused by problems in the lower back, pelvis, and abdominal cavity.Exercise to prevent arthritis and arthrosis of the knee joint 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 a complete restoration of biomechanics.Yoga further destabilizes the joints.Among the treatment methods, it is better to choosePilates and Nordic walking.
Diet
Diet is adjusted mainly to combat excess weight.It is important to avoid sugar and simple carbohydrates, add food with fiber, magnesium, B vitamins and calcium for knee arthrosis, which is important for muscle activity.Try iteliminate dairy products, because almost 80% of the population is lactose intolerant.
Prevention of arthrosis of the knee joint
Trying to strengthen muscles with exercise doesn't always help., because conservation 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 arthrosis "beer belly" is more common, as in women after polyhydramnios, some births with diastasis - weakening of the muscles of the abdominal wall.
Surgery 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 for arthrosis of the knee joint?An orthopedist will help make a diagnosis, who will insist on surgery.The best results are achieved by multidisciplinary team work 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 every three months.
Reviews of treatment
Positive reviews can only be given by the comprehensive treatment of arthrosis of the knee joint deformity 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 the pain syndrome.The cause remains unidentified and unaffected.An occupational therapist can help by teaching you how to live with knee arthrosis and how to use crutches properly.But this service is only available in private clinics that provide rehabilitation.