Osteoarthritis of the knee joint combines two processes: the destruction of cartilage and the growth of osteophytes or bones.The stage of the process is determined by radiography.Osteoarthritis is the destruction of the knee joints with age, it is believed to be a natural process of aging.The reasons are muscle weakness and poor blood supply to tissues.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.
Reasons
The causes of arthrosis have not yet been determined by medicine,Only risk factors are called:Over 45, knee injuries and overweight.Almost 50% of the adult population complains of the knee joint.
With arthrosis, the cartilage covering the edges of the bones wears out 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 repair the damaged tissue, but the cartilage grows unevenly.As a result, violations occur that damage other elements of the joint.The nature of osteophytes is explained by the compensation of smooth articular cartilage.Another version involves expansion of Spursassociated with attempted joint stabilization medially or laterally due to muscle weakness.
What causes chronic arthrosis of the knee joint?Pain occurs in tendons and ligaments only when muscle forces no longer grip and control the bones.Therefore, the biomechanical causes of pain and arthrosis are distinguished:
- In the background of long 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 causes tension in the tendon - under the knee cap.
- Sitting for long periods of time strains the gluteal muscles, weakens them.Instead, the piriformis muscles, through which the sciatic nerve passes, begin to work.When it is compressed, the biceps muscle weakens, 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 and medial meniscus on the inside of the knee are stressed, and osteophytes grow.
- Straight legs, wearing uncomfortable shoes, associated with weakening of the adductor muscles and increased lordosis, turns the tibia outward, which causes pain in the knee due to biomechanical disorders and the development of Baker's cyst.
Pathological chains affecting the knee are associated with scoliosis caused by diseases of the internal organs, falling into the tailbone in childhood.People with different shoulder heightsover time, they begin to complain about their knees, because the fascial chains on the front side of the body include the extensor of this joint - the rectus femoris muscle.
Symptoms
The degenerative process disrupts the function of the joint, causing pain and stiffness.is believed to bethe effect on muscles starts from cartilage and bone.Experience shows the opposite -Pain in the knee joint occurs in the tendons– attachments of weakened muscles of knee extensors, flexors and stabilizers.
The main signs of the danger of cartilage wear:
- Sometimes discomfort associated with walking, a feeling of "putting your foot in the wrong place".
- The appearance of pain with a direct load on the joint and the muscles that bend 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 associated with venous stasis.
The main symptoms of arthrosis are caused by stress on weakened muscles:
- Knee pain when standing up is due to failure of the gluteus and biceps femoris extensor muscles and overstretching of the rectus femoris muscle, causing discomfort in the knee.
- Pain when bending the joint is associated with weakness of the flexors - tension of the biceps muscle and quadriceps tendon.
Swelling is caused by damage to soft tissues, inflammation of tendons and joint capsule.The appearance of heat in the knee area, swelling, indicates the accumulation of inflammatory exudate -arthrosis is often accompanied by bursitis, synovitis and tendonitis.
A crisis in the knee can be painless or traumatic.Popping sounds and other sounds do not indicate that the bones are worn.Symptoms of knee instability -weakness of one of the muscles that control movement.
Crepitus caused by bone-to-bone friction, not 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.During any movement, bones are controlled by muscles.Their untimely contraction leads to the changed direction of bone movement, it is blocked.
1st degree
The degree of arthrosis is determined using an X-ray, to reveal the involvement 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, peoplehas been experiencing nagging pain for several years.
In the first stage of arthrosis, there is a slight growth of bony cartilages, which is detected incidentally.Growths appear 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 putting tension on weakened muscles.Weakness of muscles (hypotonia) is related to disruption of blood supply and innervation.
2 degrees
The second stage of arthrosis is considered mild.X-ray reveals significant bony folds, but cartilage is not affected.The amount of synovial fluid decreases, but pain symptoms appear after long walks and runs, joint stiffness and pain when bending and kneeling.
Early X-ray signs of the second stage of knee arthrosis:
- the pointed edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
- narrowing of the joint space on the medial side;
- the pointed edges of the bone condyles on the medial side, less often on the side - depending on the development of valgus or varus deformation of the joint.
According to Larsen, for the second stagecharacterized by more than 50% narrowing of the joint space, but this can only be checked in dynamics or compared to an unaffected joint.
3 degrees
In the third stage of arthrosisPain is constant when bending and straightening the joint.During an exacerbation, the joint becomes red and swollen, the aching pain does not stop even at rest.Swelling and noticeable deformation of the contours of the joint around the knee.
Symptoms of middle arthrosis of the knee joint in the third stage:
- the joint space narrows significantly;
- presence of subchondral sclerosis in loaded areas;
- many osteophytes at the margins;
- rare cases 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;
In rare cases, the fourth stage is completed with necrotic lesions.Why is arthrosis dangerous?The disease weakens the ability to move and creates dependence on others.
Diagnostics
The podiatrist examines for signs of swelling, palpates the joint for tenderness, and examines active and passive range of motion.Be sure to examine the lower back, becauseThe nerves that provide the function of the thigh muscles pass through here.
X-ray shows the presence of osteophytes, changes in the space between the femur and tibia, loss of cartilage in the knee.Sometimes X-rays of knee joints show significant signs of cartilage wear, but patients do not feel significant pain.On the contrary, arthrosis of the first stage can disrupt the function of the knee, because 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 the meniscus to look for other sources of pain.
Laboratory diagnosis is necessaryif you suspect a joint infection or gout.
Treatment
Treatment of arthrosis should be comprehensivedirected at the cause of the disease.Adequate treatment is given for endocrine dysfunctions that may affect connective tissues.Recommended for overweight patientsswitch to proper nutrition.Exacerbation is eliminated with the help of drugs.
Drug treatment
Includes drug treatment for painprescribing anti-inflammatory drugs.Non-steroidal anti-inflammatory drugs for long-term usehas a negative effect on stomach function.
The treatment regimen includes chondroprotectors, which help only when taken in long courses3-6 months.Pharmacies offer a large number of drugs from this group.
It is believed that the components of these drugs help restore cartilage structure and have an analgesic effect.
Controlled studies are few, and they were related to 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 effect.However, uncontrolled drug use is not a good idea.Consult your doctor before starting to take medicine.
How and with what to eliminate pain and swelling?Intra-articular injections are more popular:
- Steroid drugssuppressing inflammatory reactions at the level of immune cells, eliminating acute pain, joint stiffness and swelling.
- Hyaluronic acidreduces the friction of the joint surfaces and increases the viscosity of the joint fluid.
It is important!The effect of the drugs lasts 6-12 months, but the degenerative processes do not stop.
Surgical treatment
If the effectiveness of drugs is low, patients are offered arthroscopy– a minimally invasive procedure for the removal of bone growths and joint revision.If necessary, surgeons perform plastic surgery of ligaments and cartilages and remove areas of worn tissue.
Bone osteotomy is aimed at changing the load axis in 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 for severe stages of 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, so without restoring muscle balance, the hip joint suffers.
Physiotherapy treatment
In the physiotherapy environment, mud applications, phonophoresis and magnetic therapy are used.It is focused on the activity of external factorsstimulation of blood supply and tissue regeneration, eliminates 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 usuallyaims to relieve swelling and relieve pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed for the compress.
Degeneration cannot be completely stopped.You can influence kidney metabolism by using celery juice.The kidneys are attached 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 medical methods for the treatment of the initial stage of knee arthrosis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortal herb.Rubs made of dry mustard, sea salt and kerosene are used.Baths with magnesium salts and pine infusions are used.
Manual therapy and massage
Manual therapy helps for arthrosis of the knee joint, if the specialist understands the imbalance of muscle tone.Muscle tests help find weakened muscles that stabilize the knee, determine the cause of the dysfunction, and help correct it.
The source cannot be only a 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 manual therapy and an aid to self-help.A patient with arthrosis of the knee joint can independently stretch the tendons of the muscles that control the movement of the extremities:
- the 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;
- inner surface of the thigh (along the line of the adductor channel).
The massage is done with acupressure without much pressure.
Therapeutic gymnastics
The cause of arthrosis is the weakening of the muscles caused by problems in the back, pelvis and abdomen.Do exercises to prevent arthritis and arthrosis of knee joints for elderly peopleIt can 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.It is better to prioritize between treatment methodsPilates and Nordic walking.
Diet
Nutrition is primarily regulated to combat excess weight.It is important to avoid sugar and simple carbohydrates, include foods that contain fiber, magnesium, B vitamins and calcium for knee osteoarthritis, which are important for muscle function.try iteliminate dairy products, because almost 80% of the population is lactose intolerant.
Prevention of arthrosis of knee joints
Trying to strengthen muscles with exercise does not always help., because innervation and blood supply have not been restored.The function of the thigh muscles depends on the lumbar plexus.
Lower back changes associated with weak abdominal muscles also affect the knees.Therefore, arthrosis is more common in men with a "beer belly", after polyhydramnios, women have several births with diastasis - weakening of the muscles of the abdominal wall.
Surgical operations on the pelvis and internal organs disrupt the innervation of the muscles around the knee, creating adhesions that affect the lumbar vertebrae.
Which doctor should I see for knee arthrosis?An orthopedist will help make a diagnosis, will insist on the operation.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 every three months.
Treatment reviews
Positive feedback can only be provided by comprehensive treatment of deforming arthrosis or gonarthrosis of the knee joint.Anesthesia and intra-articular injections act temporarily by suppressing the natural inflammatory response.
The result
The problem with arthrosis is that drug treatment only temporarily relieves pain syndromes.The causes remain unknown and ineffective.Occupational therapists can help by teaching you how to live with knee osteoarthritis and how to use a cane properly.However, the service is available only in private rehabilitation clinics.