Knee pain

Knee pain is a very annoying ailment that, unfortunately, most people face. They can be sharp, painful, burning, throbbing, restrict joint mobility, present only during physical activity, or even at rest. But many, instead of going to the doctor, try to eliminate them with the help of painkillers, especially ointments, gels or tablets of nonsteroidal anti-inflammatory drugs. Such drugs, although having anti-inflammatory properties, are not able to affect the pathogenesis of knee pain, and therefore only temporarily contribute to their elimination. Therefore, they can only be considered as a means of symptomatic therapy.

But the causes of discomfort in the knee joints can lie in the appearance of a variety of disorders, both directly in the knee and in the spine or other parts of the body. Therefore, it is possible to develop an effective treatment strategy that will really help eliminate the pain only after determining the exact cause of their occurrence. To do this, you will need to undergo a series of diagnostic procedures and get expert advice, but this is the only way you can really improve your well-being and avoid developing complications.

Causes

Knee pain can be associated with a variety of diseases, from osteoarthritis of the knee joints to pathologies of the lumbar, sacral spine and pelvic bones. Also, the causes of discomfort or even acute knee pain can be chondropathy, arthritis, neuritis and other similar diseases.

The obvious cause of the development of pain syndrome are injuries of various kinds from bruising, dislocation, ligament rupture, meniscus damage or intra-articular fracture. But in such situations, the pain is almost always acute and appears at the moment of impact, fall or other traumatic factors. Therefore, in such cases, victims should contact a traumatologist to address the consequences of the injury.

Thus, knee pain is always a sign of a pathological process affecting the cartilaginous, bony or soft tissue structures of the knee itself, or damage to the nerve that irritates it. Consider the main reasons for their appearance.

Osteoarthritis of the knee joints or gonarthrosis

Osteoarthritis, osteoarthritis of the knee or gonarthrosis is one of the most common causes of knee pain. This disease is characterized by the appearance of degenerative-dystrophic processes in the cartilaginous structures of the joint, which is the result of violation of the course of metabolic processes, the action of traumatic factors in the past, etc. Very often, gonarthrosis is diagnosed in middle-aged and elderly people, athletes and people engaged in heavy physical work.

This disease has a chronic course, tends to progress slowly and eventually lead to a pronounced limitation of joint mobility, a violation of the supporting function of the limbs (often both), as well as pain. Initially they are dull, painful, attractive and appear during movements, accompanied by cracking in the knee, especially during climbing stairs. But in the absence of treatment, the cartilages of the knee joints continue to be consumed progressively, which leads to increased pain and its presence even at rest. Subsequently, the destruction of articular surfaces occurs, which further aggravates the situation and can even cause disability.

A typical feature of osteoarthritis of the knee joints is the presence of initial pain, for the elimination of which patients must be "dispersed". Thanks to this, the improvement is noticed within 15-30 minutes.

Gonarthrosis is often complicated by the increase of inflammatory processes that can affect the synovial sac, ligaments and tendons. This leads to a sharp increase in pain, the acquisition of an explosive character, soft tissue swelling, and a local increase in temperature.

Spinal diseases and pelvic bone asymmetry as a cause of knee pain

At first glance, there is no connection between the spine and the knees. But in reality this is not so. They are closely related to the sciatic nerve (nervus ischiadicus), which is the main nerve of the foot. It starts in the spine and is formed simultaneously by the fibers that extend from the spinal cord through natural openings in the nerve vertebrae:

• L4;
• L5;
• S1;
• S2;
• S3.

These nerves pass through the vertebrae of the same name, joining at the level of the sacrum into the nerve plexus. From it, the sciatic nerve travels along the back of each leg and irritates the knee. At the same time, this nerve is responsible for its sensory (sensory) and motor (motor) functions. Therefore, violations at any point of its passage, especially at the level of the lumbar region, can provoke the appearance of knee pain. It is most often associated with the development of:

• Osteochondrosis, extensions and intervertebral hernias. These diseases are based on degenerative-dystrophic changes in the intervertebral discs located between almost all vertebrae. They are characterized by a systematic decrease in the height of the disk and its dehydration, which leads to a decrease in the elasticity of its structures and an increased risk of their rupture under load. As a result, the vertebrae move closer to each other, which can lead to compression of the nerve roots that pass through them. If such changes occur in the lumbar region, compression of the fibers that form the sciatic nerve is possible and, accordingly, the appearance of knee pain. But more often this symptom appears already when osteochondrosis is complicated by the formation of elongation (exit) of the intervertebral disc or its hernia (rupture of the outer shell of the disc), as the elongated areas can strongly press the spinal roots directly into the spinal canaland provoke the onset of severe neurological complications, including knee pain.
• Spondylosis. This is a disease that most often develops against the background of osteochondrosis and is chronic. With it, there is an excessive growth of the surfaces of the vertebral bodies adjacent to the intervertebral discs and the formation of bone extensions (osteophytes) on them. In severe cases, neighboring vertebrae are able to grow together, which leads to their immobilization and severe compression of the nerves that run through them.
• Spondylolisthesis. This term refers to the pathology of the spine, in which the upper vertebra shifts in relation to what is below it. Most often, it is the lumbar region that is affected, which leads to damage to the nerves that form the sciatic nerve.

Signs that may be suspected due to the development of knee pain due to the appearance of spinal pathologies may also include:

• traction, pain, sharp pain in the lower back;
• muscle tension, groin, quadriceps femoris, occupying the entire anterior surface of the thigh and partly the outer side;
• pain and stiffness in the hips;
• diffuse leg pain;
• pain in the upper thighs.

In each case, the group, nature and severity of the symptoms will be different. It depends mainly on the individual characteristics of the organism and the degree of nerve compression.

Directly to the sciatic nerve damage may indicate (symptoms can be observed in only one limb, but in both immediately):

• pain in the knees, groin and lower back;
• back and leg muscle spasms;
• burns on the back of the foot;
• loss of control over bladder and intestinal functions.

With dysfunction of the sciatic nerve, there is often a feeling of instability in the knees, their compression. As a result, the patient complains that he can not fully support his legs.

Asymmetry of the sacrum and pelvic bones can also provoke the appearance of pain in the knee joint. Occurs as a result of a change in the length of the lower extremities, which may be due to congenital features or curvature of the pelvis, included in the background of scoliosis. This leads to an overload of one of the legs and faster consumption of the cartilage of the knee joint, resulting in osteoarthritis.

The abdominal muscles, which are attached to the pubic bone, are responsible for ensuring the stability of the pelvic bones. When they weaken as a result of being overweight, a sedentary lifestyle or other factors, the muscles of the back of the thigh become overloaded. This in turn provokes an overload of the knee joint.

Foot and ankle pathologies

Ankle joints, as well as the knee, can be affected by osteoarthritis. It is often diagnosed in athletes, especially dancers, gymnasts, as well as the elderly. This leads to a violation of the biomechanics of movements, which increases the load on the knee joint and contributes to its faster consumption. In such situations, a person will be bothered by pain not only in the knee but also in the ankle, which significantly affects walking due to limited movements.

Foot pathologies, especially flat feet and hallux valgus, can also provoke an increased load on the knees and cause pain in them. These orthopedic pathologies are very common today and in most cases begin to form in childhood, and worsen in adulthood. Valgus deformity is characterized by a violation of the ankle shaft as a result of the collapse of the foot from the inside. This is accompanied by increased fatigue of the legs, pain in them, but then can lead to pain in the knees.

Diagnosing

If you have knee pain, especially if it occurs regularly or is present all the time, you should consult a doctor. If the patient has recently experienced traumatic factors, he should contact an orthopedic traumatologist. In other cases, you can initially sign up for a consultation with a therapist. The doctor will assess the patient's condition, collect a medical history, and prescribe diagnostic procedures. This will allow him to make a preliminary diagnosis and refer the patient to a specialist, whose help will be most effective in a particular case.

But you can immediately contact a neurologist if a person notices the presence of back pain, diffuse pain in the leg, burning on its back surface or other symptoms described above. This will save time and money, as soon as possible to determine the true cause of the change in well-being and start treatment. If the patient notices changes in the condition of the legs, in addition to pain in the knee, worries about pain in the ankle joints, it is better to immediately leave an appointment with an orthopedist.

In each case, the doctor will study the situation in detail, assess the nature of the complaints, and refer the patient for an examination, which may include:

• laboratory tests (UAC, biochemical blood test) needed to identify signs of inflammatory processes occurring in the body;
• a two-projection knee radiograph (with a suspected pathology of the legs or spine, they are also examined using radiography), which is required to assess the condition of the bone structures, as well as to identify indirect signs of a number of diseases;
• CT is used for a more accurate diagnosis of joint diseases, as well as for a more reliable assessment of the degree of their destruction;
• Knee ultrasound, used for visual assessment of all knee structures, their size, position;
• MRI, which is currently the best method for diagnosing various pathologies of soft tissue structures, including the ankle cartilage and intervertebral discs.

In some cases, patients may be prescribed arthroscopy, which is an invasive method for diagnosing and treating knee joint pathologies. As a rule, it is required for severe arthrosis and traumatic injuries of ligaments, meniscus, etc.

Treatment

Since there are many diseases that can manifest as knee pain, there is no single treatment strategy. In each case, it develops individually, based only on the nature of pathological changes, their severity, the presence of accompanying pathologies, individual characteristics of the patient, his age, etc.

In the case of spinal pathologies that caused knee pain, treatment is performed under the supervision of a neurologist. If they were the result of osteoarthritis, other pathologies of the knee, ankle joints, feet, treatment is prescribed by an orthopedist.

When diagnosing spinal or pelvic bone pathologies, patients, in addition to consulting a neurologist, may also be recommended to visit an endocrinologist who will help resolve the problem of excess weight.

All patients with spinal disease, orthopedic pathology, including osteoarthritis of the knee joints, are shown complex treatment, which may include:

• drug therapy;
• physiotherapy;
• exercise therapy;
• manual therapy.

Each measure is selected strictly individually in accordance with the diagnosis and the degree of neglect of pathological changes. And with osteoarthritis of the knee joints of 2-3 degrees, plasmolifting is often prescribed additionally.

Medical therapy

Drug treatment usually includes 2 areas: symptomatic and etiotropic therapy. The first is aimed at rapidly improving patient well-being, eliminating knee pain and other existing symptoms. The purpose of the second is a direct impact on the cause of the development of disorders and the normalization of the patient's condition in the long run.

Therefore, in most cases, patients are prescribed a complex of drugs:

• NSAIDs are symptomatic therapies that allow you to quickly stop pain in the knee, lower back, legs and have an anti-inflammatory effect.
• Corticosteroids are drugs with potent anti-inflammatory effect, indicated for severe inflammation, and are most commonly injected into the ankle cavity. They are applied in short courses.
• Chondroprotectors are products that contain ingredients used by cartilage tissue for regeneration. They are appointed by long courses, the duration of which is usually at least 2-3 months.
• Muscle relaxants are medications prescribed for back and hip muscle spasms, which are often a reflex reaction of the body to pain impulses.
• Vitamin complexes are drugs shown to improve the flow of metabolic processes in the body, as well as for the transmission of bioelectric nerve impulses along the nerves.

Plasmolifting

Plasmolifting is an injection of plasma taken from the patient's own blood directly into the affected knee joint or into the soft tissue around it. Due to the saturation of blood plasma with platelets, cytokines and growth factors, it contributes to:

• stimulating the flow of natural regeneration processes;
• restoring the composition and normal volume of synovial fluid;
• activation of blood circulation and nutrition of the ankle cartilage;
• elimination of inflammation;
• pain relief;
• restoring the normal range of motion in the affected node;
• reducing treatment time by 2-3 times.

PRP therapy, also called plasmolifting, perfectly complements the treatment of osteoarthritis of the knee joint, so it is often included in the treatment regimen for this disease. It can also be used in the treatment of osteochondrosis of the spine and injuries, supplementing with drug therapy, physiotherapy, exercise therapy and other methods of treatment.

Physiotherapy

Different types of physiotherapy procedures can be used to treat diseases of the musculoskeletal system that cause knee pain. They increase the effectiveness of other treatments and have a positive effect on the affected area. Physiotherapy is always prescribed in courses of 7-15 procedures, which are selected individually. Most often they ask for help:

• magnetotherapy;
• ultrasound therapy;
• UHF;
• phonophoresis;
• electrophoresis;
• SMT therapy or amplipulse therapy;
• vibrating massage.

exercise therapy

Physiotherapy exercises play an important role in treating the pathologies of the joints of each localization and the spine in particular. It allows you to increase the range of motion in a dosed way, as well as stimulate blood circulation, which leads to the activation of food of all the structural elements of the knee joints and thus contributes to their regeneration.

But it is important to choose the optimal set of exercises that will be most beneficial in this situation and will not cause harm. Patients may be advised to perform tightening exercises, which are particularly important for spinal pathologies. Also, exercises are almost always prescribed to strengthen the musculoskeletal system. They contribute to the formation of a strong muscular framework, which will reduce the load on the affected joints and create favorable conditions for their recovery.

Physical therapy classes are simple and accessible for people of all ages, as an individually created program ensures the creation of a dosed load that has a positive effect on diseased joints and excludes exercises that may be harmful. But to master the methodology of each proposed exercise as accurately as possible, it is worth doing the first classes under the supervision of an exercise therapy instructor.

In the future you can practice at home, outdoors or in any other convenient place, but every day. Systematics is one of the basic rules for the success of physiotherapy exercises. Therefore, it should be added to your list of daily activities and given the right time - 20-30 minutes is usually enough. During lessons, it is important to avoid sudden movements and rushing, as this can provoke pain and worsen the condition.

Manual therapy

Manual therapy plays one of the key roles in correcting pelvic asymmetry and treating spinal diseases. It involves an in-depth study of the muscles of the back, ligaments and joints of the spine, pelvic region by the hands of a specialist. There are many methods and techniques of manual impact. They are selected depending on the type and severity of the existing pathology.

Thanks to the flow of manual therapy sessions, it is possible to:

• eliminate back pain by relieving pressure on nerve fibers;
• improving nutrition of all spinal structures due to activation of blood circulation;
• increase spinal mobility;
• improve posture by eliminating spinal deformities;
• restore the normal position of the pelvic bones and internal organs, which has a positive effect on their functioning.

But the most important effect of manual therapy for patients consulting a doctor with knee pain is the elimination of sciatica and the fibers that form it. This leads to a progressive improvement of the condition and elimination of the pain syndrome as well as other neurological disorders.

Patients notice the first positive changes after the first session. Further procedures contribute to its growth and stabilization for a long time. The first procedures can be performed only after the removal of acute inflammation with the help of drug therapy, physiotherapy and other methods of treatment.

Thus, knee pain can indicate not only its loss, but also the appearance of problems in other parts of the musculoskeletal system, especially in the back and legs. In any case, they can not be ignored, as existing pathologies, in the absence of competent treatment, tend to progress over time. This will lead to an increase in the severity of the pain, the appearance of other unpleasant symptoms and, in general, a decrease in the quality of human life. Therefore, if discomfort occurs in one or both knees, you should consult a doctor: an orthopedist or a neurologist. Timely treatment at an early stage of the development of pathological changes will allow you to reverse them and fully restore normal joint function, ensuring freedom of movement for many years.