Knee pain

Knee pain is a very annoying nuisance that, unfortunately, most people face. They can be sharp, painful, burning, throbbing, restrict joint mobility, be present only during physical activity or even at rest. But many, instead of going to the doctor, try to remove them with the help of painkillers, especially ointments, gels or tablets of non-steroidal 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 be hidden in the appearance of various 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 to 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 to really improve your well-being and avoid complications.

Reasons

Knee pain can accompany various diseases, ranging 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 reasons for the development of the pain syndrome are various injuries from bruises, dislocation, to rupture of ligaments, damage to the menisci or intra-articular fractures. But in such situations the pain is almost always sharp and occurs at the moment of impact, fall or other traumatic factors. Therefore, in such cases, victims should contact a traumatologist to treat the consequences of the injury.

Thus, knee pain is always a sign of a pathological process that affects the cartilage, bone or soft tissue structures of the knee itself, or damage to the nerve that innervates it. Think about 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 a violation of the metabolic processes, the action of traumatic factors in the past and others. Very often gonarthrosis is diagnosed in middle-aged and elderly people, athletes and people engaged in heavy physical labor.

This disease has a chronic course, tends to progress slowly and ultimately leads to severe limitation of joint mobility, impaired limb support function (often both), and pain. Initially, they are dull, painful, pulling and appear during movements, accompanied by crunch in the knee, especially when climbing stairs. But in the absence of treatment, the cartilage of the knee joints continues to wear progressively, leading to increased pain and its presence even at rest. Subsequently, the joint surfaces are destroyed, which further aggravates the situation and may 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 "disperse". Due to this, the improvement is observed within 15-30 minutes.

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

Diseases of the spine and asymmetry of the pelvic bones as a cause of knee pain

At first glance, there is no connection between the lumbar spine and the knees. But in reality this is not the case. They are closely connected by the sciatic nerve (nervus ischiadicus), which is the main nerve of the leg. It originates from the spine and is formed simultaneously by the fibers extending from the spinal cord through the natural openings in the vertebrae of the nerves:

• L4;
• L5;
• S1;
• S2;
• S3.

These nerves pass through the vertebrae of the same name, uniting at the level of the sacrum in the nerve plexus. From it the sciatic nerve deviates along the dorsum of each leg and innervates the knee. At the same time, this nerve is responsible for its sensory (motor) and motor (motor) functions. Therefore, disorders 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, bulges 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 reduction in the height of the disk and its dehydration, which leads to a decrease in the elasticity of its structures and increase the risk of rupture under load. As a result, the vertebrae get closer to each other, which can lead to compression of the nerve roots passing through them. If such changes occur in the lumbar region, it is possible to compress the fibers that form the sciatic nerve and, accordingly, the appearance of knee pain. But more often this symptom appears when osteochondrosis is complicated by the formation of a protrusion (bulge) of the intervertebral disc or its hernia (rupture of the outer shell of the disc), as the protruding areas can strongly compress the spinal roots directly into the spinal canal. and provoke severe neurological complications, including knee pain.
• Spondylosis. This is a disease that most often develops against the background of osteochondrosis and is chronic. It has an overgrowth on the surfaces of the vertebral bodies adjacent to the intervertebral discs and the formation of bony protrusions (osteophytes) on them. In severe cases, the adjacent vertebrae are able to grow together, which leads to their immobilization and strong compression of the nerves passing through them.
• Spondylolisthesis. This term refers to the pathology of the spine in which the upper vertebra is displaced relative to the underlying one. The lumbar region is most often affected, leading to damage to the nerves that make up the sciatic nerve.

Signs that may suggest the cause of knee pain due to lumbar spine pathology may further include:

• pulling, aching, sharp pains in the lower back;
• muscle tension, hamstrings, quadriceps of the thigh, occupying the entire anterior surface of the thigh and partially the outer side;
• pain and stiffness in the thighs;
• diffuse leg pain;
• pain in the upper thighs.

In each case, the set, nature and severity of the symptoms will be different. This largely depends on the individual characteristics of the organism and the degree of nerve compression.

Direct damage to the sciatic nerve can show (symptoms can be observed in one limb or in both at once):

• pain in the knees, hips and lower back;
• spasms of the muscles of the back and legs;
• burning in the back of the leg;
• loss of control over bladder and bowel function.

In disorders of the sciatic nerve there is often a feeling of instability in the knees, their compression. As a result, the patient complains that he cannot fully rely on his feet.

The asymmetry of the sacrum and pelvic bones can also provoke pain in the knee joint. It occurs as a result of a difference in the length of the lower limbs, which may be due to congenital features or curvature of the pelvis, including the background of scoliosis. This leads to overload of one leg and faster wear of the cartilage of the knee joint, which leads to osteoarthritis.

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

Pathologies of the foot and ankle

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

Pathologies of the foot, especially flat feet and hallux valgus, can also provoke increased strain 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 axis of the ankle joint as a result of the collapse of the foot inward. This is associated with increased fatigue of the legs, pain in them, but subsequently can lead to knee pain.

Diagnosis

If you experience knee pain, especially if it occurs regularly or is present all the time, you should consult a doctor. If the patient has recently had traumatic factors, he should contact an orthopedic traumatologist. In other cases, you can first make an appointment 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 contact a neurologist immediately if a person notices pain in the lower back, diffuse leg pain, burning on the back 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 knee pain, he is worried about pain in the ankle joints, it is better to immediately arrange an appointment with an orthopedist.

In each case, the doctor will examine 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;
• X-ray of the knee in two projections (if pathology of the feet or spine is suspected, they are also examined by radiography), which is necessary to assess the condition of bone structures, as well as to identify indirect signs of disease;
• CT is used for more accurate diagnosis of joint diseases, as well as for the most reliable assessment of the degree of their destruction;
• Ultrasound of the knee joint, used for visual assessment of all structures of the knee, their size, position;
• MRI, which is currently the best method for diagnosing various pathologies of soft tissue structures, including the cartilage of the knee joint and intervertebral discs.

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

Treatment

Because there are many diseases that can manifest as knee pain, there is no single treatment strategy. In each case, it is developed individually, based solely on the nature of the pathological changes, their severity, the presence of concomitant pathologies, the individual characteristics of the patient, his age and others.

In the case of pathologies of the spine that have caused pain in the knee, treatment is carried out under the supervision of a neurologist. If they are the result of osteoarthritis, other pathologies of the knee, ankle joints, feet, treatment is prescribed by an orthopedist.

When diagnosing pathologies of the spine or pelvis, patients, in addition to consulting a neurologist, may be further advised to visit an endocrinologist, who will help solve the problem of overweight.

All patients with spinal diseases, orthopedic pathologies, including osteoarthritis of the knee joints, are shown a comprehensive 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 is often prescribed additional plasmalifting.

Medical therapy

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

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

• NSAIDs are a symptomatic therapy that allows you to quickly stop the pain in the knee, lower back, feet and have anti-inflammatory effect.
• Corticosteroids are drugs with a powerful anti-inflammatory effect, indicated for severe inflammation and are most often injected into the joint cavity. They are applied in short courses.
• Chondroprotectors are products containing components used by cartilage tissue for regeneration. They are appointed with long courses, which usually last at least 2-3 months.
• Muscle relaxants are drugs prescribed for spasms of the muscles of the back and thighs, which is often a reflex reaction of the body to pain impulses.
• Vitamin complexes are drugs designed to improve the course of metabolic processes in the body, as well as the transmission of bioelectric nerve impulses through the nerves.

Plasmolifting

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

• stimulating the course of natural regeneration processes;
• restoration of the normal composition and volume of synovial fluid;
• activation of blood circulation and nutrition of the cartilage of the joint;
• elimination of inflammation;
• pain relief;
• restoration of normal range of motion in the affected joint;
• reduce treatment time by 2-3 times.

PRP therapy, also called plasmalifting, perfectly complements the treatment of osteoarthritis of the knee, so it is often included in the treatment regimen of this disease. It can also be used in the treatment of osteochondrosis of the spine and injuries, complementing drug therapy, physiotherapy, exercise therapy and other treatments.

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 seek help:

• magnetic therapy;
• ultrasound therapy;
• UHF;
• phonophoresis;
• electrophoresis;
• SMT therapy or amplipulse therapy;
• vibration massage.

exercise therapy

Physiotherapeutic exercises play an important role in the treatment of pathologies of the joints of any location and in particular the spine. It allows you to increase the range of motion in a dosed way, as well as to stimulate blood circulation, which activates the nutrition of all 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 useful in this situation and will not cause harm. Patients may be advised to perform stretching exercises, which are especially important for spinal pathologies. Also, exercises to strengthen the musculoskeletal system are almost always prescribed. They contribute to the formation of a healthy 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 the individually designed program ensures the creation of a dosed load, which has a positive effect on diseased joints and excludes exercises that can be harmful. But in order to master the methodology of each proposed exercise as accurately as possible, it is worth conducting the first classes under the supervision of a physiotherapy instructor.

In the future, you can practice at home, in nature or in any other suitable place, but daily. Systematic is one of the main rules for the success of physiotherapy exercises. Therefore, it should be added to your list of daily activities and given a suitable time - usually 20-30 minutes are enough. It is important to avoid sudden movements and rushing during exercise, as this can provoke pain and worsen the condition.

Manual therapy

Manual therapy plays one of the key roles in the correction of pelvic asymmetry and the treatment of diseases of the spine. It includes a deep examination of the muscles of the back, ligaments and joints of the spine, pelvic area by the hands of a specialist. There are many methods and techniques for manual impact. They are selected depending on the type and severity of the existing pathology.

Thanks to the course of manual therapeutic sessions it is possible:

• eliminating back pain by relieving pressure on nerve fibers;
• improving the nutrition of all structures of the spine due to activation of blood circulation;
• increase the mobility of the spine;
• improving posture by eliminating spinal deformities;
• restoration of 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 who consult a doctor with knee pain is the removal of compression of the sciatic nerve and the fibers that form it. This leads to 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 treatments.

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