Knee pain

Knee pain is a very annoying inconvenience that unfortunately most people face. They can be sharp, aching, 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 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 treatment.

But the causes of discomfort in the knee joints can lie 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 the exact cause of their occurrence is determined. To do this, you will need to undergo a series of diagnostic procedures and seek expert advice, but this is the only way to really improve your well-being and avoid complications.

Causes

Knee pain can accompany a variety of ailments, ranging from knee joint pain to lumbar, sacrum and pelvic bone diseases. Also, causes of discomfort or even acute pain in the knees can be chondropathy, arthritis, neuritis and other similar diseases.

The obvious cause of the development of pain syndrome is injuries of various kinds from bruises, dislocations, to ligament ruptures, meniscus injuries or intra-articular fractures. But in such situations, the pain is almost always acute and occurs at the time 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 that affects the structures of the cartilage, bones or soft tissues of the knee itself or damage to the nerve that innervates it. Consider the main reasons for their appearance.

Arthropathy of the knee joints or knee joint

Osteoarthritis, osteoarthritis of the knee or knee joint 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 a result of violation of the flow of metabolic processes, the action of traumatic factors in the past, etc. Most often, arthritis is diagnosed in middle-aged and elderly, athletes and people engaged in heavy physical work.

This disease has a chronic course, tends to progress slowly and eventually lead to severe limitation of joint mobility, violation of the supporting function of the limb (often both), as well as pain. Initially, they are dull, aching, pulling in nature and occurring during movements, accompanied by stinging in the knee, especially when climbing stairs. However, in the absence of treatment, the cartilage of the knee joints continues to wear progressively, which leads to increased pain and its presence even at rest. Then there is the destruction of the articular surfaces, which further aggravates the condition and can even cause disability.

A characteristic feature of knee joint arthropathy is the presence of initial pain, for the elimination of which patients must be "dispersed". Thanks to this, the improvement is observed within 15-30 minutes.

The knee joint is often complicated by the addition of inflammatory processes that can affect the articular sac, ligaments and tendons. This leads to a sharp increase in pain, the acquisition of an explosive character, swelling of the 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 related to the sciatic nerve (nervus ischiadicus), which is the main nerve of the foot. It originates from the spine and is formed simultaneously by the fibers that extend from the spinal cord through the natural openings in the vertebrae of the nerves:

• L4;
• L5;
• S1;
• S2;
• S3.

These nerves pass through the eponymous vertebrae, joining at the level of the sacrum to the nerve plexus. From this, the sciatic nerve departs along the back of each leg and innervates the knee. At the same time, this nerve is responsible for its sensitive (sensory) and motor (motor) functions. Therefore, violations at any point of its passage, especially at the level of the lumbar region, can cause the appearance of knee pain. Most often related to development:

• Osteochondrosis, protrusions 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 of the height of the disk and its dehydration, which leads to a reduction in the elasticity of its structures and an increase in the 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, it is possible to compress the fibers that form the sciatic nerve and, consequently, the appearance of knee pain. But more often this symptom occurs already when osteochondrosis is complicated by the formation of a protrusion (protrusion) of the intervertebral disc or its hernia (rupture of the outer shell of the disc), as the protruding areas can strongly compress the roots of the vertebral column. spinal canal and cause severe neurological complications, including knee pain.
• Spondylosis. This is a disease that most often develops in the context of osteochondrosis and is chronic. With this, there is overgrowth of the surfaces of the vertebral bodies next to the intervertebral discs and formation of bone protrusions (osteophytes) on them. In severe cases, adjacent vertebrae can grow together, leading to immobilization and severe 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 one below it. Most often, it is the lumbar region that is affected, which leads to the involvement of the nerves that form the sciatic nerve.

Signs that may indicate the cause of knee pain due to lumbar spine abnormalities may also include:

• pulling, pain, severe pain in the lower back.
• muscle tension, femoral, quadriceps femur, 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 totality, nature and severity of the symptoms will be different. This largely depends on the individual characteristics of the body and the degree of compression of the nerves.

Immediate defeat of the sciatic nerve may indicate (symptoms can be seen in both extremities at the same time):

• pain in the knees, hip and lower back.
• spasms of the muscles of the back and legs.
• burning in the back of the foot;
• loss of control over bladder and bowel functions.

With violations of the function 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 cause pain in the knee joint. It occurs as a result of a difference in the length of the lower extremities, which may be due to congenital features or curvature of the pelvis, including the background of scoliosis. This leads to overload of one of the legs and faster wear of the cartilage of the knee joint, resulting in arthropathy.

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

Foot and ankle pathologies

The joints of the ankle, as well as the knee, can be affected by arthropathy. It is often diagnosed in athletes, especially ballet dancers, gymnasts, and 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 wear. In such situations, a person will be bothered by pain not only in the knee but also in the ankle, which significantly affects gait due to limited movements.

Foot pathologies, especially flat feet and varicose veins, can also cause 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 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 then can lead to pain in the knees.

Diagnostics

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 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 evaluate the patient's condition, collect a 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 the presence of back pain, diffuse leg pain, burning in the back or other symptoms described above. This will save time and money as soon as possible to determine the real 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, is worried about pain in the ankle joints, it is better to make an appointment with an orthopedist immediately.

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

• Laboratory tests (UAC, biochemical blood test) necessary to detect signs of inflammatory processes occurring in the body.
• X-ray of the knee in two projections (suspected pathology of the legs or spine, also examined by x-ray), which is required to assess the condition of the bone structures, as well as to identify indirect points number of diseases;
• Computed tomography is used for a 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 to visually assess all structures of the knee, their size, position.
• MRI, which is currently the best method for diagnosing various pathologies of soft tissue structures, including cartilage of the knee joint and intervertebral discs.

In some cases, arthroscopy may be prescribed to patients, which is an invasive method for diagnosing and treating pathologies of the knee joints. As a rule, it is required for severe joints and traumatic injuries of joints, menisci, 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 solely on the nature of the pathological changes, their severity, the presence of concomitant pathologies, the individual characteristics of the patient, the age of the patient, etc.

In case of pathologies of the spine that caused knee pain, the treatment is carried out under the supervision of a neurologist. If it was the result of joints, other pathologies of the knee, ankle joints, legs, the treatment is prescribed by an orthopedist.

When diagnosing pathologies of the spine or pelvic bones, patients, in addition to the advice of a neurologist, may also be advised to visit an endocrinologist who will help resolve the problem of overweight.

All patients with diseases of the spine, orthopedic pathologies, including the knee joint, receive complex treatment, which may include:

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

Each measure is selected strictly according to the diagnosis and the degree of neglect of pathological changes. And with arthropathy of the knee joints 2-3 degrees, often additional plasmolifting is prescribed.

Medical treatment

Drug treatment usually includes 2 areas: symptomatic and etiological treatment. The first aims to rapidly improve the patient's well-being, eliminating knee pain and other existing symptoms. The aim of the latter is to have a direct impact on the cause of the development of disorders and the long-term normalization of the patient's condition.

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

• NSAIDs are symptomatic treatments that allow you to quickly stop pain in the knee, waist, legs and have anti-inflammatory action.
• Corticosteroids are drugs with strong anti-inflammatory action, are indicated for severe inflammation and are most often injected into the joint cavity. They are applied in short courses.
• Chondroprotectants 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 medicines prescribed for spasms of the back and hip muscles, which are often a reflex reaction of the body to pain impulses.
• Vitamin complexes are drugs that are indicated for the improvement of the course of metabolic processes in the body, as well as the transmission of bioelectric nerve impulses along the nerves.

Plasmolifting

Plasmolifting is a plasma injection taken from the 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 flow of natural regenerative processes.
• restoration of the normal composition and volume of synovial fluid.
• activation of blood circulation and nutrition of articular cartilage.
• eliminate inflammation;
• pain relief?
• restoration of normal range of motion in the affected joint.
• reduction of treatment time by 2-3 times.

PRP therapy, also called plasmolifting, is a perfect complement to the treatment of knee joint disease, so it is often included in the treatment regimen for this disease. It can also be used to treat osteochondrosis of the spine and injuries, supplementing medication, physiotherapy, exercise therapy and other treatments.

Physiotherapy

Various 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 of the time they ask for help:

• magnetotherapy?
• ultrasound treatment;
• UHF;
• voiceover?
• electrophoresis?
• SMT treatment or enhancer therapy.
• vibrating massage.

exercise therapy

Physiotherapy exercises play an important role in treating pathologies of the joints of any localization and the spine in particular. It allows you to increase range of motion in a dosing manner, as well as stimulate blood circulation, which leads to the activation of the nutrition of all the structural elements of the knee joints and therefore 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 do 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 strong muscular framework, which will reduce the load on the affected joints and will create favorable conditions for their recovery.

Physiotherapy classes are simple and accessible for people of any age, as a personalized program ensures the creation of a dosing load that has a positive effect on diseased joints and excludes exercises that may be harmful. But to master the methodology of each suggested exercise as accurately as possible, it is worth conducting the first classes under the supervision of an exercise therapy instructor.

In the future, you can practice at home, in nature or in any other suitable place, but daily. Regularity is one of the basic rules for the success of physical therapy exercises. Therefore, it should be added to your list of daily activities and given the appropriate time - 20-30 minutes is usually enough. During classes, it is important to avoid sudden movements and haste, as this can cause pain and worsen the condition.

Manual therapy

Manual therapy plays one of the main roles in the correction of pelvic asymmetry and in the treatment of diseases of the spine. It involves an in-depth study of the muscles of the back, ligaments and joints of the spine, the pelvic area by the hands of a specialist. There are many methods and techniques of manual influence. They are selected depending on the type and severity of the existing pathology.

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

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

But the most important effect of manual therapy for patients who consult a doctor with knee pain is the elimination of compression of the sciatic nerve and the fibers that form it. This leads to a gradual 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 processes contribute to its development and stabilization for a long time. The first procedures can be performed only after the removal of the acute inflammation with the help of drug therapy, physiotherapy and other methods of treatment.

Thus, knee pain can indicate not only its defeat, but also the appearance of problems in other parts of the musculoskeletal system, especially in the spine and legs. In any case, they can not be ignored, as existing pathologies, in the absence of appropriate treatment, tend to evolve 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. Early treatment at an early stage of the development of pathological changes will allow you to reverse them and fully restore the normal function of the joint, ensuring freedom of movement for many years.