How is arthrosis of the knee joint treated?

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 radiography.It is believed that osteoarthritis is the destruction of the knee joints with age, a natural process of aging.The reasons are the weakening of the muscles and poor tissue blood supply.How to treat yourself without surgery?Eliminate factors that reduce muscle tone.

Causes

The causes of arthrosis have not yet been determined by medicine,Only the risk factors are named:age over 45, knee injuries and overweight.Almost 50% of the adult population has ever complained of a knee joint.

With arthrosis, the cartilage that lines the ends of the bones wears away or is completely absent.Damaged tissues are not a source of pain because they have no receptors.Inflammation in nearby structures causes characteristic symptoms.

The body continues to regenerate damaged tissue, but the cartilage grows unevenly.As a result, irregularities are formed that damage 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 Spursaccompanied by an attempt to stabilize the medial or lateral joint due to muscle weakness.

What causes chronic knee osteoarthritis?Pain occurs in tendons and ligaments only when the muscle forces no longer support and control the bones.Therefore, the biomechanical causes of pain and arthrosis are distinguished:

1. Against the background of prolonged 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 leads to tension in the tendon - under the knee cap.
2. Prolonged sitting strains the gluteal muscles, weakening them.Instead, the piriformis muscles begin to work, under which the sciatic nerve passes.When contracted, the biceps muscle weakens and the angle of rotation of the hip and lower leg changes.The knee is hurt.
3. I walked in heelscauses tension in the calf muscles, rotates the pelvis and weakens the gluteal medius muscles.The femur internally rotates, the ligaments along the inside of the knee and the medial meniscus are loaded and the osteophytes grow.
4. Flat feet, associated with wearing uncomfortable shoes, weakening of the adductor muscles and increased lordosis, turns the tibia outward, which leads to pain in the knee due to impaired biomechanics and the development of a Baker cyst.

Pathological chains that affect the knee are associated with falling into the tail in childhood, scoliosis caused by diseases of internal organs.People with different shoulder heightsover time they start to complain about their knee, since the fascial chains along the front of the body include the extensor of this joint - the rectus femoris muscle.

Symptoms

The degenerative process impairs joint function, leading to pain and stiffness.It is believed to bethe effect on muscles begins with cartilage and bone.Practice shows the opposite -pain in the knee joint occurs in the tendons- weakened muscle attachments of extensors, flexors and stabilizers of the knee.

The main signs of a threat of cartilage wear:

1. Occasional discomfort associated with walking, a feeling of "putting the foot in the wrong place".
2. The appearance of pain with direct load on the joint and the muscles that bend and extend it - sitting, climbing stairs.
3. Pain and stiffness in the knees after inactivity or prolonged rest, for example, when getting out of bed in the morning, which is accompanied by venous blood stagnation.

The main signs of arthrosis are caused by stress on weakened muscles:

1. Knee pain while standing is due to the fact that the hip extensor gluteus and biceps muscles do not work and the rectus femoris muscle is overstretched, creating discomfort in the knee.
2. Pain during joint flexion is associated with weakness of the flexors - the biceps muscle and tension in the quadriceps tendon.

Swelling is caused by soft tissue injury, inflammation of the tendons and joint capsule.The appearance of warmth in the knee area, swelling, indicates the accumulation of inflammatory exudate -arthrosis is often associated with bursitis, synovitis and tendonitis.

A sprained knee can be painless or traumatic.Cracking noises and other sounds do not indicate that the bones are worn.Signs of knee instability -weakness of one of the muscles that controls movement.

Crepitus, caused by bone-on-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 stiffness is caused by wear and tear of the cartilage and tendons, which creates a feeling of being stuck in place.Bones are controlled by muscles during every movement.Their premature contraction leads to a change in the direction of bone movement, blocking.

1st degree

The degree of arthrosis is determined using an X-ray, revealing the participation of bone structures in the pathological process.Their change shows that the muscular system has been out of balance for 5-10 years.All right, peoplehave experienced nagging pain for several years.

In the first stage of arthrosis, which is discovered by chance, has a slight increase in bone spurs.Growths appear in places where the node 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 overload.Running and weight training provoke symptoms by placing strain on weakened muscles.Muscle weakness (hypotonia) is associated with impaired blood supply and innervation.

2 degrees

The second stage of arthrosis is considered mild.X-ray reveals significant bone spurs, but the cartilage is not affected.The amount of synovial fluid decreases, but symptoms of pain appear after long walking and running, joint stiffness and pain when bending and kneeling.

Early radiological signs of the second stage of knee arthrosis:

• the sharp edges of the intercondylar tubercles on the tibia, where the cruciate ligament is attached;
• narrowing of the joint space on the medial side;
• the pronounced ends of the condyles of the bones on the medial sides, less often on the sides - depending on the development of valgus or varus deformation of the joint.

For the second phase according to Larsencharacterized by a narrowing of the joint space by more than 50%, but this can only be checked dynamically or compared to an intact node.

3 degrees

In the third stage of arthrosispain when bending and straightening the joint becomes constant.During an irritation, the joint becomes red and swollen, and the aching pain does not stop even at rest.Visible swelling and deformation of joint contours appear around the knee.

Signs of moderate arthrosis of the knee joint in the third stage:

• the common space is significantly narrowed;
• the presence of subchondral sclerosis in loaded areas;
• numerous osteophytes at the edges;
• rare occurrence 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;
• changing the shape of the patella;
• foci of calcification and chondromalacia;

Rarely, the fourth stage is filled with necrotic lesions.Why is arthrosis dangerous?The disease impairs the ability to move and creates dependence on others.

Diagnosing

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 middle pillar, becauseHere pass the nerves that ensure the function of the thigh muscles.

An X-ray shows the presence of osteophytes, a change in the space between the femur and tibia, which indicates loss of cartilage in the knee.Sometimes X-rays of the knee joints show significant signs of cartilage wear, but patients do not experience significant pain.On the contrary, arthrosis of the first stage can impair the function of the knee, since the cause of pain is hypotonic muscles.

If the radiograph does not show major changes, thenthe doctor prescribes an MRI of the knee joint and the lumbar region.Diagnostics visualizes ligaments, tendons and muscles and menisci to look for other sources of pain.

Laboratory diagnosis is necessaryif you suspect a joint infection or gout.

Treatment

Arthrosis therapy should be comprehensivethat target the cause of the disease.For endocrine dysfunctions that may affect the connective tissues, appropriate treatment is carried out.Recommended for overweight patientsswitch to the right food.Aggravations are alleviated with the help of medications.

Drug treatment

Drug treatment of pain includesprescribing anti-inflammatory drugs.Nonsteroidal anti-inflammatory drugs for long-term usenegatively affect the function of the stomach.

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 to regenerate the cartilage structure and have an analgesic effect.

There have been few controlled studies, and were related to complex treatment - arthroplasty, physiotherapy, diet.

Watch out!Chondroprotectors are taken in courses - you can take one course of one drug, and a second course of another, and compare the effect.However, uncontrolled use of medication is not a good idea.Before you start taking medication, consult your doctor.

How and with what to relieve pain and swelling?Intra-articular injections are more popular:

1. Steroid drugssuppresses inflammatory reactions at the level of immune cells, relieving acute pain, stiffness and swelling of the joints.
2. Hyaluronic acidincreases the viscosity of the joint fluid, reducing the friction of the articular surfaces.

Important!The effect of the drugs lasts 6-12 months, but the degenerative processes do not stop.

Surgical treatment

If the drugs have low effectiveness, 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 cartilage and remove areas of worn tissue.

Bone osteotomy aims to change the axis of load on the joint.The doctor cuts the femur or tibia to change 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 rebalancing the muscles, the hip joint is the next to suffer.

Physiotherapy treatment

Mud applications, phonophoresis and magnetic therapy are used in the physiotherapy environment.The action of external factors is intendedstimulating blood supply and tissue regeneration, relieving 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 usuallyaimed at relieving swelling and eliminating pain.Most often, horseradish leaves and potato pulp are used, sometimes honey and vodka are mixed for bandages.

Degeneration cannot be completely stopped.You can influence the metabolism of the kidneys by using celery juice.The kidneys are connected to the iliopsoas muscle, which is associated with hip pathology.Normalizing the function of the gallbladder and liver improves the condition of the knees.

Traditional medicine methods for treating the initial stage of knee arthrosis include decoctions of anti-inflammatory herbs:chamomile, St. John's wort, immortality.Rubs made from dry mustard, sea salt and kerosene are used.Baths with magnesium salts and pine infusions are used.

Manual therapy and massage

Manual therapy for osteoarthritis of the knee joint helps, if the specialist understands muscle tone imbalances.Muscle tests help find weakened muscles that stabilize the knee, determine the cause of the dysfunction, and correct it.

The source can be not only the common block in the middle region,but also dysfunction at the level of blood supply, internal organs, endocrine and biochemical disorders.Therefore, a chiropractor must have the skills of osteopathy and applied kinesiology in order to influence many factors.

Massage acts as an adjunct to manual therapy and self-help.A patient with arthrosis of the knee joint can independently stretch the tendons of the muscles that control the movement of the limbs:

• the area around the gluteus maximus muscle;
• lines along the front surface of the thigh - from the pelvis to the patella;
• the lateral surface of the thigh from the greater trochanter to the femoral condyle;
• hip area along the inguinal ligament;
• the inner surface of the thigh (along the line of the ascending canal).

The massage is performed 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.Perform exercises to prevent arthritis and arthrosis of the knee joints for older 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 complete restoration of biomechanics.Yoga further deprives the joints of stability.Among the treatment methods, it is better to preferPilates and Nordic walking.

diets

Nutrition is mainly regulated to fight excess weight.It is important to give up sugar and simple carbohydrates, add foods with fiber, magnesium, B vitamins and calcium for knee osteoarthritis, which are important for muscle activity.Tryeliminate dairy products, as almost 80% of the population is lactose intolerant.

Prevention of arthrosis of the knee joints

Trying to strengthen muscles with exercise does not always help., as innervation 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 a "beer belly" arthrosis is more common, as in women after polyhydramnios, some births with diastasis - weakening of the muscles of the abdominal wall.

Operations in the pelvic area 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 knee arthrosis?An orthopedist will help establish the diagnosis, who will insist on the operation.The best results are achieved with 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 once every three months.

Treatment reviews

Positive evaluations can be provided only by comprehensive treatment of deforming arthrosis of the knee joint or gonarthrosis.Anesthesia and intra-articular injections act temporarily, suppressing the natural inflammatory response.

CONCLUSION

The problem with arthrosis is that drug therapy only temporarily eliminates pain syndromes.The reasons remain unidentified and unaffected.Occupational therapists can help by teaching you how to live with knee osteoarthritis and how to use a cane properly.But the service is offered only in private clinics that offer rehabilitation.