knee pain

Knee pain is a very annoying nuisance that unfortunately most people face. They can be sharp, aching, burning, throbbing, limit joint mobility, occur only with physical activity or even at rest. But many, instead of going to the doctor, try to get rid of them with the help of painkillers, especially ointments, gels or tablets of nonsteroidal anti-inflammatory drugs. Although such drugs have anti-inflammatory properties, they cannot affect the pathogenesis of knee pain, and therefore only temporarily contribute to its elimination. Therefore, they can only be used as a means of symptomatic therapy.

However, the causes of discomfort in the knee joints can lie in the occurrence of a variety of diseases, 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 get rid of pain, having established the exact cause of its occurrence. To do this, you need to undergo a number of diagnostic procedures and seek advice from experts, but this is the only way to really improve your well-being and avoid complications.

causes

Pain in the knee can accompany a variety of disorders, ranging from osteoarthritis of the knee joints to diseases of the lumbar spine, sacral spine and pelvic bones. Also, the causes of discomfort or even acute pain in the knees can be chondropathy, arthritis, neuritis and other similar diseases.

The obvious cause for the development of a pain syndrome are injuries of all kinds, from bruises and dislocations to torn ligaments, meniscus damage 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 need to turn to a traumatologist to treat the consequences of the injury.

Pain in the knee is therefore always a sign of a pathological process affecting the cartilage, bone or soft tissue structures of the knee itself, or damage to the nerve that innervates it. Consider the main reasons for their appearance.

Osteoarthritis of the knee joints or gonarthrosis

Osteoarthritis, knee osteoarthritis or gonarthrosis is one of the most common causes of knee pain. This disease is characterized by the occurrence of degenerative-dystrophic processes in the cartilaginous structures of the joint, which are the result of a violation of the flow of metabolism, exposure to traumatic factors in the past, etc. Osteoarthritis of the knee is very often diagnosed in middle-aged and elderly people, athletes and people engaged in heavy physical work.

This disease is chronic and tends to progress slowly, eventually leading to severe limitation of joint mobility, loss of limb support (often both), and pain. Initially, they are dull, painful, aching, and appear with movements, accompanied by a crunch in the knee, especially when climbing stairs. However, without treatment, the cartilage of the knee joints will continue to wear down, leading to increased pain and its presence even at rest. The joint surfaces are then destroyed, which further aggravates the situation and can even lead to disabilities.

A typical feature of arthrosis of the knee joints is the presence of the onset of pain, for the elimination of which patients have to "dissipate". Thanks to this, 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 bursting 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 so. They are closely connected by the sciatic nerve (Nervus ischiadicus), the main nerve of the leg. It originates in the spine and is simultaneously formed 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 run through the vertebrae of the same name and unite at the level of the sacrum to form the nerve plexus. From it the sciatic nerve extends 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, injuries at any point of its passage, especially at the level of the lumbar region, can provoke the appearance of pain in the knee. Most often it is associated with the development of:

• Osteochondrosis, protrusions and intervertebral hernias. These diseases are based on degenerative-dystrophic changes in the intervertebral discs, which are located between almost all vertebrae. They are characterized by a systematic decrease in disc height and their dehydration, which leads to a decrease in the elasticity of their structures and an increase in the risk of their fracture under load. This causes the vertebrae to move closer together, which can result in compression of the nerve roots that run through them. When such changes occur in the lumbar region, compression of the fibers that form the sciatic nerve is possible and, accordingly, pain in the knee appears. But more often this symptom already occurs when osteochondrosis is complicated by the formation of protrusion (bulging) of the intervertebral disc or its hernia (rupture of the outer shell of the intervertebral disc), since the protruding areas can severely compress the roots of the spine directly in the spinal canal and provokethe occurrence of severe neurological complications, including pain in the knee.
• spondylosis. This is a disease that most often develops against the background of osteochondrosis and is chronic. This leads to an overgrowth of the surfaces of the vertebral bodies adjacent to the intervertebral discs and the formation of bony prominences (osteophytes) on them. In severe cases, adjacent vertebrae can grow together, leading to their immobilization and severe compression of the nerves passing through them.
• spondylolisthesis. This term refers to the pathology of the spine in which the overlying vertebra is displaced in relation to the one below. The lumbar region is most commonly affected, resulting in injury to the nerves that make up the sciatic nerve.

Signs by which one can suspect the cause of the development of pain in the knee due to the occurrence of diseases of the lumbar spine can additionally be:

• aching, aching, stabbing pain in lower back;
• Muscle tension, hamstrings, quadriceps femoris, occupying the entire front of the thigh and partially the outside;
• pain and stiffness in hips;
• diffuse pains in the legs;
• pain in the thighs.

In each case, the amount, type, and severity of symptoms will vary. It largely depends on the individual characteristics of the organism and the degree of nerve compression.

Directly to the defeat of the sciatic nerve can indicate (symptoms can be observed both in just one limb, and in both at once):

• pain in the knees, hips and lower back;
• spasms of the back and leg muscles;
• burning on the back of the legs;
• 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 cannot fully rely on 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 length of the lower extremities, which can be due to congenital features or a curvature of the pelvis, including against the background of scoliosis. This leads to overloading of one of the legs and faster wear and tear of the cartilage of the knee joint, leading to osteoarthritis.

The abdominal muscles, which attach to the pubic bone, are responsible for the stability of the pelvic bones. When weakened by obesity, lack of exercise or other factors, the muscles in the hamstrings become overworked. This, in turn, provokes an overload of the knee joint.

Foot and ankle pathologies

The ankles, like the knees, can be affected by osteoarthritis. It is often diagnosed in athletes, especially ballet dancers, gymnasts, as well as in 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 is bothered not only by pain in the knee, but also in the ankle, which significantly impairs gait due to limited movements.

Pathologies of the foot, especially flat feet and hallux valgus, can also provoke increased stress 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 as a result of inward collapse of the foot. This is associated with increased fatigue in the legs and pain in them, but later it can lead to pain in the knees.

diagnosis

If you experience knee pain, especially if it occurs regularly or is persistent, you should see a doctor. If the patient has recently experienced traumatic factors, he should consult an orthopedic traumatologist. In other cases, you can first register for a consultation with a therapist. The doctor will assess the patient's condition, take an anamnesis and prescribe diagnostic procedures. This allows him to make a preliminary diagnosis and refer the patient to a specialist whose help will be most effective in each individual case.

However, if a person notices back pain, diffuse pain in the leg, burning sensation on the back or other symptoms described above, you can immediately contact a neurologist. This saves time and money to identify the true cause of the change in well-being and start treatment as soon as possible. If, in addition to pain in the knee, the patient notices changes in the condition of the feet, worries about pain in the ankles, it is better to immediately make an appointment with an orthopedist.

In any 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) necessary to identify signs of inflammatory processes in the body;
• an x-ray of the knee in two projections (if pathology of the feet or spine is suspected, they are also examined by x-ray), necessary to assess the condition of the bone structures, as well as to identify indirect signs of a number of diseases;
• 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 for visual assessment of all structures of the knee, their size and location;
• 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, patients may be prescribed arthroscopy, which is an invasive method of 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 one-size-fits-all 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, etc.

In diseases of the spine that caused pain in the knee, the treatment is carried out under the supervision of a neurologist. If they were the result of arthrosis, other pathologies of the knee, ankles or feet, treatment is prescribed by an orthopedist.

When diagnosing pathologies of the spine or pelvic bones, in addition to consulting a neurologist, patients may be advised to visit an endocrinologist who will help solve the problem of excess weight.

All patients with diseases of the spine, orthopedic pathologies, including arthrosis of the knee joints, are shown complex treatment, which may include:

• drug therapy;
• Physical therapy;
• exercise therapy;
• manual therapy.

Each measure is selected strictly individually according to the diagnosis and the degree of neglect of pathological changes. And with arthrosis of the knee joints of 2-3 degrees, plasma lifting is often additionally prescribed.

Medical therapy

Drug treatment usually includes 2 areas: symptomatic and etiotropic therapy. The first is aimed at quickly improving the patient's well-being, eliminating knee pain and other existing symptoms. The goal of the second is a direct impact on the cause of the emergence 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 therapy that allows you to quickly stop pain in the knee, lower back and feet, as well as having an anti-inflammatory effect.
• Corticosteroids are drugs with a strong anti-inflammatory effect, indicated for severe inflammation and most commonly 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 through long courses, the duration of which, as a rule, is at least 2-3 months.
• Muscle relaxants are drugs prescribed for spasms of the back and hip muscles, which is often a reflex response of the body to pain impulses.
• Vitamin complexes are drugs indicated to improve the course of metabolic processes in the body, as well as to transmit bioelectrical nerve impulses along the nerves.

plasma lifting

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

• Stimulating the course of natural regeneration processes;
• restoring the normal composition and amount of synovial fluid;
• Activation of blood circulation and nutrition of articular cartilage;
• elimination of 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, perfectly complements the treatment of arthrosis of the knee joint, so it is often included in the treatment regimen of this disease. It can also be used in the treatment of spinal osteochondrosis and injuries, as an adjunct to drug therapy, physical therapy, exercise therapy and other treatment methods.

physical therapy

Various physiotherapeutic 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 treatments, which are selected individually. Most often they are looking for help:

• magnetotherapy;
• 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 localization, and especially the spine. It allows you to dosely increase the range of motion, as well as stimulate blood circulation, which leads to the activation of nutrition of all structural elements of the knee joints and thus contributes to their regeneration.

However, it is important to choose the optimal set of exercises that will be most useful in this situation and will not do any harm. Patients can be advised to perform stretching exercises, which are especially important for spinal pathologies. In addition, exercises to strengthen the musculoskeletal system are almost always prescribed. They contribute to the formation of a strong muscular frame, which reduces the load on the affected joints and creates favorable conditions for their recovery.

Physiotherapy classes are easy and accessible to people of all ages, since an individually designed program ensures the creation of a dosed load that has a beneficial effect on diseased joints, and excludes exercises that can be harmful. However, in order to master the methodology of each proposed exercise as accurately as possible, it is worth conducting the first courses under the supervision of an exercise therapy teacher.

In the future, it can be practiced at home, in nature or any other convenient place, but daily. Systematics is one of the basic rules for the success of physiotherapeutic exercises. Therefore, it needs to be added to your list of daily activities and given the right amount of time - 20-30 minutes is usually enough. During class, it is important to avoid sudden movements and haste, 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 disorders. It involves a thorough examination of the back muscles, ligaments and joints of the spine and pelvic area by the hands of a specialist. There are many methods and techniques of manual influencing. They are selected depending on the type and severity of the existing pathology.

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

• Eliminate back pain by reducing pressure on nerve fibers;
• Improving nutrition of all structures of the spine by activating blood circulation;
• increase mobility of the spine;
• Improving posture by eliminating spinal deformities;
• restores the normal position of the pelvic bones and internal organs, which has a positive effect on their functioning.

However, 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 its fibers. This leads to a progressive improvement in the condition and elimination of the pain syndrome, as well as other neurological disorders.

Patients notice the first positive changes after the first session. Other processes contribute to its growth and stabilization in the long term. The first procedures can be carried out only after removing acute inflammation with the help of drug therapy, physiotherapy and other methods of treatment.

So, pain in the knee can indicate not only its defeat, but also the appearance of problems in other parts of the musculoskeletal system, especially the spine and feet. In any case, they cannot be ignored, since without competent treatment existing pathologies progress over time. This leads to an increase in the intensity of 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 allows you to reverse them and fully restore the normal functioning of the joint, providing freedom of movement for many years.