Knee pain

Knee pain is a very annoying disorder that unfortunately most people face. They can be sharp, painful, burning, pulsating, limiting the mobility of the joints, present only during physical activity, and 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 nonsteroidal anti-inflammatory drugs. Such drugs, although they have anti-inflammatory properties, are not able to affect the pathogenesis of knee pain, and therefore only temporarily contribute to their elimination. Therefore, they can be considered only as a means of symptomatic therapy.

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 eliminate pain only after the exact cause of their occurrence is determined. To do this, you will have to undergo a series of diagnostic procedures and get expert advice, but only in this way can you really improve your condition and avoid the development of complications.

Causes

Knee pain can be accompanied by various diseases, from arthrosis of the knee joints to pathologies of the lumbar, sacral spine and pelvic bones. Also, causes of discomfort or even acute knee pain can be chondropathy, arthritis, neuritis and other similar diseases.

The obvious causes of the development of pain syndrome are injuries of various types from bruises, dislocations, to ligament rupture, meniscus damage or intra-articular fractures. But in such situations the pain is almost always acute and occurs at the moment of impact, fall or other traumatic factors. Therefore, in such cases, victims should consult a traumatologist to repair the consequences of the injury.

Thus, knee pain is always a sign of a pathological process that affects the cartilaginous, skeletal 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, 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 a consequence of disruption 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 who engage in heavy physical work.

This disease has a chronic course, tends to progress slowly and eventually leads to severe limited mobility of the joints, impaired support function of the extremities (often both), as well as pain. At the beginning, they are dull, painful, trailing in nature and appear during the movement, followed by crunching in the knee, especially when climbing stairs. But in the absence of treatment, the cartilage of the knee joints continues to progressively wear out, leading to increased pain and its presence even at rest. After that, the joint surfaces are destroyed, which further aggravates the situation and can even cause disability.

A typical feature of osteoarthritis of the knee is the presence of initial pain, for the removal of which patients must "run away". Thanks to that, the improvement is noticed 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 sudden increase in pain, the acquisition of a cracking 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 lumbar spine and the knee. But in reality it is not so. They are closely interconnected by the sciatic nerve (nervus ischiadicus), which is the main nerve of the leg. It is formed in the spine and at the same time is formed from fibers that extend from the spinal cord through natural openings in the vertebral nerves:

• L4;
• L5;
• S1;
• S2;
• S3.

These nerves pass through the vertebrae of the same name, connecting at the level of the sacrum to the nerve plexus. From it the sciatic nerve runs along the dorsum 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. It is most often associated with the development of:

• Osteochondrosis, protrusions and intervertebral hernias. These diseases are based on degenerative-dystrophic changes on 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 an increase in the risk of their rupture under load. As a result, the vertebrae get 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, consequently, the appearance of knee pain. But more often this symptom occurs when osteochondrosis is complicated by the formation of protrusion (protrusion) of the intervertebral disc or its hernia (rupture of the outer shell of the disc), as protruding areas can strongly compress the roots of the spine directly into the spinal canal and cause severe neurological complications, including painin the knee.
• Spondylosis. This is a disease that most often develops against the background of osteochondrosis and is chronic. In addition, there is an overgrowth of the vertebral body surfaces along the intervertebral discs and the formation of bony protrusions (osteophytes) on them. In severe cases, adjacent vertebrae can grow together, leading to their immobilization and severe compression of the nerves that pass through them.
• Spondylolisthesis. This term refers to the pathology of the spine, in which the upper spine is displaced relative to that below it. The lumbar region is most often affected, which leads to injury to the nerves that form the sciatic nerve.

Signs that may be suspected of causing knee pain due to lumbar spine pathology may further include:

• withdrawal, aches, sharp pains in the lower back;
• muscle tension, knee tendons, quadriceps femoris, which occupy the entire front surface of the thigh and partially the outside;
• pain and stiffness in the hips;
• diffuse leg pain;
• upper thigh pain.

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

It can indicate direct defeat of the sciatic nerve (symptoms can be noticed on only one limb, and on both at once):

• pain in the knees, hips and lower back;
• back and leg muscle cramps;
• burning on the back of the leg;
• loss of control over bladder and bowel functions.

In addition to the violation of the functioning 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.

Asymmetry of the sacrum and pelvic bones can also cause pain in the knee joint. It occurs as a result of differences in the length of the lower extremities, which may be due to innate characteristics or curvature of the pelvis, including on the background of scoliosis. This leads to overload of one of the legs and faster wear of the cartilage of the knee joint, which results in arthrosis.

The abdominal muscles, which are attached to the pubic bone, are responsible for ensuring the stability of the pelvic bones. When they are weakened due to overweight, sedentary lifestyle or other factors, the muscles of the back of the thigh are overloaded. This in turn causes overload of the knee joint.

Pathologies of the foot and ankle

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

Foot pathologies, especially flat feet and hallux valgus, can also cause 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 ankle axis as a result of inward collapse of the foot. It is associated with increased leg fatigue, pain in them, but can later lead to knee pain.

Diagnosis

If you feel pain in the knee, 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 consult an orthopedic traumatologist. In other cases, you can first apply for a consultation with a therapist. The doctor will assess the patient's condition, collect a medical history and prescribe diagnostic procedures. This will enable 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 the person notices the presence of lower back pain, diffuse leg pain, tingling in the back or other symptoms described above. This will save you time and money, as quickly 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 feet, in addition to knee pain, he is worried about pain in the ankles, it is better to schedule an examination with an orthopedist immediately.

In any case, the doctor will study the situation in detail, assess the nature of the problem 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 (with suspected pathology of the foot or spine, examined by radiography), which is needed to assess the condition of bone structures, as well as to identify indirect signs of the number of diseases;
• CT is used for a more accurate diagnosis of joint diseases, as well as the most reliable assessment of the degree of their destruction;
• Ultrasound of the knee joint is 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 knee joint cartilage 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 needed for severe arthrosis and traumatic injuries of the ligaments, meniscus, etc.

Treatment

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

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

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

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

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

Each measure is chosen 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, plasmalifting 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 to directly influence the cause of the development of the disorder and the long-term normalization of the patient's condition.

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

• NSAIDs are a symptomatic therapy that allows you to quickly stop pain in the knee, lower back, feet and have an anti-inflammatory effect.
• Corticosteroids are drugs with strong anti-inflammatory action, are indicated for severe inflammation and are most commonly injected into the joint cavity. They are applied in short courses.
• Chondroprotectors are products that contain components that cartilage tissue uses for regeneration. They are called long courses, which usually last at least 2-3 months.
• Muscle relaxants are medications prescribed for back and hip muscle cramps, which are often the body’s reflex response 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 along the nerves.

Plasma lifting

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 contributes to:

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

PRP therapy, also called plasmolifting, 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 treatment methods.

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 cycles 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;
• vibration massage.

exercise therapy

Physiotherapy exercises play an important role in the treatment of pathologies of the joints of any localization, especially the spine. It allows you to increase the range of motion, as well as stimulate blood circulation, which leads to the activation of 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 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 affordable for people of any age, because an individually designed program ensures the creation of a dosed load that 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 precisely as possible, it is worth conducting the first classes under the supervision of a therapy exercise instructor.

In the future, you can exercise at home, in nature or in any other suitable place, but every day. Systematic is one of the basic rules for the success of physiotherapy exercises. So you need to add it to your list of daily activities and give it the right amount of time - usually 20-30 minutes is enough. During classes, it is important to avoid sudden movements and rushes, because that can cause pain and worsen the condition.

Manual therapy

Manual therapy has one of the key roles in correcting pelvic asymmetry and treating spinal diseases. It involves in-depth study of the muscles of the back, ligaments and joints of the spine, pelvic region by experts. 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 manual therapy sessions it is possible to:

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

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 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 over 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 defeat, but also the appearance of problems in other parts of the musculoskeletal system, especially in the spine and feet. In any case, they cannot be ignored, because existing pathologies, in the absence of competent treatment, tend to progress over time. This will lead 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: orthopedist or neurologist. Timely treatment in the early phase of the development of pathological changes will allow you to reverse them and completely restore the normal functioning of the joints, ensuring freedom of movement for many years.