knee pain

Knee pain is a very embarrassing nuisance that unfortunately most people face. They can be acute, painful, burning, throbbing, limit 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, including ointments, gels or tablets of nonsteroidal anti-inflammatory drugs. These drugs, although they have anti-inflammatory properties, are not able to influence 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, in the spine or in other parts of the body. Therefore, it is possible to develop an effective treatment strategy that will really help to eliminate pain only after establishing the exact cause of its occurrence. To do this, you will have 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 the development of complications.

causes

Knee pain can accompany various diseases, ranging from osteoarthritis of the knee joints to pathologies of the lumbar, sacral and pelvic bones. Also, the causes of discomfort or even sharp pain in the knees can be chondropathy, arthritis, neuritis and other similar diseases.

The obvious cause of the development of pain syndrome are injuries of various types ranging from bruises, dislocations, rupture of ligaments, damage to menisci or intra-articular fractures. But in such situations, the pain is almost always acute and appears at the moment of impact, fall or other traumatic factors. Therefore, in such cases, victims should contact a traumatologist to deal with the consequences of the injury.

Thus, knee pain is always a sign of a pathological process that affects the cartilaginous, 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 appearance of degenerative-dystrophic processes in the cartilaginous structures of the joint, which result from a violation of the flow 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 performing heavy physical labor.

This disease has a chronic course, tends to progress slowly and eventually leads to a pronounced limitation of joint mobility, a violation of the supporting function of the limb (often both), as well as pain. Initially, they are dull, painful, pulling in nature and appear during movement, accompanied by a cracking of the knee, especially when climbing stairs. But in the absence of treatment, the cartilages of the knee joints continue to gradually wear out, which leads to increased pain and its presence even at rest. Subsequently, the destruction of the articular surfaces occurs, which further aggravates the situation and can even lead to disability.

A typical feature of arthrosis of the knee joints is the presence of initial pain, for the elimination of which patients need to "disperse". Thanks to this, an 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 burst character, swelling of soft tissues and a local increase in temperature.

Diseases of the spine and asymmetry of the bones of the pelvis 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 to each other by the sciatic nerve (nervus ischiadicus), which is the main nerve in the leg. It originates in the spine and is formed simultaneously by the fibers extending from the spinal cord through the natural openings of the vertebrae from 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 there, the sciatic nerve runs down 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, attacks at any point of its passage, especially in the lumbar region, can cause 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 located between almost all vertebrae. They are characterized by a systematic decrease in the height of the disc 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 move closer together, which can lead to compression of the nerve roots running through them. If such changes occur in the lumbar region, compression of the fibers that form the sciatic nerve is possible and, as a result, the appearance of pain in the knee. But most often this symptom occurs already when osteochondrosis is complicated by the formation of a protrusion (protrusion) of the intervertebral disc or its herniation (rupture of the outer shell of the disc), since the protruding areas can strongly compressvertebral roots directly into the spinal canal and cause the development of severe neurological complications, including knee pain.
• Spondylosis. This is a disease that most often develops against the background of osteochondrosis and is chronic. With it, there is a proliferation of the surfaces of the vertebral bodies adjacent to the intervertebral discs and the formation of bone protrusions (osteophytes) on them. In severe cases, neighboring vertebrae are able to grow together, which leads 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 relative to the one below. Most often, it is the lumbar region that is affected, which leads to damage to the nerves that form the sciatic nerve.

Signs to suspect the cause of the development of knee pain due to the occurrence of pathologies of the lumbar spine may additionally include:

• drawing, aching, sharp pains in the lower back;
• muscle tension, hamstrings, quadriceps femoris, occupying the entire front surface of the thigh and partially the outer side;
• pain and stiffness in the hips;
• diffuse pain in the legs;
• pain in the upper thighs.

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

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

• knee, hip and lower back pain;
• spasms of back and leg muscles;
• burning on the back of the leg;
• loss of control of bladder and bowel functions.

With violations 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 legs.

The asymmetry of the sacrum and the bones of the pelvis can also cause the appearance of 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 characteristics or a curvature of the pelvis, including in the context of scoliosis. This leads to an overload of one of the legs and faster wear of the cartilage in the knee joint, leading to osteoarthritis.

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

Foot and ankle pathologies

The ankle joints, as well as the knee, can be affected by osteoarthritis. Often it is 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 will be disturbed by pain not only in the knee, but also in the ankle, which significantly affects gait due to limited movement.

Foot pathologies, especially flat feet and hallux valgus, 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 foot sagging inward. This is associated with increased fatigue in the legs, pain in them, but can then lead to pain in the knees.

Diagnostic

If you experience knee pain, especially if it occurs regularly or is present all the time, you should see a doctor. If the patient has recently suffered traumatic factors, he should contact an orthopedic traumatologist. In other cases, you can first sign up for a consultation with a therapist. The doctor will assess the patient's condition, collect an anamnesis 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 immediately contact a neurologist if a person notices the presence of pain in the lower back, diffuse pain in the leg, burning on the surface of the back or other symptoms described above. This will save time and money, establish the real cause of the change in well-being as quickly as possible and begin treatment. If the patient notices changes in the condition of the feet, in addition to pain in the knee, he is worried about pain in the ankle joints, it is better to immediately make an appointment with an orthopedist.

In all cases, the doctor will investigate 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 occurring in the body;
• an x-ray of the knee in two projections (in case of suspected pathology of the feet or spine, they are also examined by x-ray), necessary to assess the condition of the bone structures, as well as to identify indirect signs of anumber of diseases;
• Computed tomography 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 knee structures, 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 of diagnosing and treating pathologies of the knee joints. As a rule, it is necessary for severe arthrosis and traumatic injuries of ligaments, menisci, etc.

Treatment

Since many diseases can manifest as knee pain, there is no single treatment strategy. In each case, it is developed individually, depending only on the nature of the pathological changes, their severity, the presence of concomitant pathologies, the individual characteristics of the patient, his age, etc.

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

When diagnosing pathologies of the spine or pelvic bones, patients may also be recommended, in addition to consulting a neurologist, to consult 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, receive complex treatment, which may include:

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

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

medical therapy

Drug therapy 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 development of disorders and the normalization of the patient's condition in the long term.

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

• NSAIDs are symptomatic therapies that quickly stop pain in the knee, lower back, feet and have an anti-inflammatory effect.
• Corticosteroids are drugs with a powerful anti-inflammatory effect, indicated in cases of severe inflammation and 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 by long courses, the duration of which is usually at least 2-3 months.
• Muscle relaxants are medications prescribed for back and hip muscle spasms, which are often a reflex reaction of the body to pain impulses.
• Vitamin complexes are drugs indicated to improve the course of metabolic processes in the body, as well as the transmission of bioelectric nerve impulses along the nerves.

Plasmolifting

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

• stimulation of the flow 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;
• reduction of processing time by 2-3 times.

PRP therapy, also called plasmolifting, perfectly complements the treatment of arthrosis of the knee joint, therefore it is often included in the treatment regimen for this disease. It can also be used in the treatment of osteochondrosis of the spine and injuries, as an adjunct to drug therapy, physiotherapy, exercise therapy and other treatment methods.

Physiotherapy

For the treatment of diseases of the musculoskeletal system that cause pain in the knees, various types of physiotherapy procedures can be used. They increase the effectiveness of other treatments and have a positive effect on the affected area. Physiotherapy is always prescribed in the course of 7-15 procedures, which are selected individually. Most often, they ask for help:

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

exercise therapy

Physiotherapy exercises play an important role in the treatment of pathologies of the joints of any localization and the spine in particular. It allows you to increase the range of motion in a dosed manner, 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.

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. In addition, exercises are almost always prescribed to strengthen the musculoskeletal system. They contribute to the formation of a strong muscular frame, which will reduce the load on the affected joints and create favorable conditions for their recovery.

Physiotherapy classes are simple and accessible to people of any age, because an individually designed program guarantees 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 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. Systematicity is one of the basic rules for the success of physiotherapy exercises. Therefore, it should be added to your list of daily activities and given the appropriate amount of time - 20-30 minutes is usually enough. During classes, it is important to avoid sudden movements and rushing, as this can cause pain and aggravate the condition.

Manual therapy

Manual therapy plays one of the key roles in the correction of pelvic asymmetry and the treatment of spinal diseases. This is an in-depth study of the muscles of the back, ligaments and joints of the spine, pelvic region 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.

Through 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 bones of the pelvis 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 elimination of compression of the sciatic nerve and the fibers that make it up. This leads to a gradual improvement in the condition and the 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 elimination of 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 occurrence of problems in other parts of the musculoskeletal system, in particular, the spine and feet. In any case, they cannot be ignored, since existing pathologies, in the absence of competent treatment, tend to develop over time. This will lead to an increase in the severity of pain, the appearance of other unpleasant symptoms and, in general, a decrease in the quality of human life. Therefore, if discomfort appears in one or both knees, you should consult a doctor: an orthopedist or a neurologist. Timely treatment at an early stage in the development of pathological changes will allow you to reverse them and completely restore the normal functioning of the joint, ensuring freedom of movement for many years.