Knee pain

Knee pain is a very annoying nuisance that unfortunately most people face. They can be sharp, 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, in particular, ointments, gels or tablets of non-steroidal anti-inflammatory drugs. Such drugs, although they have anti-inflammatory properties, are not able to influence the pathogenesis of knee pain and therefore only temporarily contribute to its elimination. Therefore, they can only be considered as a means of symptomatic therapy.

But the causes of discomfort in the knee joints can lie in the occurrence of a variety of disorders, both directly in the knee and in the spine or in other parts of the body. Therefore, it is possible to develop an effective treatment strategy that really helps to eliminate pain only after establishing the exact cause of its onset. To do this, you will need to undergo a series of diagnostic procedures and get expert advice, but this is the only way to truly improve your well-being and prevent complications from developing.

Causes

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

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

Thus, knee pain is always a sign of a pathological process that affects the cartilaginous, bony or soft tissue structures of the knee itself, or damage to the nerve that innervates it. Consider the main reasons for your 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 is the result of a violation of the flow of metabolic processes, the action of traumatic factors in the past, etc. Often gonarthrosis is diagnosed in middle-aged and elderly people, athletes and people involved in heavy physical work.

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 movements, accompanied by a knee crunch, especially when climbing stairs. But in the absence of treatment, the cartilage of the knee joints continues to progressively wear out, which leads to increased pain and its presence even at rest. Subsequently, destruction of the joint surfaces occurs, which further aggravates the situation and may even cause disability.

A typical feature of arthrosis of the knee joints is the presence of initial pain, the elimination of which patients need to "disperse". Thanks to this, improvement is observed in 15-30 minutes.

Gonarthrosis is often complicated by the addition of inflammatory processes that can affect the synovial bursa, ligaments and tendons. This leads to a sharp increase in pain, the acquisition of a tearing character, swelling of soft tissues and a local increase in temperature.

Spinal disorders and asymmetry of 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 it is not so. They are closely interconnected by the sciatic nerve (nervus ischiadicus), which is the main nerve in the leg. It originates in the spinal column 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 vertebrae of the same name, joining at the level of the sacrum in the nervous plexus. From there, the sciatic nerve runs along the back of each leg and innervates the knee. At the same time, this nerve is responsible for your sensory (sensory) and motor (motor) functions. Therefore, violations at any point of its passage, especially at the level of the lumbar region, can provoke the appearance of knee pain. 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 their structures and an increased risk of rupture under load. As a result, the vertebrae move closer together, 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 already when osteochondrosis is complicated by the formation of a bulge (bulge) of the intervertebral disc or its hernia (rupture of the outer shell of the disc), as the bulging areas can strongly compress the spinal roots directly into the spinal canal and cause the onset of serious 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 an overgrowth of the surfaces of the vertebral bodies adjacent to the intervertebral discs and the formation of bony protrusions (osteophytes) on them. In severe cases, neighboring vertebrae are able to grow together, which leads to immobilization and severe compression of the nerves that pass through them.
• Spondylolisthesis. This term refers to spinal pathology, in which the overlying vertebra is displaced relative to the one located below it. Most often, it is the lower back that is affected, which leads to the violation of the nerves that form the sciatic nerve.

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

• pulling, aches, sharp pains in the lower back;
• muscle tension, hamstrings, quadriceps femoris, occupying the entire anterior face of the thigh and partially the external face;
• 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 symptoms will be different. This largely 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 in only one limb and in both at the same time):

• pain in the knees, hips and lower back;
• spasms of the muscles of the back and legs;
• burning in the back of the leg;
• loss of control over 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 trust 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 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, resulting in osteoarthritis.

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

Foot and ankle pathologies

The ankle joints, as well as the knee, can be affected by osteoarthritis. It is often diagnosed in athletes, especially 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 movements.

Foot pathologies, in particular flat feet and hallux valgus, can also place an increased load on the knees and cause them pain. These orthopedic pathologies are very common today and in most cases they begin to form in childhood and worsen in adulthood. Valgus deformity is characterized by a violation of the ankle joint axis as a result of the foot collapsing inward. This is associated with increased leg fatigue, leg pain, but later it can lead to knee pain.

Diagnosis

If you experience knee pain, especially if it occurs regularly or is present all the time, see a doctor. If the patient has recently suffered traumatic factors, he should contact an orthopedic traumatologist. In other cases, you may initially sign up for a consultation with a therapist. The doctor will assess the patient's condition, take 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 specific case.

But you can immediately contact a neurologist if a person notices the presence of lower back pain, diffuse leg pain, burning on the surface of the back, or other symptoms described above. This will save time and money as quickly as possible to establish the true cause of the change in well-being and start treatment. If the patient notices changes in the state of the feet, in addition to knee pain, he is concerned about pain in the ankle joints, it is better to immediately make an appointment with an orthopedist.

In any case, the doctor will study 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) needed to identify signs of inflammatory processes occurring in the body;
• a radiograph of the knee in two projections (with suspected foot or spine pathology, they are also examined by radiography), which is necessary to assess the state of bony structures, as well as identify indirect signs of a number of diseases;
• CT is used for a more accurate diagnosis of joint diseases, as well as a more reliable assessment of the degree of their destruction;
• Ultrasonography of the knee joint, used for visual assessment of all knee structures, their size, position;
• Magnetic resonance imaging, 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 necessary for severe arthrosis and traumatic injuries of ligaments, menisci, etc.

Treatment

As there are many conditions that can manifest as knee pain, there is no single treatment strategy. In each case, it is developed individually, based 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 knee pain, treatment is carried out under the supervision of a neurologist. If they were the result 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, in addition to consulting a neurologist, may also be recommended 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, receive complex treatment, which may include:

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

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

medical therapy

Drug treatment generally includes 2 areas: symptomatic and etiotropic therapy. The first aims to quickly improve the patient's well-being, eliminating knee pain and other existing symptoms. The aim of the second is 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 given 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 a potent anti-inflammatory effect, indicated for severe inflammation and are most often injected into the joint cavity. They are applied in short courses.
• Chondroprotectors are products that contain components used by cartilage tissue for regeneration. They are appointed for long courses, the duration of which is usually at least 2-3 months.
• Muscle relaxants are medications 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 indicated to improve the course of metabolic processes in the body, as well as the transmission of bioelectrical nerve impulses along the nerves.

Plasmolifting

Plasmolifting is an injection of plasma obtained from the patient's own blood directly into the affected knee joint or the surrounding soft tissue. 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 normal synovial fluid composition and volume;
• activation of blood circulation and nutrition of joint 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 osteoarthritis of the knee joint, so 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, complementing drug therapy, physical therapy, exercise therapy and other treatment methods.

Physiotherapy

For the treatment of diseases of the musculoskeletal system that cause knee pain, several types of physiotherapeutic 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 courses of 7 to 15 procedures, selected individually. Most of the time they seek help:

• magnetotherapy;
• ultrasound therapy;
• UHF;
• phonophoresis;
• electrophoresis;
• SMT therapy or amplipulse therapy;
• vibrating massage.

exercise therapy

Physiotherapy exercises play an important role in the treatment of joint pathologies of any location and of the spine in particular. It allows to increase the range of motion in a dosed way, in addition to stimulating 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 ideal 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 structure, which will reduce the load on the affected joints and create favorable conditions for their recovery.

Physiotherapy classes are simple and affordable for people of any age, as an individually designed program ensures that you create a dosed load that has a positive effect on diseased joints and excludes exercises that can be harmful. But to master the methodology of each proposed exercise as accurately as possible, it is worth taking the first classes under the supervision of an exercise therapy instructor.

In the future, you will be able to practice at home, in nature or any other suitable place, but daily. Systematicity is one of the basic rules for the success of physical therapy exercises. So it should be added to your daily activity list and given adequate time - 20 to 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 key roles in correcting pelvic asymmetry and treating spinal diseases. It involves 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 manual influence methods and techniques. 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 spinal mobility;
• improve posture by eliminating spinal deformities;
• restore the normal position of pelvic bones and internal organs, which has a positive effect on their functioning.

But the most important effect of manual therapy for patients who see a doctor with knee pain is the elimination of compression of the sciatic nerve and the fibers that form it. This leads to a 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. Additional procedures contribute to its growth and stabilization for a long time. The first procedures can be carried out only after removing the acute inflammation with the help of drug therapy, physical therapy and other treatment methods.

So, knee pain can indicate not only its defeat, but also the occurrence of problems in other parts of the musculoskeletal system, in particular in the spine and feet. In any case, they cannot be ignored, as existing pathologies, in the absence of competent treatment, tend to progress over time. This will lead to an increase in the severity of pain, the occurrence of other unpleasant symptoms and, in general, a decrease in the human quality of 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 of the development of pathological changes will allow them to be reversed and completely restore the normal functioning of the joint, ensuring freedom of movement for many years.