Knee pain

Knee pain is a very annoying nuisance that, unfortunately, most people face. They can be sharp, aching, burning, throbbing, limiting joint mobility, present only during physical activity, or even at rest. But many, instead of going to the doctor, try to get rid of them with the help of pain relievers, especially ointments, gels or tablets of non-steroidal 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 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 ailments, either directly in the knee, or in the spine or elsewhere in the body. Thus, it is possible to develop an effective treatment strategy that will really help eliminate pain only after establishing the exact cause of their appearance. To do this, you will need to undergo a series of diagnostic procedures and get expert advice, but only then can you truly improve your well-being and avoid the development of complications.

Causes

Knee pain can accompany a variety of diseases, ranging from osteoarthritis of the knee joints to pathologies of the lumbar spine, sacral spine and pelvic bones. In addition, the causes of discomfort or even acute 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 kinds from bruising, dislocations, to ruptured ligaments, damage to the 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 these cases, victims should contact a traumatologist to treat the consequences of the injury.

Therefore, knee pain is 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, osteoarthritis of the knee 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 cartilage 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. Very often gonarthrosis is diagnosed in middle-aged and elderly people, athletes and people engaged in heavy physical labor.

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

A typical feature of osteoarthritis of the knee joints is the presence of initial pain, for the elimination of which patients must "disperse". 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 bursa, ligaments and tendons. This leads to a sharp increase in pain, the acquisition of an explosive 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 the case. They are closely interconnected by the sciatic nerve (nervus ischiadicus), which is the main nerve of the leg. It originates in the spine and is formed simultaneously by fibers extending from the spinal cord through 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 nerve plexus. From it, the sciatic nerve runs 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. Thus, violations 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 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 rupture under load. As a result, the vertebrae move closer to each other, 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 more often this symptom occurs already when osteochondrosis is complicated by the protrusion (protrusion) formation of the intervertebral disc or its hernia (rupture of the outer shell of the disc), since the protruding areas can strongly compress the spinal roots directly into the canal spinal cord and provoke the appearance of serious neurological complications, including pain in the knee.
• 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 bone protrusions (osteophytes) on them. In severe cases, neighboring vertebrae are able to grow together, which leads to their immobilization and strong compression of the nerves that run through them.
• Spondylolisthesis. This term refers to the pathology of the spinal column, in which the overlying vertebra is displaced with respect to the one below it. Most often, it is the lumbar region that is affected, which leads to the violation of the nerves that form the sciatic nerve.

The signs by which the cause of the development of knee pain due to the occurrence of pathologies of the lumbar spine may be suspected may also include:

• pulling, aching and 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;
• widespread pain in the legs;
• pain in the upper thighs.

However, the overall nature, nature and severity of the symptoms will differ. This largely depends on the individual characteristics of the organism and the degree of compression of the nerve.

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

• pain in the knees, hip and lower back;
• spasms of the back and leg muscles;
• burning on 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 rely on his legs.

Asymmetry of the sacrum and pelvic bones can also provoke the appearance of pain in the knee joint. It occurs due to a difference in the length of the lower extremities, which may be due to congenital features or the curvature of the pelvis, even against the background of scoliosis. This leads to an overload of one of the legs and faster wear of the cartilage of the knee joint, resulting in osteoarthritis.

The abdominal muscles, which are attached to the pubic bone, are responsible for the stability of the pelvic bones. When they are weakened due to being overweight, sedentary lifestyle or other factors, the muscles in 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. It is often diagnosed in athletes, especially dancers, gymnasts, and 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 the gait due to limited movement.

Foot pathologies, especially flat feet and hallux valgus, can also provoke an increase in the load on the knees and cause pain in them. 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 axis of the ankle joint due to the collapse of the foot inward. This is associated with increased fatigue in the legs, pain in them, but subsequently can lead to pain in the knees.

Diagnostics

If you experience knee pain, especially if it occurs regularly or is always present, you should see a doctor. If the patient has recently experienced traumatic factors, he should contact an orthopedic traumatologist. In other cases, you can initially sign up for a consultation with a therapist. The doctor will assess the patient's condition, collect a medical history 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 contact a neurologist immediately if a person notices back pain, widespread pain in the leg, 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 begin treatment. If the patient notices changes in the state of the feet, in addition to pain in the knee, is concerned about pain in the ankle joints, it is best to make an appointment with an orthopedist immediately.

In any case, the doctor will study the situation in detail, assess the nature of the complaints and send 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 (with suspected pathology of the feet or spine, they are also examined by radiography), which is necessary to assess the state of bone structures, as well as to identify indirect signs of a number of diseases;
• CT is used for a 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 the visual assessment of all structures of the knee, their size, position;
• 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 necessary for severe osteoarthritis and traumatic injuries of ligaments, menisci, etc.

Treatment

Since there are many diseases that can manifest as knee pain, there is no single 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 case of spinal pathologies that have caused knee pain, the 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, the 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 advised to visit an endocrinologist who will help solve the problem of excess weight.

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

• pharmacological therapy;
• Physiotherapy;
• physical therapy;
• manual therapy.

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

Medical therapy

Drug treatment usually includes 2 areas: symptomatic and etiotropic therapy. The first is aimed at rapidly 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 a symptomatic therapy that allows you to quickly stop pain in the knee, lower back, feet and has an anti-inflammatory effect.
• Corticosteroids are drugs with a powerful anti-inflammatory effect, indicated for severe inflammation and are 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 drugs prescribed for spasms of the back and hip muscles, which is often a reflex reaction of the body to pain impulses.
• Vitamin complexes are drugs that are 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 surrounding soft tissue. Due to the saturation of the 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 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, integrating drug therapy, physiotherapy, physical therapy and other treatment methods.

Physiotherapy

For the treatment of diseases of the musculoskeletal system that cause pain in the knees, various 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 7-15 procedures, which are selected individually. Very often they seek help:

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

physical therapy

Physiotherapy exercises play an important role in the treatment of pathologies of the joints of any localization and of the spine in particular. It allows you to increase the range of motion in a dosed way, 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 particularly important for spinal disorders. In addition, exercises are almost always prescribed to strengthen the musculoskeletal system. They contribute to the formation of a strong muscle structure, 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, since 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 accurately as possible, it is worthwhile to conduct the first lessons under the supervision of a physical therapy instructor.

In the future, you will be able to practice at home, in nature or in any other suitable place, but on a daily basis. Systematicity is one of the basic rules for the success of physiotherapy exercises. Therefore, it must be added to the list of daily activities and given the right amount of time - 20-30 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 a thorough study of the muscles of the back, ligaments and joints of the spine, the pelvic region by a specialist. There are many methods and techniques of manual influence. They are selected based 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 nutrition of all structures of the spinal column thanks 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 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 form it. This leads to a progressive improvement in the condition and the elimination of 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 carried out only after the removal of acute inflammation with the help of drug therapy, physiotherapy and other methods of treatment.

Thus, 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 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 quality of human life. Therefore, if discomfort appears in one or both knees, you should consult a doctor - an orthopedist or neurologist. Timely treatment at an early stage of 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.