knee pain

Unfortunately, knee pain is a very annoying problem that most people face. They may be sharp, painful, burning, throbbing, restrict joint movement, appear only during physical activity, or even appear at rest. But instead of seeing a doctor, many people try to eliminate them with the help of pain relievers, especially NSAIDs, ointments, gels, or tablets. Although these drugs have anti-inflammatory properties, they cannot affect the pathogenesis of knee pain, so they can only be temporarily eliminated. Therefore, they can only be considered as a means of symptomatic treatment.

But knee discomfort can be caused by a variety of conditions, whether directly on the knee, or in the spine or other parts of the body. Therefore, it may be possible to develop an effective treatment strategy that can only really help eliminate pain once the exact cause of the pain is identified. To do this, you'll need to undergo a series of diagnostic procedures and get expert advice, but it's the only way you can really improve your health and avoid complications.

reason

Knee pain can accompany a variety of diseases, from arthropathy of the knee to lesions of the lumbar spine, sacrum, and pelvis. In addition, knee discomfort or even acute pain can be caused by osteomalacia, arthritis, neuritis, and other similar diseases.

The obvious reasons for the development of pain syndrome are various injuries, ranging from bruising, dislocation, ligament rupture, meniscus injury or intra-articular fracture. But in this case, the pain is almost always acute and occurs with a bump, fall, or other traumatic factor. Therefore, in this case, the victim needs to contact a traumatologist to treat the aftermath of the injury.

Therefore, knee pain is always a sign of a pathological process affecting the cartilage, bone or soft tissue structure of the knee itself, or damage to the nerves that innervate it. Consider the main reasons for their appearance.

Knee joint disease or knee joint disease

Osteoarthritis, knee osteoarthritis, or knee joint disease, is one of the most common causes of knee pain. This disease is characterized by a degenerative dystrophic process of the articular cartilage structure, which is the result of disruption of the flow of metabolic processes, the effects of past traumatic factors, etc. Many times, knee joint disease is diagnosed in middle-aged and elderly people, athletes, and people who do heavy physical labor.

The disease has a chronic course that tends to progress slowly and eventually results in marked limited range of motion, impaired limb support (often both), and pain. Initially, they are dull, painful, pulling, and appear during movement, with constriction of the knee, especially when climbing stairs. But without treatment, the cartilage in the knee joint continues to gradually wear down, which can lead to increased pain, even at rest. Subsequently, destruction of the articular surface occurs, which further exacerbates the condition and may even lead to disability.

A typical feature of knee arthropathy is the presence of initial pains, which the patient needs to "spread" in order to eliminate them. Therefore, improvement is observed within 15-30 minutes.

Knee arthropathy is often complicated by increased inflammatory processes that may affect synovial pockets, ligaments, and tendons. This results in a dramatic increase in pain, acquisition of bursting features, soft tissue swelling and increased local temperature.

Spinal disorders and pelvic asymmetry are causes of knee pain

At first glance, there is no connection between the lumbar spine and the knee. But it's not actually the case. They are closely connected by the sciatic nerve (sciatic nerve), which is the main nerve in the leg. It originates in the spine while being formed by fibers that extend from the spinal cord through natural openings in the nerve vertebrae:

• L4;
• L5;
• S1;
• S2;
• S3.

These nerves pass through the vertebrae of the same name and join the plexus at the level of the sacrum. From there, the sciatic nerve exits 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, at any point of its passage, especially in the lumbar region, the violation can cause the appearance of knee pain. Mostly, it is related to the following developments:

• Osteochondrosis, herniation, and intervertebral hernia. These diseases are based on degenerative dystrophic changes in the intervertebral discs that lie between nearly all vertebrae. They are characterized by a systematic reduction in the height of the disc and its dehydration, which leads to a reduction in the elasticity of its structure and increases its risk of rupture under load. As a result, the vertebrae come close to each other, which can lead to compression of the nerve roots that pass through them. If this change occurs in the lumbar area, it may compress the fibers that form the sciatic nerve, so knee pain can occur. But more commonly, this symptom has arisen when the osteochondral cause is complicated by the formation of a herniated disc (herniated disc) or its herniation (ruptured disc shell), because the herniated area can strongly compress the vertebral root directly in the disc. the spinal canal and cause serious neurological complications, including knee pain.
• Spondylosis. This is a disease that most often develops in the context of osteochondrosis and is chronic. What ensues is the overgrowth of the surface of the vertebral body adjacent to the disc and the formation of bony protrusions (osteophytes) on it. In severe cases, adjacent vertebrae can grow together, which causes them to become immobilized and severely compress the nerves that run through them.
• Spondylolisthesis. The term refers to the pathology of the spine in which the overlying vertebra is displaced relative to the vertebrae that lie below it. In most cases, the lumbar region is affected, which can lead to damage to the nerves that form the sciatic nerve.

Signs that one can suspect a cause of knee pain due to the occurrence of lumbar spine lesions may also include:

• lower back pulling, pain, severe pain;
• tight muscles, hamstrings, quadriceps, which occupy the entire front surface and part of the outer side of the thigh;
• hip pain and stiffness;
• diffuse pain in the legs;
• Pain in the upper thigh.

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

Failure directly at the sciatic nerve can indicate (symptoms can be observed in only one limb, and in both limbs at the same time):

• knee, hip, and lower back pain;
• back and leg muscle spasms;
• burns on the back of the legs;
• Loss of control over bladder and bowel function.

As the function of the sciatic nerve is violated, the knees often feel unstable and they can be compressed. As a result, the patient complains that he cannot fully rely on his legs.

Asymmetry of the sacrum and pelvis can also cause knee pain. It occurs due to differences 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 causes one of the legs to be overloaded and the cartilage in the knee joint wears down faster, leading to arthropathy.

The abdominal muscles attached to the pubic bone are responsible for ensuring the stability of the pelvis. When they become weakened by being overweight, a sedentary lifestyle, or other factors, the muscles in the back of the thigh can become overloaded. This in turn can cause overloading of the knee joint.

Foot and ankle lesions

Both the ankle and knee joints can be affected by arthropathy. It is usually diagnosed in athletes, especially ballet dancers, gymnasts, and the elderly. This leads to a violation of the biomechanics of movement, which increases the load on the knee joint and helps it wear out faster. In this case, a person suffers not only from knee pain, but also from ankle pain, which can significantly affect gait due to restricted movement.

Foot disorders, especially flat feet and hallux valgus, can also increase the load on the knee and cause knee pain. These orthopedic disorders are very common today and in most cases begin to develop in childhood and worsen in adulthood. Valgus deformity is characterized by a violation of the ankle joint axis due to the inward collapse of the foot. This is associated with increased leg fatigue, leg pain, but then knee pain.

diagnosis

If you experience knee pain, especially if it occurs frequently or persists, you should consult your doctor. If the patient has recently experienced traumatic factors, he should contact an orthopaedic trauma specialist. In other cases, you can initially register with a consulting therapist. A doctor will assess the patient's condition, collect medical records and prescribe diagnostic procedures. This will allow him to make an initial diagnosis and refer the patient to a specialist whose help is most effective in a given situation.

However, if someone notices lower back pain, diffuse pain in the legs, burning back pain, or any of the other symptoms listed above, you can contact a neurologist right away. This will save time and money by identifying the real cause of health changes and starting treatment as soon as possible. If a patient notices a change in the condition of the foot, and is concerned about ankle pain in addition to knee pain, it is best to make an appointment with an orthopaedic doctor immediately.

In any case, the doctor will study the situation in detail, assess the nature of the complaint and refer the patient for examination, which may include:

• Laboratory tests necessary to identify signs of inflammatory processes taking place in the body (UAC, biochemical blood test);
• Two-projection knee x-rays (suspected foot or spondylosis, also using radiography), the number of disorders necessary to assess the state of bone structure and to identify indirect signs of knee pain;
• CT is used to more accurately diagnose joint disease and most reliably assess the extent of its damage;
• Knee ultrasound for visual assessment of all structures, sizes and positions of the knee;
• MRI, which is currently the best method for diagnosing lesions of various soft tissue structures, including knee cartilage and intervertebral discs.

In some cases, patients may undergo arthroscopy, an invasive method for diagnosing and treating knee lesions. Typically, it is required for severe arthropathy and traumatic injuries to ligaments, meniscus, etc.

treat

Since there are many conditions that can present with 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 accompanying pathology, the individual characteristics of the patient, his age, etc.

If there is a spinal lesion that causes knee pain, it is treated under the supervision of a neurologist. If they are the result of arthropathy, other pathologies of the knee, ankle, foot, treatment is prescribed by an orthopaedic surgeon.

When diagnosing a pathology in the spine or pelvis, in addition to consulting a neurologist, patients may be referred to an endocrinologist who will help with excess weight.

All patients with spinal disorders, orthopedic disorders (including knee arthropathy) require complex treatment, which may include:

• medical treatement;
• physiotherapy;
• exercise therapy;
• Manipulative therapy.

Each measure is individually selected in strict accordance with the degree of diagnosis and neglect of lesions. And for 2-3 degrees of knee arthropathy, plasma lift is usually prescribed separately.

medical treatement

Drug treatment usually includes two aspects: symptomatic treatment and symptomatic treatment. The first is designed to rapidly improve a patient's health and eliminate knee pain and other existing symptoms. The second goal is to directly influence the causes of disease development and normalization of the long-term patient condition.

Therefore, in most cases, patients are prescribed multiple drugs:

• NSAIDs are symptomatic treatments that allow you to quickly stop pain in your knees, lower back, feet and have anti-inflammatory properties.
• Corticosteroids are powerful anti-inflammatory drugs for severe inflammation and are most often injected into the joint cavity. They are suitable for short courses.
• A chondroprotectant is a product that contains ingredients for cartilage tissue regeneration. They are appointed by long-term courses, the duration of which is usually at least 2-3 months.
• Muscle relaxants are medications used to treat muscle spasms in the back and buttocks, which are usually the body's reflex response to a painful urge.
• Vitamin complexes are drugs used to improve metabolic processes in the body and to transmit bioelectric nerve impulses along nerves.

Plasma Lift

Plasma lift is the injection of plasma from the patient's own blood directly into the affected knee joint or the soft tissue surrounding it. As platelets, cytokines, and growth factors saturate plasma, it helps:

• Stimulates the flow of natural regeneration processes;
• restore normal composition and volume of synovial fluid;
• Activates blood circulation and nutrition of articular cartilage;
• eliminate inflammation;
• relief the pain;
• restore normal range of motion to the affected joint;
• The treatment time is shortened by 2-3 times.

PRP therapy, also known as plasmolifting, perfectly complements the treatment of knee arthropathy, so it is often included in the treatment regimen for this disease. It can also be used in the treatment of spinal osteochondrosis and injuries, complementary drug therapy, physical therapy, exercise therapy and other treatments.

physiotherapy

For the treatment of musculoskeletal disorders that cause knee pain, various types of physical therapy procedures are available. They increase the effectiveness of other treatments and have a positive effect on the affected area. Physical therapy is always prescribed in courses of 7-15 programs, which are selected individually. In most cases, they seek help with:

• magnetic therapy;
• ultrasound therapy;
• UHF;
• Acoustic swimming;
• electrophoresis;
• SMT therapy or amplpulse therapy;
• Vibration massage.

exercise therapy

Physiotherapy exercises play an important role in the treatment of joint pathologies in any area, especially spinal pathologies. It allows you to increase the range of motion in a dosed manner and stimulates blood circulation, which activates the nutrition of all structural elements of the knee joint, thereby promoting their regeneration.

But it's important to choose the best set of exercises that will be most useful in this situation and won't cause harm. Patients may be advised to perform stretching exercises, which are especially important for spinal lesions. Additionally, exercise is almost always prescribed to strengthen the musculoskeletal system. They help create a strong muscular framework, which will reduce the load on the affected joints and create favorable conditions for their recovery.

Physiotherapy sessions are simple and easy to use for people of any age, as individually designed programs ensure a dose load that positively affects diseased joints and excludes potentially harmful movements. But in order to get as accurate a grasp of each suggested exercise as possible, it's worth taking the first class under the supervision of a sports therapy instructor.

In the future, you can practice at home, in nature, or any other suitable place, but every day. Systemicity is one of the fundamental rules for a successful physical therapy practice. Therefore, it must be added to your daily activity list and given appropriate time - usually 20-30 minutes is enough. During class, it is important to avoid sudden movements and rushing, as this can cause pain and worsen the condition.

manual therapy

Manual therapy plays a key role in the correction of pelvic asymmetry and the treatment of spinal disorders. It involves an in-depth study of the back muscles, spinal ligaments and joints, pelvic area by experts. There are many methods and techniques for artificial influence. Their choice depends on the type and severity of the existing pathology.

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

• Relieves back pain by reducing pressure on nerve fibers;
• Improved nutrition of all structures of the spine due to activation of blood circulation;
• increase the mobility of the spine;
• Improve posture by eliminating spinal deformities;
• Restores the normal position of the pelvis and internal organs, which has a positive effect on their function.

However, for patients who consult a doctor for knee pain, the most important effect of manual therapy is the removal of compression on the sciatic nerve and the fibers that form it. This leads to gradual improvement and resolution of pain syndrome and other neurological disorders.

The patient noticed the first positive changes after the first treatment. Further procedures contribute to its long-term growth and stability. The first procedure can only be performed after the acute inflammation has been eliminated with the help of medication, physical therapy and other treatments.

Therefore, knee pain may indicate not only its failure, but also problems in other parts of the musculoskeletal system, especially the spine and feet. In no case can they be ignored, as existing conditions tend to develop over time without effective treatment. This results in increased pain severity, other unpleasant symptoms, and generally a reduced quality of life in humans. Therefore, if you experience discomfort in one or both knees, you should consult a doctor: an orthopedist or a neurologist. Prompt treatment at the early stages of the development of pathological changes will allow you to reverse them and fully restore the normal function of the joint, ensuring years of freedom of movement.