Pain in the knee

Knee pain is a very annoying nuisance that most people unfortunately deal with. They can be sharp, painful, burning, throbbing, limit joint mobility, be 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 non-steroidal anti-inflammatory ointments, gels or tablets. 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 appearance of a variety of 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 really helps to get rid of pain only after establishing the exact cause of its occurrence. To do this, you will have to undergo a number of diagnostic procedures and get expert advice, but this is the only way you can really improve your well-being and prevent 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, sacral and pelvic spine. Also, the causes of discomfort or even acute pain in the knees can be chondropathies, arthritis, neuritis and other similar diseases.

The obvious cause of the development of pain syndrome is injuries of various types, from bruises, dislocations, ligament rupture, 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 such cases, victims should contact a traumatologist to treat the consequences of the injury.

Thus, pain in the knee is always a sign of a pathological process that affects the cartilage, bone or soft tissue structures of the knee itself, or of a nerve injury that innervates it. Consider the main reasons for its appearance.

Arthrosis 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 the result of a violation of the flow of metabolic processes, the action of traumatic factors in the past, etc. Most often, gonarthrosis is diagnosed in middle-aged and elderly people, athletes and people who perform 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, aching, pulling in nature and appear during movements, accompanied by a cracking sound in the knee, especially when climbing stairs. But in the absence of treatment, the cartilage of the knee joints continues to progressively wear down, 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 arthrosis of the knee joints is the presence of initial pain, for the elimination of which patients must "scatter". Thanks to this, the 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 bursting 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 so. They are closely interconnected by the sciatic nerve (nervus ischiadicus), which is the main nerve of the leg. It originates in the spinal column and is simultaneously formed 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 nerve plexus. The sciatic nerve runs from it 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, violations at any point of its passage, in particular 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 the vertebrae. They are characterized by a systematic decrease in disc height and its dehydration, which leads to a decrease in the elasticity of its structures and an increased risk of rupture under load. As a result, the vertebrae move closer to each other, which can lead to compression of the nerve roots passing 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 pain in the knee. But more often this symptom already occurs when osteochondrosis is complicated by the formation of a bulge (protrusion) of the intervertebral disc or its herniation (rupture of the outer layer of the disc), since protruding areas can strongly compress the spinal roots directly into the spinal canal and cause 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 can 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 with respect to the one below it. Most often, it is the lumbar region that is affected, which leads to infringement of the nerves that form the sciatic nerve.

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

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

In each case, the set, nature and severity of the 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 can indicate (symptoms can be observed both in one limb and in both at once):

• 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 provoke 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 features or curvature of the pelvis, including in the setting of scoliosis. This leads to an overload of one of the legs and a more rapid wear of the cartilage of the knee joint, which results 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 lifestyle or other factors, the muscles of the back of the thigh are overloaded. This in turn causes an overload of the knee joint.

Foot and ankle pathologies

The ankle joints, like 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 movements, which increases the load on the knee joint and contributes to its faster wear. In such situations, a person will be bothered by pain not only in the knee, but also in the ankle, which significantly affects the gait due to limited movements.

Foot pathologies, in particular flat feet and hallux valgus, can also lead to an increased load on the knees and cause pain. 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 collapse of the foot inward. This is associated with increased leg fatigue, leg pain, but can subsequently lead to knee pain.

Diagnosis

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 experienced traumatic factors, you 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, collect an anamnesis and prescribe diagnostic procedures. This will allow you 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, 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 condition of the feet, in addition to pain in the knee, 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) 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 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 knee joint pathology. As a general rule, it is required for severe arthrosis and traumatic injuries of ligaments, menisci, etc.

Treatment

Since there are many conditions 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 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 can be recommended, in addition to consulting a neurologist, to visit an endocrinologist who will help solve the problem of excess weight.

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

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

Each measure is selected strictly individually according to 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

Pharmacological treatment usually 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 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 most often injected into the joint cavity. They are applied in short courses.
• Chondroprotectors are products that contain components used by cartilage tissue for its regeneration. They are appointed by long courses, the duration of which is usually at least 2-3 months.
• Muscle relaxants are medications prescribed for spasms of the muscles in the back and hips, which is 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.

plasma lift

Plasmolifting is an injection of plasma obtained from the patient's own blood directly into the affected knee joint or the surrounding soft tissues. 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 joint cartilage;
• removal 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, 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, supplementing drug therapy, physiotherapy, exercise therapy and other methods of treatment.

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 courses of 7-15 procedures, which are selected individually. Most of the time they seek help:

• magnet therapy;
• ultrasound therapy;
• ultrahigh frequency;
• phonophoresis;
• electrophoresis;
• SMT therapy or amplipulse therapy;
• vibrating massage.

exercise therapy

Physiotherapy exercises play an important role in the treatment of pathologies of the joints of any location 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 the nutrition of all the 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 pathologies of the spine. In addition, exercises to strengthen the musculoskeletal system are almost always prescribed. 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 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 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 on a daily basis. 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 right 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 worsen the condition.

Manual therapy

Manual therapy plays one of the key roles in correcting pelvic asymmetry and treating spinal diseases. It is a deep 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.

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 the 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 has a positive effect on their functioning.

But the most important effect of manual therapy for patients who consult a doctor for 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 state and elimination of the pain syndrome, as well as other neurological disorders.

Patients notice the first positive changes after the first session. Other procedures contribute to its growth and stabilization for a long time. The first procedures can be carried out only after the elimination of acute inflammation with the help of drug therapy, physiotherapy and other methods of treatment.

Therefore, pain in the knee can indicate not only its defeat, but also the appearance 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 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 of the development of pathological changes will allow you to reverse them and fully restore the normal functioning of the joint, ensuring freedom of movement for many years.