The knees are considered the most worn joints in the human body. According to statistics, one in three patients with musculoskeletal problems complains of pain. This symptom can be a manifestation of a serious pathology, especially if both knees hurt. In order not to waste time and maintain the mobility of the legs, it is important to consult a doctor immediately after the onset of discomfort.
Where does the pain come from?
The knee is a large block joint on the legs, the structure of which includes fairly large bones (femur, tibia and patella), a joint cavity lined with hyaline cartilage, as well as several pairs of ligaments (main, upper and lower vertical, internal lateral and external, cruciate) and menisci.
Pain receptors are not present in all elements, so when pain in the knee joints is complained of, it is most often localized:
- in the synovium;
- ligaments;
- periosteum.
Good to know! The elements of the knees, made up of cartilage, have no innervation, so by definition they cannot hurt. Even if the cause of discomfort is the destruction of the tissues lining the joint, pain indicates that the periosteum and the lining of the joint capsule are involved in the process.
Pain can be caused by:
- degenerative-inflammatory processes of the cartilage that lines the joint;
- infections of the soft, connective and cartilaginous tissues;
- inflammation of the joints (bursa, cartilage, tendons);
- injuries to ligaments, menisci, bones;
- circulatory disorders in the knee area.
Each group of pathologies is characterized by specific signs, the identification of which helps to determine the diagnosis and select adequate treatment.
Degenerative-inflammatory diseases
Osteoarthritis (gonarthrosis) accounts for up to a third of all cases of localized pain in one or both knees. This disease affects older people and develops gradually. Mild discomfort after exercise gradually becomes commonplace, and after 2-3 years walking even short distances is accompanied by pain in one knee or both legs at the same time.
Good to know! Gonarthrosis is not characterized by an exacerbation of symptoms at rest. At night, when I sit and even when I stand quietly for a short time, my knees don't bother me.
In addition to the discomfort caused by osteoarthritis, patients complain of creaking and deformed joints. Swelling, redness and warmth in the leg joints are not typical of this disease.
Meniscal lesions
Meniscal tears are characterized by the sudden appearance of the main symptom: acute pain in one, less often in both legs. It always appears during active movement: running, jumping, during an unsuccessful maneuver on skis or skates. The process is accompanied by a clearly audible and perceptible crunch in the knee.
The intensity of the pain is so severe that it is impossible to bend or lift the affected leg. After a quarter of an hour the symptom disappears. If no help is provided, inflammation develops within 24 hours:
- swelling appears in the injured knee area;
- pain syndrome intensifies;
- mobility is limited.
When trying to lean on the leg, a sharp, piercing pain occurs, due to which the limb bends. If you do not consult a doctor for therapy, all the listed symptoms gradually regress and disappear after about a month. However, after a long walk, hypothermia or training, they return.
Inflammatory processes and infections
Infectious and non-infectious arthritis, bursitis, synovitis are often companions of degenerative diseases and injuries. The nature of pain in inflammatory pathologies is aching, twisting or bursting, sometimes burning.
Good to know! Unlike other causes, knee discomfort caused by arthritis increases at rest, during sleep, and decreases during movement. The symptom becomes especially strong after prolonged physical exertion.
The disease is accompanied by swelling, redness of the joints and, when the joint capsule is involved, may be accompanied by the accumulation of fluid. The deformation that occurs looks like an elastic bump on the surface of the knee. The skin above it shrinks, becomes shiny and turns red.
Disorders of joint blood supply
The so-called vascular pain often manifests itself in adolescence and accompanies a person throughout his life. The reason for their appearance may be the uneven growth of different tissues of the limbs: the bones "overtake" the vessels and muscles, causing tension in the latter.
Distinctive features of vascular symptoms in the knees:
- symmetry: discomfort occurs in both limbs;
- exacerbation of pain occurs with a sharp change in temperature, change in weather, physical activity;
- weaken quickly after massage.
This type of pain does not require special treatment, except for the use of local remedies.
Inflammation of the tendon
Periarthritis of the crow's foot (one of the ligaments of the knees) is typical of older women. The symptom occurs only when carrying heavy objects and going down stairs. When bending or moving on a flat surface you feel no discomfort, or it is very weak. There is no significant limitation in the mobility of the affected limb. There is no swelling, redness or deformation during periarthritis.
Treatment methods
It is advisable to entrust the treatment of knees to doctors: orthopedist, traumatologist, rheumatologist or surgeon. Specialists from other sectors can also participate in the therapy: physiotherapists, chiropractors, masseurs. The goals of therapy are not only the elimination of the symptom, but also the restoration of its functionality and the prevention of repeated exacerbations.
Before starting therapy, diagnostics are performed:
- X-ray of the joint, which allows you to see damage to the bones, cartilage and menisci;
- CT or MRI are methods capable of detecting anomalies of blood vessels, soft tissues, bones and cartilage;
- Ultrasound of the joints, which allows you to detect cartilage damage and determine the volume and density of synovial fluid;
- arthroscopy - a method of visual examination of the joint cavity using an optical device;
- microscopic analysis of intra-articular fluid to detect infections and inflammation.
Therapeutic tactics are selected based on the diagnosis, but the scheme is always the same:
- The initial phase is symptomatic treatment and pain relief.
- The main stage is to eliminate the causes of discomfort.
- The final stage is the restoration of the joints.
To eliminate the symptoms, conservative therapy with painkillers and anti-inflammatory drugs is sufficient. They are prescribed in the form of local remedies - ointments, gels - and in tablets for oral administration. Additionally, doctors recommend distractions and warming agents.
In the initial phase, it is important to ensure rest for the affected joint. It is necessary to exclude loads:
- walk for a long time;
- weightlifting;
- practice some sports that require squats or active jumping.
If a limb is injured, on the advice of the attending physician, a tight immobilizing bandage, an orthosis or even a plaster cast can be used.
Additional medications may also be prescribed depending on the diagnosis made:
- general strengthening agents and vitamin-mineral complexes;
- NSAIDs, also in the form of injections;
- preparations with chondroitin and glucosamine;
- agents that accelerate the regeneration of damaged tissues.
After objective improvement, a course of general strengthening exercises, physiotherapy, massage and physical therapy is prescribed to restore the functionality of the joints, strengthen muscles and ligaments.
If conservative therapy is ineffective, radical methods are used: minimally invasive and surgical interventions. Direct indications for them are:
- intense pain that is not corrected by analgesics;
- formation of purulent exudate in the joint cavity or purulent cavities in the soft tissues of the joints;
- partial or total blockage of the joint;
- significant deformation of the cartilage that alters or blocks the functionality of the joints;
- damage to the internal elements of the joint: bones, cartilage, menisci, cruciate ligaments.
After surgery, conservative therapy is continued to prevent complications and relieve discomfort. To restore mobility, strengthen and stabilize the joints of the legs, rehabilitation is performed, consisting of physiotherapy, physical therapy, massage, hydrotherapy, etc. To prevent repeated flare-ups, it is recommended to moderately load the limbs, avoid hypothermia and consult a doctor promptly in case of discomfort.