Arthrosis of the knee joint - gonarthrosis

If you feel in the morning stiffness or pain in the joints, it takes you longer to limber up or the pain follows you even in a peaceful regime, and the doctor told you that you have arthrosis, and you search for an alternative treatment then the surgical treatment proposed by your doctor? In the following words we will try to explain you this topic and offer you a solution.

KNEE JOINT

Knee joint is the biggest joint of the human body and it is composed from two big bones - thigh bone and shinbone (tibia) - and patella. The surfaces, on which these two bones meet, are composed from two crescent shaped menisci. Stability of the knee joint is further secured by the posterior cruciate ligament and anterior cruciate ligament, lateral ligaments, and big role is also played by the quadriceps tendon which connects the patella to the joint, and it is attached to the front side of the joint. Another important part of the knee are ligaments and attachments of the surrounding muscles, which create a stabilizing support for the joint thanks to their tension.

WHAT HAPPENS IN THE KNEE JOINT DURING ARTHROSIS

Similarly as by all joints disabled by arthrosis, even here the shape of the joint surfaces is changing, which leads to destruction of the soft tissues of the knee - menisci, ligaments, etc…
Affected structures of the soft tissues are often manifested as a visible deformity in the axis of the joint (joint is deflected/dislocated).

Subjective symptoms

The main symptom is a pain, which is manifested during burdening, walking in a harder terrain, into the stairs etc… In a later stage of the disease, the pain occurs even in a peaceful regime, during night. Instability is a frequent subjective feeling, which can result in knee buckling, that is when the leg buckles by itself, it is often accompanied by falling down. Knee is often swelling during arthrosis, it is painful on touch, and a significant complication is the restricted range of movement in the joint, that is often followed by a flexion contracture, which is such an intensive tension of the muscles, that it invokes pain and at the same time it restricts the person from moving.

Objective symptoms

Objectively we find during the examination changed position of the pelvis, disorder of the spine statics, incorrect walking stereotype. During examination we often meet with one leg being shortened, which can be a cause, but also a result of arthrosis. Significant restriction of the passive movement in the joint, can lead to increased pressure on the bones which can be deformed and deflect from the axis of the bone. The knee joints and ankle joints often receive varus deformity (“O” shape). Arthrosis is often accompanied by increased muscle tension especially in the area of the inner side of the thighs and around the flexors of the knee joints - attachments of the hamstrings are significantly getting shorter, on the other hand, the outer muscles are weakened. During examination we meet with the so called creaking in the joints.

THERAPY

Pharmacological and surgical treatment

The symptoms can be treated only pharmacologically, so doctors may prescribe you painkillers or non-steroid antirheumatics (anti-inflammatory drugs). It is ideal to supplement the treatment with chondroprotective compounds which are slowly and gradually releasing the compounds and it has long lasting effect. They slow down the degradation of the cartilage, because the cartilages do not restore after the birth. The most ideal products should contain glucosamine sulfate, chondroitin sulfate, hyaluronic acid etc…

Surgical approach contains less invasive methods, such as arthroscopy, during which the doctor cures the surface of the joints, and removes the osteophytes (spurs on the bones), or directly replacement of the whole joint.

It doesn’t matter for which variant you decide, but keep in mind that people suffering from obesity should start to decrease their weight before the treatment. It will lower the pressure which would be otherwise involved on the joint.

PHYSIOTHERAPY

Choosing the ideal physiotherapeutic approach depends on the stage of the illness. In acute conditions, peaceful regime is recommended. That is supplemented with release of the soft tissues, which are often reflexively contracted. By the knee joint it is usually in the back of the knees (flexors of the knee joints) and inner thigh muscles. Outer thigh muscles are usually reflexively dampened, which can result in instability of the whole joint. Therefore is it ideal to exercise these muscle groups (isometrically - activating muscles without moving the leg) and relaxing the overloaded muscles. Isometrically you can exercise buttocks muscles, thighs and abdomen. Very effective and relieving is the gentle manual traction (stretching) of the knee joint.

It is important to continue to exercise even after the problems subside, but it is unnecessary to burden the joint and avoiding other positions which only cause pain. Very popular and effective is an exercise with the use of unstable surfaces, such as balance disc, BOSU, Posturomed and sensory motor skills exercise. Thanks to these techniques, not only the affected area but the whole body receives back its stability and certainty during walking and sport. Among ideal sport activities is swimming, where the pressure on the joints is significantly reduced, but also nordic walking and other activities are ideal. During the physical activity it is ideal to avoid hitting the ground too hard, as well as avoiding impacts and swinging moves. Very ideal option is to use the functional tape (special band applied on the skin), which directly affects the specific muscles. Whether the tape is used for a specific stimulation or just for relaxation, the area will be stabilized and the movement and exercising more effective. Functional tape will last you one week from application on the skin.

Lunge on the BOSU Lunge into standing position BOSU Flowin

THERAPY ESWT - FOCUSED SHOCKWAVE THERAPY

If the arthrosis is accompanied with swelling, it is ideal to start with the focused shock wave therapy, which can aim on the swelling and get rid of quickly it by starting the natural repairing process, usually after the first application. It is also optional to use radial shock wave therapy on the muscles or muscle groups which are in a high tension. Shockwave can relax such muscles and its effect is long lasting, but the treatment has to be started immediately in the first stages of the illness. Application is then repeated according to the need 1-3x, in the interval of 7-10 days.

CASE FROM A CLINICAL EXPERIENCE

A woman visited us at FYZIOklinika, with painful problems in the knee. She was waiting for operation, she needed complete endoprosthesis (TEP). the knee was significantly swelling and it was painful. The pain shooted into the whole leg and foot. In a specific angle she was able to bend her knee, but it got blocked and thanks to the swelling it was less movable and flexible.

She started to visit FYZIOklinika before the operation took place, she went through shock wave therapy, and pressotherapy, 2-3x a week for 3 months. At the end of the treatment, she felt much better, the knee was without any swelling and the pain was much lower. She wasn’t even troubled by any pain shooting into the whole leg. She didn’t even have to take painkillers anymore. Only sometimes during night she needed the pills, but even after taking the pills, the pain remained in the knee in a specific angle. This relates to the degenerative wearing off of the cartilage of the knee joint, therefore the replacement was needed here anyway.

Therapeutic point of view

Before the operation, it is ideal to go to pressotherapy and physiotherapy. It will accelerate the mobility of the whole leg, smaller swelling does not create pressure on the blood vessels, the wounds then heal more easily and the client will be able to rehabilitate faster and return back to the daily activities. Lowered pain contributes to a more positive approach towards the treatment, operation and post-operational treatment. Pressotherapy before and after the operation decreases the risk of inflammation of the veins, thrombosis and embolism.

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Arthrosis of the hip join



Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: KOLÁŘ, P. et al., Rehabilitace v klinické praxi. Praha: Galén, 2012. ISBN: 978-80-7262-657-1., Clinical experience in diagnostics and therapy with focused shock wave.

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