As the saying goes, “the old man gets old before his legs”. If the knee joint is diseased, walking slowly and swaying will give people the impression that the person is old. This also shows how important the knee joint is to a person. On the other hand, the human body cannot move without the knee joint. People are upright and the knees carry most of the body’s weight. If you are overweight, you put a lot of pressure on the knee joint, which is why it is one of the organs that degenerates earlier and faster. Modern medicine divides knee disease into secondary and primary injuries. Secondary injuries are often secondary to congenital or acquired deformities of the joint, joint injuries such as joint fracture or dislocation, obesity, congenital hip dislocation, knee valgus, diabetes, acromegaly, deformational osteitis, osteochondrosis of the femoral head, slipped epiphysis of the femoral head, neuropathic joint (Charcot joint), and ischemic necrosis. Primary osteoarthrosis is often hereditary, characterized by the presence of heberden’s nodes, and is most often seen in middle age and in the elderly (over 50 years of age).
The pathogenesis is like this. The disease begins with a lesion on the cartilage surface of the human knee. The normal cartilage surface is light blue in color, moist and shiny, and firm when pressed. At the beginning of the disease, a part of the cartilage surface becomes light yellow, rough and lustrous, and soft when pressed, and later the part of the bone surface develops a fissure or a fuzzy appearance. The cartilaginous surface becomes soft, fractures and falls off, exposing the cartilage plate to the knee joint cavity, and the exposed subchondral bone plate is directly impacted by repeated stresses, resulting in reactive osteophytes. The ligaments attached to the epiphysis are also relaxed by the loss of articular cartilage, and the various activities of the joint can stimulate the cartilage membrane, so that bone spurs often form at the edges of the bone ends. In most cases, intercondylar spur hyperplasia can also be seen, which is due to the high involvement of the cruciate ligament and calcium deposition. In most cases, the injury is secondary to an injury to the tissues surrounding the knee joint, which causes adhesions and ties that disrupt the balance of forces in the knee joint and create high stress points in the joint. The second is due to other diseases, such as rheumatoid arthritis, which disrupt the soft tissues around the joint, thus causing an imbalance in the force balance within the joint, which leads to the development of bone spurs.
In terms of knee joint mechanics, in extension, the knee joint is stable in both rotation and inversion, with the soft tissues holding it firmly in place; in flexion, from 0° to 90°, it becomes more and more mobile. When walking, the knee joint is flexed and extended, and the range of flexion is within 30°. When the joint is straightened, it is under pressure, but when it is flexed, the joint is not under pressure.
In summary, we know some of the causes and development process, the key is how to prevent and treat.
I. How to prevent;
Prevention is the main focus of any disease. Chinese medicine says “not to treat the disease to cure me before the disease”. In a word, treat our joints well. First of all, we should prevent some diseases, such as diabetes, obesity, etc. On the other hand, we should take care of the knee joint to avoid trauma, fracture and overstrain. Osteoarthrosis of the knee is also a gradual process, so avoid cold and moisture as much as possible. For example, some women love beauty and wear skirts very early in life, but according to clinical observation, 40% of knee arthropathies in women are due to cold stimulation. Knee joints should also be cared for like the face, the blood circulation of the face and knee joints are not the same. The face is not afraid of cold because the blood flow is rich and the skin structure is different from that of the knee. The synovial membrane inside the knee joint produces synovial fluid and lubricates the knee joint, so cold stimulation will impede blood circulation and affect the production of synovial fluid, which will inevitably produce an inflammatory response and over time produce osteoarthrosis. Another point is to do exercise moderately, too much is not enough. Office workers, out of the car exercise is not enough to produce premature degeneration of motor tissue, with into the waste, muscle and ligament flaccid weakness, bone calcium content is reduced; especially after menopause hormone levels decline, serious decalcification, coupled with insufficient exercise osteoporosis is common, so it is easy to produce bone spurs. Conversely, there are some older people, busy at work, exercise less, after retirement time has, every day climbing and will be over-exercised, accelerating the destruction of the joints. Because some cartilage surfaces have degenerated and fallen off after 40 years of age, repeated excessive friction and weight-bearing will accelerate osteophytes. Therefore, I believe that young people and middle-aged people should increase their exercise, old people can walk, but climbing such a large amount of exercise should be moderate. It is important to do the appropriate exercise according to the individual’s physical condition.
II. Diagnosis.
1, knee pain, squatting difficulties, unfavorable extension and flexion.
2. Joint pain is usually worse after exercise and less after rest. There is also pain when standing after rest.
3, The joint is often glued and accompanied by the phenomenon of soft legs, and there is a feeling of stiffness during movement, which improves again after activity.
4. Mild or moderate limitation of joint function.
5, X-ray front and side view of the knee joint shows narrowing of the joint space, sclerosis of the subchondral bone edges, hyperplasia of the joint edges, or bone spur generation.
6. Positive floating patellar test in case of effusion
Third, rehabilitation treatment.
Can be combined with massage, physical therapy, Chinese medicine and other treatments.
Deer horn gum, deer bitter herb, bonesetter, wolfberry, mulberry bark, Wei Ling Xian, Epimedium
Radix Angelicae Sinensis, Glycyrrhiza glabra
Addition and subtraction: add Moutong, Zhi Mu, Fried Coix Seed, Chuan Dioscorea if there is fluid, add Yin Hua and Fang Feng if there is heat, add Tao Ren and Safflower if the knee is dull in color.
Rehabilitation training: This includes reducing pain, maintaining joint mobility, maintaining muscle strength, reducing joint weight bearing, preventing and reducing contractures, and maintaining joint alignment. Strenuous exercise of normal joints does not lead to osteoarthritis, but waiting for the presence of osteoarthritis, frequent use of the joints will accelerate the development of osteoarthritis. However, proper exercise increases muscle strength and aerobic capacity, reduces pain, and patients with osteoarthritis have less functional impairment after training. Pain often involves “”joint capsules and tendon contractures. If the knee cannot be fully extended, it relies on the weak quadriceps to provide stability, resulting in increased pressure within the joint structures and further joint dysfunction. Greater knee flexion should be avoided to avoid increasing the pressure between the joints. Shoes with medial or lateral wedge or tapered soles may reduce inversion and valgus deformities.
Patients should not place pillows under the knee at night, as this can induce knee flexion contractures, ankle plantarflexion and N-fossa venous insufficiency. One of the important functional goals is to maintain knee extension, and contractures beyond 10 degrees of flexion alter the optimal mechanics of the knee and increase the stresses generated by weight bearing.
The quadriceps and posterior calf muscle groups in OA show decreased muscle strength on both isometric and isometric tests. To increase muscle strength, the non-weight-bearing quadriceps and posterior calf muscles on the side of the knee with OA should be trained isometrically twice daily. Due to knee and femoral disorders, compression of the patella and femur should be avoided when extending the knee quadriceps isometric contraction. More complex knee isometric and isotonic training and aerobic training programs can increase quadriceps and posterior calf muscle strength and enhance sitting, standing, walking and stair climbing abilities.