Sports medicine: diseases — симптомы, диагностика и лечение

Osteoarthritis of the knee joint is the gradual destruction of articular cartilage, due to which the bones begin to rub against each other. This is the most common cause of knee pain in people over 45 years of age. Modern medicine cannot restore already lost cartilage, and this should be understood immediately - so as not to spend years on products that promise to “grow cartilage.” But it is quite possible to slow down the destruction, remove pain and maintain mobility, and in severe cases, endoprosthetics returns a person to normal life.

The menisci are two cartilaginous crescents between the femur and tibia that act as pads: they distribute the load across the joint, absorb shock and keep the knee from excessive displacement. Their rupture is one of the most common findings in the knee joint and at the same time the most overrated. The statement “the meniscus is torn, which means surgery is needed” sounds logical, but has long been refuted: for a degenerative tear in a middle-aged person, the correct program of physical therapy gives results no worse than arthroscopy, and this has been confirmed by large international studies. Moreover, altered menisci are found on MRI in many people over fifty years of age who do not complain of anything at all. Therefore, they operate not on a snapshot, but on a specific situation: a true blockade of the joint, a fresh traumatic rupture in an active person, a displaced flap that mechanically prevents the joint from working.

The anterior cruciate ligament runs inside the knee joint and keeps the tibia from moving forward and from excessive rotation. Its rupture is an injury that almost always occurs without any contact with an opponent: a person brakes sharply, turns on the supporting leg or lands poorly, hears or feels a click, and after an hour or two the knee swells. There are two misconceptions here. The first is “if I walk, then the ligament is intact”: a torn ligament does not interfere with walking in a straight line, problems begin when turning and on uneven surfaces. The second is “I’ll lie down and it will heal”: a completely torn ligament inside the joint does not heal on its own, because it is washed by the joint fluid and its ends diverge. At the same time, not everyone needs surgery - and this is the third, most important detail, which is talked about least often.

Osteochondrosis is age-related degenerative changes in the intervertebral discs and joints of the spine. It is important to understand: to one degree or another, almost all people after 30–35 years have them, and in themselves they are not a disease. The problem is that this diagnosis in post-Soviet medicine is used to explain almost any pain - in the back, neck, head, arm, heart. Meanwhile, in most cases, back pain is not associated with “salt deposits”, but with muscles and joints, and responds well to movement, rather than rest and IVs.

Ankle sprain is the most common injury of the musculoskeletal system and at the same time the most underestimated. The name itself is misleading: the ligament does not stretch like an elastic band, tears in the fibers occur in it, and in case of severe injury, a complete rupture. Hence the main misconception: “stretching is nonsense, it will go away on its own.” Pain and swelling do go away in one or two weeks even without treatment, but a significant portion of people are left with a feeling of an unreliable leg, and they begin to twist it over and over again - on a curb, on a carpet, out of the blue. This condition is called chronic ankle instability, and it develops precisely because the first injury was considered a trifle and was not treated. The correct tactics in the first weeks are inexpensive and take a couple of months, but treating instability years later is a different story.

A heel spur is a bony growth on the heel bone that is usually found on x-rays in a person with heel pain. Hence the natural conclusion: it hurts because of the thorn, which means it needs to be removed. This conclusion is incorrect, and understanding why changes the entire treatment. The spur does not prick soft tissues and does not hurt in itself: it is also found in many people who have never complained about the heel, and vice versa, in some patients with severe pain it does not exist at all. The pain is caused by the condition of the plantar fascia - a dense ligament running from the heel to the toes: due to overload, microdamage and inflammation occur at the site of its attachment. The spur is only a trace of a long-standing overload, an imprint of the process, and not its cause. Therefore, it is not the spur that is treated, but the fascia, and the main remedy is not injections, but regular stretching.

Osgood-Schlatter disease is the most common cause of knee pain in active teenagers. During the period of rapid growth, bones lengthen faster than muscles, and the powerful quadriceps femoris muscle, through its own patellar ligament, forcefully pulls the not yet strengthened growth zone at its attachment to the tibia. The repetitive pull of jumping, running and squatting causes irritation and micro-damage, causing tenderness and the characteristic hard bump to appear under the kneecap. The condition is benign and self-limiting: it resolves as the growth plates close, although the raised bump often remains permanently.

Shoulder impingement syndrome is a condition in which the rotator cuff tendons and bursa become pinched in the narrow space between the head of the humerus and the acromion of the scapula. When you raise your arm, the tissues rub against the bony protrusion, become inflamed and swell, and the edema narrows the space even more - a vicious circle is formed. A person notices that raising his arm above shoulder level or placing it behind his back has become painful, and at night the pain prevents him from sleeping on that side. The reasons are different: overload when working with raised arms, weakness of the scapula muscles, the shape of the acromion, age-related changes in the tendons. Most patients benefit from a proper exercise program.

Jumper's knee is a tendinopathy of the patellar tendon that damages its attachment to the inferior pole of the kneecap. Occurs with repeated jumps, squats and sudden braking: volleyball, basketball, athletics, football, weightlifting. The ligament does not have time to recover between workouts, microdamages accumulate in it, and the structure of the tissue changes. The main symptom is a pinpoint pain just below the kneecap, which at first only bothers you after exercise, and then during it. There is little inflammation here in the usual sense, so injections and ointments do not solve the problem: the basis of treatment is a gradual force load on the ligament under the supervision of a specialist.

Periostitis of the lower leg is overuse pain along the inner edge of the tibia, which occurs in runners, dancers, football players and military personnel with a sharp increase in impact load. The leg muscles are attached to the bone through the periosteum; with constant shaking, the area of ​​their attachment is irritated, and the bone itself responds with restructuring. The pain first appears only at the beginning of the workout and goes away during the warm-up, then accompanies the entire run, and in advanced cases it also bothers you when walking. This is an important signal: with continued stress, the process may develop into a stress fracture. The good news is that with timely correction of the load and technique, the condition is completely reversible.