Gonarthrosis is also known as a degenerative disease of the knee. The degenerative process begins in the joint cartilage, leading to its gradual destruction, secondary inflammation and destruction of the remaining knee structures. Symptoms of degeneration are pain and swelling in the knee that increases with walking or other activities that overload the joint. There is also a gradual limitation of mobility in the joint and its deformation. In advanced forms of gonarthrosis, gait is significantly more difficult, and knee pain may also be present at rest.

Osteoarthritis of the knee (gonarthrosis) is caused by a number of factors related to:

- reduced quality of joint cartilage (genetic and metabolic factors),
- increased joint overload (overweight, standing work, competitive sports),
- chronic arthritis (rheumatoid diseases),
- disturbance of the joint axis (valgus knees, varus knees),
- disturbance of joint biomechanics (knee instability, condition after menisectomy),
- acute articular cartilage injuries (condition after joint fractures, knee sprains).

Degenerative changes can occur faster when a person with knee instability intends to play a sport that requires full knee function (skiing, contact sports). The ACL ligament reconstruction procedure is recommended for people:

- who underwent a conservative treatment process, but are not satisfied with the results,
- professionally practicing sports,
- with ACL ligament insufficiency found in both knee joints.

Treatment of osteoarthritis of the knee is mainly based on reducing factors accelerating the wear of the articular cartilage. Treatment includes: body weight normalization, avoidance of excessive joint overload, exercises to strengthen the muscles stabilizing the knee joint, physical therapy procedures and biological therapies (plasma with concentrated platelets, Orthokine). Sometimes it is necessary to surgically correct the joint axis (to prevent further progression of the deformity) or arthroscopic cleaning of the joint from pathological productive changes. Advanced degrees of degeneration may require knee arthroplasty, i.e. replacement of the damaged joint with an artificial implant.

Patellar chondromalacia is one of the major medical conditions affecting the kneecap. Initially, it is an inflammation that leads to a slow softening of the cartilage structure, followed by its abrasion and thinning. It is a progressive disease process that ultimately leads to the destruction of the kneecap. The changes affecting the patella cause its structure to defibrate, the formation of fissures and, as a consequence, degenerative changes within the patellofemoral joint and a clear limitation of the patella movement, which translates into restriction of the movement of the entire knee.

The reasons that provoke the development of patellar chondromalacia are divided into:

post-traumatic - each injury and repeated overstraining leads to the weakening of the cartilage,
dysplastic - defective shape of the articular surfaces, especially the patellofemoral joint or too close positioning of the patella to the femur, lead to cartilage irritation - conflict in the patellofemoral joint; in addition, any disturbances of the knee axis (valgus, varus) or the foot (flat feet) may be factors determining the development of chondromalacia,
idiopathic (of unknown origin) - in which the cause of degenerative changes cannot be determined,
others - a consequence of diseases (e.g. aseptic bone necrosis) or a complication of the use of steroidal anti-inflammatory drugs.

The main symptoms accompanying cartilage chondromalacia include:

- knee pain, located in the front of the knee, which increases when walking, climbing or descending stairs, squats, and in some cases is also very troublesome at rest,
- palpation pain in the patella area,
- feeling of stiffness in the knee
- swelling that appears after overloading the joint,
- a feeling of "crackling" and "crunching" in the joint, caused by rubbing uneven joint surfaces against each other,
- feeling of joint instability.

Treatment of chondromalacia mainly consists in reducing the factors accelerating the wear of the articular cartilage. Treatment includes normalizing body weight, avoiding excessive joint overload, exercises to strengthen the muscles that stabilize the knee joint, physical therapy and biological therapies. With advanced lesions, surgical treatment is necessary, most often with the use of an arthroscope. During arthroscopy, the doctor assesses the inside of the joint and, depending on the degree and extent of the cartilage damage, takes repair measures. In the case of a minor damage to the cartilage, the most common is to clean and even out the articular surface of the cartilage with a shaver. The following procedures are performed during arthroscopy: microfractures and patellar cartilage reconstruction techniques using Hyalofast or collagen membranes.

Symptoms that may initially indicate a tear of the tibial collateral ligament include pain and hematoma on the medial surface of the knee. Complete rupture of the MCL ligament may be accompanied by an audible click, sharp pain, significant swelling, and a feeling of instability in the knee joint. The diagnosis of knee ligament injuries should be performed by an orthopedic surgeon, who may also detect other injuries during the examination, e.g. a rupture of the medial meniscus.

Rehabilitation mainly consists in manual preparation of the site where the MCL ligament fibers have been damaged. As a result, the resulting scar will be flexible and painless. Rehabilitation is also aimed at strengthening the muscles that actively stabilize the knee joint to reduce the risk of repeated ligament injury.

When the result of the MCL ligament injury is instability of the knee joint, which hinders daily activity, the aim is to repair or reconstruct the tibial collateral ligament. The procedure is also performed when the ACL anterior cruciate ligament or PCL posterior cruciate ligament are simultaneously ruptured. After the surgery, the patient must participate in the rehabilitation process to enable safe return to the desired level of activity or sports.

Clicking hip syndrome affects mainly young and active people. As a result of overload as a result of, for example, too strenuous training, the muscles (most often the iliopsoas and the tension of the broad fascia along with the iliotibial belt) tighten, which rub against the bone parts of the femur, causing characteristic clicks and jumping during movement. This disease is not dangerous but requires treatment and consultation with an orthopedic doctor and a physiotherapist.

There are two ways of treatment - conservative and operative. Rehabilitation is recommended when the pain is minor and the disease does not interfere with the patient's everyday life. Properly selected exercises, manual therapy and physical therapy aimed at restoring the correct biomechanics in the hip joint.

On the other hand, when the symptoms are severe and the changes are directly related to the joint, arthroscopy, i.e. joint endoscopy, is performed. Then the doctor releases the tense muscle so that it does not create a conflict with the femur. It takes about 6 weeks to return to normal functioning. It is quite a safe procedure, provided that we entrust ourselves to qualified specialists.

Coxarthrosis (coxae - hip, arthrosis - degeneration) is otherwise a degenerative disease of the hip joints. The essence of the degeneration is the gradual destruction of the hip articular cartilage until the subcartilage layer of the bone is exposed. The damage causes secondary inflammation in the joint, which also affects the capsule and ligaments, leading to their fibrosis. The result is a painful restriction of the range of motion and pain when loading the hip with body weight.

Degeneration of the hip joint is accompanied by pain in the groin when walking, limitation of the mobility of the hip joint and the possible feeling of jumping when making movements with the lower limb. Advanced forms of degeneration are characterized by severe pain, stiffening of the hip joint and shortening of the length of the lower limb, causing limp and even difficulty in changing position.

Treatment of osteoarthritis is mainly symptomatic - its aim is to relieve pain and prevent the joint deformation from getting worse. Treatment is aimed at limiting the factor accelerating the degenerative process. Conservative management includes: joint relief, modification of physical activity, rehabilitation, biological therapies (plasma with concentrated platelets), and the use of painkillers and anti-inflammatory drugs. In selected patients, it is recommended to perform hip arthroscopy, which allows to remove changes that could lead to rapid destruction of the joint. The advanced stage of coxarthrosis requires arthroplasty, i.e. implantation of an artificial hip prosthesis.

Platfus to inaczej płaskostopie, które polega na nadmiernym obniżeniu się łuku podłużnego i/lub poprzecznego stopy. Widocznym objawem płaskostopia podłużnego jest wypłaszczenie sklepienia od przyśrodkowej strony stopy oraz nadmierne pochylenie pięty do środka (koślawość tyłostopia). Płaskostopiu poprzecznemu towarzyszy tworzenie się bolesnych modzeli i odgniotów na podeszwie z przodu stopy, poszerzenie przodostopia oraz zniekształcenia palców: haluksy, palce młotkowate lub szponiaste.

In the course of flat feet, the foot loses the ability to absorb shocks and to effectively bounce off the big toe. This leads to overloading the muscles and joints of the foot and disturbs the biomechanics of the higher parts of the body (knees, hips, spine). Flat feet may be accompanied by deformation of the foot and toes, making footwear selection difficult. The main problem of symptomatic flatfoot, however, is pain in damaged tissues, which makes it difficult to walk and worsens the quality of life.

Physiological flat feet in children and mild corrective forms of flat feet in adults do not cause pain. Pain from flat feet may occur when a person with flat feet is competing in sports (e.g., jogging), is overweight or spends the entire day standing. In such cases, muscles and joints may be overloaded, micro-injuries accumulate and pain may be triggered. Foot pain in advanced and permanent flat feet results most often from degenerative changes in joints and pathological stresses of soft tissues (ligaments, plantar fascia and muscle tendons).

Morton's neuroma belongs to the so-called pressure neuropathies, i.e. diseases manifested by impaired sensation in the area supplied by the compressed nerve. Morton's neuroma forms a pathological thickening of the common plantar nerve innervating the toes of the foot. This thickening is caused by mechanical irritation by misaligned metatarsal bones, transverse ligament of metatarsal heads or, less frequently, by the presence of a cystic nodule (ganglion).

Common symptoms of Morton's neuroma include a feeling of numbness and burning sensation in the second or third metatarsal spaces. Pain can radiate to the toes and is worsened when walking in narrow toe shoes or high heels. Initial diagnosis is facilitated by the Mulder test, which involves lateral compression of the foot at the level of the metatarsal heads. A sudden reduction in the space in which Morton's neuroma runs provokes pain and may cause a characteristic audible click. If Morton's neuroma is suspected, you should see an orthopedist who, in addition to clinical examination, will order imaging tests (ultrasound or magnetic resonance imaging).

Conservative treatment includes wearing shoes with wide toes and the use of orthopedic insoles that relieve the transverse arch of the foot. In the case of severe discomfort, a nerve block is performed. Surgical decompression of the nerve or complete excision of the neuroma is the best chance for a permanent cure.

The duration of treatment for an ankle sprain depends on the severity of the injury. With slight strains of a single ligament, recovery is usually possible after 2-3 weeks. When one or two ligaments are damaged or completely ruptured, the rehabilitation time may be extended to about 3 months. Some severe torsion injuries of the ankle, causing instability of the ankle joint, require surgical treatment followed by special rehabilitation protocols.

Walking is possible with the orthosis on and with the relief of the injured limb with elbow crutches. Partial stressing of a sprained ankle is permitted where it does not aggravate the pain or cause swelling of the ankle. Complete withdrawal of crutches is an individual matter - in most cases it is possible around 2 weeks after the injury. The orthosis is used until the 5-6 week.

Each sprain of the ankle joint should be diagnosed by an orthopedist for accompanying damage and complications. You should strictly follow the instructions of your doctor and physiotherapist regarding the weighting and movement of the injured ankle. Reduction of pain and swelling in the first days after the injury can be achieved by: applying cool compresses, bandaging the ankle joint and placing the limb slightly higher than the hip level.

It is now believed that the heel spurs visible on x-rays are not the primary cause of heel pain. Heel pain is most often caused by plantar fasciitis at the site of its attachment to the calcaneus. Treatment should focus on reconstructing the fascia structure, rather than breaking down or removing the calcaneus bone spur. In most cases, conservative treatment is sufficient, which includes regular exercises to stretch the plantar fascia and calf triceps, wearing orthopedic insoles, and shock wave therapy. Treatments in the field of regenerative medicine are a modern form of therapy. If you want to read more about how we treat it in our hospital, click here. Surgical treatment is the last resort and involves a partial dissection of the aponeurosis (fasciotomy).

A typical symptom of plantar fasciitis is pain in the medial area of ​​the heel, which is strongest in the morning, especially during the first steps after getting out of bed. The feet appear stiff and painful, only after the feet “part” or massaged, the heel discomfort slightly diminishes. Palpation tenderness at the heel is also observed, and there is often increased tension in the calf muscles.

Prophylaxis of plantar fasciitis consists in limiting the factors leading to contracture and overload of the fascia. The treatment includes regular stretching of the aponeurosis and triceps muscle of the calf, self-massage of the plantar part of the foot, weight reduction, wearing insoles correcting possible valgus of the feet and selection of comfortable footwear. The above-mentioned treatments help to reduce the risk of the disease recurrence.

The length of treatment depends on the location and degree of damage to the peroneal nerve. Electrodiagnostic tests - electroneurography (ENG) are used to assess the degree of nerve damage. The nerve regenerates 1-1.5 mm a day. The precise determination of the time of the foot dorsiflexion recovery is very individual. Sometimes the foot function returns only partially and it is necessary to continue using the foot drop brace. In some cases, the foot never regains active dorsiflexion movement again.

Surgery may be considered when there is evidence of nerve damage that prevents the dorsiflexus of the foot from resuming activity. The time that has elapsed since the loss of the ability to perform active movement is of great importance - it is important that the ankle joint retains the required passive range of dorsiflexion until the operation.

The iliotibial band, or ITB, is the lateral part of the broad fascia that closely covers the thigh muscles. It is a strong, inelastic connective tissue structure up to approx. 6 cm wide, which begins in the pelvic area, on the iliac crest, connected by three tendon strands originating from the broad fascia tensioner muscles as well as the gluteus and gluteus muscles, which ensure the appropriate tension of the band. It then runs along the lateral surface of the thigh, attaching on the way to the roughened line of the femoral shaft, successively to the lateral epicondyle of the femur, lateral patellas and ends at the anterolateral side of the tibia condyle (the so-called Gerdi's tubercle).

The task of the iliotibial band is to inhibit the adduction movement in the hip joint and to stiffen the knee joint in an upright position. By connecting with the collateral ligament and the biceps muscle of the thigh, it provides stabilization of the knee from the outside.

Physiotherapeutic procedures in the case of a runner's knee are usually conservative and involve targeted rehabilitation. In the first stage of treatment, it is especially important to temporarily stop training or limit it to activities that do not cause ailments or introduce replacement training. Then, implement measures to control inflammation, pain and swelling in line with the RICE principle. Additionally, non-steroidal anti-inflammatory drugs (e.g. ibuprofen) can be used. In the next stage, the rehabilitation procedure should be aimed at relaxing the iliotibial band and strengthening the gluteus medius muscle. It is also time to identify the biomechanical factors and training errors that caused the ailments, which is a key element in minimizing the risk of recurrence.

The main and characteristic symptoms of a runner's knee include:

- Burning, sharp pain in the side of the knee joint, in the area of ​​the lateral epicondyle of the femur or in the entire ITB area,
- diffuse pain, difficult to localize,
- ailments increase during physical activity, climbing stairs and getting up from a sitting position, and decrease during knee extension,
- discomfort occurs with every training, almost the same distance and does not cease when the effort is continued,
- swelling and redness at the site of injury
- limb function limitation.

Sports pubalgia manifests itself as pain in the groin or the symphysis pubis caused by torn tendons in the abdominal muscles and / or those of the thigh adductors. These muscles attach to the pubic bone. Sports pubalgia occurs in athletes practicing disciplines that are characterized by sudden changes in the direction of running and positions in wide legs combined with torsional movements of the torso (footballers, hockey players, rugby players, tennis players). The pelvis in the area of ​​the symphysis is then subjected to enormous forces related to the tension of the abdominal muscles and the thigh adductors, which leads to an injury. Sports pubalgia also includes damage to the transverse fascia of the abdomen, which can sometimes lead to an inguinal hernia.

Treatment of torn prote muscle attachment to the pubic bone involves properly directed rehabilitation. In the first stage, the aim is to heal the damaged tendon of the muscle. The next goal is to equalize abnormal tensions within the spine-pelvis-lower limb complex and learn to activate the muscles responsible for the active stabilization of the trunk. The last stage includes strengthening exercises and strength and endurance training in patterns typical for a given sports discipline. In most cases, it is possible to return to sports in the 6-8 weeks after starting physiotherapy.

Inguinal hernia may occur only in some cases of damage to the abdominal integuments typical of sports pubalgia. Extensive tearing of the abdominal transverse fascia may be related to the actual bulging of the lower abdominal organs by the damaged area. In most cases, however, pubalgia involves injuries to the attachments of the abdominal muscles and the muscles that add to the thigh to the pubic bone, which is not accompanied by the formation of a hernia.

Osteoporosis is a metabolic disease of bone in which the bone mass gradually loses itself. The essence of the disease is the excessive predominance of bone resorption processes over the processes of creating new bone tissue. Osteoporosis leads to a reduction in the mechanical strength of bones, and therefore significantly increases the risk of fractures. Osteoporotic fractures occur as a result of a low-severity injury, such as when you lean on your arm or fall from a standing position. Osteoporosis can be the result of inadequate diet, a sedentary lifestyle, hormonal disorders, comorbidities, and the chronic use of certain medications.

The early stages of osteoporosis are often asymptomatic. Only when the bones are fractured or fractured do pain in the spine and long bones appear. The force of gravity and the load on the body weight lead to deformation of the vertebral bodies, which is manifested by changes in the figure - a reduction in body height and rounding of the back in the thoracic spine.

Densitometric examination allows to assess bone mineral density. The examination is performed using an apparatus that emits small amounts of X-rays. During the diagnosis, the patient lies on a special table, and the device x-rays the bone tissue in a given area of ​​the body - most often it is the proximal epiphysis of the femur or the lumbar spine. Densitometry is a completely painless examination and does not require any special preparation. The results are presented in the form of indicators that compare the bone mineral density of the examined person with the bone density of the healthy population (T-score) and people in the same age group (Z-score).

Diet in patients with osteoporosis should be well-balanced, adjusted to age, gender, and the degree of deficiency of certain components shown in laboratory tests. Particular attention should be paid to meeting the demand for protein, calcium and vitamin D, which build bone tissue or affect its metabolism.

Dobór metod leczenia osteoporozy zależy od ewentualnej przyczyny jej wystąpienia. Postępowanie w większości przypadków jest kompleksowe i uwzględnia:

• przyjmowanie leków hamujących utratę masy kostnej,
• rehabilitację pod postacią bezpiecznych ćwiczeń poprawiających postawę i zmniejszających ryzyko upadku,
• leczenie dietetyczne,
• suplementację wapnia i witaminy D,
• ograniczenie czynników ryzyka (rzucenie palenia, rezygnację z alkoholu).

U kobiet po menopauzie lub z niedoborem estrogenów stosuje się hormonalną terapię zastępczą. Plan leczenia ustalany jest przez lekarza prowadzącego po dokładnej diagnostyce uwzględniającej ocenę zaawansowania osteoporozy oraz indywidualnych uwarunkowań zdrowia pacjenta.

The degenerative spine consists in the sliding of the vertebra along with the higher section of the spine in relation to the lower vertebrae. The most common is the formation of anterior spondylolisthesis in the lumbosacral section of the spine - the last lumbar vertebra slides forward relative to the first sacral vertebra. The causes of degenerative spondylolisthesis are degenerative changes in the intervertebral disc and intervertebral joints. Symptoms of spondylolisthesis increase with the degree of skidding - from slight discomfort in the lumbar region and limited mobility to the appearance of neurological symptoms resulting from compression of nerve structures (sensory disturbances, weakening of the muscles of the lower extremities).

The procedure depends on the severity of the spondylolisthesis. Slight shifts (1st and 2nd degree) are rehabilitated. Painkillers and anti-inflammatory drugs are used as supportive measures. In the event of unsuccessful rehabilitation, further progression of the spondylolisthesis, the appearance of paresis or urinary incontinence, as well as third and fourth degree spondylolisthesis, the doctor will qualify for surgical treatment. The aim of the procedure is to decompress the nerve structures and to stabilize the retracted vertebra with implants in the corrected position.