Treatment of osteoarthritis of the knee, treatment of gonarthrosis – to put it mildly, not the easiest task. Therefore, before you begin your difficult struggle with this disease, be sure to find a good doctor, examine him and make a treatment plan with him.
Do not try to establish a diagnosis yourself!
The fact is that lesions of the joint, resembling arthrosis, occur in many other diseases, and people with little knowledge very often make mistakes in determining the diagnosis. It is better not to save time and money on medical advice, because a mistake can cost you much more in all respects.
But this does not mean that you are obliged to blindly believe any doctor and should not delve into the essence of his recommendations, comprehending the mechanism of action of those drugs that you are prescribed. The patient must understand the meaning of medical appointments and represent what these or other medical procedures are carried out for.
So, in the therapeutic treatment of gonarthrosis It is important to combine a number of therapeutic measures in such a way as to solve several problems at once:
- eliminate pain;
- improve the nutrition of the articular cartilage and speed up its recovery;
- activate blood circulation in the affected joint;
- reduce pressure on damaged articular bones and increase the distance between them;
- strengthen the surrounding muscles;
- increase joint mobility.
Below we consider how this or that treatment method helps to achieve the goals:
New! Video: Treatment of osteoarthritis of the knee joint. How to cure a sore knee,
1. Non-steroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs – NSAIDs: diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, celebrex, nimulide and their derivatives.
With arthritis, nonsteroid, that is, non-hormonal, anti-inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, since it is impossible to start a normal treatment against the background of severe pain. Only by eliminating the acute pain with anti-inflammatory drugs, you can subsequently move on, for example, to massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.
However, it is undesirable to use drugs of this group for a long time, as they are able to mask the manifestations of the disease. After all, when pain decreases, a deceptive impression is created that a cure has begun. Arthrosis, meanwhile, continues to progress: NSAIDs only eliminate the individual symptoms of the disease, but do not cure it.
Moreover, in recent years, evidence has been obtained indicating the harmful effects of long-term use of nonsteroidal anti-inflammatory drugs on the synthesis of proteoglycans. Proteoglycan molecules are responsible for the entry of water into the cartilage, and the violation of their function leads to the dehydration of cartilage tissue. As a result, the cartilage already affected by arthrosis begins to break down even faster. Thus, tablets that a patient takes to reduce joint pain can accelerate the destruction of that joint.
In addition, using nonsteroidal anti-inflammatory drugs, it must be remembered that all of them have serious contraindications and with prolonged use can have significant side effects (which are described in detail in Dr. Evdokimenko’s book “Pain in the legs”).
2. Chondroprotectors – glucosamine and chondroitin sulfate
Glucosamine and chondroitin sulfate belong to the group of chondroprotectors – substances that nourish cartilage tissue and restore the structure of damaged cartilage of the joints.
Chondroprotectors (glucosamine and chondroitin sulfate) are the most useful group of drugs for the treatment of arthrosis.
Unlike nonsteroidal anti-inflammatory drugs (NSAIDs), chondroprotectors not only alleviate the symptoms of arthrosis, but affect the foundation of the disease: the use of glucosamine and chondroitin sulfate helps restore the cartilage surfaces of the hip joint, improve the production of joint fluid and normalize its lubricant properties.
Such a complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis. However, do not exaggerate the capabilities of these drugs.
Chondroprotectors are not very effective in the third stage of arthrosis, when the cartilage is almost completely destroyed. After all, it is impossible to grow new cartilage tissue or return the former shape to the deformed bones of the knee using glucosamine and chondroitin sulfate. And at the first-second stages of gonarthrosis chondroprotectors act So slow and improve the patient’s condition is not immediately. To get a real result, it is required to undergo at least 2-3 courses of treatment with these drugs, which usually takes from six months to one and a half years, although advertising of glucosamine and chondroitin sulfate usually promises recovery in a shorter time.
I want to note with regret that in these promises there is some slyness. With all the usefulness of chondroprotectors, miraculous medicinal healing of arthrosis is not to be expected. Recovery usually requires much more effort than taking two or three dozen pills.
Probably, the very fact that the chondroprotection opportunities are often overestimated in advertising caused the attacks on these drugs in one of the “popular” TV shows. The TV presenter of the Health program, with someone’s filing, said that chondroprotectors are useless to treat arthrosis.
Thus, she threw a huge shadow on these very useful drugs, questioned the work of a number of serious medical institutions and clinics that tested these drugs and proved that chondroprotectors uniquely contribute to the restoration of articular cartilage and retard the development of arthrosis.
Indeed, only after clinical approbation of chondroprotectors, the Ministry of Health of Russia allowed them to be sold in pharmacies as medicines (of course, this does not apply to those medicines that have not been registered as a medicine and are sold as bio-additives). Another thing is that, as I said, chondroprotectors are not “omnipotent”. Treatment with these drugs requires proper and long-term use in combination with other methods of treatment.
Nevertheless, of all the drugs used in the treatment of arthrosis, it is chondroprotectors that are the most beneficial. In addition, they have virtually no contraindications and rarely give unpleasant side effects.
It is important to know! For maximum therapeutic effect chondroprotectors must be used in courses, regularly, for a long time. Practically it is meaningless to take glucosamine and chondroitin sulfate once or occasionally.
In addition, in order to obtain the maximum effect from the use of chondroprotectors, it is necessary to ensure the daily intake of adequate, that is, sufficient doses of drugs throughout the course of treatment. A sufficient dose of glucosamine is 1000-1500 mg (milligram), and chondroitin sulfate – 1000 mg per day.
Note Dr. Evdokimenko. Scientists are now arguing about how best to take glucosamine and chondroitin sulfate – simultaneously or separately. Opinions are divided. Some scientists argue that glucosamine and chondroitin sulfate should be taken together at the same time. Others also argue that glucosamine and chondroitin sulfate, while taking it, interfere with each other, and they must be taken separately.
It is possible that there is a clash of interests of those manufacturers who produce monopreparations containing only glucosamine or only chondroitin sulfate, with those manufacturers that produce “two in one” preparations containing a combination of glucosamine with chondroitin sulfate. Therefore, the issue of joint or separate use of glucosamine and chondroitin sulfate remains open.
Although my personal observations suggest that monopreparations and combination medications are useful, the only question is who produces them and how well. That is, the drug, released on the knee by some dubious firm, and even with violations of technology, is unlikely to be useful, regardless of whether it contains glucosamine, or chondroitin sulfate, or both. Conversely, any chondroprotector released by the rules will be useful. But, in my opinion, a high-quality combined preparation containing both glucosamine and chondroitin sulfate is still more beneficial than any single preparation.
At present (in 2016), in our pharmacological market, chondroprotectors are most widely represented by the following proven drugs:
Artra, US production. Good drug. Available in tablets containing 500 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full therapeutic effect, you must take 2 tablets per day.
Dona, production of Italy. Monopreparation containing only glucosamine. Release form: solution for intramuscular injections; 1 ampoule of solution contains 400 mg of glucosamine sulfate. The solution is mixed with an ampoule of special solvent, and injected into the buttock 3 times a week. The course of treatment is 12 injections 2-3 times a year. In addition, there are drugs for oral administration DONA: powder, packaging of 1500 mg of glucosamine in 1 sachet; per day, you must take 1 sachet of the drug; or capsules containing 250 mg of glucosamine; per day you need to take 4-6 capsules of the drug.
Struktum, production of France. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 or 500 mg of chondroitin sulfate. Per day, you must take 4 tablets containing 250 mg of chondroitin sulfate, or 2 tablets containing 500 mg of chondroitin sulfate.
Teraflex, UK production. Product form: capsules containing 400 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full therapeutic effect, you must take at least 2 tablets per day.
Chondroitin AKOS, production of Russia. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 mg of chondroitin sulfate. To achieve a full therapeutic effect, you must take at least 4 capsules per day.
Hondrolon, production of Russia. Monopreparation containing only chondroitin sulfate. Product form: ampoules containing 100 mg of chondroitin sulfate. To achieve a full therapeutic effect, it is necessary to conduct a course of 20-25 intramuscular injections.
Elbona, production of Russia. Monopreparation containing only glucosamine. Release form: solution for intramuscular injections; 1 ampoule of solution contains 400 mg of glucosamine sulfate. The solution is mixed with an ampoule of special solvent, and injected into the buttock 3 times a week. The course of treatment is 12 injections 2-3 times a year.
As you can see from the above list, the choice of chondroprotectors for the treatment of arthrosis is quite large. What exactly to choose from all this variety? Check with your health care provider. Personally, I really like Artra – it is a good, proven and balanced drug.
From injection drugs (that is, for injections), I most often use Don. But in powder or capsules, according to my observations, Don is less effective.
In any case, with proper use, any proven chondroprotectors will definitely benefit the treatment of osteoarthritis, especially stage 1-2 arthrosis. And what is important, drugs containing glucosamine and chondroitin sulfate, almost no contraindications. They should not be used only by those who suffer from phenylketonuria or are hypersensitive to one of these two components.
They also have very few side effects. Chondroitin sulfate sometimes causes allergies. Glucosamine can occasionally provoke abdominal pain, bloating, diarrhea or constipation and very rarely – dizziness, headache, pain in the legs or leg edema, tachycardia, drowsiness or insomnia. But in general, I repeat, these drugs very rarely cause any discomfort.
The duration of treatment with glucosamine and chondroitin sulfate may be different, but most often I suggest my patients to take chondroprotectors daily for 3-5 months. After at least six months, the treatment must be repeated.
Keep in mind! In addition to the above preparations of chondroprotectors, bioadditives containing glucosamine and chondroitin sulfate can be found on the market: for example, Susanorm Life Formula, chondro, stopartrit other. These supplements are not full-fledged medicines, as they have not yet passed medical testing and are not registered as drugs! They have yet to undergo clinical trials to prove their clinical efficacy!
3. Healing Ointments and Creams
Healing ointments and creams in no way can heal osteoarthritis of the knee joints (even if their advertising claims the opposite). Nevertheless, they can alleviate the patient’s condition and reduce pain in the diseased knee. And in this sense, ointments are sometimes very useful.
So, in case of osteoarthritis of the knee joint, which is without synovitis, I recommend to my patients warming ointments in order to improve blood circulation in the joint.
Menovazin, Gevkamen, Espol, Nikofleks-cream, etc. are used for this. The listed ointments usually cause the patient a feeling of pleasant warmth and comfort. They rarely give any side effects.
Ointments based on nonsteroidal anti-inflammatory substances (Indomethacin, Butadionovaya, Dolgit, Voltaren-gel, Fastum) are used in cases where the course of gonarthrosis is aggravated by symptoms of synovitis. Unfortunately, they do not act as effectively as we would like – because the skin does not miss more than 5 – 7% of the active substance, and this is clearly not enough to develop a full-fledged anti-inflammatory effect.
4. Means for compresses
Means for compresses have a slightly greater therapeutic effect compared with ointments.
Of the means of local action used in our time, in my opinion, three drugs deserve the most attention: dimexide, bischofite and medical bile.
Dimexide – the chemical, a liquid with colorless crystals, has a good anti-inflammatory and analgesic effect. At the same time, unlike many other substances of external use, dimexide is really able to penetrate the skin barriers. That is, the dimexide applied to the skin is actually absorbed by the body and works inside it, reducing inflammation in the focus of the disease. In addition, dimexide has absorbable properties and improves metabolism in the field of application, which makes it most useful in the treatment of arthrosis, occurring with the presence of synovitis.
Bishofit – oil derivative, brine, produced by drilling oil wells. He gained his fame thanks to the drillers, who were the first to pay attention to its therapeutic effect in case of arthrosis. During work on oil wells from the continuous contact with the oil brine, drillers resorbed arthritic nodules on their hands. Later it turned out that Bishofit has a moderate anti-inflammatory and analgesic effect, as well as a warming effect, causing a feeling of pleasant warmth.
Bile medical – natural bile, extracted from the gallbladder of cows or pigs. Bile has an absorbing and warming effect and is used in the same cases as bishofit, but has some contraindications: it cannot be used for pustular skin diseases, inflammatory diseases of the lymph nodes and ducts, feverish states with fever.
5. Intra-articular injections (injections into the joint)
Intra-articular injections are often used to provide emergency care for osteoarthritis of the knee joint. In many cases, intra-articular injection can really alleviate the patient’s condition. But at the same time, injections in the joint with arthrosis are done much more often than necessary in reality. It is about this wrong trend, in my opinion, that I want to talk in more detail.
Most often, the joint is injected drugs of corticosteroid hormones: kenalog, diprospan, hydrocortisone, phosterone, celeston.
Corticosteroids are good because they quickly and effectively suppress pain and inflammation in synovitis (swelling and swelling of the joint). It is the speed with which the therapeutic effect is achieved – the reason why corticosteroid injections have gained particular popularity among doctors. But this led to the fact that intra-articular injections of hormones began to be carried out even without real need. For example, I have repeatedly encountered the fact that hormones were injected into a patient’s joint with a prophylactic purpose in order to prevent the further development of arthrosis.
However, the problem is that just the arthrosis itself does not corticosteroids and cannot be treated. So, they cannot prevent the development of arthrosis! Corticosteroids do not improve the condition of the articular cartilage, do not strengthen the bone tissue and do not restore normal blood circulation. All that they can do is reduce the body’s response to an inflammatory response to a particular injury in the joint cavity. Therefore, the use of intra-articular injections of hormonal drugs as an independent method of treatment is meaningless: they should be used only in the complex therapy of arthrosis.
For example, a patient has gonarthrosis stage II with swelling of the joint due to fluid accumulation in it. Fluid accumulation (synovitis) makes it difficult to carry out therapeutic procedures: manual therapy, gymnastics, physiotherapy. In such a situation, the doctor performs intra-articular injection of a hormonal drug to eliminate synovitis, and after a week proceeds with the rest of the active therapeutic measures – this is the right approach.
Now imagine another situation. The patient also has stage II gonarthrosis, but without fluid accumulation and swelling of the joint. Is it necessary to introduce corticosteroids into the joint in this case? Certainly not. No inflammation – there is no point of impact for corticosteroid hormones.
But even if intra-articular administration of corticosteroids is indeed necessary, a number of rules must be followed. Firstly, it is undesirable to make such injections into the same joint more often than 1 time in 2 weeks. The fact is that the medicine administered “will work” in full force not immediately and the doctor will be able to finally evaluate the effect of the procedure after just 10 to 14 days.
You also need to know that usually the first injection of corticosteroids brings more relief than the next. And if the first intra-articular administration of the drug did not work, it is unlikely that the second or third administration of the same drug will give it to the same place. In the case of the ineffectiveness of the first intra-articular injection, you must either change the drug, or, if the change of medication did not help, it is more accurate to choose the injection site.
If, after this, the introduction of corticosteroid into the joint did not give the desired result, it is better to abandon the very idea of treating this joint with hormonal drugs. Especially since it is generally undesirable to inject hormones into the same joint more than four or five times, otherwise the likelihood of side effects increases significantly.
Unfortunately, in practice, one has to deal with excessive “purposefulness” of doctors, who repeatedly inject corticosteroids over and over into the same joint, without having achieved at least the minimum effect with the first three injections. More than others I was struck by two such cases.
One of the patients was given “only” ten injections of kenalog, and the procedure was performed daily, even without the prescribed 10-day break necessary to evaluate the results of the injection. And the second patient was injected with hormones inside the knee joints, observing the interval (albeit only 3-5 days), but he received twenty to twenty-five injections of corticosteroids into one joint for the course of treatment!
It would seem that the doctor overdone a little – no big deal. Is there any harm in this treatment? It turns out it can! First, with each injection, the joint, although slightly, is injured by the needle. Secondly, with intra-articular injection, there is always some risk of infection in the joint. Thirdly, the frequent administration of hormones provoke a violation of the structure of the ligaments of the joint and surrounding muscles, causing a relative “looseness” of the joint.
And most importantly, frequent injections of corticosteroids worsen the condition of those patients in whom joint damage is associated with diabetes mellitus, high blood pressure, obesity, renal failure, peptic ulcer or intestinal ulcer, tuberculosis, purulent infections and mental illness. Even introduced exclusively into the joint cavity, corticosteroids affect the entire body and can aggravate the course of these diseases.
It is much more useful to enter into the knee joint affected by arthrosis. hyaluronic acid drugs (another name for hyaluronic acid is sodium hyaluronate). They went on sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called “liquid prostheses” or “liquid implants” because they act on the joint as a healthy synovial fluid — that is, as a natural “joint lubricant.”
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate forms a protective film on the damaged cartilage that protects the cartilage tissue from further destruction and improves the slip of the contacting cartilage surfaces.
In addition, preparations of hyaluronic acid penetrate deep into the cartilage, improving its elasticity and elasticity. Thanks to hyaluronidase, the “dried out” cartilage, which has become thinner during arthrosis, restores its shock-absorbing properties. As a result of the weakening of the mechanical overload, the pain in the sore knee joint decreases and its mobility increases.
At the same time, hyaluronic acid preparations, which were correctly inserted into the joint cavity, have practically no side effects.
Treatment with hyaluronic acid preparations is carried out with courses: a total of 3-4 injections are required for each patient’s knee per course of treatment, the interval between injections is usually from 7 to 14 days. If necessary, repeat the course in six months or a year.
From my point of view, the main and only serious lack of preparations of hyaluronic acid is their high price. So, in 2015, hyaluronic acid is represented in our market mainly by imported drugs. synvisc, fermatron, ostenil, deuralan and domestic drug Hiastat.
On average, each injection of these drugs cost the patient no less than 3000 – 5000 rubles.
But returning to the issue of economy, I want to note that despite the relatively high cost of hyaluronic acid drugs, their use has literally made it possible to “put on their feet” many patients from those who earlier, before the advent of these drugs, clearly would have to be operated on.
And given the cost of surgery on the joints, it turns out that the timely use of hyaluronic acid (even for several years) in any case and in all senses costs the patient much cheaper than surgery for endoprosthesis replacement of the knee joint. Of course, provided that the doctor who conducts such injections, owns the injection technique.
Note Dr. Evdokimenko. It is important to know: hyaluronic acid drugs are instantly destroyed in the joint, in which pronounced inflammatory processes take place. Therefore, it is practically useless to introduce them to those patients in whom gonarthrosis occurs on the background of the active stage of arthritis. But it is useful to use them for persistent remission of arthritis for the treatment of secondary gonarthrosis.
In case of primary gonarthrosis, one should also pay attention to such moments. For example, if a patient’s joint is “bursting out” from the accumulation of excess, pathological fluid, it makes sense to first “extinguish” the symptoms of synovitis (inflammation) and remove the excess pathological fluid using a pre-articular injection of hormones or taking non-steroidal anti-inflammatory drugs. And only then enter hyaluronic acid into the joint, freed from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid drugs, attempts are being made to introduce various chondroprotectors, such as Alflutop, Chondrolone or homeopathic medicine T. T.
But these drugs are at times inferior in effectiveness to hyaluronic acid drugs. They help on the strength of 50% to the sick, and it is impossible to predict in advance the effect of their use or not. In addition, the course of treatment requires from 5 to 20 injections into the joint, which, as we said, is fraught with possible injury to the joint and various complications.
6. Manual therapy and physiotherapy
Manual therapy for gonarthrosis stage I and II often gives excellent results. Sometimes a few procedures are enough to make the patient feel a significant relief. Especially good manual therapy of the knee joints helps, if combined with stretching of the joint, taking chondroprotectors and intra-articular injections of ostenil.
Such a combination of medical procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures offered at any clinic. I will give one example from practice.
A case from the practice of Dr. Evdokimenko.
A 47-year-old woman came to the reception with arthrosis of the right knee joint, stage II. By the time of our meeting, she was sick for 5 years. Over the years, the woman had time to experience all possible physiotherapy methods that can only be offered in our district clinics: laser, magnetic therapy, ultrasound, phonophoresis, etc. Despite all the efforts of the physiotherapists, the condition of the patient’s joints continued to deteriorate – and this is natural , since, say, chondroprotectors for all five years were assigned to a woman only once, in a short course.
In complete despair, the woman decided to take extreme measures – she underwent a course of treatment with cauterization of wormwood cigarettes according to the eastern method. As a result, the knee was covered with scars from burns, but did not become better to move. Yes, and I could hardly, – despite all my respect for Eastern medicine, I understand that wormwood cauterization cannot eliminate bone deformities and increase the distance between bones in the knee.
After the woman was not helped by numerous physiotherapeutic procedures and even cauterization of wormwood cigarettes, she almost agreed to surgical treatment. But then all the same I changed my mind and decided to try the complex method proposed by me.
The first treatment session was, as they say, “with a squeak” – we managed to “stir up” the joint only a little with the help of manual mobilization. Therefore, we appointed the following session after preliminary preparation: for 3 weeks, the woman took chondroprotectors, did self-massage and compresses with dimexidum. After 3 weeks, I started again with the mobilization of the joint, and then repositioned (“retraction”) the joint using manual manipulation. There was a click and suddenly the joint began to move much easier and freer. The woman felt a clear relief.
In the next two sessions, we mobilized the achieved improvement with the help of mobilization, after which we consolidated the success with two intra-articular injections of ostenil. And after a month and a half from the beginning of our not very intensive treatment (after all, it took us only six meetings), the woman was able to finally throw off the wand that had bored her and began to move fairly freely.
Since then, two years have passed. Twice a year, the patient takes chondroprotectors in a short course, and occasionally comes to me at a follow-up visit, where I am pleased to note that my knee condition only gets better from year to year. And now even the first stage of osteoarthritis would be very difficult to assume – the patient’s knee joint was restored almost completely.
Thus, only six treatment sessions (manual therapy plus intra-articular injections of ostenyl) in combination with a course of chondroprotectors proved to be more effective than five years of physiotherapy.
From this story (and by no means the only one of its kind), it becomes clear why I consider physical therapy to be important, but only an additional part of the treatment program for gonarthrosis. In this sense, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling) more than other procedures.
In more detail about each method of physiotherapy separately described in the book Pain in the legs.
Diet for arthritis is also very important. Read more about anti-arthritis diet here.
8. Using a cane
Leaning on a stick while walking, patients with arthritis of the knee joints seriously assist their treatment, since the stick takes up 30–40% of the load intended for the joint.
It is important to pick a stick for their height. To do this, stand up straight, lower your arms and measure the distance from your wrist (but not from your fingertips!) To the floor. That is the length and should be a cane. When buying a wand, pay attention to its end – it should be equipped with a rubber nozzle. Such a stick is damped and does not slip when it is supported.
Remember that if your left leg hurts, you should hold the stick in your right hand, and vice versa. Taking a step with a sore foot, transfer part of the body weight to the wand.
9. Therapeutic gymnastics
The most important method for the treatment of osteoarthritis of the knee is a special therapeutic gymnastics. Practically neither a person suffering from gonarthrosis can achieve a real improvement without remedial gymnastics.
Indeed, it is impossible to strengthen muscles in any other way, to “pump” the vessels and to activate the blood flow as much as this can be achieved with the help of special exercises.
At the same time, Dr. Evdokimenko’s gymnastics is almost the only method of treatment that does not require financial expenses for the purchase of equipment or medicines. All the patient needs is two square meters of free space in the room and a rug or blanket thrown on the floor.
There is no need for anything more than consulting a gymnastics specialist and the desire of the patient himself to do this gymnastics. True, just such a desire, the majority of suffering do not burn. Practically every patient, in whom I detect arthrosis on examination, has to literally persuade them to do physical therapy. And to convince a person most often possible only when it comes to the inevitability of surgical intervention.
The second gymnastic problem lies in the fact that even those patients who are set up to exercise therapy, often can not find the necessary complexes of exercises. Of course, brochures for patients with arthrosis are on sale, but the competence of a number of authors is doubtful – after all, some of them do not have medical education.
So, such “teachers” do not always understand the meaning of individual exercises and the mechanism of their action on sore joints. Often gymnastic complexes simply mindlessly correspond from one brochure to another. At the same time, they contain such recommendations, that it’s just fit to clutch at the head!
For example, many pamphlets prescribe to a patient with osteoarthritis of the knee joints to perform at least 100 squats a day and walk as much as possible.
Often, patients follow such advice, without first consulting with a doctor, and then sincerely wonder why they feel worse. Well, I will try to explain why the condition of the diseased joints from such exercises, as a rule, only worsens.
Let’s imagine the joint as a bearing. Damaged by arthrosis, the affected joint has already lost its ideal shape. The surface of the bearing (or cartilage) is no longer smooth. Moreover, it appeared cracks, potholes and burrs. Plus, the lubricant inside the sphere thickened and dried out, it was clearly not enough.
Try to put such a structure into the work and in addition give it a load of excess. Do you think that due to excessive rotation such a deformed “bearing” can become smoother and more even, and the lubricant more fluid and “sliding”? Or, on the contrary, the whole structure will be quickly erased, loosened and collapsed? In my opinion, the answer is obvious: from excessive load such a “bearing” will collapse ahead of time. In the same way, any bearings are destroyed and erased while moving, if sand, for example, gets into the lubricant and excessive friction occurs.
It is easy to understand that in the same way, already damaged, cracked and “dried” joints are destroyed from the load. So, from exercise, which creates an excessive load on sore joints, this very joint will only get worse.
So maybe, with arthritis in general, you can not do gymnastics? Nothing of the kind is possible and even necessary. As already mentioned, gymnastics is an important treatment for osteoarthritis. However, of all the exercises, it is necessary to choose only those that strengthen the muscles of the affected limb and ligaments of the sore joint, but do not force it to flex and straighten.
Probably, after such a recommendation, many of the readers will be surprised: how can you load the muscles and ligaments of a limb without forcing its joints to bend and unbend?
In fact, everything is very simple. Instead of our usual dynamic dynamic exercises, that is, active flexion-extension of the legs, we need to do static exercises. For example, if, lying on your back, you slightly lift up your straightened leg and keep it on weight, then in a minute or two you will feel tiredness in the muscles of the leg and abdomen, although the joints in this case did not work (did not move). This is an example of a static exercise.
Another variant. You can very slowly raise the straightened leg to a height of 15 – from the floor and slowly lower it. After 8 to 10 of these slow exercises, you will also feel tired. This is an example of a gentle dynamic exercise.
It is quite another thing if the exercise is performed quickly and vigorously, with a maximum amplitude. Swinging your legs or crouching actively, you expose your joints to increased stress, and their destruction is accelerated. But muscles, oddly enough, with such movements strengthened much worse. We conclude: to strengthen the muscles and ligaments with arthritis, exercises should be done either statically, fixing the position for a certain time, or slowly dynamically.
By the way, it is the slow dynamic and static exercises that most of my patients do not like to do, since it is especially difficult to perform them. But it should be so: correctly chosen, these exercises strengthen those muscles and ligaments that in a person have atrophied due to illness. Therefore, at first, be patient.
Doing gymnastics, do not rush. If you want to recover, you somehow have to train yourself to do the exercises slowly and smoothly, without jerks. The pull force can only “tear down” the muscles and will bring absolutely no benefit. And remember: if any exercise causes a sharp pain, it means that it is contraindicated to you or you do it incorrectly. In this case, be sure to consult with your doctor about the correct implementation of this exercise.
Video with gymnastics for the treatment of osteoarthritis of the knee joints can be viewed here.
Advanced complex of therapeutic gymnastics (text) here: Nine best exercises for the treatment of osteoarthritis of the knee
At the end of the section on the treatment of osteoarthritis of the knee I want to touch upon one question that patients often ask me: do I need to develop a leg with a long walk and is walking useful for gonarthrosis?
The answer is: of course, for a healthy person, long walking is useful in all senses – for the heart, for the respiratory system, for blood vessels, for the legs, etc. But with arthritis, especially neglected, the knee joints do not cope even with minimal daily exercise, but here It is proposed to download them even more! Such actions, most likely, will only lead to aggravation and further destruction of the joints.
Before loading, or rather overloading the knees, you must first remove the aggravation, strengthen the muscles of the legs and how to treat the diseased joints. Only then you can move on to active everyday activities, gradually increasing the load and in no case allowing pain.