Treatment of the arthrosis of the knee joints, treatment of gonartrosis- To put it slightly, not the simplest task.Therefore, before starting the hard struggle with this disease, make sure you find a good doctor, examine it and create a treatment plan with him.
In no case not to try to establish a diagnosis for yourself!
The fact is that the injuries of the joint, which resemble arthrose, occur with many other diseases and people with low presences are very often wrong in determining the diagnosis.It is better not to save time and money for medical consultation, because the error can cost much more expensive in all respects.
But this does not mean that you have to blindly believe any doctor and should not deepen the essence of his recommendations, understanding the mechanism of action of those drugs that are prescribed to you.The patient should understand the meaning of medical prescriptions and represent why some therapeutic procedures are performed.
Therefore, with the therapeutic treatment of Gonartrosi, it is important to combine a series of therapeutic measures in order to solve several problems simultaneously:
- eliminate pain;
- Improve the nutrition of joint cartilage and accelerate its restoration;
- activate blood circulation in the articulation concerned;
- Reduce pressure on damaged bones joints and increase the distance between them;
- strengthen the muscles surrounding the sick articulation;
- Increase joint mobility.
Below we will consider how this or that method of treatment helps to achieve your goals:
1
Non -steric -inflammatory -inflammators -Fans: diclofenac, pyroxic, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
With arthrosis, non -hormonal and anti -inflammatory anti -inflammatory drugs are traditionally used to eliminate the pain and inflammation of the joint, since against the background of severe pain it is impossible to start normal treatment.Only by eliminating acute pain with anti -inflammatory drugs, can you subsequently go, for example, to massage, gymnastics and those physiotherapy procedures that would be intolerable due to pain.
However, it is undesirable to use drugs of this group for a long time, since they are able to "mask" the manifestations of the disease.
After all, when the pain decreases, a deceptive impression is created that a cure began.In the meantime, arthrosis continues to progress: fans eliminate only the individual symptoms of the disease, but do not treat it.
In addition, in recent years, data have been obtained by indicating the harmful effects of the prolonged use of anti -anti -non -steering anti -inflammatory drugs on the synthesis of the proteoglycans.Protegogue molecules are responsible for the flow of water in the cartilage and a violation of their function leads to the dehydration of the cartilage tissue.As a result, the cartilage already affected by osteoarthritis begins to collapse even faster.Therefore, the pills that the patient takes to reduce pain in the joint can accelerate the destruction of this articulation.
Furthermore, using non -pounded anti -inflammatory drugs, it must be remembered that everyone has serious contraindications and with prolonged use it can give significant side effects.
2
Condroprotectors - glucosamine and condroitin sulfate - these are substances that feed the cartilage tissue and restore the structure of the damaged cartilage of the joints.
Condroprotectors are the most useful group of drugs for the treatment of arthrosis.
Unlike non -short anti -inflammatory drugs (NSAIDs), the chondroprotectors do not eliminate as much the symptoms of osteoarthritis as well as the "base" of the disease: the use of glucosamine and the condroitin sulphate.
Such a complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial phase of arthrosis.However, it is not necessary to exaggerate these drugs.
The chondroprotectors are not very effective in the third phase of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to cultivate a new cartilage tissue or return the first form to the deformed bones of the knee with glucosamine and condroitin sulphate.
And in the first or second phases of Gonartrosis, the chondroprotectors act very slowly and improve the patient's conditions at the same time.To obtain a real result, it is necessary to undergo at least 2-3 treatment courses with these drugs, which usually take a year and a half from six months.
3. Ointments and therapeutic creams:
Ointments and therapeutic creams cannot in any way take care of the arthrosis of the knee joints (even if their advertising approves the opposite).However, they can alleviate the patient's condition and reduce pain in a painful knee.And in this sense, the ointments are sometimes very useful.
Therefore, with the arthrosis of the knee joint that occurs without synovates without phenomena, I recommend a heating pain to my patients in order to improve blood circulation in the joint.
To do this, use pepper fruit extract, etc.Ointments listed usually cause a pleasant feeling of warmth and comfort in the patient.Rarely give side effects.
Ointments based on non -pounded anti -inflammatory substances are used in cases where Gonartrosis's course is aggravated by Sinovite.Unfortunately, they act not effectively as we would like -because the skin does not pass more than 5-7% of the active substance, and this is not clearly sufficient to develop an anti -inflammatory effect.
4. Funds for compressions:
The compresses have a slightly large therapeutic effect compared to the ointments.
Local funds used in our times, in my opinion, three drugs deserve greater attention: Dimexide, Bishophytus and Bile Medica.
Dimexide- Chemical substance, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, the dimexide is really able to penetrate the barriers of the skin.That is, the dimexide applied to the skin is really absorbed by the body and works inside, reducing inflammation to the center of the disease.In addition, the Dimexide has an absorbable property and improves the metabolism in the application area, which makes it the most useful in the treatment of arthrosis, which occurs with the presence of synovite.
Bishophite- derivative of oil, brine extracted during the perforation of oil wells.He gained his fame thanks to the drillers, who were the first to pay attention to his therapeutic effect with arthrosis.As they worked on the oil wells with a constant contact with an oil salary from the drill, nodules of arthrose on the hands occurred.In the future, it has been discovered that Vescofita has a moderate anti -inflammatory and analgesic effect and also acts warmly, causing a pleasant feeling of heat.
Medical bile- Natural bill extracted from the biliary bubbles of cows or pigs.Bile has an absorbable and heating effect and is used in the same cases as the biscuit, but has some contraindications: it cannot be used for pustling skin diseases, inflammatory lymph nodes and ducts, feverish states with an increase in body temperature.
5. Intra -articular injections (injections in the joint):
Intra -articular injections are often used to provide emergency care for the arthrosis of the knee joint.In many cases, intra -articular injection can really alleviate the patient's condition.But at the same time, the injections in the arthrosis joint are made much more often than necessary.It concerns this incorrect, in my opinion, the tendencies, I want to speak more detailedly.
Very often, corticosteroid hormones drugs are introduced into the joint: Tiamcinone, Betametasone, Hydrocortisone.
Corticosteroids are good as they quickly and effectively suppress pain and inflammation with synovite (edema and swelling of the joint).It is the speed with which the therapeutic effect is obtained, which is the reason why corticosteroid injections have gained particular popularity among doctors.
But this led to the fact that the intra -articular hormone injections have started to be performed even without a real need.For example, I repeatedly faced the fact that the hormones were introduced into the patient's joint for a preventive purpose in order to prevent the further development of arthrosis.
However, the problem is that only arthrosis itself the corticosteroids are not treated and cannot be treated.Therefore, they cannot prevent the development of osteoarthritis!Corticosteroids do not improve the conditions of joint cartilage, do not strengthen bone tissue and do not restore normal blood circulation.
Everything that can reduce the response to the inflammatory reaction of the body to one or the other damage in the joint cavity.Therefore, it is useless to use intra -articular injections of hormonal drugs as an independent treatment method: they should only be used in the complex arthrosis therapy.
For example, the patient detected the gonartrosis of stadium II with a swelling of the joint due to the accumulation of liquid in it.The accumulation of liquid (synovite) makes it difficult to conduct medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs an intra -articular injection of the hormonal drug to eliminate synovitis and in a week he starts other active therapeutic measures - this is the right approach.
Now imagine another situation.The patient also has Gonartrosi in Stadio II, but without accumulation of fluid and joint edema.Is it necessary to enter corticosteroids in the joint in this case?Of course, no.There is no inflammation: there is no "exposure point" for corticosteroid hormones.
But even if the intra -articular introduction of corticosteroids is really necessary, a series of rules must be observed.Firstly, it is undesirable to make these injections in the same joint more often than 1 time in 2 weeks.The fact is that the medicine introduced "will work" in the whole immediate and the doctor will be able to finally evaluate the effect of the procedure immediately after 10-14 days.
You must also know that usually the first injection of corticosteroids brings more relief than the following ones.And if the first intra -articular administration of the drug has not given a result, it is unlikely that it will give to the second or third introduction of the same drug in the same place.In case of ineffectiveness of the first intra -articular injection, it is necessary to change the drug or if the change of medicine has not helped, more precisely, to choose the injection site.
If even after the introduction of a corticosteroid in the joint it did not give the desired result, it is better to abandon the very idea of treating this articulation with hormonal drugs.In addition, the injection of hormones in the same articulation is more than 4-5 times in general, it is extremely undesirable in a different way in a different way increases the probability of side effects.
Unfortunately, in practice, you must face an excessive "determination" of the doctors who, again and again, introduce corticosteroids in the same articulation, without reaching at least the minimum effect with the first three injections.Two of these cases struck me more than others.
One of the patients made "only" ten injections of a kenalog, while the procedure was performed daily, even without a ten -day break needed to evaluate the results of the injection.And the second patient was introduced into the hormones inside the knee joints, observing the interval (even if only from 3 to 5 days), but at the same time, the Poor received twenty to twenty and five corticosteroid injections in an articulation for the course of treatment!
It would seem that the doctor "went too far" - okay.Can there be damage from this treatment?It turns out, maybe!
Firstly, with every injection, the articulation, although slightly, is injured by a needle.Secondly, with intra-articular injection, there is always a certain risk of infection in the joint.Third, frequent hormones introduce a violation of the structure of the articulation of the joint and the surrounding muscles, causing relative "decomposition" joints.
And, above all, frequent injections of corticosteroids worsen the condition of those patients in whom the joint damage is combined with diabetes mellitus, hypertension, obesity, renal failure, stomach ulcer or intestine, tuberculosis, purulent infections and mental diseases.Even introduced exclusively in the joint cavity, the corticosteroids affect the entire body and can aggravate the course of these diseases.
It is much more useful to administer hyaluronic acid drugs in the knee joint influenced by arthrosis (another name for hyaluronic acid - sodium hyaluronate).They appeared on sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid prostheses" or "liquid plants", since they act on the joint as a healthy synovial fluid, that is, as a natural "joint lubrication".
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate is a protective film on the damaged cartilage, protecting the cartilage tissue from further destruction and improving the sliding of the contact cartilage surfaces.
In addition, hyaluronic acid preparations penetrate the depths of the cartilage, improving its elasticity and elasticity.Thanks to Ialuronidase, "dried" and thinning with arthrosis, the cartilage restores its shock properties.As a result of the fulfillment of the mechanical overload, the pain in the articulation of the sick knee decreases and its mobility increases.
At the same time, the joints administered correctly in the joint cavity, the preparations of hyaluronic acid practically do not give side effects.
Treatment with hyaluronic acid preparations is carried out in courses: in total, 3-4 injections are required for the course of treatment in each painful knee, the interval between injections is generally from 7 to 14 days.If necessary, the course is repeated in six months or a year.
From my point of view, the main and only serious disadvantage of hyaluronic acid drugs is their high price.Therefore, in 2020, hyaluronic acid is represented in our market in the main import drugs.
But returning to the issue of savings, I want to notice that, despite the relatively high cost of hyaluronic acid preparations, their use has literally allowed many patients by those who before, before these drugs, would certainly have had to be managed.
And given the cost of the operation on the joints, it turns out that the timely use of hyaluronic acid (for several years) in any case and in every sense it costs the much cheaper patient than surgery for endoprothetics of the knee joint.Of course, provided that the doctor who leads these injections has the introduction technique.
It is important to know: hyaluronic acid preparations are immediately destroyed in that articulation in which pronounced inflammatory processes are underway.Therefore, it is practically useless to introduce them to those patients in which gonartrosis proceeds against the active background of arthritis.But it is useful to use them with the remission of persistent arthritis for the treatment of the phenomena of secondary gonartrosis.
With primary gonartrosis, you must also pay attention to these moments.For example, if the patient's "explosions" with an excess accumulation, pathological fluid, makes sense to "extinguish" the phenomena of synovitis (inflammation) and remove the excessive pathological fluid with the help of an intra -articular injection or intake of anti -inflammatory drugs.And only then to introduce hyaluronic acid into the articulation, freed from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, attempts to introduce various chondroprotectors into the joint.
But these drugs are many times lower in the effectiveness of hyaluronic acid drugs.They help from the strength of 50% to patients and guess whether the effect of their use or not, is impossible in advance.In addition, the course of treatment requires 5 to 20 injections in the joint, which, as we have said, is fraught with possible injuries to the joint and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for the Gonartrosis of Stadium I and II often gives a great result.Sometimes different procedures are sufficient for the patient to experience significant relief.Manual therapy particularly well of the random joints helps, if it is combined with the extension of the joints, the intake of chondroprotectors and the intra -articular injections of the point.
This combination of therapeutic procedures from my point of view is much more effective than the numerous physiotherapy measures proposed in any clinic.I will give an example from the practice.
The case of the doctor's practice.
A 47 -year -old woman with arthrosis of the joint of the right knee of phase II has reached the reception.At the time of our meeting, he had been sick for 5 years.Over the Years, The Woman Managed to Experience Al Possible Methods of Physiotherapy That Can Be proposed in Our District Clinics: Laser, Magnetotherapy, UltraSound, Phonophoresis, etc.Despite all the efforts of physiotherapists, The patient's condition of the patient continued to deteriorate - and this is natural, since, let's say, chondroprotectors were per appointed to the woman only ounces, only ounces, a woman was peri a a a ala, only once, a woman was a woman,named.short course.
Completely desperate, the woman has decided to extreme measures: she underwent a cigarette treatment course cigarette cauterizing according to the eastern methodology.As a result, the knee was covered with Burns scars, but did not move better.Yes, and it was unlikely that I could, despite all my respect for oriental medicine, I understand that the cauterization of Wormwood cannot eliminate bone deformations and increase the distance between the bones articulated in the knee.
After the woman has not helped the numerous physiotherapy procedures and even the cauterization in Wormwood cigarettes, it has practically almost accepted surgical treatment.But then he changed his mind and decided to try the complex method I proposed.
The first treatment session has passed, as they say, "with a creaking" - we managed to "arouse" the articulation with the help of manual mobilization a little.Therefore, we planned the next session after the preliminary preparation: within 3 weeks, the woman took the chondroprotectors, made a car -maxaggi and compresses with Dimexide.After 3 weeks, I started again with the mobilization of the joint and then I made a reposition ("reduction") of the joint using manual manipulation.There was a click and suddenly the joint began to move much easier and more free.The woman had a clear relief.
In the next two sessions using mobilization, we resolved the improvement achieved, after which we resolved the success of two intra -articular injections of the point.And after a month and a half since the beginning of our not very intense treatment (after all, we needed only six meetings), the woman was finally able to discard the wand that she had bored with her and started moving quite freely.
Two years have passed since then.Twice a year, the patient takes the chondroprotectors in a short course and occasionally comes to my control technique, where I am happy to notice that the knee condition is better only from year to year.And now, even the first phase of arthrosis would be very difficult to take: the patient's knee joint has been restored almost completely.
Therefore, only six treatment sessions (manual therapy plus intra -subtosurve of Orenil) in combination with the course of the chondroprotectors were more effective than five years of physiotherapy.
From this story (and in no way the only one of the genre) becomes clear because I consider physiotherapy an important one, but only an additional part of the medical program for gonartrosis.In this sense, I like laser therapy, thermal treatment (Ozokinete, paraffin therapy, therapeutic mud) and in particular cryotherapy (treatment with local cooling).
7. Diet:
The diet with arthrosis is also very important.
8. Use of the stick:
On the basis of the stick during the walk, patients with arthrosis of the knee joints seriously help their treatment, since the stick takes 30-40% of the load intended for the joint.
It is important to choose a stick based on your height.To do this, stay straight, lower your hands and measure the distance from the wrist (but not from the tip of the fingers!) To the floor.It is such a length that there should be a stick.When buying a wand, pay attention to its end: it should be equipped with a rubber nozzle.Such a stick is cushioned and does not slip when it rests on it.
Remember that if the left leg hurts, then the stick should be held in the right hand and vice versa.Taking a step from the patient with one foot, transfer part of the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for the arthrosis of the knee joints is special therapeutic gymnastics.Almost no person who has gonartrosis can obtain a true improvement in the therapeutic gymnastics without state.
After all, it is impossible to strengthen the muscles, the "pump" blood vessels and activate the bloodstream as much as this can be achieved using special exercises.
At the same time, the doctor's gymnastics is almost the only method of treatment that does not require financial costs for the purchase of equipment or drugs.All the patient needs are two square meters of free space in the room and a carpet or a blanket thrown on the floor.
There is nothing more to consult a specialist in gymnastics and the patient's desire to do this gymnastics.It is true, only with such a desire, most of the sick do not burn.Almost every patient, in which arthrosis I see, literally I must persuade physiotherapy exercises.And it is often possible to convince a person only when it comes to the inevitability of the surgical intervention.
The second "gymnastic" problem is that even those patients who are configured for physiotherapy exercises often cannot find the sets of necessary exercises.Of course, there are brochures for patients with arthrosis for sale, but the competence of a number of authors is doubtful - after all, some of them do not have a medical education.
Therefore, these "teachers" do not always understand the meaning of individual exercises and the mechanism of their action on the painful joints.Often, the gymnastic complexes simply correspond without thoughts from one brochure to another.At the same time, there are such advice that it is right to grab your head!
For example, many brochures prescribe the patient with arthrosis of the knee joints "to perform at least 100 squats per day and walk as much as possible".
Often, patients follow these advice, without previously consulted with a doctor, and then honestly perplexed because they worsened.Well, I will try to explain why the condition of the sick joints of these exercises, as a rule, worsens.
Let's imagine the joint is a bearing.Damaged by osteoarthritis, the painful joint has already lost its ideal form.The surface of the "bearing" (or cartilage) has ceased to be smooth.In addition, cracks, holes and "Burrs" appeared.In addition, lubrication inside the sphere thickened and won, clearly it was not enough.