Treatment Arthrosis Knee joints, Treatment of gonartrosis- To put him a treasure, not the easiest task.Therefore, before you start a hard struggle with this disease, be sure to find a good doctor, test it and make a treatment plan with him.
In no case try to establish a diagnosis for yourself!
The fact is that the lesions of the wrist are resembling an arthrosis, they appear with many other diseases, and low -prentious people are very often mistaken in determining the diagnosis.It is better not to save time and money for medical consultations, because a mistake can cost you much more expensive in every way.
But that doesn't mean you have to blindly trust any doctor and should not enter their recommendations, which understands the mechanism of the action of these medications prescribed.The patient should understand the meaning of medical recipes and represent why certain therapeutic procedures are carried out.
So, with the therapeutic treatment of gonartrosis, it is important to combine a number of therapeutic measures in such a way to solve several problems at once:
- eliminate pain;
- improve the nutrition of articulated cartilage and speed up its renewal;
- Activate blood circulation into affected compound;
- Reduce pressure on damaged bone compounds and increase the distance between them;
- strengthen the muscles that surround the sick joint;
- Increase shared mobility.
Below we will consider how this or that treatment method helps achieve your goals:
1. Not -steroidal anti -infalmator drugs:
Not -steroidal anti -inflammatory drugs - NSAIDS: DICLOFENAC, Pyroxici, Ketoprofen, indometacin, butadion, meloxicam, treatment, nimulid and their derivatives.
With arthrosis, immonals, anti-animal drugs are traditionally used to remove pain and inflammation of the wrist, because it is impossible against normal treatment against the background of heavy pain.Just by removing acute pain with anti-inflammatory drugs, for example, you can, for example, massage, gymnastics and those physiotherapy actions that would be unbearable due to pain.
However, it is a long time to use the drugs of this group, because they are able to "mask" disease manifestations.
After all, when the pain is reduced, a sparking impression is created, which started the medicine.Meanwhile, arthrosis is still progressing: NSAIDs eliminate only individual symptoms of the disease, but do not treat it.
Moreover, data have been obtained in recent years that indicate the harmful effects of long-term use of non-anti -infammaturac drugs on proteobican synthesis.Proteoglycana molecules are responsible for water flow in cartilage, and violating their function leads to dehydration of cartilage tissue.As a result, the cartilage already affected by arthrosis begins to accelerate even faster.Thus, the pills that patient take to reduce the pain in the joint can speed up the destruction of this compound.
In addition, the use of non-atleinflammatory drugs must be borne in mind that everyone has serious contraindications and with extended use can give significant side effects.
2. Chondroprotektori - glucosamine and hondroitinski sulfat:
Chondroprotectors - Glucosamine and chondroitine sulfate - these are substances that feed piles of piles of cartilage and return the structure of damaged cartilage wrists.
Chondroprotectors are the most useful group of drugs to treat arthrosis.
Unlike non-behaviors (NSAIDs), hondroprotectors have not so much eliminated the symptoms of the diseases: the use of glucosamine and hondroitine sulfate helps to restore the production of shared fluids and normalize their "massive" properties.
A similar complex hondroprotector effect on the wrist makes them necessary in the treatment of the initial phase of arthrosis.However, there is no need to overdo it of these medications.
Chondroprotectors are slightly efficient in the third phase of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to grow a new cartilage fabric or returning a former form for deformed bones of knees with glucosamine and hondroitine sulfate.
And in the first or second phase of gonartrosis, hondroprotectors operate very slowly and improve the patient's condition at once.To obtain the actual result, you must submit at least 2-3 treatment courses to these medicines, which usually lasts from six months to a year and a half.
3. Therapeutic fat and creams:
Therapeutic fats and creams can in no way cure the knee joint arthrosis (even if their advertising approves the opposite).However, they can alleviate the patient's condition and reduce pain in the painful knee.And in that sense, fat is sometimes very useful.
So, with an arthrosis of the knee joint that occurs without sinovitis without phenomenon, I recommend warming fat to my patients to improve blood circulation in the wrist.
To do this, use the extract of pepper fruits, etc.These fats usually cause a sense of pleasant warmth and comfort in the patient.They rarely give any side effects.
Fats based on non-asteoid anti -infalmaturants are used in cases where gonartrosis course is worsening with sinovitis.Unfortunately, they do not act as effectively as we would like - because leather does not exceed No more than 5 - 7% of the active substance, and this is obviously not enough to develop a complete anti -infallamic effect.
4. Funds for compresses:
Compresses have some great therapeutic effect in relation to fat.
From local funds used in our time, in my opinion, three medicines deserve the greatest attention: Dimexide, Bishophytus and Medical Žučica.
Dimexide- Chemical substance, liquid with colorless crystals, has a good antinamal and analgesic effect.At the same time, unlike many other external substances, Dimexide is really able to penetrate the barriers of the skin.That is, a dimexide that applies to the skin really absorbs the body and acts within it, reducing inflammation into the focus of the disease.In addition, Dimexide has absorbent assets and improves the metabolism in the area of application, which makes it the most useful in the treatment of arthrosis, which arise with the presence of synonitis.
Bishophyte- Oil derivatives, drilling room during drilling petroleum wells.She arrived her fame thanks to drills, who first paid attention to their therapeutic effect with arthrosis.While working on petroleum wells from permanent contact with the salty island from the drill, there was a nodule on their hands.In the future, Bishophyte has been shown to have moderate anti-inflammatory and analgesic effect, and also works cordially, causing a sense of pleasant heat.
Medical bile- Natural bile mined from Žučica bubbles of cows or pigs.It was absorbent and heating effect and used in the same cases as Bischophyte, but there are some contraindications: cannot be used for powder diseases of the skin, inflammatory diseases of lymph nodes and fever, with increasing body temperature.
5. Intra -Articular injections (joint injections):
Intra -Articular injections are often used to provide an emergency for the knee joint arthritis.In many cases of intra -articular injection can really mitigate the patient's condition.But at the same time, injections in the joint with arthrosis are done much more often than necessary.It is the wrong thing, in my opinion, trends, I want to talk in more detail.
Corticosteroid medications were most often introduced: Triamcinone, Betamamason, hydrocortisone.
Corticosteroids are good to quickly and efficiently combine pain and inflammation of sinovitis (edema and swelling of the compound).This is the speed that the therapeutic effect is achieved that the injections of corticosteroids have received special popularity among doctors.
But that led to the fact that the inside-begins injection hormones began to spend even without real need.For example, he has repeatedly faced the fact that the hormones were introduced into the patient's connection for preventive purpose to prevent further development of arthrosis.
However, the problem is that only corticosteroids are not treated and cannot be treated.So, I can't prevent the development of arthrosis!Corticosteroids do not improve the condition of the articulated cartilage, do not strengthen bone tissue and does not return normal blood circulation.
All they can reduce the inflated body reaction to one or other harm in the common cavity.It is therefore pointless to use intra -ticular injections of hormonal drugs as a standalone treatment method: they should only be used in complex arthrosis therapy.
For example, the patient revealed Gonartrozo II degrees with the swelling of the community due to the accumulation of liquid in it.Fluid accumulation (synonitis) makes it difficult to implement medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs intra-competing injection of hormonal drug to remove sinovitis, and in a week, other active therapeutic measures start - it is a real approach.
Now imagine another situation.The patient also has a phase of II gonartrosis, but without the accumulation of fluid and shared edema.Is it necessary to enter corticosteroids in the wrist 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 needed, a number of rules must be noticed.First, it is undesirable to make such injections in the same common common more often than 1 times in 2 weeks.The fact is that the drug introduced "immediately work" in full force and the doctor will be able to finally assess the effect of the proceedings immediately after 10 - 14 days.
You also need to know that usually the first injecting the corticosteroid brings more relief from the next one.And if the first intra -articular medicinal administration did not result in the result, they are unlikely to give another or third introduction of the same medicine to the same place.In the event of the inefficiency of the first intro-valuable injection, you must change the medicine or if the drug change did not help, more precisely, select the injection site.
If even after that, the introduction of corticosteroids in the joint did not give the desired result, it is better to leave the idea of the treatment of this compound with hormone medicines.Moreover, the injection of hormones in the same joint is more than four to five times in general, extremely undesirable differently increased the likelihood of side effects.
Unfortunately, in practice you have to face excessive "determination" of a doctor who, over and over, introduce corticosteroids in the same compound, without achieving at least minimum performance with the first three injections.Two such cases hit me more than the others.
One of the patients has done "only" ten injections of the Kenalog, while the procedure is performed on a daily basis, even without ten days needed to assess injection results.And the other patient was introduced into hormones inside the knee joints, observing the interval (although only 3 to 5 days), but at the same time a poor guy received twenty-twenty -fish injections of corticosteroids in one compound during treatment!
It seems that the doctor "went too far" a little - it's okay.Can damage from such treatment?It turns out, maybe!
First, with each injection, wrist, though a little, is hurt by needle.Second, with intrally injection, there is always a certain risk of ankle infection.Third, frequent hormones introduction causes violation of the structure of joints and surrounding muscles, causing relative "decaying" joints.
And the most important, frequent injections of corticosteroids worsen the condition of those patients in which the damage is combined with diabetes, mellitude, obesity, ulcers in the stomach or intestines, tuberculists, pure infections and mental illnesses.It is even introduced exclusively into a common cavity, corticosteroids affect the entire body and may worsen the course of these diseases.
It is much more useful to give hyaluronic acid medications in knee joints affected by arthrosis (second name for hyaluronic acid - sodium hyaluronate).They appeared in sales about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid stresses" or "liquid implants", because they operate as a healthy synonymous fluid - it is like a natural lubrication.
Hyaluronic acid preparations are very useful and efficient drugs: Sodium hyaluronate forms a protective film on a damaged cartilage, protection of tissue cartilage from further destruction and improvement in the Turks.
In addition, hyaluronic acid preparations penetrate the depths of cartilage, improving its elasticity and elasticity.Thanks to Hialuronidase, "dried" and thinning arthrosis, cartilage returns its shock-absorbing properties.As a result of the weakening of mechanical overload, pain in the painful knee joints decreases and its mobility increases.
At the same time, the joints were properly given to the common cavity, the preparation of hyaluronic acid practically do not give side effects.
Hyaluronic acid treatment is performed in courses: a total of 3-4 injections needed for the course of treatment in every painful knee, interval between injections is usually 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 lack of hyaluronic acid medications are their high price.Thus, 2020. year, the hyaluronic acid was presented in our market in the main import drugs.
But returning to the question of savings, I want to mention that despite the relatively high cost of hyaluronic acids, their use literally allowed many patients from those who have definitely had to act before these medicines.
And given the costs of joint operation, it turns out that the timely use of hyaluronic acid (even a few years) in any case and in each sense costs the patient much cheaper than the operation of the knee wrist.Of course, provided that the doctor who leads such injections possesses the technique of introduction.
It is important to know: Hyaluronic acids are immediately destroyed in this compound in which inflammatory processes are pronounced.Therefore, it is practically useless to acquaint those patients in which gonartrosis continues against the background of the active phase of arthritis.But useful to use them with permanent arthritis remission to treat the occurrence of secondary gonartrosis.
With primary gonortiness, you also need to pay attention to such moments.For example, if the patient "bursts" from the accumulation of surplus, the pathological fluid, it seems to first "shut down the appearance of sinovitis (inflammation) and remove the overthrow pathological fluid with the help of previous intra-starting injection of hormones or taking non-anti-inflammatory drugs.And only then introduce hyaluronic acid into a joint, exempt from inflated elements.
In addition to corticosteroid hormones and hyaluronic acids, he tries to introduce various hondroprotectors in the wrist.
But these medications are much inferior to the effectiveness of hyaluronic acid medications.They help with 50% patients and guess whether the effect of their use is or not, impossible to advance.In addition, the course of treatment requires 5 to 20 injections in the wrist, which, as we said, are full of possible injuries to common and different complications.
6. Hand therapy and physiotherapy:
Hand therapy for gonartrosis I and II stages often gives an excellent result.Sometimes several actions are enough for the patient to feel significant relief.Especially well-handed random joint therapy helps, if you combine it with a joint extension, entering hondroprotects and intraarticular injections in points.
Such a combination of therapeutic procedures, from my angle, is much more efficient than numerous physiotherapy measures proposed in any clinic.I'll give an example from the exercise.
The case from the doctor's practice.
A woman 47 -to with the arthrosis of the right connector in the II level came to the reception desk.By the time of our meeting, she was sick for 5 years.Over the years it managed to experience all possible physiotherapy methods that can be suggested in our district clinics: laser, magnetotherapy, ultrasound, phonophopes, etc.Only once, a woman is appointed.A short course.
Completely desperate, the woman decided on extreme measures - he undergoed during treatment with the crew-cigarette caderization towards the Oriental Methodology.As a result, the knee was covered with scars from the burn, but it was not moving better.Yes, it was unlikely that I could, despite my respect for eastern medicine, I understand that cauterization from pelit cannot eliminate the deformation bones and increase the distance between bones articulated in the knee.
After the woman did not help numerous physiotherapy procedures, and even cigaretting in cigarettes from Pela, practically almost agreed to surgical treatment.But then she still changed my mind and decided to try the complex method I suggested.
The first treatment session passed, as they say: "with poles" - we only managed to "mix" the connection with the help of handmade.Therefore, we scheduled the next session after preliminary preparation: within 3 weeks, the woman took hondroprotectors, made self-consideration and compresses with dimexide.After 3 weeks, I started mobilizing the compound again, and then I made a move ("reduction") wrist using manual manipulation.The click followed and suddenly the wrist started moving much easier and more free.The woman felt clear relief.
In the next two sessions using mobilization, we improved the achieved improvement, followed by the success of the two intra-valuable injections in the point.And after the month and a half of the beginning, it is not exactly intense treatment (after all, we were only six meetings), the woman could finally reject a stick that bored with her and began to match her.
Since then, two years have passed since.Twice a year, the patient takes chondroprotectors on a short exchange rate, and occasionally comes on my control technique, where I am happy to notice that the state of my knees is just better from year to year.And now, even the first phase of arthrosis would be very difficult to assume - the patient's wrist knee was renovated almost completely.
Therefore, only six treatment sessions (hand therapy plus intra-rupilve injection of Orenila) in combination with chondroproteket's course was more efficient than five years of physiotherapy.
From this story (and no one is the only one) becomes clear why I think that physiotherapy is important, but only an additional part of the medical program for gonartrosis.In that sense, I love laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (local cooling treatment).
7 Diets:
Diet with arthrosis is also very important.
8. Use of reeds:
Based on the stick when you walk, patients with arthrosis with knee joints seriously help their treatment, as the stick lasts 30 - 40% load intended for the wrist.
It is important to choose a stick toward your height.To do this, stand flat, lower your hands and measure the distance from the wrist (but not from your fingers!) To the floor.Such is the length that there should be reeds.When buying a stick, pay attention to his end - should be equipped with a rubber nozzle.Such a stick is depreciated and does not slide when they rest on it.
Remember that if your left legs hurt, then the stick should be kept in the right hand and the other way around.Taking a step of patient with a leg, transfer part of body weight on a stick.
9. Therapeutic gymnastics:
The most important treatment of knee joint arthrosis is a special therapeutic gymnastics.Almost a single person who has gonartrosis can achieve the right to improve the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, "pump" blood vessels and activate blood flow as much as it can be achieved by using special exercises.
At the same time, medical gymnastics is almost the only method of treatment that does not require financial costs to buy equipment or medications.All the patient needs two square meters of free space in the room and rugs or blankets thrown to the floor.
No more nothing is to consult a specialist in the gymnastics and the patient's wish that I did this gymnastics.True, just with such a desire, most patients are not worse.Almost every patient, in which I reveal arthrosis, I have to literally convince physiotherapy exercises.And most often persuade a person only when it comes to the inevitability of surgical intervention.
The second "gymnastic" problem is that even those patients configured for physiotherapy exercises often cannot find the necessary sets of exercises.Of course, the for sale are brochures for patients with arthrosis, but the competence of a series of authors suspicious - after all, some of them do not have medical education.
Thus, such "teachers" do not always understand the meaning of individual exercises and the mechanism of their actions on aching joints.Often gymnastic complexes are simply powerlessly suitable from one brochure to another.At the same time there are such recommendations in them that it is just ok to grab your head!
For example, many brochures prescribe a patient with the arthrosis of knee joints "to perform at least 100 squats per day and walk as much as possible."
Often patients follow such advice without being previously advised with a doctor, then sincerely confused why they have worsened.Well, I'll try to explain why the state of sick joints from such exercises, as a rule, just worse.
Let's imagine the wrist as a bed.Damaged by arthrosis, the painful joint has already lost its ideal form.The area of "bearing" (or cartilage) stopped being smooth.Moreover, cracks, holes and "burres" appeared on it.In addition, lubrication inside the sphere thickened and dried, that was obviously not enough.