Treatment of arthrosis of the knee joints, treatment of gonarthrosis- To put it mildly, not the easiest task.Therefore, before you start your severe fight against this disease, be sure to find a good doctor, look at it and make a treatment plan with it.
In no case do you try to make a diagnosis for yourself!
It is a fact that joint lesions that resemble arthrosis are found in many other diseases and low -end people are very often mistaken for determining the diagnosis.It is better not to save time and money for medical consultation, because the mistake can cost you much more expensive in all respects.
But this does not mean that you should blindly believe every doctor and you should not deepen the essence of his recommendations by understanding the mechanism of action of those medicines that are prescribed to you.The patient should understand the importance of medical recipes and be why certain therapeutic procedures are performed.
So, with 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:
- elimination of pain;
- improving the nutrition of the articular cartilage and accelerates its recovery;
- Activation of blood circulation in the affected joint;
- Reducing pressure on damaged bone joints and increasing the distance between them;
- strengthening the muscles around the patient's joint;
- Increasing joint mobility.
Below we will look at how this or that method of treatment helps to achieve your goals:
1. Nesteroidal anti -inflammatory drugs:
Non -steroidal anti -inflammatory drugs -NPPVS: Diclofenac, Piroxicists, Ketoprofen, Indomethacin, Butadion, Meloxicam, Healing, Nimulid and their derivatives.
With arthrosis non -hormonal, anti -inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, as it is impossible to start normal treatment in the background of severe pain.Only by eliminating acute pain with anti -inflammatory drugs, you can subsequently go for massage, gymnastics and those physiotherapy procedures that would be intolerable due to pain.
However, it is undesirable to use medicines in this group for a long time as they are able to "mask" the manifestations of the disease.
After all, when the pain decreases, a deceptive impression is made that treatment has begun.In the meantime, arthrosis continues to progress: NSAIDs only eliminate the individual symptoms of the disease, but they do not cure it.
In addition, in recent years, data has been obtained showing the harmful effects of prolonged use of non -steroidal anti -inflammatory drugs on proteoglycan synthesis.The Protoglycan molecules are responsible for the flow of water in the cartilage, and the impairment of their function leads to dehydration of cartilage tissue.As a result, the cartilage, which is already affected by arthrosis, begins to collapse even faster.In this way, the pills that the patient takes to reduce joint pain can accelerate the destruction of this joint.
In addition, using non -steroidal anti -inflammatory drugs, it should be remembered that they all have serious contraindications and with prolonged use can give significant side effects.
2. Chondroprotectors - glucosamine and chondroitin sulfate:
Chondroprotectors - glucosamine and chondroitin sulfate - these are substances that feed cartilage tissue and restore the structure of damaged cartilage of the joints.
Chondroprotectors are the most helpful group of medicines for the treatment of arthrosis.
Unlike non -steroidal anti -inflammatory drugs (NSAIDs), chondroprotectors do not eliminate the symptoms of arthrosis as the "base" of the disease: the use of glucosamine and chondroitin sulfate helps to restore the cartilage surfaces of the horsetail, to improve the production of joint fluid and the production of the joints.
A similar complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis.However, it is not necessary to exaggerate these drugs.
Chondroprotectors are a little effective in the third stage of arthrosis, when cartilage is almost completely destroyed.After all, it is impossible to grow new cartilage material or to return the previous form of deformed knee bones with glucosamine and chondroitin sulfate.
And at the first or second stage of gonarthrosis, chondroprotectors act very slowly and improve the patient's condition at once.To get a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually takes six months to a year and a half.
3. Therapeutic ointments and creams:
Therapeutic ointments and creams cannot in any way cure knee arthrosis (even if their ad is approved).Nevertheless, they can relieve the patient's condition and reduce pain in the sore knee.And in this sense, ointments are sometimes very useful.
So, with knee arthrosis, which happens without synovitis without phenomena, I recommend warming my patients' ointments to improve blood circulation in the joint.
To do this, use pepper extract and more.The listed ointments usually cause a feeling of pleasant warmth and comfort in the patient.They rarely give side effects.
Non -steroidal anti -inflammatory ointments are used in cases where the course of gonarthrosis is aggravated by synovitis.Unfortunately, they act not as effectively as we would like - as the skin passes no more than 5 - 7% of the active substance and this is obviously not enough to develop a complete anti -inflammatory effect.
4. Remedies for compresses:
Compresses have a slightly large therapeutic effect compared to ointments.
Of the local remedies used in our time, in my opinion, three medicines deserve the most attention: demexide, bishopitis and medical bile.
Demexide- The chemical substance, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, Dimexide is really able to penetrate the skin barriers.That is, the demexide applied to the skin is really absorbed by the body and works inside it, reducing inflammation in the focus of the disease.In addition, Dimexide has an absorbent property and improves metabolism in the field of application, which makes it most useful in the treatment of arthrosis, which is found with the presence of synovitis.
Bischophyte- Oil derivative, brine derived during the drilling of oil wells.He won his fame thanks to the workouts that were the first to pay attention to their therapeutic effect with arthrosis.While working on oil wells from constant contact with the brine from workout, nodes of arthrosis occur on their hands.In the future, it turned out that Bishophyte had a moderate anti -inflammatory and analgesic effect, and also acts warmly, causing a feeling of pleasant warmth.
Gall- Natural bile obtained from the bile bubbles of cows or pigs.The bile has an absorbent and warming effect and is used in the same cases as bicofit, but there are some contraindications: it cannot be used for pustular skin diseases, inflammatory diseases of the lymph nodes and ducts, feverish conditions with fever.
5. Intracecular injections (joint injections):
Intracelicular injections are often used to provide emergency assistance for knee arthrosis.In many cases, the intra -leaf injection can really alleviate the patient's condition.But at the same time, arthrosis injections are made much more often than necessary.It's wrong, in my opinion, the trends I want to speak more detailed.
Most often, corticosteroid hormone drugs are introduced into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good as they quickly and effectively suppress pain and inflammation with synovitis (swelling and swelling of the joint).This is the speed at which the therapeutic effect is achieved, this is why corticosteroid injections are particularly popular among doctors.
But this led to the fact that internal -articular injections of hormones began to take place even without real need.For example, I have repeatedly encountered the fact that the hormones have been introduced into the patient's joint for preventive purposes to prevent the more increasing development of arthrosis.
However, the problem is that only arthrosis itself corticosteroids are not treated 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 bone tissue, and do not restore normal circulation.
Anything that can reduce the inflammatory reaction of the body to one or another damage in the joint cavity.Therefore, it is pointless to use internal -articular injections of hormonal drugs as an independent method of treatment: they should only be used in the complex therapy of arthrosis.
For example, the patient found gonarthrosis at stage II with swelling of the joint due to the accumulation of fluid in it.The accumulation of fluid (synovitis) makes it difficult to perform medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs an internal -articular injection of the hormonal drug to eliminate the synovitis and after a week of other active therapeutic measures begins - this is the right approach.
Now imagine another situation.The patient also has gonarthrosis of stage II, but without the 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 - no "exposure point" for corticosteroid hormones.
But even if the internal -articular administration of corticosteroids is needed, a number of rules must be observed.First, it is undesirable to have such injections in the same thing becomes more than 1 time in 2 weeks.The fact is that the medicine Introduced will "work" immediately with full force and the doctor will finally finally evaluate the effect of the procedure shortly after 10 - 14 days.
You should also know that usually the first corticosteroid injection brings more relief than the next ones.And if the first internal -articular administration of the drug does not produce results, it is unlikely to give the second or third introduction to the same medicine in the same place.In the case of ineffectiveness of the first intra -tech injection, you should either change the medicine, or if the change in medicine has not helped, more precisely, choose the injection site.
If even then the introduction of a corticosteroid into the joint does not give the desired result, it is better to give up the very idea of treating this joint with hormonal medicines.In addition, the injection of hormones into the same joint is more than four to five times in general, it is extremely undesirable differently in a different way increases the likelihood of side effects.
Unfortunately, you should actually encounter an excessive "determination" of doctors who again and again introduce corticosteroids into the same joint without achieving at least the minimum effect with the first three injections.Two such cases struck me more than others.
One of the patients has made "only" ten injections of a ketogal, while the procedure is performed daily, even without a ten -day interruption required to evaluate the results of the injection.And the second patient was introduced into the hormones inside the knee joints, observing the interval (albeit only 3 to 5 days), but at the same time the poor associate received twenty to twenty -five injections of corticosteroids into one treatment!
It seems that the doctor "goes too far" - is it good. Can there be any harm from such treatment?It turns out, maybe!
First, with each injection, the joint, though slightly, is injured by the needle.Second, with intra -tech injection there is always some risk of infection in the joint.Third, the frequent introduction of hormones causes impaired joint structure and the surrounding muscles, causing relative "decaying" joints.
And most importantly, frequent corticosteroid injections worsen the condition of those patients, in which joint damage is combined with diabetes mellitus, high blood pressure, obesity, kidney failure, stomach or intestinal ulcer, tuberculosis, purulent infections and mental illness.Even introduced exclusively into the joint cavity, corticosteroids affect the entire body and can worsen the course of these diseases.
It is much more useful to administer medicines for hyaluronic acid in the knee joint affected by arthrosis (another name for hyaluronic acid - sodium hyaluronate).They appeared on sale about 15 years ago.
Hyaluronic acid (sodium hyaluronate) preparations are also called "liquid dentures" or "liquid implants" as they act on the joint as a healthy synovial fluid - that is, as a natural "lubrication of the joints".
Hyaluronic acid preparations are very useful and effective medicines: sodium hyaluronate forms a protective film on damaged cartilage, protecting cartilage tissue from further destruction and improving the sliding of the cartilage surfaces.
In addition, hyaluronic acid preparations penetrate the depths of cartilage, improving its elasticity and elasticity.Thanks to hyaluronidase, "dried" and thinning with arthrosis, cartilage restores its properties that absorb shock.As a result of the weakening of mechanical overload, pain in the diseased knee joint decreases and its mobility increases.
At the same time, the joints properly administered in the joint cavity, hyaluronic acid preparations practically do not have side effects.
Treatment with hyaluronic acid preparations is performed in courses: a total of 3-4 injections are required for the course of treatment in each sore knee, the interval between injections is usually 7 to 14 days.If necessary, the course is repeated after six months or a year.
From my point of view, the main and only serious disadvantage of hyaluronic acid drugs is their high price.So, in 2020, hyaluronic acid is presented on our market in the main import medicines.
But returning to the issue of savings, I would like to point out that despite the relatively high cost of hyaluronic acid preparations, their use literally allows many patients from those who before these drugs will definitely have to be operated.
And given the cost of joint surgery, it turns out that the timely use of hyaluronic acid (even for a few years) in any case, and in every sense, the patient is much more cheaper than the surgery for knee joint endoprothetics.Of course, provided that the doctor conducting such injections has the introduction technique.
It is important to know: hyaluronic acid preparations are destroyed immediately in this joint, which expresses pronounced inflammatory processes.Therefore, it is practically useless to introduce them with those patients in whom gonarthrosis occurs against the background of the active stage of arthritis.But it is useful to use them with constant remission of arthritis to treat secondary gonarthrosis phenomena.
With primary gonarthrosis, you should also pay attention to such moments.For example, if the patient's joints "bursts" from the accumulation of excess, pathological fluid, it makes sense to first "extinguish" the phenomena of synovitis (inflammation) and to eliminate excessive pathological fluid using a previous internal -articular injection of hormones or the administration of non -steroidal anti -adhesive anti.And only then to introduce hyaluronic acid into the joint, released from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, they try to introduce various chondroprotectors into the joint.
But these drugs are many times more in the efficiency of hyaluronic acid drugs.They help with the power of 50% of patients and know whether or not the effect of their use is impossible in advance.In addition, the course of treatment requires 5 to 20 joint injections, which, as we said, is fraught with possible joint injury and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for gonarthrosis at the I and II stage often produces a great result.Sometimes several procedures are sufficient for the patient to experience significant relief.Particularly good manual therapy for random joints helps if you combine it with joint extension, taking chondroprotectors and intra -articular injections at the point.
A similar combination of therapeutic procedures from my point of view is much more effective than the numerous physiotherapy measures proposed at each clinic.I will give an example of practice.
The case of the doctor's practice.
A 47 -year -old woman with arthrosis on the right knee joint on stage II reached the reception.At the time of our meeting, she has become ill for 5 years.Over the years, the woman has been able to experience all possible physiotherapy methods that can be proposed in our regional clinics: laser, magnetotherapy, ultrasound, phonophoresis, etc. a woman is appointed.A short course.
Completely desperate, the woman decided for extreme measures - she underwent a course of treatment with wormwood cigarettes according to the Oriental methodology.As a result, the knee was covered with Burns scars, but it did not move better.Yes, and it was unlikely, despite all my respect for Eastern medicine, I understand that the cauterization of wormwood cannot eliminate bone deformities and increase the distance between the bones articulated in the knee.
Since the woman did not help the numerous physiotherapy procedures and even cauterization in wormwood cigarettes, she almost agreed to surgical treatment.But then she still changed my mind and decided to try the complex method I offered.
The first treatment session passed, as they say, "with creaking" - we were able to "blush" the joint with the help of manual mobilization a little.Therefore, we scheduled the next session after preliminary preparation: Within 3 weeks the woman took chondroprotectors, did a self -massage and compress with demexide.After 3 weeks, I started again with the mobilization of the joint and then did the joint of the joint using manual manipulation.There was a click and suddenly the joint began to move much easier and more free.The woman felt a clear relief.
In the next two sessions, using mobilization, we have fixed the improvement achieved, and then determined the success of two intravenous injections at the point.And after a month and a half since the beginning of our not very intensive treatment (after all, we only needed six meetings), the woman finally managed to throw away the stick, which was bored with it and began to move quite freely.
Two years have passed since.Twice a year, the patient accepts chondroprotectors for a short course and occasionally comes to my control technique, where I am happy to note that the knee condition is better only from year to year.And now even the first stage of arthrosis would be very difficult to assume - the patient's knee joint was almost completely restored.
Thus, only six healing sessions (manual therapy plus internal -enchanting oreel injections) in combination with the course of chondroprotectors are more effective than five years of physiotherapy.
From this story (and by no means the only such thing) it is clear why I consider physiotherapy important, but only an additional part of the medical program for gonarthrosis.In this sense, I like laser therapy, thermal treatment (ozoquet, paraffin therapy, therapeutic mud) and especially cryotherapy (topical cooling treatment).
7. Diet:
Diet with arthrosis is also very important.
8. Using reeds:
Based on the rod when walking, patients with knee arthrosis seriously help their treatment as the rod acquires 30 - 40% of the load intended for the joint.
It is important to choose a stick according to your height.To do this, stand straight, lower your hands and measure the distance from the wrist (but not from the tips of your fingers!) To the floor.It's such a length that there should be a cane.When buying a stick, pay attention to your end - it must be equipped with a rubber nozzle.Such a stick is depreciated and does not slip when resting on it.
Remember that if the left leg hurts, then the stick should be held in your right hand and back.By taking a step from the patient with a foot, transfer a portion of the body weight of a stick.
9. Therapeutic gymnastics:
The most important treatment for knee joint arthrosis is the special therapeutic gymnastics.Almost no one who has gonarthrosis can achieve real improvement in the country without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, the "pump" blood vessels and to activate blood flow, as long as this can be achieved with the help of special exercises.
At the same time, the doctor of the doctor is almost the only method of treatment that does not require financial costs to buy equipment or medicines.Everything that the patient needs is two square meters of free space in the room and a carpet or blanket thrown on the floor.
There is nothing to consult a gymnastics specialist and the patient's desire to do this gymnastics.It is true that with such a desire, most sufferers do not burn.Almost every patient I discover arthrosis, I should literally persuade physiotherapy exercises.And most often it is possible to convince one only when it comes to the inevitability of surgery.
The second "gymnastic" problem is that even those patients who are configured for physiotherapy exercises often cannot find the necessary sets of exercise.Of course, there are brochures for patients with arthrosis on sale, but the competence of many authors is doubtful - after all, some of them do not have medical education.
So, such "teachers" do not always understand the importance of individual exercises and the mechanism of their action on inflamed joints.Often, gymnastic complexes simply simply correspond to one brochure of another.At the same time, they have such recommendations that it is correct to grasp your head!
For example, many brochures prescribe the patient with knee arthrosis, "to perform at least 100 squats a day and walk as much as possible."
Often, patients follow similar tips without consulting a doctor beforehand, and then genuinely disturb why they are getting worse.Well, I will try to explain why the condition of the diseased joints of such exercises, as a rule, worsens only.
Let's imagine the joint as a camp.Damaged by arthrosis, the inflamed joint has already lost its ideal shape.The surface of the "camp" (or cartilage) stopped being smooth.In addition, cracks, holes and "storms" appeared on it.Plus, lubricating inside the sphere thickens and dries, obviously not enough.