Treatment of knee joint arthrosis, gonarthrosis treatment- To put it a little, not the easiest task.Therefore, before you start your hard struggle with the disease, make sure you find a good doctor, examine him and make a treatment plan with it.
In case no, don't try to create a diagnosis for yourself!
The fact is that the wounds are together, resembling arthrose, occurring with many other diseases, and low people are often misunderstood in determining diagnosis.It is best not to save time and money for medical consultation, as the mistake can make you more expensive in all aspects.
But this does not mean that you must blindly believe in any doctor and cannot investigate the essence of his recommendation, understand the mechanism of action of the drugs prescribed to you.Patients should understand the meaning of medical prescriptions and represent why certain therapeutic procedures are performed.
Therefore, with therapeutic treatment of gonartrosis, it is important to combine several therapeutic steps in such a way to solve some problems at once:
- eliminate pain;
- improving articular cartilage and accelerates its recovery;
- activate blood circulation in the affected joints;
- reduce pressure on damaged bone joints and increase the distance between them;
- strengthen the muscles that surround the joints;
- Increase mobility together.
Below we will consider how this treatment method or this helps to achieve your goals:
1. Non -steroidal Anti -Inflammation of Medicines:
Anti -anti -Non -NSAIDS drugs: diclofenac, pyroxycs, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
With arthrosis, anti -unused drugs are traditionally used to eliminate pain and inflammation of the joints, because against the background of severe pain, it is impossible to start normal treatment.Only by eliminating acute pain with anti-inflammatory drugs, you can then go, for example, for massage, gymnastics and physiotherapeutic procedures that cannot be detained due to pain.
However, it is not desirable to use these groups for a long time, as they can "close" the manifestation of the disease.
After all, when the pain decreases, the deceptive effect is created that the antidote begins.Meanwhile, arthrosis continues to develop: NSAIDs only eliminate the individual symptoms of the disease, but do not treat it.
Moreover, in recent years, data has been obtained showing the harmful effects of anti -non -stable drug use in proteoglican synthesis.Proteoglycan molecules are responsible for the flow of water in the cartilage, and their functional violation leads to dehydration of cartilage tissue.As a result, the cartilage that has been affected by arthrosis begins to collapse faster.Therefore, the pill taken by the patient to reduce the pain in the joints can accelerate the destruction of the joints.
In addition, using anti -non -ssteroid drugs, keep in mind that all have serious contraindications and with prolonged use can have significant side effects.
2. Chondroprotectors - Glucosamine and Chondroitin Sulfate:
Chondroprotectors - Glucosamine and Chondroitin Sulfate - these are substances that feed on cartilage tissue and restore damaged cartilage structure.
Chondroprotectors are the most useful group of drugs for the treatment of arthrosis.
Unlike anti -unstable drugs (NSAIDs), chondroprotectors do not eliminate the symptoms of arthrosis as "basic"
The same complex effect of chondroprotectors on the joints makes it very needed in the early stage treatment of arthrosis.However, there is no need to grow -exaggerate these drugs.
Chondroprotectors are slightly effective in the third stage of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to develop a new cartilagin or return the container to the knee -defective bone with glucosamine and chondroitin sulfate.
And in the first or second stage of gonartrosis, chondroprotectors act slowly and improve the patient's condition at once.To get the real results, you need to undergo at least 2-3 courses of treatment with these drugs, which usually take from six to half a year.
3. Ointment and Therapeutic Cream:
Ointment and therapeutic creams cannot cure knee joint arthrosis (although their advertising approves otherwise).However, they can reduce the patient's condition and reduce pain in the sore knee.And in this sense, ointment is sometimes very useful.
Therefore, with knee joint arthrosis that occurs without synovitis without phenomena, I recommend heating ointment to my patients to improve blood circulation in the joints.
To do this, use pepper extract, and more.Listed ointments usually cause warmth and comfortable comfort in the patient.They rarely have side effects.
Anti -ssteroid -based clock is used in cases where gonarthrosis courses are aggravated by synovitis.Unfortunately, they act not as effective as we want - because the skin does not exceed 5 - 7% of the active ingredient, and this is clearly not enough to develop a full anti -inflammatory effect.
4. Fund to compress:
Compressed has a slight therapeutic effect compared to ointment.
From the local funds used in our time, in my opinion, three drugs deserve the greatest attention: dimexide, bishophytus and medical bile.
Dimexide- Chemicals, fluids with colorless crystals, have good anti -anti -analgesic effects.At the same time, unlike many other external ingredients, dimexide is actually able to penetrate the skin barrier.That is, the dimexide used for true skin -is actually absorbed by the body and functions in it, reducing inflammation in the focus of the disease.In addition, Dimexide has the property that can be absorbed and improves metabolism in the field of application, which makes it the most useful in the treatment of arthrosis, which occurs in the presence of synovitis.
Bishophyte- Oil derivatives, salt water extracted during oil drilling.He got his fame thanks to Drillers, the first to pay attention to his therapeutic effects with arthrosis.While working in the oil wells from continuous touch with oil salt water from the drill, the arthrose nodules in their hands occur.In the future, it turns out that the bishophyte has anti -anti -analgesic effects, and also acts warmly, causing a pleasant heat.
Bile medical- Natural bile is mined from cow bile bubbles or pigs.Bile has absorbable effects and heating and is used in the same case as bischophyte, but has some contraindications: it cannot be used for pustular disease, inflammation of lymph nodes and channels, countries -fever country with increased body temperature.
5. Intra -articular injection (injection in joints):
Intra -articular injection is often used to provide emergency care for knee joint arthrosis.In many cases, the intra -articular injection is true -can actually reduce the patient's condition.But at the same time, injections in the joints with arthrosis are made more often than needed.It's about this wrong, in my opinion, trend, I want to talk in more detail.
Often, corticosteroid hormone drugs are introduced into the joints: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good as they quickly and effectively suppress pain and inflammation with synovitis (edema and swelling of the joints).It is the speed in which the therapeutic effect is achieved that the cause of corticosteroid injection has gained certain popularity among doctors.
But this leads to the fact that intra -articular hormone injections begin to be carried out even without real requirements.For example, I have repeatedly faced the fact that hormones are introduced into the patient's joints for preventive purposes to prevent further arthrosis.
However, the problem is that only the arthrosis itself is not treated and cannot be treated.So, they can't 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 blood circulation.
All they can reduce the reaction of the body's reaction to one or another damage to the joint cavity.Therefore, it is a waste to use intra -articular injection of hormone drugs as a free treatment method: they should only be used in complex therapy of arthrosis.
For example, the patient detects stage II gonartrosis with swelling of the joints due to the accumulation of fluid in it.Liquid accumulation (synovitis) makes it difficult to perform medical procedures: manual therapy, gymnastics, physiotherapy.In such cases, doctors perform intra -articular injections of hormone drugs to eliminate synovitis, and in a week starting with other active therapeutic steps -this is the right approach.
Now imagine another situation.The patient also has stage II gonartrosis, but without the accumulation of fluid edema and joints.Is it necessary to enter the corticosteroids in the joints in this case?Of course, no.No inflammation - no "exposure point" for corticosteroid hormones.
But despite the introduction of intra -articular corticosteroids -is actually required, some rules must be observed.First, it is not desirable to make such an injection in the same joint more often than 1 time in 2 weeks.The fact is that the drug introduced will "function" immediately and the doctor can finally evaluate the effects of the procedure only after 10 - 14 days.
You should also know that the first injection of the corticosteroids brings more relief than the next.And if the first -Particular intra administration does not produce the results, it is unlikely that it will provide the second or third identification of the same drug to the same place.If the first -articular intra -articular injection is ineffective, you should either change the drug, or if the medical change does not help, more precisely, select the injection site.
If the introduction of corticosteroids into the joints does not provide the desired results, it is best to leave the idea of treating this joint with hormone medication.In addition, hormone injections in the same joints are more than four to five times in general, which are very unwanted differently in different possible side effects.
Unfortunately, in practice, you must face excessive "determination" of the doctor who, repeatedly, introduces corticosteroids into the same joint, without reaching at least the minimum effect with the first three injections.Two such cases hit me more than the others.
One of the patients performs "only" the ten kenalog injections, while the procedure is performed daily, even without the ten -day breaks required to evaluate the injection results.And the second patient was introduced into the hormone in the knee joint, observing the interval (though only 3 to 5 days), but at the same time, the poor received twenty -twenty -five corticosteroid injections in one joint for treatment!
It looks like the doctor "goes too far" - it's okay.Can there be a danger from such treatment?Apparently, maybe!
First, with each injection, the joints, though slightly, injured by the needle.Second, with intra-articular injection, there is always a risk of certain infections in the joints.Third, the introduction of frequent hormones causes a violation of the joint and muscle structure of the surrounding, causing the "rotting" joints relative.
And most importantly, corticosteroid injections often worsen the patient's condition where joint damage is combined with diabetes mellitus, high blood pressure, obesity, kidney failure, stomach or intestinal ulcer, tuberculosis, purulent infection and mental illness.Even introduced exclusively into the joint cavity, corticosteroids affect the whole body and can worsen the disease.
It is more useful in administering hyaluronic acid drugs in the knee joint affected by arthrosis (another name for hyaluronic acid - sodium hyaluronate).They appeared in sales about 15 years ago.
The preparation of hyaluronic acid (sodium hyaluronate) is also called "liquid prosthesis" or "liquid implant", as they act on the joints as a healthy synovial fluid - that is, as a natural "co -lubrication".
Hyaluronic acid preparation is a very useful and effective remedy: sodium hyaluronate forms a protective film on damaged cartilage, protects cartilage tissue from further destruction and increases the sliding of the cartilage surface.
In addition, the preparation of hyaluronic acid penetrates the depth of the cartilage, increasing its elasticity and elasticity.Thanks to hyaluronidase, "dry" and thinning with arthrosis, cartilage restores the properties that absorb it.As a result of the weakness of the mechanical advantages, the pain in the knee joint decreases and its increased mobility.
At the same time, the joints are properly administered into the joint cavity, the preparation of hyaluronic acid practically does not have any side effects.
Treatment with hyaluronic acid preparation is carried out in the course: Overall, 3-4 injections are required for treatment in each knee, interval between injections from 7 to 14 days.If necessary, the course is repeated in six months or a year.
From my point of view, the main disadvantages and only serious hyaluronic acid drugs are high prices.Therefore, by 2020, hyaluronic acid was represented in our market in major import drugs.
But back to the issue of savings, I would like to note that despite the high cost of hyaluronic acid preparation, its use literally allows many patients from those who had previously, before these medicines, it would have to be handled.
And in view of the cost of surgery in the joints, it appears to be timely use of hyaluronic acid (though for several years) in any condition and in every terms of the patient's cost is lower than surgery for endoprosthetics knee joints.Of course, on the condition that the doctor performs the injection has an introductory technique.
It is important to know: the preparation of hyaluronic acid is immediately destroyed in the joints where the inflammation process is carried out.Therefore, it is useless to introduce them to patients -Patients where gonarthrosis continues the background of active level of arthritis.But it is useful to use it with persistent arthritis to treat secondary gonarthrosis phenomena.
With the main gonarthrosis, you also need to pay attention to those moments.For example, if the "rupture" of the patient's joints from excess accumulation, pathological fluid, it makes sense for the first to "erase" the phenomenon of synovitis (inflammation) and produce excess pathological fluid with the help of intra -particular hormone injection or take uncertain medications.And only then to introduce hyaluronic acid into the joints, released from the elements of inflammation.
In addition to corticosteroid hormones and hyaluronic acid preparations, trying to introduce a variety of chondroprotectors into the joints.
But these medicines are many times lower than the effectiveness of hyaluronic acid drugs.They help from 50% strength to patients, and guess whether or not the effect is, it is impossible first.In addition, treatment requires 5 to 20 injections in the joints, which, as we say, are full of possible injuries to joint and varied complications.
6. Manual and Physiotherapy Therapy:
Manual therapy for gonartrosis stages I and II often produces great results.Sometimes some procedures are enough for patients to feel significant relief.Good manual therapy from random joints helps, if you combine it with extension, intake chondroprotectors and intraarticular injection at that point.
The combination of therapeutic procedures like this, from my point of view, is much more effective than many physiotherapeutic measures suggested anywhere in the clinic.I will give you an example of practice.
Case from doctor's practice.
A 47 -year -old woman with stage II's right knee joint arthrosis comes to acceptance.During our meeting, he had been sick for 5 years.Over the years, the woman has successfully experienced all possible physiotherapy methods that can be suggested in our district clinic: laser, magnetotherapy, ultrasound, phonophyesis, and others.Women, only once, a woman was appointed.short course.
Completely desperate, the woman decides on extreme steps - she has been treated with wormwood cigarettes that delight according to oriental methodology.As a result, the knee is covered with scars from burns, but it does not move better.Yes, and it is impossible for me to be, despite all my respects of Eastern medicine, I understand that wormwood destroyers cannot eliminate bone deformation and increase the distance between bones that are articulated in the knee.
After the woman did not help many physiotherapeutic procedures and even Cauterization in wormwood cigarettes, she almost agreed to surgical treatment.But then he still changed my mind and decided to try the complex method I suggested.
The first treatment session passed, as they said, "by screaming" - we only managed to "move" the joints with the help of a little manual mover.Therefore, we scheduled the next session after the initial preparation: within 3 weeks, the woman took chondroprotectors, made herself and compressed with Dimexide.After 3 weeks, I started again with joint movers, and then made a reposition ("reduction") of the joints using manual manipulation.There is one click and suddenly -the joints start to move easier and more free.The woman was relieved.
In the next two sessions using mobilization, we set the improvement, after which we set the success of two intra -Articular injections at that point.And after one and a half months from the beginning of our not so intense treatment (after all, we only needed six meetings), the woman was finally able to remove the bored stick with her and began to move freely.
Two years have passed since.Twice a year, patients take chondroprotectors in short courses, and sometimes come to my control techniques, where I am happy to notice that the knee condition is better than year to year.And now, although the first stage of arthrosis will be very difficult to assume - the patient's knee joint has been restored almost completely.
Therefore, only six treatment sessions (manual therapy plus intra -surveillance orangeil injection) in combination with condoprotector is more effective than five years of physiotherapy.
From this story (and not the only one like that) it is clear why I consider the physiotherapy important, but only part of the medical program for gonarthrosis.In this sense, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling).
7. Diet:
Diet with arthrosis is also very important.
8. Using sugarcane:
Based on the sticks while walking, patients with knee joint arthrosis seriously helps their treatment, as the stick takes 30 - 40% of the load intended for the joints.
It is important to choose a stick according to your height.To do this, stand straight, lower your hand and measure the distance from the wrist (but not from the tip of the finger!) To the floor.It is a length that should be a stick.When buying a stick, keep an eye on it - it should be equipped with a rubber nozzle.Such a stick is paid and does not slip when they rest on it.
Remember that if your left foot is sick, then the stick should be held in your right hand, and vice versa.Take steps by the patient with the legs, transfer part of the weight to the stick.
9. Therapeutic Gymnastics:
The most important treatment for knee joint arthrosis is special therapeutic gymnastics.Almost no one with gonartrosis can achieve a real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, "pump" blood vessels and activate this as much blood flow can be achieved using special exercises.
At the same time, doctors gymnastics are almost one of the treatment methods that do not require financial costs for the purchase of equipment or drugs.All that the patient needs is two square meters of empty space in the room and carpet or blanket thrown to the floor.
There is nothing more to consult a gymnastics and the patient's own desire to do this gymnastics.True, only with such a desire, most patients do not burn.Almost every patient, where I reveal arthrosis, I have to persuade physiotherapy training literally.And it is most likely to convince someone only when it is inevitable with surgical intervention.
The second "gymnastics" problem is that even a patient configured for physiotherapy training often cannot find the required set of training.Of course, there are brochures for patients with arthrosis sold, but the efficiency of some authors is doubtful - after all, some of them do not have medical education.
Therefore, such "teachers" do not always understand the meaning of individual training and their mechanism of action in the joints.Often, the gymnastics complex alone does not match one brochure to another.At the same time, there are such suggestions in it that it is right to grab your head!
For example, many brochures set patients with knee joint arthrosis "to perform at least 100 squats a day and walk as much as possible."
Often, patients follow such advice, without consulting a doctor, and then sincerely confused why they get worse.Well, I will try to explain why the joint conditions of such exercises, as a rule, are just worse.
Let's imagine the joints as a bearing.Damaged by arthrosis, the joints have lost their ideal form.The "bearing" surface (or cartilage) is no longer smooth.In addition, cracks, potholes and "burrs" appear on it.In addition, lubrication in the thick and dry spheres, it is clearly not enough.