Treatment of knee arthritis, gonarthrosis treatment- Speaking gently, not the easiest task.Therefore, before you start the difficult struggle with this disease, make sure a good doctor, check him and make a treatment plan with him.
There is no case that does not try to set a diagnosis for yourself!
The fact that joint lesions, like Arthrose, occurs with many other diseases and low people who are often mistaken in determining diagnosis.It is better not to save time and money for medical advice, because errors can make you much more expensive in all aspects.
But this does not mean that you have to blindly trust any doctor and should not go into the nature of his recommendations, understand the mechanism of action of the drugs prescribed for you.Patients should understand the meaning of medical prescriptions and represent why some treatment procedures are carried out.
Therefore, with Gonartrosis treatment, it is important to combine some treatment measures in the way to solve some problems at the same time:
- eliminate pain;
- Improve the nutrition of articular cartilage and accelerate its recovery;
- Activate blood circulation in the affected joints;
- Reduce the pressure on the broken joints of the bone and increase the distance between them;
- strengthen muscles around the disease;
- Increase general mobility.
Below we will consider how this treatment or that treatment helps achieve your goals:
1. Anti -inflammatory drugs are not main
Anti -inflammatory drugs are not not -NSAID: diclofenac, pyroxycs, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
With arthritis, no drugs, anti -inflammatory drugs are used in tradition to eliminate pain and arthritis, because of fighting severe pain, unable to start normal treatment.Only by eliminating acute pain with anti -inflammatory drugs, then you can go, for example, massage, gymnastics and physical therapy procedures will not be able to withstand pain.
However, the use of drugs of this group is unwanted for a long time, because they can hide the manifestations of the disease.
In the end, when the pain decreased, a scam was created that a treatment began.Meanwhile, muscle disease continues to progress: NSAID only eliminates the individual symptoms of the disease, but is not treated.
Moreover, in recent years, the obtained data shows the harmful effects of prolonged use of non -informal anti -inflammatory drugs for the synthesis of Proteoglycans.Proteoglycan molecules are responsible for the water in cartilage and violate their functions leading to dehydration of cartilage tissue.Therefore, cartilage was affected by arthritis began to collapse even faster.Therefore, the pills that patients use to relieve joint pain can accelerate the destruction of this joint.
In addition, using anti -inflammatory drugs is not incorrect, remember that all of them have serious contraindications and prolonged use can cause significant side effects.
2. Chondroprotector - Glucosamine and Chondroitin Sulfate:
Chondroprotector - Glucosamine and Chondroitin Sulfate - these are nourishing cartilage and restoring the structure of the damaged cartilage of joints.
Chondroprotector is the most useful group of drugs to treat arthritis.
Unlike anti -inflammatory drugs (NSAID), Chondroprotectors does not eliminate too many symptoms of Arthricis as the basis of the disease: The use of glucosamine and chondroitin sulfate helps restore operating surfaces.
A similar complex effect of chondroprotors on joints makes them indispensable in the initial treatment of arthritis.However, there is no need to exaggerate these drugs.
Chondroprotector is very effective in the third stage of arthritis, when cartilage is almost completely destroyed.In the end, it is not possible to grow a new cartilage fabric or return the previous form for the deformed bones of the knee with glucosamine and chondroitin sulfate.
And in the first or second phase of Gonartrosis, Chondroprotector works very slowly and improves the patient's condition at the same time.To get real results, you need to undergo at least 2-3 treatment courses with these drugs, usually takes from six months to a year and a half.
3. Eintment and cream:
Ointments and therapeutic creams have no way to heal knee muscles (even when their ads approve the opposite).However, they can reduce the patient's condition and reduce knee pain.And in this sense, ointment is sometimes very helpful.
Therefore, with knee arthritis that occurs without an active inflammation without the phenomenon, I recommend that you warm the ointment for your patients to improve blood circulation in the joints.
To do this, using pepper fruit extract, etc. ... The ointments are listed often causing heat and comfort in patients.They rarely offer any side effects.
The ointments based on anti -inflammatory agents are not because they are not used in the case of gonarthrosis of arthritis.Unfortunately, they work ineffective as we want - because the skin does not exceed 5 - 7% of the active substance and this is obviously not enough to develop the completely anti -inflammatory effect.
4. Fund for compression:
Compression has a slightly large treatment for ointment.
Among the local funds used in our time, in my opinion, three drugs deserve the greatest attention: Dimexide, Bishophytus and Medical Bile.
Dimexide- Chemicals, liquids with colorless crystals, have good anti -inflammatory and analgesic effects.At the same time, unlike many other external substances, Dimexide can actually penetrate skin barriers.That is, Dimexide is applied to the skin that is actually absorbed by the body and acts inside it, reducing inflammation in the center of the disease.In addition, Dimexide has a property that can absorb and improve metabolism in the field of application, which makes it most useful in treating arthritis, which occurs in the presence of epidemic inflammation.
Bishophyte- Oil derivative, brine extracted during drilling of oil wells.He was famous for his drilling workers, the first to pay attention to his treatment effect on muscle disease.While working on oil wells from continuous contact with salt water from the drill, the Arthrose notes in the hand have occurred.In the future, it turns out that Bishophyte has a moderate anti -inflammatory and analgesic effect, and also works warmly, causing a pleasant hot feeling.
Medical- Natural honey is exploited from bile bubbles of cows or pigs.The bile has the effect of absorbing and heating and is used in cases similar to bischophyte, but there are some contraindications: it cannot be used for skin acne diseases, inflammatory diseases of lymph nodes and tubes, fever when increasing body temperature.
5. Introduction injecting (injected into the joints):
Content injections are often used for urgent care for knee joints.In many cases, organs can actually reduce the condition of the patient.But at the same time, injecting in joints with arthritis is done much more often than the necessary level.It is not accurate, in my opinion, the trend, I want to say more details.
Typically, corticosteroid hormones are included in the joints: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good in that they quickly inhibit pain and inflammation with epidemic inflammation (edema and joint swelling).That is the speed that the treatment effect achieved is the reason for corticosteroid injection that has become particularly common in doctors.
But this leads to the fact that the internal hormonal injection begins to be done even without real needs.For example, I have repeatedly faced the fact that the hormones are put into the patient's joints for the purpose of preventing to prevent the development of arthritis.
However, the problem is that it is corticosteroids that are not treated and cannot be treated.Therefore, they cannot prevent the development of arthritis!Corticosteroid does not improve the condition of articular cartilage, does not increase bone tissue and does not restore normal blood circulation.
All they can reduce the reaction of the body's inflammatory reaction to one or another damage in the joint.Therefore, the use of hormonal drugs is meaningless as meaningless as an independent treatment: they should only be used in complex therapy of arthritis.
For example, the patient has detected Gonartrosis of Phase II with joint swelling due to the accumulation of liquid in it.The accumulation of liquids (epidemic inflammation) makes it difficult to carry out medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs hormonal hormonal injections to eliminate epidemic inflammation, and within a week starting other positive treatments - this is the right approach.
Now imagine another situation.The patient also has Gonartrosis phase II, but does not accumulate appropriately and edema.Is it necessary to import corticosteroids in this case?Of course, no.There is no inflammation - no exposure point for corticosteroid hormone.
But even if the internal introduction of corticosteroid is really necessary, some rules must be followed.Firstly, there is no desire to perform such injections in the same joint more often more than once in 2 weeks.The fact that the drugs introduced will work all over the entire force immediately and the doctor will eventually be able to assess the effectiveness of the procedure after only 10-14 days.
You also need to know that often the first corticosteroid injection is more relieved than the next people.And if the first internal medication of the drug does not give results, it is not sure that it will give the second or third introduction of the same drug for the same place.In case of ineffective organs, you need to change the drug or if the change of medicine does not help, more accurately choosing the injection site.
If even after that, bringing corticosteroids into the joints does not give the desired results, it is better to give up the idea of treating this joint with hormonal drugs.Moreover, the injection of hormones in the same joint is more than four to five times in general, it is extremely unwanted to increase the ability to increase side effects.
Unfortunately, in fact, you face the excessive determination of doctors, people, many times, bring corticosteroids into the same joint, without achieving at least the minimum effect with the first three injections.Two such cases hit me more than other cases.
One of the patients who performed only ten injections of Kenalog, while the process was done daily, even without the need for ten days needed to evaluate the injection results.And the second patient is put into hormones inside the knee joint, observing the time period (although only 3 to 5 days), but at the same time, the poor have received twenty to twenty times corticosteroid injections in one joint for treatment!
It seems that the doctor has gone too far - it's okay.Can any harm from such treatment?Turns out, maybe!
Firstly, for each injection, joint, although slightly, injured by needles.Secondly, with the inner injection, there is always a certain risk of infection in the joint.Third, the introduction of hormones often causes a violation of the structure of joints and surrounding muscles, causing relative decaying joints.
And most importantly, the injection of corticosteroids often worsens the condition of patients with joint damage combined with diabetes, high blood pressure, obesity, kidney failure, stomach or intestinal ulcers, tuberculosis, pus infections and mental illness.Even when being exclusively put into the general compartment, corticosteroid affects the whole body and can worsen the process of these diseases.
It is much more useful when managing hyaluronic acid drugs in the knee joint affected by arthritis (another name for hyaluronic acid - sodium hyaluronate).They appeared when sold about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also known as Muslims' liquid parts, or implanted liquids, as they work on joints as a healthy fluid fluid - that is, as a natural joint lubricant.
Hyaluronic acid preparations are very useful and effective drugs: Sodium Hyaluronate forms a protective film on damaged cartilage, protecting cartilage tissue from further destruction and improving contact cartilage surface.
In addition, hyaluronic acid preparations penetrate the depth of cartilage, improving its elasticity and elasticity.Thanks to Hyaluronidase, dry and thin with arthritis, cartilage restores its shocking properties.Due to the weakness of mechanical overload, the pain in the knee joint is reduced and its ability to exercise increases.
At the same time, accurate management joints into the joint cavity, hyaluronic acid preparations do not produce side effects.
Hyaluronic acid treatment is performed in the courses: Total, need to be injected 3-4 for the treatment process at each knee, the distance between injections is usually from 7 to 14 days.If necessary, the course is repeated for six months or a year.
In my opinion, the main and unique drawback of hyaluronic acid is their high price.Therefore, in 2020, Hyaluronic Acid is represented in our market in the main imported drugs.
But back to the problem of savings, I would like to note that although the cost of preparing hyaluronic acid is relatively high, the use of them allows many patients from previous people, before these drugs, it will definitely have to operate.
And with the cost of operating on joints, indicating that the timely use of hyaluronic acid (even in a few years) in any case and in all meanings, the patient is much cheaper than the surgery for the endoprosthetic surgery of the knee joint.Of course, provided that the doctor conducts such injections possessing introduction techniques.
It is important to know: Hyaluronic acid preparations are immediately destroyed in the joints in which obvious inflammatory processes are being conducted.Therefore, the reality is useless to introduce them to patients in which Gonarthrosis conducts on the basis of the active phase of arthritis.But it is useful to use them with persistent remission of arthritis to treat secondary Gonarthrosis phenomena.
With the main gonarthrosis, you also need to pay attention to such moments.For example, if the patient joints from each other from the accumulation of excess liquid and pathology, it is meaningful to the first extinguishing, the phenomenon of the active inflammation (inflammation) and the removal of the medical liquid too much with the help of the previous hormonal injection.And only then to introduce hyaluronic acid into the joints, released from inflammatory factors.
In addition to corticosteroid hormones and hyaluronic acid preparations, try to bring different chondroprotector into the joints.
But these drugs are much lower in the effectiveness of hyaluronic acid.They help from the power of 50% for patients and guess whether the effects of their use or not, is not possible first.In addition, the treatment requires 5 to 20 times in the joints, as we said, fully with the ability to cause injury to the joints and various complications.
6. Craft therapy and physiotherapy:
Craft treatment for Gonartrosis of phase I and II usually produce excellent results.Sometimes some procedures are sufficient for patients to feel significant relief.Especially the manual therapy of random joints helps, if you combine it with the joint extension, the amount of chondroprotors and the intracranial injection of the point.
A combination of treatment procedures, in my opinion, is much more effective than many physiotherapy proposed in any clinic.I will give an example from practice.
The case from the doctor's practice.
A 47 -year -old woman with the right knee joint of Phase II came to reception.At the time we met, she was sick for 5 years.For many years, a woman managed to experience all physical therapy methods that could be proposed in our district clinics: laser, from chemotherapy, ultrasound, and phonemes of a woman who was appointed.Short course.
Absolutely desperate, the woman decided about extremist measures - she went through a process of treatment by processing Wormwood cigarettes by Eastern method.As a result, the knee is covered by burn scars, but it does not move better.Yes, and I couldn't, although all my respect for Eastern medicine, I understood that Cauterization Wormwood could not eliminate bone deformity and increase the distance between joints in the knee.
After the woman did not help many physical therapy procedures and even automated in Wormwood cigarettes, she really agreed to treat surgery.But then she still changed my mind and decided to try the complicated method I proposed.
The first session was approved, as they said, with a creaking sound - we just tried to stir online with the help of a little mobilization.Therefore, we planned the next session after preliminary preparation: within 3 weeks, the woman took Chondroprotors, made it and compressed with Dimexide.After 3 weeks, I started to mobilize the joints again, and then performed a reconstruction (decrease) of the joint using manual manipulation.There was a click and suddenly the match began to move easier and more freely.The woman feels relieved.
In the next two sessions using the mobilization, we corrected the improvement achieved, then we have successfully repaired the two internal injections of the point.And after a month and a half since the beginning was not intensely treated (after all, we only need six meetings), the woman who was able to remove her wand was bored with her and started moving quite freely.
Two years have passed since then.Twice a year, the patient uses chondroprotors in a short course and sometimes comes to my control technique where I am very happy to note that the condition of the knee is better from year to year.And now, even the first stage of muscle disease will be very difficult to think that the patient's knee joint has been restored almost completely.
Therefore, there are only six sessions of treatment (public therapy with Orenil's internal injection) in combination with the process of chondroprotector more effectively than five years of physical therapy.
From this story (and does not mean that the only one) becomes clear why I consider physiotherapy as an important part, but it is only an additional part of the medical program for Gonarthrosis.In this sense, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, sludge) and especially cold pressure therapy (local cooling treatment).
7. Diet:
Diet with arthritis is also important.
8. Use sugarcane:
Based on the stick when walking, the patient has a knee joint to help treat seriously, because the stick accounts for 30-40% of the load for joints.
It is important to choose a stick according to your height.To do this, stand upright, lower your hands and measure the distance from the wrist (but not from the tip of your fingers!) To the floor.It was such a length that should have a stick.When buying a wand, pay attention to its end - it should be equipped with rubber nozzles.Such a stick is depreciated and does not slip when they rest on it.
Remember that if your left leg hurts, the stick should be kept in your right hand and vice versa.Take one step of the patient with one foot, convert a part of the body weight to a stick.
9. Gymnastics Therapy:
The most important treatment for knee joint disease is the special treatment for treatment.Almost no one with Gonartrosis can achieve real improvement in the state without gymnastics.
In the end, it is impossible to enhance muscles, pump blood vessels and activate blood flow as much as this can be achieved by using special exercises.
At the same time, physical gymnastics are almost the only treatment that does not require financial costs for buying equipment or drugs.All the patient needs are two square meters of empty space in the room and a carpet or blanket throw to the floor.
There is nothing left to refer to an expert in gymnastics and the patient's own desire to perform this gymnastics.Yes, with just one desire, most people suffer from burning.Almost every patient, in which I reveal muscle disease, I have to convince physiotherapy exercises in the literal sense.And often can only convince one person only when it comes to inevitable intervention.
The second exercise problem of the Viking is that even patients who are configured for physiotherapy exercises often cannot find the necessary exercise.Of course, there are advertising documents for patients with arthritis, but the capacity of some authors is suspicious - after all, some of them have no health education.
Therefore, the teachers of the Viking people like that, not always understand the meaning of personal exercises and their action mechanism for painful joints.Typically, exercise complexes simply do not think corresponding from one set of documents to another.At the same time, there are such recommendations in which it is moderate to get your head!
For example, many advertising documents prescribed for patients with knee joints "to perform at least 100 squats a day and walk as much as possible."
Normally, the patient followed such advice, but before he was not consulted, the doctor, and then sincerely confused why they became worse.Well, I will try to explain why the condition of the joints is sick from such exercises, as a rule, only worse.
Imagine joints like a bearing.Damaged due to joints, joints have lost the ideal shape.The surface of the "bearing" (or cartilage) is no longer smooth.Moreover, cracks, potholes and Burs Burs Burs appear on it.In addition, the lubrication inside the sphere is thick and dry, it is obviously not enough.