Medical gymnastics and physiotherapy in osteoarthritis of knee joint
Therapeutic exercises in osteoarthritis of the knee joint is an effective way of treating this very unpleasant disease. Gymnastics is the basis of any scheme of treatment of the disease, at whatever stage of development they were in. The physicians have accumulated vast practical experience and developed methods provide the required efficiency.
An Important condition for the correctness of the designed treatment programs – therapeutic exercises in osteoarthritis of the knee should be individualized, based characteristics of the organism of a sick person. Accurate diagnosis stage the disease and consideration of all factors is a guarantee that physical therapy will be a real cure for the patient.
Osteoarthritis of the knee, or gonarthrosis, is a disease of degenerative nature, which causes destruction of cartilage, articular deformity and dysfunction of the knee joint. The initial lesion of tissue of cartilage arises on the molecular level with a consequent change in the structure of matter, leading to opacification, thinning and delamination of the cartilage, and cracking it in all directions.
The clinical picture of the disease distinguish 3 main stages. In the first stage there was a slight anomaly of the hyaline cartilage, while the joint retains its shape. In the cavity accumulates fluid, penetrating into the area of the popliteal fossa with the possibility of a Baker's cyst. Pain appears while walking and prolonged standing (particularly noticeable when descending the stairs), but goes dormant.
The Second stage is characterized by significant thinning of the cartilage, until the complete disappearance of the strip. Develop regional growth of bone tissue and the narrowing gap. Any motion accompanied by pain syndrome, and to weaken it needed a long rest.
The Main signs of the third stage – the disappearance of the cartilage at a considerable plot, obvious bone sclerosis, the proliferation of osteophytes, severe joint space narrowing. Pain syndrome is expressed by high intensity and never goes dormant. There is some limited joint mobility, muscle wasting in the thigh and lower leg, begins the deformation of the bones. There has been a change of gait and the shape of limbs.
Causes of gonarthrosis
The etiology of the disease there are the following main causes: genetic predisposition, inherent to the genetic level; old knee injury; excess body weight causes increased load on the knee joint; excessive exercise; metabolic disorders as a result of certain diseases, leading to intra-articular deposition of crystals (e.g., uric acid); the age factor, associated with natural degenerative processes.
Currently completely cure the osteoarthritis is not possible, but to stop the destruction of tissues and to provide full disabled person is possible by applying an integrated approach to treatment. Modern treatment scheme includes the following directions: to wear a special knee brace to relieve loads on the medial areas; the appointment of a non-steroidal anti-inflammatory drugs; a diet aimed at weight loss; therapeutic exercise, including the special complex of exercises; administration of muscle relaxants; physical therapy; injection of hyaluronic acid to replace synovial fluid; the use of chondroprotectors; prescription of drugs to normalize blood circulation and improve blood rheology; PRP method based on the introduction of the drug to cartilage; surgical treatment if necessary (arthroscopy and the arthroplasty of joint). The most important element of treatment is physical exercise in osteoarthritis of the knee, including special exercises for the elderly with osteoarthritis.
Basic principles of physical therapy
exercise therapy for osteoarthritis is a physical exercise that helps to develop the affected joint, improve motor function, to strengthen the muscles and improve their tone. Charging should be carried out on the individual program, long-term systematic treatment. The program must consider the person's condition, stage and phase of the disease, draws attention to contraindications. In the period of remission exercises for osteoarthritis of the knee are performed more often, longer and with heavier loads, and during exacerbation of the disease intensity is reduced to a minimum.
generally Recognized are the following basic principles: exercise should not cause pain; exercise firstassigned minimal in magnitude and duration with increasing intensity exercises begin with simple movements, with a gradual complication; physiotherapy for osteoarthritis should be regular (without long breaks).
All schemes of therapeutic exercises include the basic rules to avoid overload and ensure maximum efficiency, but the main rule – do no harm:
- All movements are performed smoothly, in slow motion, and their amplitude increases gradually.
- Exercises are held daily.
- the Total duration of physical exercise during the day should not exceed 35-45 minutes divided into 3-4 period of 10-15 minutes each.
- Rest after each session should be at least 4 hours.
- the Number of repetitions of the same exercises in the initial period (12-14 days) is not more than 4-5 times with a subsequent increase up to 6-10 times if necessary.
- to Begin a session with relaxation of foot muscles to improve the blood flow.
- After each session ensures rest in the supine position with their legs stretched relaxed, a bit spaced to the side; bend legs at the knees or rest while sitting is not recommended.
- Good fastening of therapeutic exercises – easy self-massage of the joint and entire limb for 6-8 minutes.
In exercise therapy for osteoarthritis includes both very simple and more advanced exercises depending on the severity of joint disease.
They were run from different initial positions (IP): lying, sitting and standing; and in the supine position on the bed can be PIS on your side, back or stomach.
Exercise in the lying position. The most common are physical therapy exercises performed in the supine position:
- IE: arms along the body; on the inhalation the hands go up and are discharged back slightly while simultaneously bending the sole of the foot, exhale – return to the SP.
- inspiratory hands lifted knee to the stomach on one leg, exhale – return to the SP; then performed the same exercise with the other leg.
- Legs are bent at the knees with elevation of the pelvis.
- IE: legs bent at the knees. First lifted one leg and falls, then the same is done with the other leg.
- Lead one straight leg to the side and return; then the same with the other leg.
- IE: arms along the body; the breath both hands and leg up, exhale – return to the SP.
- is Repeated with the other leg.
- Exercise "Bicycle" for at least 12-15 seconds.
- Exercise "Scissors" raised legs for 10-12 seconds.
In the side-lying exercises are performed first on the left, and then on the right:
- bottom leg bent at the knee, and the upper straight rises to a height of 25-30 cm.
- Alternate flexion legs in the knee joint.
- Alternate the lead leg back and forth.
In the prone position is recommended to do the following exercises:
- SP: hands under the chin; alternately legs straight up.
- inspiratory rises head and upper torso without lifting the feet from the surface, exhale – return to the SP.
- Alternate flexion of legs at the knee, lifting the lower part of the limb.
- Imitation of movements of the swimmer when swimming crawl.
Exercises in the sitting position (sitting on chair). You can offer these exercises (IE – the back is straight, hands rest on the chair):
- "Hanging down": fast alternating flexion and extension of knee.
- Alternate straightening legs to a right angle with the fixation in the top position for 2-3 seconds.
- rising from a chair with the lifting of hands and a quick return back.
- Lift both legs at a right angle and move them to the side.
Exercise in the standing position are performed using a support on the back of a chair or table. To often made the following motion:
- Hands embrace the back of a chair; the legs are alternately discharged maximally to one side.
- IE: standing sideways to a chair, hands on the back, alternately Mahi straight leg forward and backward.
Exercises according to the system of Hatha yoga. Gonarthrosis is recommended a few exercises included in the complex of Hatha yoga exercises:
- IE: standing, feet shoulder width apart, arms omitted; the torso with hands ripping off the toes with a small lowering of body; breathing evenly.
- IE: sitting on your knees, body upright, arms hanging; you need to gradually sit down on your heels and remain in this state for 1.5-2 minutes.
- SP: sitting on the floor, legs straight; slow tilt without bending the legs, the exercise duration is 1,5-2 minutes.
Physical exercise should be combined with walks in the fresh air, swimming, bath treatments and a Solarium, as well as to combine with physiotherapy and therapeutic massage. Be healthy!