Therapeutic exercise for arthrosis of the lower extremities

An important role in the treatment of diseases of the musculoskeletal system is played by physical exercises - specially organized for a specific purpose and strictly dosed movements. They are one of the important factors that support the life activity of a healthy person and stimulate restoration and compensatory mechanisms in the body of a sick person, since all adaptive processes are involved through the system of central regulations to ensure homeostasis.

I. P. Pavlov noted that movement is a natural function necessary for human existence, affecting the entire organism and relating “to the main reactive activity of the body.”

Regular exercise creates dominant foci of excitation in the cerebral cortex, which, through the mechanism of negative induction, leads to the suppression of foci of stagnant excitation, i.e. eliminates “pain points”.

Systematic use of physical exercises in the complex treatment of a patient eliminates the negative effects of physical inactivity on the body and has a multifaceted beneficial effect.

Rhythmic contraction and relaxation of skeletal muscles, tension and relaxation of tendons help improve venous outflow, prevent venous stagnation, and normalize microcirculation in tissues.

Physical exercise prevents the development of atrophy and degenerative changes in tissues and organs.

When choosing a physical therapy technique, it is necessary to take into account a number of factors. The nature and severity of the injury, the stage of the pathological process, the physical and mental state of the patient, his physical fitness. A set of exercises must be compiled strictly individually, taking into account the phase of the process.

Physical therapy is an important method of restoring joint function in arthrosis. The use of dosed physical exercises reduces pain, improves joint mobility, reduces muscle tension, increases the tone of weakened muscles, enhances the nutrition of joint tissues, and improves the patient’s functional abilities.

Physical therapy must be carried out taking into account the nature of the joint damage, the stage of the pathological process, and the general condition of the patient. It is advisable to carry out exercise therapy under the supervision of an experienced instructor, or after consulting a specialist. It should be remembered that in our body in general, and in the musculoskeletal system in particular, everything is interconnected. If one joint suffers, this will certainly lead to changes primarily in the spine and adjacent joints. Therefore, when prescribing a set of exercises to a patient, it is necessary to take these changes into account.

The basic principle of physical education for arthrosis is physical education in the pain-free zone

Otherwise, muscle spasms, painful contractures, spasms of blood vessels, overexcitation of the nervous system develop, and the general condition worsens.

Principles of physical education for arthrosis.

“Walking accessibility” - don’t rush things - enjoy the slightest success achieved, the range of movements should be increased very carefully, gradually. Energetic, forced movements are contraindicated
“Work in the pain-free zone” - stop doing the exercises when pain appears, and under no circumstances “overcome the pain.”
“Light mechanical load with static unloading” - exercises are best performed in a light state - lying or sitting, movements in the joints should be done slowly, but with sufficient amplitude.
“Move, but avoid overload” - movements should not be too intense, causing injury to the affected joint.
“Hardware physical training” - devices help stretch and relax the joint.
“Physical training in the pool” - there is no vertical load on the joints, mechanical and psychological comfort is achieved.
“Regularity” of exercises. Repeat the exercises frequently throughout the day for a few minutes
“Assessment of the arthrosis phase” - exacerbation or remission of arthrosis determines the intensity of exercise

What to do if you have constant foot pain

Pain in any part of the body can indicate simple fatigue or serious pathology. It is useless to guess about the causes of pain; it is recommended to immediately consult a doctor and not wait for the disease to spread to neighboring areas of the body.

The causes of frequent pain in the lower extremities can be:

Incorrectly selected shoes. Shoes should be made of natural material, loose and warm.
Heavy load on the legs. If your job requires you to walk a lot, carry heavy weights, or be in a position that is uncomfortable for your legs, change your position or do stretching and gymnastics more often.
Diseases of internal organs. If your feet hurt despite maximum care, you should undergo a comprehensive examination in a specialized clinic.
Consequences of old injuries. Pain can also be caused by a poorly healed fracture, displacement, sprain and other problems.

The initial examination is carried out by a therapist, after which the doctor schedules a visit to a specialized specialist and the necessary tests.

Working on the physical condition of the body and, in particular, the legs, should not be a forced or last resort measure. It is recommended to do gymnastics for the feet and toes before any symptoms appear. A little warm-up will help you avoid constant fatigue and feelings of weakness. The absence of leg pain will improve your mood and allow you to focus on truly important tasks.

Requirements for sports shoes.

Particular attention should be paid to shoes. Shoes should be well chosen in both length and width. There should be a distance of 1 cm between the tip of the longest toe and the toe of the shoe. Poorly fitting shoes can permanently damage the foot. Tight shoes create painful calluses on both sides of the foot. Choose a flexible, stretchy but firm sole and soft upper. Heavy leather boots are not the best option for you. Laces and small buckles can make it difficult to put on shoes, so it is better to replace them with elastic inserts. You need sports shoes or sneakers with thick, well-cushioned soles. The sole should be 2-3 cm thick or have a thicker flat heel. The leather or material from which the shoes are made should not be very hard. Two instep supports should be inserted inside to support the longitudinal and transverse feet. The fastener of sports shoes should make it possible to grasp the feet without interfering with blood circulation. Sports shoes with Velcro are comfortable and easy to put on.

Exercises during an exacerbation

During the period of exacerbation, when there is pain at rest, swelling, redness of the joint, it is necessary to reduce physical activity. Reduce the amount of daily workload for yourself. Under no circumstances should movement be carried out “through force.” Do not perform movements that cause acute pain.

Exercises during remission

During the period of remission, there is no pain in the joint at rest, but there may be discomfort during movements of large amplitude or mild pain after physical activity. During this period, it is necessary to return to the muscles their strength, which they lost during the period of exacerbation. This can be done by performing the exercises slowly, gradually increasing the number of repetitions. While performing these exercises, you should feel your muscles working hard, so some discomfort may be associated with the exercises. However, these exercises should not cause severe joint pain or joint swelling after performing them. If you easily perform the exercise once, then repeat two or three times, gradually increasing the number of repetitions.

From the practice of an orthopedist: all about short leg syndrome

Risk factors for asymmetry

Normally, the body structure should be symmetrical.
There are four pairs of main musculoskeletal “hinges” of the body: in the area of the shoulder girdle, acetabulum, knee and ankle joints, all these pairs must be at the same level. In this case, the center of gravity of the body is located between the feet, and the support reactions are symmetrical. The balance of the “core” of the body (pelvis and lumbar region) and the stability of the foot as a support are extremely important, since almost all movements pass through this very “core”, this is especially important when playing sports. Shortening of the foot can be anatomical, functional or combined. Anatomical shortening of the limb, as a rule, occurs after injuries and fractures. Bone fragments may not heal properly, resulting in shortening of the limb. This shortening can also form due to idiopathic developmental anomalies, degenerative diseases and tumors, injuries to growth zones, etc.

Functional shortening of the leg develops due to the following factors: spasm and shortening of muscles, hypermobility - stretching of ligaments and muscles, the presence of joint contractures, misalignment of axial structures, torsion of the pelvis, asymmetrical hyperpronation. In turn, asymmetries of the pelvis lead to deformations of the foundation of the body – the feet.

Why is short leg syndrome dangerous?

This pathology can lead to the following dangerous disorders:

scoliotic deformities
chronic cervicalgia, lumboischialgia
coxarthrosis
osteoarthritis of the spine, knee joint, foot
TMJ dysfunction
chronic fatigue

Research data

International studies emphasize the importance and relevance of the prevalence of the problem of short legs. A 1981 study by DB Clement ea noted that in 59% of cases of “idiopathic” low back pain in endurance runners, leg length differences could be the etiological factor. SI Subotnik's 1981 work collected data that among 4,000 athletes examined, differences in leg length were observed in almost 40% of cases. RH Gross indicates that among 35 marathon runners examined, according to the results of orthoradiographs in the “lying” position, a “short” leg was observed in 34 cases. Moreover, in 28.5% of cases the shortening was 5-9 mm, in 20% - 10 mm or more.

Functional shortening of the limbs as a consequence of asymmetrical hyperpronation may be the main etiological factor in the development of lumbosacral radiculitis (B. Rothbart, L. Estabrook, 1988). Dr. Vladimir Nechaev draws attention to the difference in leg length, indicating that the threshold value for correcting leg length is 5 mm. If we are talking about runners, then their value is already 3 mm - a reason for correction; 6 mm is a clinically significant value, 9 mm is sufficient for the development of lumbago, with a difference of 10 mm intervertebral hernias can occur, and 15 mm is the threshold level for the development of scoliosis. With a shortening of 20 mm, physical capabilities become limited.

Diagnostics

Clinical studies have proven that the gold standard for determining leg length and measuring spinal and pelvic ring abnormalities is a postural radiograph. These images, taken in accordance with a standard protocol (with feet fixed, knees locked in neutral, and arms positioned appropriately), are assessed by a physician to obtain data on static functional body position. The postural x-ray is always functional: the patient's body is placed in a position in which a weight load is applied to it. The image should be taken with an independent radiopaque vertical reference line running perpendicular to the surface of the patient's foot placement platform.

However, many radiographs taken in the standing position are useless for making an accurate postural diagnosis or monitoring the patient over time.

Methods for correcting different leg lengths

Treatment depends primarily on the causes that caused the development of short leg syndrome. In the presence of anatomical factors, lift therapy has proven itself well. For functional deformities, various methods of manual therapy, exercise therapy, etc. are used to work with the feet. The main thing is to use all possible approaches for different types of deformation, since the use of insoles with heels or supports for the legs to compensate for different lengths in case of functional disorders in the long term is useless.

Anatomical shortening

Correcting pelvic distortion by lifting the heel on the side of the short leg with a special shoe insert, also called “lift therapy,” dates back to the 19th century. Even then, a piece of cork was placed in boots to compensate for the length of the leg. If there is anatomical shortening of the leg, it is advisable to begin lift therapy in childhood. HH Fryette wrote in 1936: “For the last 15 years I have used a heel pad on the short side of the leg in adolescents up to 14 years of age and have always been surprised to find that after some time the limbs have straightened out.” Other authors in different years came to the same conclusions. Modern studies demonstrate that with a well-chosen lift therapy strategy and leveling the inclination of the sacral base, it is possible to reduce the severity of dorsalgia and other symptoms associated with postural disorders by close to 80%. The main goal of lift therapy is to level the base of the sacrum, as well as prevent coxarthrosis and correct compensatory scoliosis.

When prescribing lift therapy, a flexible approach to each patient is necessary: individually select the thickness of the heel pad (“braids”) with the possibility of gradually increasing it if necessary. The patient’s comfort must also be taken into account: he should be comfortable in shoes with a heel support. Options for a combination of braid and heel caps are possible.

Functional asymmetry

Functional disorders have not been studied enough to date, and there is no consensus on the strategy for their treatment in the medical community. According to research, lift therapy improves the balance of the pelvic ring, but can cause significant disturbances in the statics of the lower spine. The well-known sports doctor S. Subotnick is confident that with a functionally shortened limb, a heel support should not be used, due to the fact that it does not treat the causes of the development of differences in leg length and can provoke weakening of the muscles on the corrected leg. However, many years of practice of using “braids” even for functional disorders speaks in favor of their effectiveness, but only for the rapid release of myofascial tension. Heel lift therapy can serve as a temporary (no more than a month) measure, a kind of “first aid” until a doctor’s consultation. Then it is necessary to include manual therapy, kinesitherapy, exercise therapy and other methods of permanent normalization of the patient’s condition.

To prevent dangerous disorders that can lead to short leg syndrome, it is necessary to consult an orthopedist in time for a comprehensive diagnosis and treatment of this problem.

The recommendations are extremely wrong.

Strengthen the joint.
“Knock out a wedge with a wedge.”
“Disperse the salts.”
“Overcoming the pain” - this often increases the pain syndrome, provokes inflammation and destruction of the joint.

Don't crawl on your knees at home - it destroys the joint!
Remember - regular exercise and relaxation will help more than medications or massage, rest and moderate exercise should be balanced, never put stress on the damaged area. Whether sitting or standing, be aware of your posture. Medical rehabilitation has accumulated extensive experience in the rehabilitation of patients with pathologies of the musculoskeletal system using physical therapy methods. Classes are conducted according to an individual program, under the supervision of a physical therapy doctor and experienced instructors. Author: V.I. Dikul

Particular attention when performing exercises is for elderly patients

Elderly patients suffering from deforming arthrosis, when performing exercises, must remember that running, jumping, exercise with weights, as well as all types of competitions are excluded even in a state of remission. You should also exclude exercises with prolonged holding of breath, sudden movements, rotation of the head, long tilts of the head down, jumps, etc.

No matter how useful physical exercise is for arthrosis, it is important to follow three principles: caution, gradualness, and regularity. Remember - even physical therapy if done too hard can accelerate the destruction of the joint.

Who is suitable for joint gymnastics?

The complex of muscle-joint gymnastics is suitable for everyone, without exception, to maintain a healthy state, as well as for those who have questions about the health of the spine or joints and those in need of rehabilitation after injuries and fractures. Appropriate exercises are selected as the bone fusion process is completed by a qualified specialist, allowing the damaged limbs to return to full movement. Thanks to such activities, recovery is much faster and easier for the patient.

There are a number of restrictions for training in the joint gymnastics program. It is not recommended:

Pregnant women, young mothers in the postpartum period.
Elderly people.
Patients with thyroid dysfunction.
For hypertension.
With infectious diseases in the acute stage.
For malignant neoplasms.

These restrictions are not contraindications, therefore, we recommend that this category of people consult with their doctor to eliminate the risk of complications.

How does joint gymnastics work?

With systematic repetition of gymnastics, after a period of several sessions to several months (based on the initial state), your joints will work much better. An important advantage of the exercises is their accessibility for people of any age and physical well-being, including severe patients at the rehabilitation stage. Exercises can be broken down into parts and performed at any time and anywhere (moving your head and shoulders while driving a car while you are stuck in a traffic jam, or side bending and twisting back during a break at work).

When performing gymnastics, it is enough to focus on your feelings, because all exercises are physiological and natural, so the body is able to suggest the required amplitude and nature of the movement being performed. If you had to spend an hour sitting in a chair, then simply stretching your arms up can relieve the accumulated static tension. By stretching your legs forward, you will sufficiently relax the lower part.

Positive effects of joint exercises

Our body is a complex complex of organs and systems that work harmoniously, influencing each other's functionality. If problems occur in one area, there is a high probability that failures will occur in others. Therefore, it is better to immediately pay attention to a specific problem, working with the help of muscle-joint gymnastics.

Regular exercise ensures:

Active production of synovial fluid to improve joint mobility and reduce pain when performing large-amplitude movements that were previously inaccessible.
Warming up the muscles, increasing the plasticity of the body.
Preparing for strength training or cardio training.
Reducing salt deposits on joints involved in gymnastics.
Improvement of the musculoskeletal system by stimulating blood supply and metabolic processes at the cellular level.
A surge of energy, a feeling of vigor, thanks to the production of happiness hormones.
Coordinated work of the hormonal system of the whole body.

The exercises do not require any special preparation, since they are natural and physiological for the body. The healing processes launched as a result will provide invaluable benefits to your body, strengthening the muscular-ligamentous system, relieving signs of fatigue, and reducing the risk of developing serious pathologies.