Recovery after knee surgery: medications, exercises and physical therapy

Cold air therapy, or cryotherapy, refers to the method of exposing a limited area of ​​skin to a limited area of ​​skin for a short period of time (from a few seconds to a few minutes) with air cooled to temperatures below 0°C (about -30°C with the Crio 5 device). ).

Cryotherapy is used for a variety of purposes in many areas of medicine, such as in functional rehabilitation, where cryotherapy has a positive effect in therapy aimed at reducing inflammation, pain relief and muscle tone.

Cold treatment: effects

The clinical tissue effects of cryotherapy can be summarized as follows:

• Improving the trophism of bone and cartilage tissue.
• Improving blood microcirculation in tissues, increasing arterial blood flow and, to a large extent, venous outflow, reducing intra-articular effusion, and, consequently, reducing edema and infiltration of vascular origin.

• Myorelaxation - reduction of basal muscle tone and elimination of muscle contractures.
• Lymphatic drainage effect, i.e. improving the outflow of lymph from tissues and, therefore, eliminating edema of lymphatic origin.
• Blocking proprioceptive conduction and increasing the pain threshold.

• Improving the trophism of muscle connective and other tissues, stimulating the body's regenerative mechanisms.
• Reducing the total treatment time for diseases of the musculoskeletal system: joint pain; polyarthritis; rheumatic lesions of joints and soft tissues; bursitis; distortion; swelling.

The clinical tissue effects of cryotherapy can be summarized as follows:

• Lymphatic drainage effect, i.e. improving the outflow of lymph from tissues and, therefore, eliminating edema of lymphatic origin.
• Improving blood microcirculation in tissues, increasing arterial blood flow and, to a large extent, venous outflow, reducing intra-articular effusion, and, consequently, reducing edema and infiltration of vascular origin.
• Myorelaxation - reduction of basal muscle tone and elimination of muscle contractures.
• Improving the trophism of bone and cartilage tissue.
• Blocking proprioceptive conduction and increasing the pain threshold.
• Improving the trophism of muscle connective and other tissues, stimulating the body's regenerative mechanisms.
• Reducing the total treatment time for diseases of the musculoskeletal system: joint pain; polyarthritis; rheumatic lesions of joints and soft tissues; bursitis; distortion; swelling.

Cryotherapy: Therapeutic effects of low temperatures

According to Russian and foreign clinicians and experience in the use of cryosystems, three main areas of use of local cryotherapy in complex therapy can be distinguished: 1. Clinical: - treatment of collagenosis, burns, arthrosis, arthritis, spondylitis, radiculitis, atopy, etc.

2. Rehabilitation: - after severe somatic diseases, operations, injuries, depressive states, chronic fatigue syndrome, etc. 3. Health-improving and preventive: - in sports medicine, in sanatoriums, in gerontology, for the prevention of colds.

Thanks to its analgesic, anti-inflammatory or muscle relaxing effect, cold air cryotherapy ensures the restoration of joint mobility, as well as a quick return to sports or professional activities.

Cryotherapy is of great interest for the treatment of various diseases for which physiotherapy is used.

The essence of the procedure

To get a positive effect, you need to apply refrigerant to the damaged part of the body. But first you need to consult a doctor, because he is the one who decides how cool the nitrogen should be. Different parts of the body have different temperatures.

When the joint is very cold, standard reactions can be observed:

● blood vessels narrow, the speed of blood flow in the treated area decreases;

● the heart rate increases slightly;

● blood pressure increases;

● adrenaline and norepinephrine are released.

Thanks to all these processes, a large amount of blood, which is saturated with nutrients, flows to the damaged diseased joints. Tissues are saturated with oxygen, microcirculation is stimulated. When the second phase of nitrogen exposure begins, the body tries to compensate for temporary hypothermia. Body temperature rises slightly, the process of tissue and cell restoration accelerates. Over the entire cycle of the procedure, pain in the body is not simply reduced. He is tempered and mobilized to restore health.

Treatment of joints with nitrogen gives visible results that cannot be obtained with medications. However, therapy is often used in combination and supplemented with certain medications and special health-improving exercises.

Doctors recommend cryotherapy for joints for several diagnoses:

● arthritis;

● arthrosis;

● osteochondrosis;

● radiculitis;

● muscle spasms;

● myalgia.

However, there are also contraindications that prevent you from attending a cryotherapy session for knee or other joints. You will have to wait if you have one of these diseases:

● serious damage, wounds on the area of ​​skin that will be treated;

● thrombophlebitis;

● blood diseases;

● diseases of the cardiovascular system;

● colds and ARVI.

Discussion

The results of a scientific study using statistical methods and criteria for assessing the effectiveness of OMERACT-OARSI indicate the comparability of CT as a treatment method with NSAID therapy in terms of its effect on improving the patient’s functional capabilities, as well as the advantage of CT in relieving pain and stiffness in the joints. It is not recommended to exclude drug therapy for OA, since in the first 2-3 days all patients took NSAIDs in varying dosages.

Timely connection of CT to the treatment of OA with diclofenac made it possible to avoid complications from the gastrointestinal tract, vascular accidents and complications from the kidneys, since most patients refused to take NSAIDs after the 2-3rd procedure. However, 12% of patients in the main group (patients with stage III-IV OA) continued to take NSAIDs on demand after the CT course.

In the control group, 25% of patients continued to take NSAIDs. The drug was well tolerated in these patients.

Of course, all types of CT, as the study showed, are a fairly effective method of treating OA, while in general clinical practice each type has its own disadvantages and advantages in terms of methodological approaches.

It is necessary to emphasize that, depending on the selected refrigerants and temperature conditions, from the point of view of the time spent on the procedure, both in the opinion of the medical professional and the patient, it is very important how perfect the technical support is in terms of convenience and comfort procedures performed.

The most convenient from a practical point of view are the VKT (–30 °C) and CO2 HA (–78 °C) procedures. However, in practice, of these two methods, VCT is chosen to provide physiotherapy departments in hospitals and clinics. This is due to organizational difficulties, since equipment with CO2 requires systematic refilling with liquefied gas. At the same time, GK has an advantage over VKT - it is sterile, unlike VKT, it can be used in the postoperative period (after endoprosthetics of patients with OA) and does not require special temperature conditions for rooms, like AL ​​and cryo-SMT, while the VKT device may stop working when the room temperature rises above +25 °C.

In addition, VKT equipment requires constant dependence on the electrical network and consumes a large amount of electricity. The GK equipment has an autonomous power supply and can be easily moved in any hospital room. AL can be called the most democratic method of therapy, since it can be used in almost any medical institution and even by the patients themselves or their loved ones with proper training.

How is joint cryotherapy performed?

After consultation with a doctor, the patient is referred for general or local cryotherapy to treat joints. A refrigerant is applied to the skin (over the entire surface or just a certain area). It is customary to use either nitrogen (cooled to -190 degrees), helium (the coldest - up to -270 degrees), or carbon dioxide (maximum permissible temperature - -80 degrees) as a refrigerant.

Before the session begins, the patient is prepared: doctors measure his pulse and blood pressure. Gloves and socks are provided to protect his fingers and toes.

The whole procedure consists of several steps:

1. The patient must be in a special cryochamber. Only the head is outside the processing area.
2. The capsule is filled with cold gas.
3. Body temperature drops. This causes natural physiological reactions, including activation of the immune system, as well as thermoregulation.
4. The patient is in the chamber for about 3 minutes, then he is taken out of the capsule.

Already after the first procedure, the patient feels an improvement in health, but for a full recovery it is recommended to undergo a course of procedures, usually consisting of 10 sessions.

Sometimes it is not the entire body that is frozen, but a specific area. In this case, a camera is not required. The patient sits on the couch during the procedure. The doctor applies an antiseptic to the selected area. Then a special device is used that sprays the refrigerant in doses. Using a special hose, nitrogen is delivered to the desired area.

Cause and mechanism of development (etiology and pathogenesis) of the disease

The cause of gouty arthritis is a disorder of purine metabolism. Purines are chemical compounds that form the basis of nucleic acids necessary for the formation of DNA and RNA molecules. As cells break down, purines are broken down into uric acid (UA). The latter enters the intercellular space and into the blood plasma, where it combines with sodium, forming a salt - monosodium urate (MUN).

An increased level of urate in the blood (hyperuricemia - GU) may be a consequence of a genetic predisposition (the kidneys do not eliminate MUN completely), high blood pressure (BP), consumption of large amounts of animal food, and alcohol.

With an excess of urates, when they can no longer dissolve in the surrounding fluid (EOR concentration more than 0.4 mmol/l), the salts crystallize, deposit in the articular and periarticular tissues and are surrounded by protein rings. This formation is called tophi. The release of MUN from the tophi causes an immunological reaction: a large number of neutrophils (one of the types of leukocytes responsible for cellular immunity) appear in the synovial membrane and joint fluid.

Neutrophils ingest MUN crystals, which causes the release of proinflammatory (inflammation-causing and maintaining inflammation) cytokines and the development of an acute inflammatory response in the synovium. Acute attacks in the form of synovitis are very painful, but do not leave any consequences. The long-term chronic course of the disease with frequent repeated attacks leads to the destruction of articular cartilage, proliferation of bone tissue, deformation and dysfunction of the joint. Deposition of MUN in the kidneys causes a decrease in their function.

Factors contributing to increased urate levels in the blood:

• the presence in the diet of a large number of meat dishes, offal, eggs, alcoholic beverages,
• overweight;
• taking certain medications - diuretics, aspirin, nicotinic acid, medications to lower blood pressure (Concor), etc.;
• lead poisoning;
• increased breakdown of purines in blood diseases, psoriasis, etc.;
• increased formation of purines;
• impaired renal function and uric acid excretion.

General cryotherapy of joints

During the general cryotherapy procedure, the refrigerant enters the patient's entire body. For this purpose, a special chamber is used - a cryochamber. Inside it, either a nitrogen-air mixture or nitrogen liquid is directed at a person.

During general cryotherapy, the entire body is exposed to nitrogen. As a result, the functioning of the muscular system and nervous system improves. Due to cooling, the skin receptors are first briefly excited, and then an inhibition phase begins. Already after the first procedure, therapeutic effects can be noted:

● joint pain subsides;

● muscles relax;

● connective tissue joint structures are restored.

General cryotherapy is not always used. It is especially often recommended for compression or inflammation of the spinal cord roots. When the body cools down, the activity of the immune and endocrine system increases. Thermoregulation is activated. As pleasant side effects, patients note a decrease in anxiety, an increase in mood and a boost of vigor.

Principles of rehabilitation after knee surgery

Rehabilitation treatment includes:

• careful planning of rehabilitation taking into account the specific medical problem and body criteria;
• developed daily schedule, including medication, procedural, and physical rehabilitation;
• the principle of balance, gradualism and dosing of physical activity;
• careful control over the patient’s performance of all treatment and rehabilitation procedures.

Each individual patient needs his own recovery program after knee surgery, specially developed for him by a board of specialists (surgeon, rehabilitation specialist, neurologist, physiotherapist, exercise therapy methodologist, etc.). Therefore, there is no single rehabilitation scheme for all patients. Recovery goals:

• early activation of the patient;
• prevention of congestion in the respiratory system;
• stimulation of regional blood circulation and lymphatic drainage in the lower extremities;
• reduction in the secretion of pathological fluid in the knee;
• rapid elimination of pain syndrome;
• active prevention of muscle wasting, contractures and adhesions;
• stimulation of metabolic metabolism and tissue regeneration;
• preventing the emergence of an infectious environment in the operated tissues;
• restoration of lost limb functions.

Your doctor will tell you how to develop your knee after surgery. Don't self-medicate! Incompetent tactics will prevent a favorable prognosis. Take this fact into account if you don’t want your knee to bend and hurt after undergoing major surgery.

Local cryotherapy

If it is necessary to cool a particular joint (for example, cryotherapy for arthrosis), solid, liquid or gaseous substances are used. When nitrogen comes into contact with an area of ​​skin, heat is removed from that area. Local cooling of tissues leads to the following effects:

● pain in the joint is less pronounced;

● inflammatory processes are stopped;

● if there are muscle spasms, they disappear.

Patients also notice a slowdown in metabolic processes. While nitrogen is in effect, cells in the treated area require less oxygen.

Local therapy has several advantages:

● the first results appear faster - after 1-2 sessions;

● the procedure itself takes less time - about 1-5 minutes.

Conclusion

Acknowledgment: The authors of the article express gratitude to Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Prof. Razumov Alexander Nikolaevich, who headed the Russian Research Center for Rehabilitation Medicine and Balneology, where this work was carried out, for scientific support and assistance in the development of the study.

Authors' participation: concept and design of the study, collection and processing of materials - T.A. Dashina; analysis of the data obtained, writing the text - T.A. Dashina, L.G. Agasarov.

The authors declare that there is no conflict of interest related to the publication of this article.

Cryotherapy at Medicap&SPA Resort “Alfa Radon”

At the Alfa Radon sanatorium you can undergo complex cold treatments to treat diseases and strengthen the body. You can sign up for cryotherapy according to your doctor’s indications or on your own, having undergone a preliminary examination to ensure there are no contraindications.

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