Doctor Myasnikov about arthrosis of the knee joint, diagnosis and treatment

Doctor Myasnikov Alexander Leonidovich

The opinion of Dr. Myasnikov is highly valued in the professional community. Many medical publications refer to it. Alexander Leonidovich is not only an active doctor, but also the author of a large number of publications on the topic of gonarthrosis.

His books encourage sick people to contact specialists in a timely manner, rather than engage in treatment on their own. They are written in a common language, so they are very popular even among those who are not familiar with medicine.

Television is considered the easiest way to convey information to people. That is why the doctor hosts thematic programs that are designed to help people navigate many medical terms and avoid mistakes when treating joints.

Sports and arthrosis

Arthrosis is not a reason to give up physical activity. If you have arthrosis of the knee joint, walking on your knees and squats becomes useful, which helps strengthen the cartilage tissue. Such loads for arthrosis should continue even in the presence of severe pain, while at the same time engaging in exercise time. During the first approach, you should perform more than 50 steps in the starting position, kneeling. At the end of walking, you should switch to your heels. Movements during exercise should be smooth and slow. A horizontal bar will be useful. Few people know that an expander, which is an elastic spring that helps strengthen cartilage joint tissue, helps with arthrosis. Swings are also useful in case of illness, when the knee joints are developed during the rolling process. This also includes numerous doubts regarding whether the sea is beneficial for arthrosis. Help for arthrosis lies in the effect of salt water on the skin through which the joints are nourished. Various marine procedures also additionally help with arthrosis.

Prevention of knee arthrosis

Prevention of arthrosis of the knee joint largely reduces the risk of the disease. People who are at risk should be especially vigilant, because, as we know, the disease is easier to prevent than to treat. The main preventive measures include:

healthy lifestyle;
exercises to strengthen joints;
weight control;
avoiding hypothermia;
timely vitaminization of the body.

healthy lifestyle;
exercises to strengthen joints;
weight control;
avoiding hypothermia;
timely vitaminization of the body.

It should be remembered that contacting a specialist at the first signs of gonarthrosis will help the patient get rid of the disease without surgical intervention and in the shortest possible time.

Joints must be taken care of from a young age

Osteoarthritis and its treatment. Guest - Dr. Alexander Myasnikov .

The presenter of Vesti FM is Anna Shafran.

Shafran : On the eve of the broadcast, Alexander Leonidovich says: “Somehow my knee hurt, apparently, it’s related to the topic of our program.”

Myasnikov : Because literally this weekend I decided that we need to talk about the treatment of osteoarthritis, because it concerns everyone. A very common disease. But this morning I can’t walk, my knee hurts. Is this the power of suggestion? If you look, what do cardiologists die from? From a heart attack. Oncologists - from cancer. Psychiatrists are all...

Saffron : Crazy...

Myasnikov : Let’s just say that my friends and strangers will forgive me...

Saffron : You know, the few times that I visited them, little doubts creep in.

Myasnikov : You communicate with people, you experience their illnesses. You still worry, it involuntarily accumulates in you.

Shafran : The funniest thing was when one acquaintance after university was deciding where to go next, they suggested to him: “Maybe into the organs, son?” And there it was necessary to see a psychiatrist, naturally. After talking with the psychiatrist, it began to seem to me that I should work separately with these psychiatrists in order to put them in order too.

Myasnikov : No, this is specific. Apparently, the profession leaves its mark. Let's return to joint pain, osteoarthritis. Joints can hurt for a variety of reasons. This may be pain in small joints, if not longer than 6 weeks, it can be a viral infection, it can also be inflammatory diseases, such as rheumatoid arthritis, which is also characterized by symmetrical damage to small joints.

Ostearthritis is mainly the fate of the elderly, when the articular surfaces wear out, especially large joints. Although it could be small bones on the hands. But what prevents us from living is osteoarthritis of the knee joints, hip joints, because after some even minor injury, if the integrity of the cartilage is damaged, then a whole cascade of changes is launched: some cells try to restore this cartilage, others counteract this, and the cartilage eats away , the articular surface wears off, and the person’s leg swells. And stiffness also appears. By the way, this is different from rheumatoid arthritis - the more you move, the more stiffness you get. It's tight here, but you can go your separate ways. That is, you walk, and the joint is developed. This is precisely what is typical for osteoarthritis.

The reason is age, there is also a genetic factor, so it is quite common for a person to have osteoarthritis at the age of 40. And even by the set of genes you can determine which joint will be affected, your knee or, say, your arms. In addition to age, excess weight also plays a role here. If you weigh a lot, you put more pressure on your joints.

How to treat? So, we say: let's take painkillers. But that's not an option. We know very well that painkillers cause stomach bleeding, damage the kidneys, liver, and most importantly, they are simply contraindicated for people with heart disease. They themselves can provoke heart attacks, heart failure, and hypertension. Therefore this is a very dangerous thing.

Listen in full in audio version.

Watch the video broadcast from the Vesti FM studio

How to treat a sore knee with arthrosis, Dr. Myasnikov

In joint pathologies, timely initiation of therapy is already half the success of treatment. An accessible presentation of accumulated scientific knowledge plays an important role in medical education of the population and timely seeking medical help at the initial stage of the disease. One of the polarizers of useful information in the field of degenerative changes in joints is Alexander Leonidovich Myasnikov.

Relevance of the problem

Medical and reference publications often refer to what Dr. Myasnikov says about arthrosis.

The representative of the famous medical dynasty has long been closely paying attention to this problem, writing books that in an accessible form give an idea of the symptoms, causes and methods of treating pathological processes. The lack of the required level of such information often leads to the fact that a person begins to self-medicate or does not pay attention to the disease until it approaches closely

The lack of the required level of such information often leads to the fact that a person begins to self-medicate or does not pay attention to the disease until it approaches closely.

The information about gonarthrosis that Dr. Myasnikov conveyed to viewers who watched his television programs saved many people from common mistakes and incorrect behavior tactics in the occurrence and development of joint pathologies.

The information allowed us to correctly navigate and start treatment in a timely manner, choose the necessary tactics and settle on a complex method, which is the only possible one in the treatment of knee joints, according to Dr. Myasnikov.

The indisputable merit of Alexander Leonidovich is that he popularized the techniques that he considered appropriate to implement in complex therapy.

He used them in his own scientific research, which helped hundreds and thousands of patients with gonarthrosis.

Diagnosis and disease development factors

The knee is a complex and perfect natural mechanism that experiences daily and hourly stress. Joint pathologies arise not only under the influence of physical conditions. the reason is that a person does not pay attention to the health of the joint in a timely manner, does not provide it with normal nutrition and does not care about maintaining functionality.

According to Dr. Myasnikov, modern people have a tendency to pathology of the knee joints at the genetic level.

By examining the set of genes of each patient, it is possible to find the sources of the development of arthritis or arthrosis. However, arthrosis at this level is not realized in all patients.

This pathology arises under the influence of a complex of negative factors, and no amount of treatment, even the most progressive and modern, will stop its development unless a reliable diagnosis is made.

To begin treatment, many components must be taken into account.

Therapeutic treatment of arthrosis of the hip joint - treatment of coxarthrosis without surgery

If we want to try to avoid surgery treating coxarthrosis , we need to try to restore the diseased hip joint . We must combine therapeutic measures in such a way as to solve several problems at once:

eliminate pain;
improve nutrition of articular cartilage and accelerate its recovery;
activate blood circulation in the area of the affected joint;
reduce pressure on the damaged articular head of the femur and increase the distance between it and the acetabulum;
strengthen the muscles surrounding the sore joint;
increase joint mobility.

The trouble is that most of the treatment methods offered in our clinics do not solve these problems: doctors at clinics most often either prescribe drugs that relieve pain but do not cure, or prescribe physiotherapeutic procedures that are almost useless for arthrosis of the hip joint .

The same approach exists in most clinics in the USA and Europe: take a painkiller - it doesn’t help - go for surgery. In commercial clinics, on the contrary, “commercially reasonable treatment” is prescribed: the patient is prescribed a lot of unnecessary procedures and medications.

You and I will be wiser and together we will think about what treatment will really be useful, and about how and due to what this or that treatment method will help us achieve the goals set at the beginning of this section. So:

Nonsteroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs - NSAIDs. The main drugs in this group: diclofenac, piroxicam, ketoprofen, indomethacin, butadione, movalis, nimulid, Celebrex, arcoxia, and their derivatives. These medications are prescribed to relieve pain in the groin and hip.

Doctors are very fond of prescribing non-steroidal, that is, non-hormonal, anti-inflammatory drugs for arthrosis, since these drugs effectively reduce pain in the affected joint. Therefore, in every hospital or clinic, treatment of coxarthrosis, like any other joint disease, usually begins with the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs).

Sometimes this is justified - NSAIDs can be recommended to the patient during an exacerbation of the disease, if due to severe pain it is impossible to carry out normal treatment. Then, having eliminated acute pain with anti-inflammatory drugs, we can subsequently move on to those procedures that would be intolerable due to pain: for example, massage, gymnastics, joint traction, etc.

But you need to understand that although NSAIDs are good at reducing inflammation in the joint and eliminating pain, they do not treat arthrosis itself. Nonsteroidal anti-inflammatory drugs for coxarthrosis provide only temporary relief. Arthrosis, meanwhile, continues to progress. And as soon as the patient stops taking NSAIDs, the disease returns with renewed vigor.

In addition, when using non-steroidal anti-inflammatory drugs, it is necessary to remember that they all have serious contraindications and can cause significant side effects with long-term use.

Read more about anti-inflammatory drugs here*

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Chondroprotectors - glucosamine and chondroitin sulfate

Glucosamine and chondroitin sulfate belong to the group of chondroprotectors - substances that nourish cartilage tissue and restore the structure of damaged joint cartilage.

Chondroprotectors (glucosamine and chondroitin sulfate) are the most useful group of drugs for the treatment of coxarthrosis. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotectors do not so much eliminate the symptoms of coxarthrosis as act on the “base” of the disease: the use of glucosamine and chondroitin sulfate helps restore the cartilaginous surfaces of the hip joint, improve the production of joint fluid and normalize its “lubricating” properties.

Such a complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of coxarthrosis. However, there is no need to exaggerate the capabilities of these drugs. Chondroprotectors are not very effective in the third stage of coxarthrosis, when the cartilage is almost completely destroyed.

After all, it is impossible to grow new cartilage tissue or return the previous shape to the deformed head of the femur with the help of glucosamine and chondroitin sulfate.

And even in the first and second stages of coxarthrosis, chondroprotectors act very slowly and do not immediately improve the patient’s condition.

To get a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually takes from six months to a year and a half, although advertising for glucosamine and chondroitin sulfate usually promises recovery in a shorter time.

I would like to note with regret that there is some deceit in these promises. Despite all the usefulness of chondroprotectors, one cannot expect miraculous medicinal cure for coxarthrosis. Recovery usually requires much more effort than taking two or three dozen pills.

However, of all the drugs used in the treatment of coxarthrosis, it is chondroprotectors that bring the greatest benefit. In addition, they have virtually no contraindications and extremely rarely give unpleasant side effects.

Muscle relaxants are drugs used to relieve muscle spasms.

mydocalm and sirdalud are most often used for coxarthrosis . Muscle relaxants are prescribed to relieve painful muscle spasms that often accompany arthrosis of the hip joints.

These drugs sometimes really do a good job of eliminating muscle pain and, in addition, somewhat improving blood circulation in the area of the affected joint. However, their use requires some caution.

The fact is that muscle spasm is often a protective reaction of the body, protecting the joint from further destruction. And if we simply relieve the protective tension of the muscles, but do not take measures to save the joint from excessive pressure, subsequently the damaged joint will begin to deteriorate at an accelerated pace.

That is, it makes sense to use muscle relaxants only in combination, in combination with chondroprotectors and joint traction. And it makes absolutely no sense to use them separately as an independent method of treatment.

I would also like to note that although many clinic doctors love to prescribe Mydocalm or Sirdalud to their patients, I have not seen many patients for whom these drugs would help to radically improve the condition of their joints. Therefore, in my practice I use muscle relaxants quite rarely, only for special indications.

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Medicinal ointments and creams

Medicinal ointments and creams are often advertised as guaranteeing cure for joint diseases. Unfortunately, as a practicing doctor, I have to disappoint you: I have never encountered cases of healing of coxarthrosis with the help of any medicinal ointment.

But this does not mean that ointments are useless. Although coxarthrosis cannot be cured with ointments and creams, their use sometimes significantly alleviates the patient’s condition.

For example, for coxarthrosis, you can successfully use that warm or irritate the skin: menovazin, gevkamen, espol, finalgon, nicoflex cream or other similar ointments.

It has been proven that the irritation of skin receptors that occurs when rubbing these ointments leads to the production of endorphins - our internal painkillers “drugs”, due to which pain is reduced and painful spasm of the periarticular muscles is partially eliminated; In addition, warming ointments help increase blood circulation in the tissues and muscles around the affected joint.

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Intra-articular injections (injections into the joint)

Intra-articular injections for coxarthrosis are used quite rarely, since even a healthy hip joint has a narrow joint space and a small articular cavity. Accordingly, with coxarthrosis, when the joint gap narrows by half, it is quite problematic to introduce the medicine directly into the cavity of the affected joint.

Firstly, the risk of missing is very high. Secondly, there is a risk of damaging the vascular and nerve trunks located along the intended needle insertion (since the needle is inserted through the groin). That is why most doctors inject medicine through the thigh, but not into the joint itself, but into the periarticular area.

Such periarticular, or “periarticular” injections are most often performed to eliminate exacerbation of pain. Then corticosteroid hormones are injected into the periarticular area: Kenalog, Diprospan, Flosterone, Hydrocortisone .

However, I would like to emphasize once again that these are not so much therapeutic procedures as a means to eliminate exacerbations and reduce pain. Accordingly, there is no point in injecting corticosteroid hormones in the case of a relatively calm course of the disease, when the joint does not hurt much.

Attempts are also being made to treat coxarthrosis with intra-articular injections of hyaluronic acid (an artificial joint lubricant). For this purpose, the drugs synvisk, fermatron, ostenil, and duralan are used.

Hyaluronic acid preparations are injected directly into the hip joint itself, through the groin. They are really useful, but there is one circumstance that significantly limits their use in coxarthrosis: as we said at the beginning of this section, it is quite difficult to introduce the medicine exactly into the cavity of the affected hip joint.

And if the doctor missed even by a centimeter and did not hit the needle clearly inside the joint, there will be no benefit from the injection at all (according to statistics, when trying to inject medicine into the hip joint, in at least 30% of cases doctors end up in the “milk”, that is, past the cavity of the joint ).

For this reason, it is best to trust the administration of hyaluronic acid preparations only to very experienced doctors. It’s even better if you find a doctor who inserts them under direct control using an X-ray machine or tomograph (to clearly record the needle entering the joint cavity).

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Physiotherapeutic treatment of coxarthrosis

From my point of view, most physiotherapeutic procedures are not suitable for the treatment of coxarthrosis. The fact is that the hip joint is a “deep-lying” joint. That is, it is hidden under the thickness of the muscles, and most physiotherapeutic procedures simply cannot “get” it, so they cannot radically influence the course of coxarthrosis.

Moreover, no physiotherapeutic procedures can “stretch the joint,” that is, they cannot separate the bones from each other and increase the distance between the articular head and the acetabulum.

And although sometimes such procedures can still bring some relief to the patient (thanks to improved blood circulation and reflex analgesic effects), in general, physiotherapeutic procedures for coxarthrosis bring little benefit: doctors prescribe them either out of ignorance or to simulate vigorous activity.

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Diet

Adequate fluid intake

At the very beginning, we looked at the mechanism of joint destruction during arthrosis. In particular, we talked about the fact that with arthrosis, diseased joints lose moisture and become “dry”. This partly explains the fact that arthrosis occurs more often in older people, whose moisture content in the body decreases compared to young people.

Therefore, we can assume that people with arthrosis need to drink more water (a fact not scientifically proven, but probable). However, difficulties may arise here due to the fact that many older people have a tendency to edema. And they rightly fear that increasing water consumption will lead to increased swelling.

In such cases, I have to explain that the presence of edema is usually not associated with excessive drinking of water, but most often indicates poor functioning of the kidneys (or heart and liver). Many doctors, for example, know of cases where edema occurred in a patient who, on the contrary, drinks too little.

Therefore, by gradually increasing water consumption, you just need to take care of better removal of fluid from the body, and improving the functioning of the above organs. For these purposes, you can use various diuretics or herbs, as well as agents that improve the functioning of the kidneys, heart and liver. And in case of serious problems with internal organs, it is necessary, of course, to see a specialist first.

Well, for those who do not have a tendency to edema, you can safely increase your water consumption (up to about 2 liters per day), but observing basic conditions. You only need to increase the consumption of regular non-carbonated water (can be bottled, or just boiled).

But it is undesirable to greatly increase the consumption of tea, coffee, juices, soda, etc. After all, it is ordinary water, unlike various “saturated solutions,” that actively circulates inside the body, penetrates deeply into the joints, and is then easily excreted by the kidneys.

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Using a cane and reducing harmful stress on the joint

Almost all patients with arthrosis begin to listen to numerous ridiculous, and often simply harmful, advice from others about how they should now live and behave in order to “get better sooner.” One of the most harmful pieces of advice for coxarthrosis is: “you need to walk as much as possible to exercise your sore leg.”

It is difficult to think of anything more stupid than this, since the presence of coxarthrosis in itself indicates that the hip joint cannot cope even with normal everyday load. And an attempt to load the sore joint even more will only lead to its rapid further destruction (you can study this issue in more detail below, in the section on gymnastics).

Before loading, or rather overloading, a diseased joint, it must first be properly treated, the aggravation removed, and the muscles around the damaged joint strengthened with the help of special gymnastics. Only then can you move on to active everyday activities, gradually increasing the load and in no case allowing pain.

Therefore, I initially advise prudent patients, on the contrary, to, if possible, reduce the load on the sore joint. It is necessary to reduce such types of physical activity as running, jumping, lifting and carrying heavy objects, squats, brisk walking, especially over rough terrain, climbing hills, walking on stairs without relying on railings - especially down stairs. All of these activities place a force on the affected joint that is significantly greater than the body's weight, which is harmful to the already damaged cartilage.

Studies carried out at the University Biomechanical Laboratory at the Orthopedic Hospital of Berlin showed that the hip joint experiences minimal load when walking steadily at a slow pace. So, if when standing it is, as we have already said, 80–100% of body weight, and when walking slowly evenly it is 200–250% of body weight, then when walking quickly it rises to 450%. When running slowly, it is already 500% of body weight, and when slightly stumbling, it is 720–870%. But when walking with support on a stick, the load is reduced by 20–40%. Climbing up the steps with support on the railing relieves the joint even more. When descending stairs, the harmful load on sore hip joints, on the contrary, increases significantly. Carrying heavy loads also increases the load on sore leg joints: carrying 10% of the body weight in one hand leads to an increase in the load on the hip joint by 22%, and when the weight is distributed evenly in both hands, it increases the load on both legs by 9% each. for each.

In addition, it is advisable for those suffering from coxarthrosis to avoid fixed positions, such as prolonged sitting or standing in one position, squatting or bent position when working in the garden. Such postures impair blood flow to diseased joints, as a result of which the nutrition of the cartilage also deteriorates.

It is necessary to develop such a rhythm of motor activity so that periods of load alternate with periods of rest, during which the joint should rest. The approximate rhythm is 20–30 minutes load, 5–10 minutes rest. You need to unload the leg joints in a lying or sitting position. In the same positions, you can perform several slow movements in the joints (flexion and extension of the joints) to restore blood circulation after exercise.

In addition, if conditions permit, it is advisable to use a stick or cane when moving. Leaning on a stick when walking, patients with coxarthrosis greatly help their treatment, since the stick takes on 20–40% of the load intended for the joint.

However, in order for the stick to be useful, it is important to choose it exactly according to your height. To do this, stand up straight, lower your arms and measure the distance from your wrist (not your fingertips) to the floor. This is exactly the length the cane should be. When buying a stick, pay attention to its end - it is advisable that it be equipped with a rubber nozzle. Such a stick cushions and does not slip when people lean on it.

Remember that if your left leg hurts, you should hold the stick in your right hand. Conversely, if your right leg hurts, hold the stick or cane in your left hand.

Important: train yourself to transfer your body weight to the stick exactly when you take a step with your sore leg!

If one of the legs is severely shortened due to coxarthrosis, it is also advisable to use an insole or pad for the shortened leg. The lining will help equalize the length of the legs, prevent “falling” on the shortened leg when walking, and thereby protect the hip joint from the impact that occurs during a “falling” step.

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Dosed sports activities

Despite the above limitations, it is necessary to lead an active lifestyle by increasing physical activity that does not have a negative effect on cartilage.

You need to force yourself to do special exercises every day from those given below. These exercises allow you to form a good muscle corset around the joint, maintain normal mobility, and provide the joint with the necessary blood supply.

Regular exercise should turn from an unpleasant chore into a useful habit, which is the best way to maintain normal joint function.

In addition to therapeutic exercises, the patient may benefit from leisurely skiing, since due to sliding the weight load is reduced and sore joints are almost not loaded. In addition, leisurely skiing, in addition to its beneficial effect on the joints, also brings a positive emotional charge.

To begin with, it is enough to ski for 20–30 minutes, and later, depending on the condition of the joints, the duration of skiing can be increased to 1–2 hours. The only “but”: with coxarthrosis, you can only ski in the usual classic style, and you cannot use the newfangled skating skiing.

The issue with cycling is more complicated. Long, fast, or too active cycling with coxarthrosis is definitely harmful. But riding a bike slowly will most likely not cause any harm. You just need to avoid riding on uneven terrain (bouncing movements are hard on your joints) and also minimize the risk of falling from your bike.

You need to choose the right bike. You need to choose between sport and semi-sport types, as they are easier to ride and weigh less than road bikes. Since the handlebars on sports bikes are lowered down, while on road bicycles they are usually horizontal or raised, it is more convenient to raise the handlebars on a sports bike.

The most problems arise when the saddle height is set incorrectly. It should be set so that when the pedal is fully pressed in the down position, the leg is fully straightened. If the knee is bent in this pedal position, pain in the joints and muscles occurs. The distance to the steering wheel is also important - your elbows should be slightly bent.

A cyclist places stress on different muscles than a pedestrian. Therefore, to begin with, a 20–30 minute drive is enough; later, depending on the capabilities, the duration of the trips can be extended to 40–60 minutes. And I would like to emphasize once again - when riding a bicycle, do not rush into fast riding, as in this case you will harm your joints. Ride with pleasure, but calmly.

In addition to skiing and cycling, a person suffering from coxarthrosis can benefit from swimming . But here, too, there are some rules - you need to swim calmly, without jerking or too vigorous movements that can injure the joint. Choose a swimming style that does not cause discomfort or even mild pain in the joint.

When engaging in the listed sports, do not try to become “great athletes” before you get your sore joints in order. Such attempts in the overwhelming majority of cases, believe me, end sadly. “Frantic athletes” usually suffer from coxarthrosis more severely than others, and suffer many more complications.

And if you really want to help your aching joints, using the reserve physical capabilities of your body, it’s better to do the special gymnastics suggested below. The benefits from it will be much greater than from any other treatment. Moreover, without such gymnastics we are unlikely to be able to count on a significant improvement in the condition of sore hip joints.

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Therapeutic exercises for arthrosis of the hip joint

Dear readers! We have come to consider one of the most important methods of treating arthrosis of the hip joints. Almost no person suffering from coxarthrosis will be able to achieve real improvement in their condition without therapeutic exercises . After all, it is impossible in any other way to strengthen muscles, “pump” blood vessels and activate blood flow as much as this can be achieved with the help of special exercises.

At the same time, Dr. Evdokimenko’s gymnastics is almost the only treatment method that does not require financial costs for the purchase of equipment or medications. All the patient needs is two square meters of free space in the room and a rug or blanket thrown on the floor. Nothing more is needed except consultation with a gymnastics specialist and the desire of the patient himself to do this gymnastics.

True, there are big problems with desire - almost every patient in whom I detect coxarthrosis during an examination has to be literally persuaded to engage in physical therapy. And it is most often possible to convince a person only when it comes to the inevitability of surgical intervention.

The second “gymnastic” problem is that even those patients who are committed to physical therapy often cannot find the necessary sets of exercises. Of course, there are brochures for sale for patients with arthrosis, but the competence of a number of authors is questionable - after all, some of them do not have a medical education. This means that such “teachers” themselves do not always understand the meaning of individual exercises and the mechanism of their action on sore joints.

Often, gymnastic complexes are simply thoughtlessly copied from one brochure to another. At the same time, they contain such recommendations that you can just grab your head! For example, many brochures instruct a patient with arthrosis of the knee joints to “do at least 100 squats a day and walk as much as possible,” and for arthrosis of the hip joints to “cycle a bicycle vigorously.”

Often patients follow such advice without first consulting a doctor, and then sincerely wonder why they feel worse. Well, I’ll try to explain why the condition of sore joints from such exercises, as a rule, only worsens.

Let's think of a joint as a bearing. Damaged by arthrosis, the diseased joint has already lost its ideal round shape. The surface of the “bearing” (or cartilage) is no longer smooth. Moreover, cracks, potholes and “burrs” appeared on it. Plus, the lubricant inside the sphere had thickened and dried out, and it was clearly not enough.

Try to put such a structure into operation and, in addition, give it a load beyond the norm. Do you think that due to excessive rotation, such a deformed “bearing” can become smoother and more even, and the lubricant more liquid and “sliding”? Or, on the contrary, will the entire structure quickly wear out, become loose and collapse?

In my opinion, the answer is obvious: such a “bearing” will collapse prematurely due to excessive load. In the same way, any bearings are destroyed and worn out during movement if, for example, sand gets into the lubricant and excessive friction occurs. It is not difficult to understand that already damaged, cracked and “dried out” joints are destroyed by stress in the same way. This means that exercises that place excessive stress on sore joints will only make those joints worse.

So maybe if you have arthrosis you can’t do gymnastics at all? Nothing like that is possible and even necessary. As already mentioned, gymnastics is an important method of treating arthrosis of the hip joints. However, of all the exercises, it is necessary to choose only those that strengthen the muscles of the affected limb and the ligaments of the diseased joint, but do not force it to bend and unbend excessively.

Probably, after such a recommendation, many of the readers will be surprised: how can you load the muscles and ligaments of a limb without forcing its joints to bend and straighten?

In fact, everything is very simple. Instead of the fast dynamic exercises that are familiar to us, that is, active flexion and extension of the legs, we need to do static exercises. For example, if, while lying on your stomach, you slightly lift your leg straight at the knee and hold it suspended, then after a minute or two you will feel fatigue in the muscles of your leg, although the joints in this case did not work (did not move). This is an example of a static exercise.

Another variant. You can very slowly raise your straightened leg to a height of 15–20 centimeters from the floor and slowly lower it. After 8-10 of these slow exercises, you will also feel tired. This is an example of a gentle dynamic exercise. This movement algorithm is also useful, although in this case the hip joints are still a little loaded. But the gentle amplitude and speed of movement do not provoke joint destruction.

It’s a completely different matter if the exercise is performed quickly and energetically, with maximum amplitude. By swinging your legs or actively squatting, you put increased stress on your joints, and their destruction accelerates. But the muscles, oddly enough, are strengthened much worse with such movements.

We conclude : to strengthen muscles and ligaments with arthrosis, exercises should be done either statically, fixing the position for a certain time, or slowly dynamically.

By the way, it is slow dynamic and static exercises that most of my patients do not like to do, since they are especially difficult to perform. But this is how it should be: correctly selected, these exercises strengthen those muscles and ligaments that have atrophied in a person due to illness. Therefore, at first, be patient. But, having endured the first 2-3 weeks, you will be rewarded with improved condition of your joints, overall well-being, increased strength, and you will notice how your figure will tighten.

In addition to exercises to strengthen muscles and ligaments, exercises to stretch the joint capsules and ligaments of the joints are of great benefit for arthrosis. But here, too, certain rules cannot be broken. Such exercises should be performed very gently, stretching the ligaments and joints either with very light pressure, or simply by relaxing properly. Under no circumstances should you apply force to the sore joint or pull with a jerk! And I’ll emphasize again: don’t do exercises while overcoming pain.

This applies to both stretching and strengthening exercises. All of them should not cause sharp pain. Although moderate, aching pain after performing a gymnastic complex may last for some time. They are caused by the inclusion of previously uninvolved muscles and ligaments. Such soreness usually disappears after 2-3 weeks of exercise.

Remember: if an exercise causes sharp pain, it means it is contraindicated for you or you are doing it incorrectly. In this case, you should consult with your doctor about the advisability of including this exercise in your individual complex.

In general, it is ideal when a set of exercises for a patient is prepared by a doctor who knows the basics of physical therapy. After all, gymnastics is a fairly serious treatment method that has its own contraindications.

For example, (for all their usefulness) these exercises cannot be performed :

on menstruation days in women;
with significantly increased arterial and intracranial pressure;
at elevated body temperature (above 37.5 C);
in the first month after operations on the abdominal and chest organs;
for inguinal hernias and abdominal hernias;
for acute diseases of internal organs;
for severe heart damage and blood diseases.

And, of course, you can’t do gymnastics during an exacerbation of the disease . It is necessary to first eliminate the exacerbation of the disease with other therapeutic measures. Only then, in the absence of contraindications, the doctor chooses the exercises that are optimal for the patient and prescribes the mode of their implementation: sequence, number of repetitions, time to hold a certain position.

However, I am aware that not every sick person has the opportunity to consult with a competent gymnastics specialist. That is why below I present a number of exercises that are useful for arthrosis of the hip joints.

Note from Dr. Evdokimenko When doing gymnastics, do not rush. If you want to recover, you will somehow have to train yourself to do the exercises slowly and smoothly, without jerking. A jerking effort can only “tear” the muscles and will bring absolutely no benefit.
And remember that even if you perform gymnastics correctly, improvement does not come immediately. As already mentioned, in the first 2 weeks of training, joint pain may even intensify somewhat, but after 3-4 weeks you will feel the first signs of improvement.

I wish you the will and perseverance necessary to regain your former ease of movement. And if you are ready to work hard for your health, then the following set of exercises is at your service: A video with gymnastics for the treatment of coxarthrosis can be viewed here*

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READ MORE:

No more medications needed?
Symptoms of coxarthrosis
What is arthrosis of the hip joint (coxarthrosis) often confused with?
Causes of arthrosis of the hip joint (coxarthrosis)
Structure of the hip joint
Changes in the hip joint with coxarthrosis
Examination of a patient with arthrosis of the hip joint
X-ray diagnosis of coxarthrosis: the most common mistakes
Treatment of arthrosis of the hip joint: prospects
Surgical treatment of arthrosis of the hip joint
Our best exercises for the treatment of coxarthrosis

All articles by Dr. Evdokimenko

OSTEOARTHRITIS. TREATMENT

“When we start believing in miracles, we lose our way”

F. Nietzsche

Risk factors for osteoarthritis:

Heredity
Gender (w)
Obesity
Profession

The problem is that traditional medicine has little to offer for the treatment of joint pain. Painkillers for the most part are dangerous and almost the entire choice comes down to paracetamol in large doses.

Non-steroidal anti-inflammatory drugs - only if paracetamol is ineffective. If they don’t help either, then before resorting to narcotic painkillers, it is recommended to try topically capsaicin, an alkaloid found in red pepper. The irritating substance used as the basis for gas protective cartridges has been known for a very long time. The unique properties of pepper were used by the Incas in the fight against the Spanish colonialists. At the Battle of the Orinoco River in 1532, the burning smoke from burning peppers put the Spanish colonizers to flight. Local intra-articular injections of hormones are quite effective, but cannot be done frequently (no more than 3 times a year in each joint). For refractory cases - intra-articular injections of hyularonic acid (Synvisc, Fermatron, Ostenil, Duralan) and joint replacement surgery. Hyaluronic intra-articular injections are very effective, but their effect reaches a maximum in the eighth week, then it begins to decline. They are also trying to use colchicine for inflammatory OA, including prophylactic use, as for gout. In some cases, they try to use chloroquine.

Most patients are not satisfied with the quality of life that traditional medicine can give them, and they try to alleviate the situation by taking alternative medications.

In America and Europe, 2/3 of patients use medications in addition to (or instead!) of those prescribed to them by their rheumatologists. Often they do not even inform doctors about this and cross-harmful effects of this combination occur. With such a massive use of alternative drugs, this is no longer an issue; it is necessary to study scientifically the possible positive and negative aspects of their use.

We started with the notorious Glucosamine and Chondroitin. Extensive and lengthy tests were carried out in various countries. In some cases there was an effect, in others there was no effect. As a result, today it is believed that their effect does not exceed the placebo effect. Moreover, the doctor will not object to their use after warning that their effect is unproven. However, he will advise you to stop taking them if pain relief does not occur after six months of use.

Dietary supplements and herbs . In an experiment on mice, data were obtained on the possible beneficial effect of salts of copper, selenium, zinc, vitamin B-6 and C on OA. (Hence, by the way, the fashion for wearing copper bracelets came from!)

Numerous studies have not confirmed the usefulness of these substances, some of which also had side effects (the same copper salts).

There are a huge number of medicinal herbs available in the market to treat joint pain. Some have been clinically tested, most have not. With a few exceptions (Tripterydium Wilfordii Hook F, a Chinese herbal extract for rheumatoid arthritis, for example), the effect was no greater than placebo. At the same time, one must remember the unpredictable effect of taking poorly studied herbs on various organs with the possible development of toxic damage to the liver, kidneys, thyroid gland, etc.

Homeopathy. It has been used for 200 years. According to evidence-based medicine, the effect is no higher than placebo. However, for example, in France, 2/3 of patients with joint pain resort to it. Moreover, insurance pays 30% of the cost of these drugs. An example of how the traditions and faith of patients created an industry that evidence-based medicine is not yet capable of overthrowing. Today for France, for example, this is not economically profitable.

Hirudotherapy, treatment with leeches. There have been studies showing their good analgesic effect (even compared to Voltaren ointment), which, however, turned out to be short-lived. In addition, most leeches carry the bacterium Aeronomus Hydrophillia and can be a source of cellulitis and bacteremia in humans.

Bee venom has been shown to have possible anti-inflammatory properties in experiments, but there is no objective evidence for use in humans. Moreover, “beekeepers' arthritis” is well known.

Hyperbolic oxygenation - the effect has not been proven.

Laser irradiation . Preliminary data suggest possible effectiveness in rheumatoid arthritis, but not osteoarthritis. However, treatment protocols vary greatly (frequency and intensity of radiation, etc.), further research is needed.

NEW APPROACHES IN THE TREATMENT OF OSTEOARTHRITIS

Bisphosphonates ( Fosomax, Bonviva, etc.). They improve the condition of the bone under the cartilage and show an analgesic effect significantly higher than placebo. This effect practically disappears after 4 years of use. Further tests are underway.

Strontium renalate (Bivalos). The drug is also used to treat osteoporosis. At a dose of 2 grams per day, it significantly reduced pain and narrowed the interarticular space. Trials for osteoarthritis are still ongoing. Complications: increased risk of thromboembolism and myocardial infarction.

Calcetonin . Also from the arsenal of osteoporosis treatment. In osteoarthritis, cartilage damage occurs not only as a result of mechanical stress, but also as a result of the activation of certain receptors (Toll-like receptors), which release aggressive cytokines and substances that provoke inflammation. Calcetonin blocks these receptors. Research continues.

Sprifermin is a recombinant human fibroblast growth factor 18 . When injected into a joint, it stops the breakdown of cartilage and can even restore it - research is ongoing.

Verapamil (Isoptin), a medicine widely used in cardiology. What does osteoarthritis have to do with it? The fact is that the cells responsible for the structure of bone and cartilage - osteocytes and chondrocytes - are regulated by a complex chain of signals, which partly consists of specialized proteins). Verapamil may increase the production of one of these proteins, which prevents the breakdown of cartilage.

Platelet-rich plasma. The data is promising: relieves pain, restores function, and even possibly restores cartilage! The mechanism of action is unclear, but probably contains specific growth factors for cartilage.

Tanezumab - Tanezumab , a monoclonal antibody that inhibits (suppresses) nerve growth factor. It had a significant effect in clinical trials, but the study was stopped due to evidence of bone necrosis in some patients. Nerve growth factor inhibitors are still in the development stage, and it is possible that they will develop into a class of reserve drugs for the treatment of resistant cases of osteoarthritis.

Doctor Myasnikov’s opinion on the treatment of arthrosis of the knee joints