Osteoarthritis: What should the patient know?

Human joints are wonderful anatomical formations. What man-made device can exist and work for decades and decades? To better evaluate the work of such a wonderful device as joints, consider the following facts. If a person's body weight is 50 kg, with each step his knee joint bears a load of more than 150 kg.

Most people take an average of over 8,000 steps a day, which means that the knee joint must absorb a load of over 600,000 kg. If the body weight of a person who takes the specified number of steps during the day is 75 kg, his knee joint absorbs a load of over 900,000 kg. Now you can imagine what kind of load the knee joint of an athlete or a person engaged in heavy physical labor absorbs. It is not surprising that, despite its strength, the knee joint is vulnerable, susceptible to injury and disease.

Osteoarthritis is one of the most common joint diseases, which affects the cartilage covering the contacting bone structures inside the joint. The exact cause of its development is unknown. The most likely are two reasons - hereditary predisposition (a defect in the structure of the articular cartilage is inherited) and excessive microtraumatization of the joint tissues (for example, with excess body weight in some professions, etc.). As a result, the cartilage wears out, becomes thinner, and osteophytes - so-called spurs - form in the underlying bone. Most often, the joints that bear the greatest static (knee, hip and spinal joints) or dynamic (some joints of the hand) load are affected.

The most typical symptoms of osteoarthritis are pain in the joint when standing, walking, or running for a long time, which goes away when resting. Osteoarthritis of the knee joints is characterized by pain that occurs when going down stairs. In patients with osteoarthritis of the hand joints, the fingers acquire a characteristic "knottiness". Today, this disease is not completely curable, but with regular treatment and adherence to certain rules of life, it is possible to slow down and even stop the progression of the disease.

A patient suffering from osteoarthritis should carefully follow the doctor's recommendations. Treatment of osteoarthritis usually includes taking painkillers, the right combination of rest and exercise, which is extremely important to maintain the functioning of the affected joints. It is important to remember that painkillers are prescribed to patients with osteoarthritis to relieve pain, and not to subject their joints to even greater strain. You should not kneel while cleaning the apartment, push drawers and close doors with your knees, etc.). It is necessary to avoid prolonged vertical static loads on the joints, i.e. do not stand for a long time, try to sit down, if this is possible. Do not run to the bus, it is better to slowly approach the stop, sit on a bench and wait for the next one. When walking, do not rush, make quick turns and stops, walk on an uneven road. When you return home, you should rest on a high chair with armrests or an armchair so that when you get up after resting, you can help yourself with your hands.

It is recommended to avoid overcooling of the extremities and use procedures such as hot wraps, hot baths, dry heat. Old woolen items are suitable for wrapping knee joints.

If your local doctor has diagnosed you with osteoarthritis of the hip joints, try to visit an orthopedist as soon as possible. Unfortunately, this is the most unfavorable variant of the disease, characterized by rapid progression. Therefore, the most radical method of treatment in this case is prosthetics. A “new” joint will give you the opportunity to fully experience the pleasure of being able to move independently without pain and the use of additional devices. If the operation is postponed for some reason, remember that the only way to slow down the progression of osteoarthritis of the hip joint is to change your lifestyle. First of all, always use a cane when walking, it will unload the joint by 50%. Distribute static (standing) and static-dynamic (walking) loads during the day so as to minimize the load on the affected joint.

Sometimes after excessive loads, infectious diseases, hypothermia, etc. the affected joint may increase in size (“swell”), the skin above it becomes hot, the pain intensifies, occurs with the slightest movement, and sometimes at rest. These symptoms indicate the development of inflammation in the joint and the accumulation of fluid in it. This is a serious problem, you should not wait for it to resolve on its own and self-medicate, but you should immediately consult a doctor. Postponing a visit to a specialist can lead to irreversible changes in some structures inside the joint, which will contribute to a protracted or only partial resolution of this inflammation, its frequent and long-term exacerbations.

In overweight individuals, normalizing it will help reduce joint pain. It is recommended to exclude easily digestible carbohydrates (sugar, baked goods, potatoes, rice, chocolate, etc.), fatty meats, and animal fat from the daily diet.

Physical exercises are extremely important for patients with any knee joint pathology. Particular importance in the treatment of osteoarthritis is given to strengthening the quadriceps muscle of the thigh, located on its anterior surface, which extends the knee joint and stabilizes it. Performing exercises to strengthen this muscle leads to a significant reduction in pain in the joint. It is necessary to remember that with osteoarthritis, any exercises should be performed only in a sitting or lying position.

On the back of the thigh is a group of muscles that flex the knee. These muscles are usually much stronger than the quadriceps, which extend the knee and straighten the leg. That is why, when the knee joint is injured or inflamed, the lower limb tends to bend, since the hip flexor muscles in this case form a permanent flexion contracture.

To prevent contracture of the flexor muscles, it is useful to perform an exercise to stretch the heel tendon.

Stand 40 cm away from the wall (or cabinet), feet firmly on the floor, knees straight; lean your arms outstretched against the wall; bend your arms at the elbows, try to touch the wall with your chest, then return to the starting position. This exercise stretches the Achilles tendon, calf muscles and hip flexor muscles. Another exercise to strengthen the knee flexor muscles: starting position - lying on your stomach; slowly bend and straighten your legs at the knee joints. It is advisable to do this exercise with weights-bracelets on the ankle joints.

A properly organized program of therapeutic exercises is the most important part of rehabilitation measures for osteoarthritis after joint inflammation. If you experience unexpected difficulties during the exercise, you cannot maintain your balance or do not notice any improvement, consult your doctor.

Passive exercises are the first stage of the recovery period, as they do not require any effort from the patient. The assistant (nurse, physiotherapist) bends and unbends the patient's lower limb as much as the knee joint and relaxed muscles allow.

Semi-active exercises are the next step. With the help of an assistant, you (actively) bend and straighten the limb at the knee joint.

Active exercises are performed without any help. There are two types of active exercises: isometric and isotonic.

Isometric exercises are used as a transition between semi-active and active isotonic exercises. When performing them, you tense and relax different muscle groups, while the limb remains motionless. To perform them, you should rest your feet against a fixed object (wall, closet, bed) and tense the opposite muscle groups that perform flexion and extension of the legs at the knee joints, or press both limbs tightly against each other at different angles. Consult a doctor or physical therapist about what sports equipment can be used to perform these exercises.

Isotonic exercises involve active body movements. The exercises described below will help you strengthen your knee joints. Your doctor will advise you which ones to do and may also recommend additional exercises.

1. Starting position - lying on your back, legs bent at the knees. Lower your bent legs to the floor first to the left, then to the right and return to the starting position. Starting position - lying on your back. Raise your straight leg 50-70 cm above the floor and return to the starting position.
2. Starting position - sitting on a table, one leg hanging freely, the other lying on a chair standing nearby, place a towel roll under the knee joints. Raise the leg lying on the chair by 10-20 cm and return to the starting position.
3. Starting position: sitting on the floor, hands behind you. Spread your straight legs so that there is a distance of 35-40 cm between your knee joints and tie your legs with a belt or rope above your knee joints. Try to spread your legs as much as possible, overcoming the resistance of the belt or rope.
4. Starting position - lying on your back. Without lifting your heels off the floor, bend your leg at the knee joint and pull your heel to your buttock, return to the starting position.
5. Starting position - lying on your back. Bend your leg at the knee joint and press it to your stomach with your hands, return to the starting position.
6. Starting position: lying on your back. Spread your straight legs as far apart as possible and bring them together again.
7. Starting position: lying on your back, legs apart so that the distance between your heels is 25-30 cm. Turn your feet inward, try to touch your big toes, then turn your feet outward as much as possible and try to touch the floor with your little toes.

How often can you do these exercises?

The most reasonable recommendation is to do them until the next morning you feel a slight stiffness and soreness in your muscles, but so that you can do them again. Your doctor will give you more precise advice. Complicate the exercises gradually, do not overload your joints. Try warm wraps for your knee joint or the entire limb before doing the exercises.

Swimming is not only a great sport for strengthening muscles, it is a great way to unload and give rest to the joints of the lower limbs and spine. In the pool, you can do special exercises for the knee joint. For example, walking in water that reaches your hip or waist (you get an additional load due to the resistance of the water). At the same time, try to walk without bending your knees and lifting your legs as much as possible ("goose walk"), which will significantly strengthen the quadriceps muscle of the thigh.

Cycling is a very useful sport for osteoarthritis: on the one hand, the muscles of the lower limb are strengthened and become more elastic, on the other hand, the knee joints do not experience such a load on the foot as when running or walking fast.

An important point is the height of the bicycle seat. It is necessary that when rotating the pedals, the legs at the knee joints bend slightly. To determine the necessary height of the bicycle seat, it must first be raised so that the leg hangs, not reaching the pedal, then lowered a little.

If the bike has a gear shifting device, the optimal speed for a patient with osteoarthritis is 80 revolutions per minute. If joint pain occurs after riding a bike, the seat should be raised a couple of centimeters. The feet should be positioned on the pedals so that the foot is turned slightly inward. Before riding, you should warm up and do muscle stretching exercises. It is important to remember that riding at high speed in cold weather is an additional cooling factor, so you should dress warmer.

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Some devices for protecting knee joints

1. "Knee warmer". Knee joints should not be overcooled. To do this, use a warmer, special knee pads, which can be bought at a pharmacy or made yourself from old warm clothes.
2. Elastic stockings, bandages and dressings will help you with instability of the knee joint. However, they are not recommended for use in the development of inflammation in the joint, after surgery and injury, accompanied by swelling of the joint, as this can lead to deterioration of the blood supply to the tissues.
3. A cane is a simple but very useful tool. When choosing a cane, you need to consider the following:
   • Make sure it is strong enough. If you are a heavy person, you will need a stronger cane.
   • The end of the cane should have a tip to prevent it from slipping.
   • The cane should be the right length for you (your elbow should be bent at 10° when you lean on the cane). Do not use other people's canes.
   • Make sure the handle of the cane is comfortable and the cane itself is not heavy for you.
   • When walking, hold the cane in the hand opposite the sore leg.
4. Crutches. Their purpose is to reduce the load of body weight on the joints. Crutches should be comfortable, fit you in length, and should not slip.