Physiotherapy for joint diseases

The main diseases of the joints include arthritis of the corresponding etiology, rheumatoid arthritis and osteoarthrosis. And if arthritis and rheumatoid arthritis are not so common in the patients under our care, then osteoarthrosis - a degenerative-dystrophic process in the joints begins to manifest itself from the age of 40, and after 60 years, almost every person has it.

Despite the differences in the etiology and pathogenesis of the listed diseases, the tasks of physiotherapy in the complex treatment of any joint pathology are common. They come down to providing the following clinical effects:

• painkiller,
• anti-inflammatory,
• decongestant,
• regenerative,
• to normalize or improve blood circulation in the tissues of the affected joints.

All other clinical effects in physiotherapy of joint diseases arise due to the generalization of the local action of the physical factor and the integral reaction of the whole organism to this effect.

In case of joint pathology, the following methods and factors of direct impact on joints are used in clinical practice from physiotherapy methods that have an analgesic effect (listed in order of decreasing clinical effect):

• medicinal electrophoresis of the corresponding pharmacological agents;
• high intensity pulsed magnetic therapy;
• low-energy laser (magnetolaser) action and medicinal photophoresis of appropriate means;
• UHF therapy;
• ultrasound therapy and medicinal phonophoresis of appropriate agents.

Of the physiotherapy methods that have an anti-inflammatory and anti-edematous effect, the following are mainly used (listed in order of decreasing clinical effect):

• medicinal electrophoresis of certain pharmacological agents;
• ultrasound therapy and medicinal phonophoresis of certain agents;
• laser (magnetic laser) therapy;
• UHF therapy.

Accordingly, the most frequently used methods that have a regenerative effect and contribute to the improvement of vascular microcirculation include (listed in order of decreasing clinical effect):

• magnetic therapy (exposure to high magnetic fields);
• low-energy laser (magnetolaser) exposure;
• ultrasound therapy and medicinal phonophoresis of certain agents.

When carrying out treatment, preventive and rehabilitation measures for patients with joint diseases, the methods of choice are medicinal electrophoresis using appropriate pharmacological agents, laser (magnetic laser) therapy and magnetic therapy using the effects of a low-frequency alternating magnetic field (LFAF).

Outside of a medical facility (at home, at work, etc.), it is advisable to carry out medicinal electrophoresis of the necessary pharmacological agents on patients using the Elfor-I (Elfor™) device using generally accepted methods of influencing the corresponding joints.

Laser (magnetic laser) therapy of joint diseases can be performed under any conditions. The presence of laser therapeutic devices "Orion-5", "Azor-2K" and "MILTA-F-5-01" in the arsenal of a general practitioner (family doctor) allows to fully realize all the possibilities of laser (magnetic laser) therapy. General recommendations include the following provisions.

Devices with infrared emitters (wavelength 0.8 - 0.9 μm) are used both in continuous radiation generation mode and in pulsed mode with the appropriate frequency. The impact is carried out on exposed skin along the projection of the joint space of a certain joint. The impact method is contact, stable.

Impact fields using NLI emitters with an irradiation area using the contact method of about 1 ^cm2.

• Shoulder joint: field - the anterior surface of the joint, below the greater tubercle of the humerus; field II - the upper lateral surface of the joint, between the acromial process of the scapula and the greater tubercle of the humerus; field III - the posterior surface of the joint, below the acromial process of the scapula.
• Elbow joint: field - the outer surface of the joint near the olecranon; field II - the inner surface of the joint near the olecranon; field III - the middle of the elbow bend.
• Wrist joint: field - the dorsal surface of the joint, closer to the ulna; field II - the palmar surface of the joint in the middle of the wrist fold.
• Metacarpophalangeal joints of the hand: I - II fields - the dorsal and palmar surfaces of the hand along the projection of the corresponding joint space of the metacarpophalangeal joints.
• Interphalangeal joints of the hand: I - II fields - the dorsal and palmar surfaces of the hand along the projection of the corresponding joint space of the interphalangeal joints.
• Hip joint: I - III fields - above, behind and below 1 cm from the projection of the greater trochanter of the femur in the gluteal region when using an emitter with an irradiated surface area of about 1 cm2 ⁽ Orion-5 device) and one field with an irradiated surface of 3 cm2 ⁽ MILTA-F-5-01 device); IV field - the middle of the inguinal fold on the side of the affected joint.
• Knee joint: I - IV fields - one or two fields (depending on the volume of the joint) along the lateral surface (right and left) along the projection of the joint space; V field - the center of the popliteal fossa of the affected joint.
• Ankle joint: 1 field - dorsal flexion of the foot along the projection of the joint space; 2 field - the area between the outer ankle and the Achilles tendon; 3 field - the area between the inner ankle and the Achilles tendon.
• Chopart's joint (transverse tarsal joint): I - IV fields - lateral, dorsal and plantar surfaces of the foot along the projection of the joint space of the tarsal articulations.
• Lisfranc joint (tarsometatarsal joints): I - IV fields - two fields on the dorsal and plantar surfaces of the foot along the projection of the joint space of the tarsometatarsal joints.
• Metatarsophalangeal joints: I - II fields - one each on the dorsal and plantar surfaces of the foot along the projection of the joint space of the metatarsophalangeal joints.
• Interphalangeal joints of the foot: I - II fields - one field on the dorsal and plantar surfaces of the foot along the projection of the joint space of the interphalangeal joints.
• Impact fields using a matrix emitter with an area of 5 - 20 ^cm2:
• Shoulder joint: field - anterior surface of the joint; field II - posterior surface of the joint.
• The elbow joint is the middle of the elbow bend.
• The wrist joint is the palmar surface of the joint in the middle of the wrist crease.
• Metacarpophalangeal joints of the hand - the palmar surface of the hand along the projection of the corresponding joint spaces of the metacarpophalangeal joints.
• Interphalangeal joints of the hand - the palmar surface of the hand along the projection of the corresponding joint spaces of the interphalangeal articulations.
• Hip joint: field - projection of the greater trochanter of the femur in the gluteal region; field II - the middle of the inguinal fold on the side of the affected joint.
• The knee joint is the center of the popliteal fossa of the affected joint.
• The ankle joint is the dorsal flexion of the foot along the projection of the joint space.
• Chopart's joint (transverse tarsal joint) - the dorsal surface of the foot along the projection of the joint space of the tarsal articulations.
• Lisfranc joint (tarsometatarsal joints) - the dorsal surface of the foot along the projection of the joint space of the tarsometatarsal articulations.
• Metatarsophalangeal joints - the dorsal surface of the foot along the projection of the joint space of the metatarsophalangeal articulations.

PPM OR 5-10 mW/cm2. Magnetic nozzle induction 20-40 mT. Frequency of pulsed laser radiation generation: in case of severe pain syndrome - 50-100 Hz; in case of mild pain, as well as after significant reduction of pain syndrome during treatment - 5-10 Hz. Exposure time per field is 1-5 min (depending on the joint size); in case of polyarthritis (polyarthrosis), the total time per procedure: with continuous radiation mode - up to 30 min, with pulsed radiation mode - up to 20 min. The course of laser (magnetolaser) therapy is 10-15 procedures daily, once a day in the morning (before 12 a.m.).

Magnetic therapy using the effect of a low-frequency alternating magnetic field (LFAF) is recommended to be carried out using the device "Pole-2D" on the area of the projection of the joint space of a certain joint. The method of action is contact, stable.

The fields of action are similar to those of laser therapy with a matrix emitter.

The exposure time for one field is 10-20 minutes (depending on the size of the joint); the total time for one procedure is no more than 1 hour.

A course of magnetic therapy is 10-15 procedures daily, once a day in the morning (before 12 noon).

It is possible to carry out procedures sequentially in one day at home in case of joint pathology:

• laser (magnetic laser) therapy (in the morning) + medicinal electrophoresis (in the evening);
• magnetic therapy (in the morning) + medicinal electrophoresis (in the evening).

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