Physiotherapy for joint diseases

The main diseases of joints include arthritis of the corresponding etiology, rheumatoid arthritis and osteoarthritis. And if arthritis and rheumatoid arthritis are not so common in patient wards, osteoarthritis - the degenerative-dystrophic process in the joints begins to appear from the age of 40, and after 60 years there is practically every person.

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

• anesthetizing,
• anti-inflammatory,
• decongestant,
• regenerative,
• to the normalization or improvement of the blood circulation of the tissues of the affected joints.

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

With articular pathology of the methods of physiotherapy, which have analgesic effect, in clinical practice the following methods and factors of direct impact on the joints are used (listed in order of decreasing clinical effect):

• drug electrophoresis of appropriate pharmacological agents;
• high-intensity pulsed magnetotherapy;
• Low-energy laser (magneto-laser) action and drug photophoresis of appropriate means;
• DMV-therapy;
• ultrasound therapy and drug phonophoresis of appropriate agents.

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

• drug electrophoresis of certain pharmacological agents;
• ultrasound therapy and drug phonophoresis of certain drugs;
• laser (magnetolaser) therapy;
• DMV-therapy.

Accordingly, to the most frequently used methods, which have a regenerative effect and promote! Improvement of vascular microcirculation, include (listed in order of decreasing clinical effect):

• magnetotherapy (the impact of PeMP);
• low-energy laser (magneto-laser) effect;
• ultrasound therapy and drug phonophoresis of certain drugs.

In the treatment and prophylaxis and rehabilitation activities, patients with joint diseases are treated by drug electrophoresis with the use of appropriate pharmacological agents, laser (magnetolaser) therapy and magnetotherapy with the use of low-frequency alternating magnetic field (PeMP).

Outside the treatment facility (at home, at the workplace, etc.), it is advisable to carry out the drug electrophoresis of the necessary pharmacological agents to patients using the Elfor-I apparatus (Elfort ™) according to the generally accepted methods of influencing the corresponding joints.

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

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

The exposure fields with the help of LI radiators with the irradiation area with a contact technique of about 1 cm ².

• Shoulder joint: the field is the anterior surface of the joint, below the large tubercle of the humerus; II field - the upper lateral surface of the joint, between the acromial process of the scapula and the large tubercle of the humerus; III field - the posterior surface of the joint, below the acromial process of the scapula.
• Elbow joint: the field is the outer surface of the joint near the elbow process; II field - the inner surface of the joint near the elbow process; III field - the middle of the elbow fold.
• The wrist-wrist joint: the field is the back surface of the joint, closer to the ulnar bone; II field - the palm surface of the joint in the middle of the wrist fold.
• Pseudo-phalanx joints of the hand: I - II fields - dorsum and palmar surface of the hand on the projection of the corresponding joint slit of the metacarpophalangeal articulations.
• Interphalangeal joints of the hand: I - II fields - back and palmar surface of the hand on the projection of the corresponding joint gap of interphalangeal articulations.
• Hip joint: I - III fields - from above, behind and below 1 cm from the projection of a large trochanter of the femur in the gluteal region, when using a radiator with an area of irradiated surface of about 1 cm ² ("Orion-5" apparatus) and one field at the irradiated surface 3 cm ² (apparatus "MILTA-F-5-01"); 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 joint volume) along the lateral surface (right and left) along the projection of the joint space; V field is the center of the popliteal fossa of the affected joint.
• Ankle joint: 1 field - back fold of the foot along the projection of the joint space; II field - the area between the outer ankle and the Achilles tendon; III field - the area between the inner ankle and Achilles tendon.
• Joint of the Chopar (transverse joint of the tarsus): I - IV of the field - lateral, posterior and plantar surfaces of the foot according to the projection of the articular gap of the tarsal articulations.
• Joint of Lisfranc (tarsus-metatarsal joints): I - IV fields - two fields from the rear and plantar surfaces of the foot along the projection of the articular cleft of the tarsal-metatarsal joints.
• Plusus-phalangeal joints: I - II fields - one from the back and plantar surfaces of the foot according to the projection of the joint slit of the metatarsophalangeal articulations.
• Interphalangeal joints of the foot: I - II fields - one field from the back and plantar surfaces of the foot along the projection of the joint gap of the interphalangeal joints.
• Fields of influence with a matrix emitter area of 5 - 20 cm ² :
• Shoulder joint: the field is the anterior surface of the joint; II field - the back surface of the joint.
• The elbow joint is the middle of the elbow fold.
• The wrist joint is the palm surface of the joint in the middle of the wrist fold.
• Pseudo-phalangeal joints of the hand - palmar surface of the hand on the projection of the corresponding joint slits of metacarpophalangeal articulations.
• Interphalangeal joints of the hand - the palm surface of the hand on the projection of the corresponding joint slits of the interphalangeal joints.
• Hip joint: field - projection of the large trochanter of the femur in the gluteal region; II field - 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.
• Ankle joint is the back fold of the foot along the projection of the joint space.
• The joint of the Chopar (transverse joint of the tarsus) is the dorsal surface of the foot along the projection of the articular gap of the tarsal articulations.
• The joint of Lisfranca (tarsus-metatarsal joints) is the dorsal surface of the foot according to the projection of the articular cleft of the tarsal-metatarsal joints.
• Pliusnephalangeal joints are the dorsal surface of the foot along the projection of the joint slit of the metatarsophalangeal articulations.

MRP OR 5 - 10 mW / cm2. Induction of the magnetic nozzle 20 - 40 mT. Generation frequency of pulsed laser radiation: with severe pain syndrome - 50 - 100 Hz; with mild pains, and after a significant reduction in pain during treatment - 5 - 10 Hz. The time of exposure to one field is 1-5 min (depending on the size of the joint); in polyarthritis (polyarthrosis), the total time for one procedure: continuous radiation mode - up to 30 minutes, with pulsed radiation - up to 20 minutes. The course of laser (magnetolaser) therapy 10 - 15 procedures daily once a day in the morning hours (up to 12 hours).

Magnetotherapy with the use of low-frequency alternating magnetic field (PeMP) is recommended to be carried out with the help of the "Polyus-2D" apparatus on the area of projection of the articular gap of a certain joint. Technique of exposure is contact, stable.

The influence fields are similar to the fields of action for laser therapy with a matrix radiator.

The time of exposure to one field is 10 to 20 minutes (depending on the size of the joint); the total time in one procedure is not more than 1 hour.

The course of magnetotherapy 10 - 15 procedures daily once a day in the morning hours (up to 12 hours).

It is possible to consistently perform procedures in one day at home with articular pathology:

• laser (magnetolaser) therapy (in the morning hours) + medicinal electrophoresis (in the evening hours);
• magnetotherapy (in the morning hours) + medicinal electrophoresis (in the evening hours).

[1], [2], [3], [4], [5]