Physiotherapy for osteoarthritis

Physiotherapy is especially helpful with osteoarthritis of large joints of the lower extremities. To relieve pain, reduce edema of the periarticular tissues, reflex spasm of the periarticular muscles, improve microcirculation, treat weak or moderate synovitis:

• exposure to electromagnetic fields of ultrahigh and high frequencies,
• ultrasound therapy (including phonophoresis of anti-inflammatory drugs),
• shortwave diathermy (in the absence of synovitis),
• microwave therapy
• electrophoresis of anti-inflammatory drugs (voltaren, hydrocortisone, dimethyl sulfoxide),
• laser therapy
• applications of heat carriers (silt and peat mud, paraffin, ozokerite),
• balneotherapy (radon, sulfur-hydrogen, sodium chloride, turpentine, iodide-bromine baths),
• hydrotherapy (reduces the gravitational load on the joints, mainly hip).

[1], [2], [3]

UV exposure

In the period of exacerbation of osteoarthritis caused by reactive synovitis, you can use ultraviolet irradiation in erythemal doses (5-6 procedures), electric field and decimeter waves in a low-heat dose (8-10 procedures), magnetic therapy (10-12 procedures), phonophoresis or metamizole electrophoresis sodium, procaine, trimecaine, dimethyl sulfoxide on the area of the affected joint. Contraindications to the use of ultraviolet therapy are concomitant coronary artery disease, transient disorders of cerebral circulation, thyrotoxicosis, and kidney disease. Exposure to the UHF electric field is contraindicated in severe vegetative-vascular dystonia, cardiac arrhythmias, and hypertension of IIB-III stage.

Electrophoresis

Among the various physiotherapeutic methods, electrophoresis has proven itself, combining the therapeutic effects of direct electric current and the drug administered. From the mechanisms of biological action of direct electric current, the following physicochemical effects can be distinguished:

• electrolysis - the movement of charged particles (cations and anions) to the oppositely charged electrode and their transformation into atoms with high chemical activity;
• the movement of charged particles under the action of direct electric current causes a change in the ionic situation in the tissues and cells. The accumulation of oppositely charged particles in biological membranes leads to their polarization and the formation of additional polarization currents;
• As a result of changes in the permeability of biological membranes, passive transport of large protein molecules (ampholytes) and other substances through them increases — electrodiffusion;
• electroosmosis - multidirectional movement of water molecules included in hydration shells of ions (mainly Na ⁺, K ⁺, CL).

Under the action of electric current in the underlying tissues, the systems of regulation of the local blood flow are activated and the content of biologically active substances (bradykinin, kallikrein, prostaglandins) and vasoactive mediators (acetylcholine, histamine) increase. As a result, the vascular lumen of the skin expands and hyperemia occurs.

The expansion of the capillaries and the increase in the permeability of their walls due to local neurohumoral processes occur not only in the place of application of the electrodes, but also in deep tissues, through which a constant electric current passes. Along with increased blood and lymph circulation, increased tissue resorption, there is a weakening of muscle tone, an increase in the excretory function of the skin and a decrease in edema in the focus of inflammation. In addition, due to electroosmosis, the compression of the painful conductors is reduced, more pronounced under the anode.

Constant electric current enhances the synthesis of high-energy compounds in cells, stimulates metabolic and trophic processes in tissues, increases the phagocytic activity of macrophages, accelerates regeneration processes, stimulates the reticuloend ophthalmic system, increases the activity of factors of nonspecific immunity.

Thus, a constant electric current has the following therapeutic effects: anti-inflammatory, metabolic, vasodilating, sanitizing (draining and dehydrating), analgesic, muscle relaxant, sedative (at the anode).

[4]

Electromagnetic fields of high and microwave frequencies

During the period of "subsidence" of exacerbation, as well as in the initial stage of the disease, when synovitis is mild or absent, effects of high and ultrahigh frequency electromagnetic fields (inductothermia, decimeter and centimeter wave therapy) are shown, low-frequency impulse currents - sinusoidal modulated and diadynamic, magnetic therapy, laser exposure, hydrocortisone phonophoresis. To stimulate the trophism of articular cartilage, electrophoresis of lithium, calcium, sulfur, zinc salts, 0.01% solution of humic acid fractions of the Haapsalu marine curative in an isotonic sodium chloride solution is carried out. To potentiate the analgesic effect, electrophoresis of procainum, metamizole sodium, salicylic acid is used.

Electromagnetic fields of high and ultrahigh frequencies - inductothermy, decimeter and centimeter wave therapy - when exposed to joints with weak heat and heat doses (12-15 procedures per course of treatment) have articular and periarticular tissues expressed heat effect, increase blood flow to the joint tissues, increase lymphatic drainage, diffusion processes, eliminate muscle spasm. It helps to improve the nutrition of cartilage, has a resorptional effect in case of synovitis, and also has a positive effect on periarticular proliferative processes. Induction is used in patients with osteoarthritis stage I-II, in the absence or mild secondary synovitis, the presence of pain, periarticular changes. Induction is not indicated for exacerbation of secondary synovitis, as well as for patients with senile age, coronary artery disease, atherosclerotic lesion of heart vessels, cardiac arrhythmias, marked cerebral atherosclerosis, transient violation of cerebral circulation, climacteric disorders, fibromyomas, fibromyomas, fibromyomas, transient cerebral circulation, climacteric disorders, fibromyomas These patients are prescribed decimetro or centimetrovye effects.

Decimeter and centimeter wave therapy is used in osteoarthrosis of stages I-IV in the absence or mild manifestation of secondary synovitis, as well as in ischemic heart disease with frequent strokes, in patients with severe climacteric disorders, fibromyoma.

[5], [6], [7], [8],

Low-frequency impulse currents

The analgesic effect, beneficial effects on hemodynamics and metabolic processes in the joint have low-frequency impulse currents - sinusoidal modulated and diadynamic. Sinusoidal modulated currents are better transported than diadynamic currents. The “addictiveness” of tissues develops to them less, therefore they are preferable. Low-frequency impulse currents are indicated for patients of elderly and senile age with stage I-IV osteoarthrosis, severe pain, changes in the periarticular tissues. Impulse currents are not prescribed for symptoms of secondary synovitis, as well as for patients with impaired mid-rhythm with bradycardia or a tendency to bradycardia.

[9], [10], [11]

Ultrasound therapy

Ultrasound therapy is often used in the treatment of various acute and chronic diseases of the musculoskeletal system. Ultrasound provides heat (increased blood flow, increased pain threshold, increased metabolic rate) and non-thermal (increased permeability of cell membranes, calcium transport through the cell membrane, nutrient influx into tissue, phagocytic activity of macrophages). With the pulse method of ultrasound delivery, the thermal effects are reduced, while non-thermal ones remain unchanged, therefore, the use of pulse ultrasound is indicated for patients with osteoarthritis in the presence of synovitis. Ultrasound is indicated in patients with stage I-IV of osteoarthritis without the occurrence of synovitis with severe pain, proliferative changes in the periarticular tissues. Ultrasound therapy is contraindicated during exacerbation of synovitis, as well as elderly patients with severe atherosclerotic lesions-ical heart and brain blood vessels, hypertension stage III, transient ischemic attacks, thyrotoxicosis, vegetososudistoydistonii, menopausal disorders, fibroids, mastitis.

Massage

Muscle spasm is one of the sources of pain and the cause of limiting the function of the joints in patients with osteoarthritis. A spasm of the periarticular muscles causes an increase in intra-articular pressure and stress on the articular surface, as well as a decrease in blood flow in the muscle, as a result of which local ischemia develops. Therefore, the removal of muscle spasm is of great importance in the treatment and rehabilitation of patients with osteoarthritis.

Massages, deep and superficial warming (thermal applications, infrared radiation, short-wave or microwave diathermy, sauna or steam room) are used to relax spastic muscles. Local application increases blood flow in the affected area, reduces pain and muscle spasm, causes general relaxation. Increased blood flow in the muscles contributes to the elimination of metabolites (lactic acid, CO ₂, etc.) and the influx of energy sources (O ₂, glucose, etc.). In addition, superficial warming, acting on the nerve endings, has a sedative and analgesic effect. Another mechanism of muscle relaxation with the help of applications is to reduce the excitability of the neuromuscular spindles.

[12], [13], [14]

Applications

Applications of silt or peat mud (temperature 38-42 ° C), paraffin and ozokerite (temperature 50-55 ° C) are prescribed in the amount of 10-15 procedures on the affected joint or on the part of the body that includes the affected joints. Applications of mud, ozokerite and paraffin are shown to patients with stage I-II OA without synovitis or with minor manifestations, with severe pain syndrome, proliferative phenomena, and reflex changes in skeletal muscles. They are not used for significant changes in the joints affected by osteoarthrosis, pronounced symptoms of synovitis, as well as for coronary artery disease, hypertension IIB-III stage, circulatory failure, varicose veins, CNS vascular disease, acute and chronic nephritis and nephrosis, etc.

As has been repeatedly noted, articular cartilage has no nerve endings and therefore the process of degradation occurring in it is not the cause of pain in osteoarthritis. Causes of pain can be divided into two groups:

intra-articular:

• increased intra-articular pressure caused by articular effusion,
• overload on subchondral bone,
• trabecula microfractures,
• intraarticular ligament rupture,
• pinching of the villi of the synovial membrane,
• tensile joint capsule
• inflammation of the synovial membrane;

non-articular:

• decrease in venous outflow followed by blood stagnation in the sub-chondral bone,
• muscle spasm
• inflammation of the periarticular tendons (tendonitis).

Before choosing adequate pain therapy, the doctor must determine the source of the pain. Among physiotherapeutic methods, the application of coolants and sources of cold, ultrasound, pulse electromagnetic field, ionization, electrotherapy, electroacupuncture and vibrotherapy have an anesthetic effect.

In order to reduce pain and inflammation, you can use cold - ice packs, cryogel, local cooling spray, cooled gas supply system. Superficial cooling reduces muscle spasm, reduces the activity of neuromuscular spindles and increases the pain threshold. In osteoarthritis, it is effective to spray cooling sprays over the zone where the painful muscle trigger points are located.

[15], [16]

Shortwave diathermy

Deep warming is achieved through shortwave, microwave and ultrasound therapy. According to K. Svarcova and co-authors (1988), short-wave diathermy caused a significant decrease in pain in patients with osteoarthritis of the knee and hip joints. Superficial warming with infrared radiation also reduces the severity of pain and improves the function of the affected joints in osteoarthrosis of the knee joints and joints.

[17], [18], [19], [20], [21],

Balneotherapy

Balneotherapy has a beneficial effect on metabolic processes, cartilage metabolism, peripheral hemodynamics and microcirculation — sulfide, radon, iodide-bromine, sodium chloride, and turpentine baths. If OArazvovulis young age (35-40 years) without concomitant cardiovascular diseases, then use a bath with an average concentration of substances and gases, with a sufficiently long duration of exposure (15-20 minutes) and a course of treatment (12-14 procedures). Patients older than 45 years, as well as young people with residual symptoms of secondary synovitis, are prescribed balneotherapy according to a sparing technique: baths with a low concentration of substances and gases, with a duration of not more than 8-10 minutes, for a course of treatment - 8-10 procedures. Taking into account the age of the patient, concomitant cardiovascular diseases, it is possible to prescribe a semi-tubular, four-and two-chamber baths that are more easily tolerated by patients.

Radon baths are recommended for patients with I-II stage of osteoarthritis with residual symptoms of synovitis, severe pain syndrome and without it, changes in muscles, impaired locomotor function of the joints, with associated autonomic disorders, menopausal disorders. Sulfide, sodium chloride and turpentine baths are indicated for patients with stage I-II of osteoarthritis without symptoms of secondary synovitis, with impaired locomotor function, obesity, and atherosclerotic vascular disease. Iodine-bromine baths are prescribed to patients with osteoarthrosis without symptoms of synovitis, with concomitant functional changes in the CNS, thyrotoxicosis, menopausal disorders, atherosclerotic vascular lesions, etc.

Contraindications to balneotherapy are exacerbation of synovitis, as well as coronary artery disease, hypertension IIB-III stage, marked atherosclerotic lesion of the coronary and cerebral vessels, acute and subacute inflammatory diseases, and for sulphidic and turpentine baths - also diseases of the liver and biliary tract, kidneys.

[22], [23], [24], [25], [26],

Use of assistive devices

These include various bandages, knee pads, canes, crutches, orthopedic shoes, etc. They all contribute to reducing the load on the affected joint, thereby reducing pain. Instead of special orthopedic shoes, the patient can recommend wearing sports shoes (sneakers), equipped with special pads that reduce the load on the joints of the lower extremities. DA Neumann (1989) found that when using a crutch, the load on the hip joint is reduced by 50%. The wedge-shaped pad of elastic material, which is placed in the shoes under the heel area at an angle of 5-10 °, is effective in patients with osteoarthritis of the medial TFO of the knee joint, especially at stage I-II according to Kellgren and Lawrence. With the instability of the knee joint or an isolated lesion of the medial or lateral part of the joint, the use of kneecaps is effective.

Stabilization of the patella

With the defeat of the PPO of the knee joint, patients often develop instability of the patella. Stabilization of the patella in various ways leads to a significant reduction in pain in the affected joint, reducing the need for painkillers. One way to stabilize the patella is to fix it with a strip of wide adhesive plaster. The method of stabilization consists in the following: with one end a long strip of adhesive plaster is fixed on the outer surface of the knee joint, then the thumb of the right hand the doctor displaces the patella medially and fixes it in this position with the adhesive plaster, the second end of which fixes on the inner surface of the knee joint.

[27], [28], [29], [30], [31], [32]