Gymnastics for joint diseases (arthrosis, coxarthrosis) is one of the effective ways to maintain their mobility and not become disabled. The patient must remember that during acute pain it is not recommended to do any exercises, even the simplest ones. It is necessary to relieve inflammation and only then start exercising.
Coxarthrosis (or arthrosis deformans) is the most common pathology of the articular surfaces of the hip. It occurs due to microtraumas (bad falls or bruises), excess stress (in particular, excess weight), arthritis causing secondary arthrosis, aseptic necrosis of the hip joint, prolonged stress and emotional restraint.
The task of exercise therapy is to relieve mobility restrictions (as far as possible), reduce pain, and strengthen atrophying thigh muscles. Gymnastics can be done for patients of any gender and age. Regularity is important. Start with small loads and a very slow pace. Gymnastics is stopped at the first sign of pain.
Gradually the load is increased. The patient should keep a diary and record all improvements/worsening of his condition. These records are analyzed by the attending physician to adjust treatment methods and add/remove certain types of exercises.
The main aspect for increasing the load is increasing the range of motion of the diseased joint.
If your body is able to withstand longer sessions without experiencing pain, then the duration of the workout can be gradually lengthened.
From a large complex of therapeutic exercises for hip joints with arthrosis and coxarthrosis, 5 exercises stand out, which can be done even without consulting a specialist. Three of them are performed in a lying position, one sitting and one standing, as well as exercises according to Evdokimenko.
To perform these exercises you need a gymnastics mat, mat or blanket. Ventilate the room and relax:
To perform this exercise, you will need a comfortable, stable chair. Sit on it, back straight, arms along your body, legs together. Now bend forward and touch the floor near your feet with your fingertips. The minimum number of repetitions is 10. The exercise should bring a feeling of tension and work, but in no case pain.
When doing coordination exercises, carefully monitor your well-being; at the slightest sign of dizziness, immediately stop the activity and sit down.
You will need a chair and a small, stable platform. Stand on it with one foot, grab the chair with your hand. Swing forward/backward with your free leg. The minimum number of repetitions is 10 (less is possible depending on how you feel). Repeat the swing with the other leg.
Now you can lie down on the floor and relax. Therapeutic gymnastics gives good results for arthrosis only with regular exercise.
The famous rheumatologist and psychophysiologist - Pavel Valerievich Evdokimenko - developed his own system of exercises. It allows you to properly pump the leg muscles and develop the hip joints, which are affected by coxarthrosis.
Even in difficult cases, Evdokimenko can return patients the joy of independent movement using his treatment methods. The complex includes 11 exercises, most of which are performed in a sitting or lying position. Here are some of them:
Gymnastics exercises are performed once a day. Regularity is very important. After a few months, you will be able to completely relieve tension from the posterior thigh muscle and free up the hip joint.
Arthrosis is insidious. The disease can go unnoticed for a long time, undermining your joints. Excessive or unusual loads (for example, a long walk), injuries (falls) can throw the body out of balance.
It is important to perform the described exercises constantly, without waiting for pain to appear.
They are useful not only for patients with diseased joints, but also for absolutely healthy people.
Arthrosis of the hip joint (coxarthrosis) is a very common disease accompanied by degenerative processes.
In some cases, the disease manifests itself in only one joint; a more complex option is damage on both sides.
Among the main symptoms that worry patients are:
Timely treatment of pathology becomes a guarantee of successful recovery from the disease. The main methods of therapeutic treatment are the use of:
In addition, physiotherapeutic procedures, massage, joint traction, dietary nutrition and a physical therapy complex are prescribed.
Gymnastics for coxarthrosis of the hip joint occupies a special place. It is a specially designed restorative set of exercises that help eliminate the symptoms of the disease, normalize blood flow in the affected joints, which has a beneficial effect on the condition of cartilage and bone tissue.
In addition, therapeutic exercises help strengthen the entire muscle frame..
It should be noted that exercise therapy is used not only for already emerging symptoms of coxarthrosis or its exacerbation. This is also a preventive measure that can prevent disease in people who are potential members of the risk group.
Treatment of coxarthrosis with the help of physical education is a long process and requires strict adherence to certain instructions. The most prudent approach involves systematic training under the supervision of an experienced instructor or physician.
Particular care is required for osteoarthritis, accompanied by bone growths and joint deformation.
Physical therapy is based on a principle that lies not only in the truism that movement is life. The main thing is not to harm sore joints during various exercises. That is why gymnastics for arthrosis is of a special, gentle nature and is distinguished by its unique specificity.
For example, it should be taken into account that:
The main thing that should not be forgotten is that the load on the joints should not be accompanied by painful sensations . If they occur, you should seek advice from your doctor or instructor, who will advise you to change the set of exercises, and in some cases cancel them for the duration of the lesson.
Each of the existing developed complexes is characterized by pros and cons. The most common and effective methods for eliminating pain, increasing motor capabilities, and also helping to supply cartilage with necessary nutrients are the methods of Gitt, Popov, Evdokimenko and Bubnovsky.
The physiotherapeutic exercise complexes they developed are distinguished by good results in the fight against arthrosis of the hip joints and are an excellent addition to the main therapy.
It should be noted that Dr. Bubnovsky’s special gymnastic exercises not only eliminate the symptoms of pathology, but are also able to influence its causes.
Fundamental to his method is a mandatory preliminary examination in order to make an accurate diagnosis and identify the localization of the focus of arthrosis. The next stage is the development of an individual complex of therapeutic exercises for the patient.
A mandatory requirement, which S. Bubnovsky also considers very important, is special attention to the state of breathing, which significantly affects the effectiveness of physical therapy.
Among its complexes there are those that focus on general strengthening exercises for the entire musculoskeletal system, as well as those that contribute to the healing of individual joints.
Following the principle that in order to successfully influence the joints it is necessary to prepare the musculoskeletal system, Bubnovsky developed a unique gymnastic complex for beginners that does not require special loads and is quite simple to perform.
Its value lies in the fact that performing the recommended exercises is acceptable at home.
The effectiveness of the complex for beginners is manifested in the restoration of mobility of joints and ligaments of the entire muscle corset. At the same time, it not only gives excellent results in the treatment of joints, but also becomes an effective prophylactic agent that can prevent diseases.
Most exercises using the Bubnovsky method are performed in a lying position on a mat, so that the load on the joints is minimal.
Here are some of them:
According to Bubnovsky’s recommendation, you should gradually increase their implementation to 15-20 repetitions.
Some exercises are also possible when replacing a diseased joint. Sitting on a chair, lean forward and reach your toes with your hands. Standing near a chair and holding onto its back, you can perform slow movements with your leg - forward, backward, to the side.
Bubnovsky’s gymnastics involves gradual inclusion in training with light loads and a minimum number of exercises at the initial stage, but with subsequent increase. Due to the fact that its main purpose is to relieve pain, sudden movements are not recommended; a gentle approach to all movements is observed.
Depending on the severity of coxarthrosis, different loads on the diseased joints are recommended. This is due to the fact that exceeding the permissible complexity of the exercises can cause the condition to worsen.
For example, with stage 1 of the disease, you can perform the following complex while lying on your stomach:
At first, the exercises are performed as much as possible and gradually increased to 10 times.
The main condition is the absence of pain and fatigue in the joints and limbs during the implementation of the complex.
Coxarthrosis of the 2nd degree involves performing the complex in the supine position:
The complex ends with a repetition of the first exercise. All movements (except the fifth) are performed 10 times.
For coxarthrosis of degrees 1 and 2, you can try to perform exercises of both complexes if discomfort or fatigue does not appear. If any exercises are difficult to perform or cause pain, you should avoid them.
Stage 3 disease is the most complex form of coxarthrosis, for which it is advisable to use the Gitt technique. In this case, movements are minimized. Example of some exercises:
It is advisable to perform the exercises whenever possible without overloading the sore joints.
It must be taken into account that with osteoarthritis of the hip joint it is not always possible to do gymnastics.
If at the initial stage of the disease, as well as in the stage of remission at all degrees of pathology, they are an integral part of the therapeutic course, then with an exacerbation of the inflammatory process they will bring harm instead of benefit.
There are also contraindications in the presence of certain diseases. Among them are:
In addition, taking into account all the positive qualities of therapeutic exercises, it is necessary to begin classes only after consultation with your doctor and under the supervision of a qualified instructor.
It is impossible to overestimate the importance of therapeutic exercises in the treatment of coxarthrosis . By strengthening muscles and improving blood circulation in joints, it promotes restoration processes in cartilage tissues and returns them to motor activity.
However, we must not forget that it is one of the components of an integrated approach to a therapeutic course, consisting of methods of getting rid of the disease professionally selected by an experienced doctor.
Therapeutic gymnastics for hip joints
These videos present a set of exercises for treating hip joints .
The exercises from our video are useful for diseases of the hip joints:
- in case of infarction of the hip joint - aseptic necrosis of the femoral head (also known as avascular necrosis);
- with ankylosing spondylitis, which occurs with inflammation of the hip joints;
- for faster recovery of the hip joint after injuries - joint dislocations and hip fractures.
Basic set of exercises
I would like to clarify that part 1 is a basic set of exercises with which you need to start treating your hip joints. And it is advisable to gradually increase the load. This is especially true for the first 2 exercises: over time, when performing them, you will need to do 12-15 lifts with each leg (and not 5-6, as in the video).
When you have mastered this set of exercises (part 1), then about a week from the start of classes, proceed to mastering an enhanced set of exercises (part 2) - see below.
In the future, it is best to practice alternating both complexes. Let's say on Monday, Wednesday and Friday you do hip exercises, part 1 .
And on Tuesday, Thursday and Saturday (or Sunday) - gymnastics for the treatment of hip joints, part 2 . And one day a week, Saturday or Sunday, is a day off.
Strengthened set of exercises
The exercises from the second complex of therapeutic gymnastics are very effective - in many patients, a decrease in pain in the hip joints occurs immediately after the first session.
This complex of therapeutic exercises was improved by us quite recently - in 2016. And it quickly proved its effectiveness - almost immediately there were positive reviews from our patients and our viewers on YouTube.
Gymnastics for the knee and hip joints, part 3 - these are exercises that can be done in any conditions - at home, at work, in the office or in the country. All you need to study is a chair and just a little free space!
You can do exercises from the third complex daily or every other day - as an addition to gymnastics for the hip joints, part 1 or part 2.
More information about this complex is described here:
Therapeutic gymnastics for the hip joints is a fairly serious treatment method that has its own contraindications .
Despite 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 ºС); for influenza, ARVI and sore throat - you need to wait for recovery and wait another 3-4 days;
• in the first month after operations on the abdominal and thoracic organs;
• for inguinal hernias and abdominal hernias;
• for acute diseases of internal organs, for example, with appendicitis, exacerbation of cholelithiasis or exacerbation of cholecystitis, etc.;
• with severe heart damage and severe blood diseases.
Attention! If a particular exercise causes sharp pain, it means that it is contraindicated for you or you are doing it incorrectly.
In this case, it is better not to do it, or at least postpone it until you consult with your doctor.
The main rule is that 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.
Snatching will only tear muscles and damage joints, and will do you absolutely no good.
And remember that even if you perform gymnastics correctly, improvement does not come immediately. In the first 2 weeks of training, joint pain may even intensify slightly, 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! Be healthy!
Therapeutic exercise will help you cope with the disease, the main thing is not to be lazy and do the exercises daily
Osteoarthritis of the hip joint is a common disease. Every tenth person has a degenerative pathology. Carrying out physical procedures, taking medicines and folk remedies are necessary for this disease. But you can’t do without physical therapy. Specially designed exercises for arthrosis of the hip joint will help restore range of motion and mobility. The training complexes, instructions for implementation of which are presented in this article, will help reduce pain. Therapeutic gymnastics is selected by a physiotherapist, exercises must be performed under the supervision of a doctor.
Training complexes are selected individually. The choice of a specific type of exercise depends on the patient’s age, the severity of the disease, the degree of destruction of cartilage tissue, and the general health of the victim. Performing gymnastics for arthrosis of the hip joints is possible when the disease is in remission. Physical activity aimed at restoring mobility of the hip joint cannot be carried out in the following cases:
Physiotherapists prohibit exercising if the patient has an elevated body temperature, an aggravated concomitant chronic disease, or an infectious disease. Doctors recommend that women during their periods try to rest more rather than exercise.
Physical activity is the best non-drug treatment for pain relief and restoration of joint function. The main goal of therapy is to learn to control the symptoms of the disease. What complexes are effective for this disease? What are the benefits of exercise?
Flexibility exercises and stretching help strengthen the periarticular muscles and ligaments, protecting the joint from possible damage. Stretching improves the flow of nutrients to tissues. Aerobics strengthens the heart, reduces fatigue, and increases endurance. Aerobic exercise helps control weight and maintain and improve muscle strength. The following two types of exercises are especially good for patients diagnosed with hip arthrosis:
Physical education improves the functioning of the joint due to improved blood circulation. In addition, the respiratory system is trained, reducing the risk of diabetes.
Just because the physiotherapist has given permission to exercise does not mean that you can exhaust yourself with exercises. During the period of remission, you are allowed to exercise no more than 30–40 minutes. Exercises should be performed carefully, no sudden movements, jerks, or lifting weights for better effectiveness. Physiotherapists do not allow certain types of exercises. These include squats, the “bicycle” exercise, you can’t jump or run. Physiotherapists recommend eliminating exercise on an exercise bike.
Between exercises, it is important to control the heart rate; people with diseases of the cardiovascular system should not overload it so that complications do not arise in the form of exacerbation of the disease, a heart attack. After each exercise, you need to take a break; 30 seconds should be enough to restore breathing and allow your joints to rest. You shouldn’t work to the point of exhaustion; believe me, even if you didn’t feel tired during the workout, it will come later when the body begins to relax.
The benefits of exercise and its benefits were described above in the section “Benefits of physical training and its purpose.” Now let's look at the best stretching complex. It is important to stretch your muscles before performing exercises. You can’t start training right away; you can get microscopic tears, which will cause problems in the future. Exercises:
The picture shows a series of exercises that need to be done for arthrosis of the hip joint
Stretching is a must. It prepares the thigh muscles for serious loads.
Strong muscles help support the joint. Thanks to strong muscle tissue, the load on the hip joint is reduced. When doing exercises, pay attention to the sensations; if pain appears, stop performing the training complex. The best exercises selected to strengthen muscle tissue:
Exercise therapy is an important component in the complex of patients with arthrosis of the hip joint. If the complex is performed correctly, the patient will quickly recover, the range of motion will improve, and the muscles will become stronger.
Yoga for arthrosis of the hip joint will help get rid of the disease that everyone hates. Exercises strengthen muscles and tendons, improve mobility, and have a positive effect on the functioning of the cardiovascular system. The technique of performing the training complex is slow, without sudden movements.
Rotating your legs in Corpse Pose releases tightness in your hip joints. Lie on your back, upper limbs lie on your stomach, lower limbs are spread out to the sides so that the distance between them is 15–30 cm. Gently use your knee joints to turn your legs in and out at the hip. The lower limbs should not be lifted off the floor.
The pose of Janu Shirshasana is performed as follows: sitting on the floor, straighten one leg, bend the second at the knee so that the foot rests on the inner side of the first lower limb. Lean forward, trying to reach your fingers. Another good exercise for coxarthrosis of the hip joint is Uttita Parshvakonasana. First, they lunge to the left side, then they raise their right hand behind their head and stretch to the right, trying to stretch the spine and pelvis on the left side as best as possible. As you can see, yoga exercises are performed quite simply, without effort. And their effect is miraculous. Relief will come within a week of regular implementation of the complex.
Exercise therapy in the treatment of arthrosis of the shoulder joint is an addition to the rehabilitation complex, which includes medications, physiotherapy and magnetic therapy. However, without gymnastics, treatment for arthrosis may be delayed or may not give the desired result. What exercises should you do for a speedy recovery?
Arthrosis of the shoulder joint is a degenerative-dystrophic disease of cartilage tissue. The cartilage plate between the bones becomes thinner, and the joint becomes like an engine without lubrication.
Over the years (without proper treatment), the situation only worsens and leads to loss of performance.
However, drug treatment alone is not enough. It needs to be combined with therapeutic physical training. Gymnastics is aimed at strengthening the muscles around the joint, improving blood circulation and metabolism in the affected area, developing mobility and elasticity of the ligaments.
Exercise therapy for arthrosis of the shoulder joint begins only when the disease is in remission. Before this, inflammation and pain are relieved. During an exacerbation, gymnastics will only do harm, since at this stage rest is the main medicine.
There are many manuals on the Internet that list exercises for shoulder arthrosis. However, not all of them were written by doctors and exercise therapy instructors. Before starting self-study, you need to consult a doctor. If the patient has a temperature above normal, then physical rehabilitation is also contraindicated. Do not overload the body if you have heart or lung diseases.
Remember! Any manifestations of pain or painful condition, for example, fever, muscle weakness, aching joints and spasms, are a contraindication to gymnastics. Exercise is allowed only if the condition is stable.
Exercise therapy should be a joy, not a burden. If it hurts, then it is better to give up physical exercise for a while. After the pain has passed, they begin work again.
If exercise causes pain, then you need to stop and continue medication and physical therapy.
When nothing prevents you from doing restorative gymnastics normally, then working on yourself should be intense and constant. Exercise therapy for shoulder arthrosis is carried out daily to consolidate the positive result. After exercise, it is recommended to massage the affected shoulder. Here you can cope on your own. Rubbing can improve blood flow to the joint to help remove macrophages from the joint.
Advice. Physical rehabilitation is the only method of treatment that is carried out without spending money and nerves. Having once learned a series of exercises, you can then perform them yourself at home.
If we want to try to do without surgery treating coxarthrosis , we need to combine therapeutic measures in such a way as to solve several problems at once:
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 coxarthrosis . 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:
1. Non-steroidal anti-inflammatory drugs (NSAIDs). The main drugs in this group: diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, Celebrex, nimulide and their derivatives are prescribed to reduce pain in the groin and thigh.
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, in recent years, data have been obtained indicating the harmful effects of long-term use of non-steroidal anti-inflammatory drugs on the synthesis of proteoglycans (as you remember, proteoglycan molecules are responsible for the entry of water into cartilage, and disruption of their function leads to dehydration of cartilage tissue). Thus, pills that a patient takes for a long time to reduce pain in a joint, in some cases, can even slightly accelerate the destruction of this joint (if the patient has been constantly drinking NSAIDs for a year or longer).
In addition, when using non-steroidal anti-inflammatory drugs, it is necessary to remember that they all have serious contraindications and, with long-term use, can give significant side effects (which are discussed in more detail in Chapter 20).
Therefore, if long-term use of anti-inflammatory substances in the treatment of coxarthrosis is necessary, it is better to use selective anti-inflammatory drugs (the drug movalis). Selective agents are much less likely to produce unpleasant side effects, cause almost no complications and do not have such a negative effect on the structure of articular cartilage. They can be taken for a long time, even in courses from several weeks to several years (of course, only under the supervision of a doctor).
2. 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.
It is probably the fact that the capabilities of chondroprotectors are often overestimated in advertising that was the reason for attacks on these drugs in one of the “popular” television shows. The TV presenter of the “Health” program, at someone’s suggestion, said that chondroprotectors are useless for the treatment of arthrosis. Thus, she cast a huge shadow on these very useful drugs, calling into question the work of a number of serious medical institutes and clinics that tested these drugs and proved that chondroprotectors definitely contribute to the restoration of articular cartilage and inhibit the development of arthrosis.
After all, only after the clinical testing of chondroprotectors, the Russian Ministry of Health allowed their sale in pharmacies as medicines (we are, of course, not talking about those medicines that have not been registered as medicines and are sold as dietary supplements). Another thing is that, as I already said, chondroprotectors are not “omnipotent”. Treatment with these medications requires proper and long-term use in combination with other treatment methods.
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.
It is important to know! To achieve the maximum therapeutic effect, chondroprotectors must be used in courses, regularly, for a long time. practically pointless to take glucosamine and chondroitin sulfate once or occasionally.
In addition, in order to get the maximum effect from the use of chondroprotectors, it is necessary to ensure that the body receives adequate, that is, sufficient doses of drugs daily throughout the course of treatment. A sufficient dose of glucosamine is 1000-1500 mg (milligrams), and chondroitin sulfate is 1000 mg per day.
Scientists are currently arguing over whether it is better to take glucosamine and chondroitin sulfate - simultaneously or separately. Opinions were divided. Some scientists argue convincingly that glucosamine and chondroitin sulfate should be taken together, at the same time. Others also argue convincingly that glucosamine and chondroitin sulfate, when taken simultaneously, interfere with each other and should be taken separately. Perhaps there is a clash of interests between those manufacturers who produce single-drug products containing only glucosamine or only chondroitin sulfate with those manufacturers who produce two-in-one drugs containing a combination of glucosamine and chondroitin sulfate. Therefore, the question of the joint or separate use of glucosamine and chondroitin sulfate remains open.
Although my personal observations indicate that both single drugs and combination drugs are useful, the only question is who produces them and how well they are produced. That is, a drug produced “on the knee” by some dubious company, and even with violations of technology, is unlikely to be useful, regardless of whether it contains glucosamine, or chondroitin sulfate, or both. Conversely, any chondroprotector produced “according to the rules” will be useful. But a high-quality combination drug containing both glucosamine and chondroitin sulfate, in my opinion, is still more useful than any single drug.
Currently (in 2012) on our pharmacological market, chondroprotectors are most widely represented by the following proven drugs:
Arthra , made in the USA. One of the best chondroprotective drugs. Available in tablets containing 500 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve the full therapeutic effect, you need to take 2 tablets per day.
Dona, made in Italy. A monotherapy containing only glucosamine. Release form: solution for intramuscular injection; 1 ampoule of solution contains 400 mg of glucosamine sulfate. The solution is mixed with an ampoule of a special solvent and injected into the buttock 3 times a week. The course of treatment is 12 injections 2-3 times a year. In addition, there are DONA preparations for oral administration: powder, packaged with 1500 mg of glucosamine in 1 sachet; You need to take 1 sachet of the drug per day; or capsules containing 250 mg glucosamine; You need to take 4-6 capsules of the drug per day.
Structum, made in France. A monopreparation containing only chondroitin sulfate. Release form: capsules containing 250 or 500 mg of chondroitin sulfate. Per day you need to take 4 tablets containing 250 mg of chondroitin sulfate, or 2 tablets containing 500 mg of chondroitin sulfate.
Teraflex, made in Great Britain. Release form: capsules containing 400 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full therapeutic effect, you must take at least 2 tablets per day.
Chondroitin AKOS, made in Russia. A monopreparation containing only chondroitin sulfate. Release form: capsules containing 250 mg of chondroitin sulfate. To achieve a full therapeutic effect, you must take at least 4 capsules per day.
Chondrolone, made in Russia. A monopreparation containing only chondroitin sulfate. Release form: ampoules containing 100 mg of chondroitin sulfate. To achieve a full therapeutic effect, it is necessary to carry out a course of 20-25 intramuscular injections.
Elbona , made in Russia. A monotherapy containing only glucosamine. Release form: solution for intramuscular injection; 1 ampoule of solution contains 400 mg of glucosamine sulfate. The solution is mixed with an ampoule of a special solvent and injected into the buttock 3 times a week. The course of treatment is 12 injections 2-3 times a year.
As you can see from the above list, the choice of chondroprotectors for the treatment of arthrosis is quite large. What exactly to choose from all this variety? Consult your healthcare provider. Personally, I really like Arthra - it is a good, proven and balanced drug.
Of the injectable drugs (that is, for injections), I most often use Dona. But in powder or capsules, according to my observations, Dona is less effective.
In any case, if used correctly, any proven chondroprotectors will bring clear benefits for the treatment of arthrosis, especially stage 1-2 arthrosis. And what’s important is that drugs containing glucosamine and chondroitin sulfate have almost no contraindications. They should not be used only by those who suffer from phenylketonuria or have hypersensitivity to one of these two components.
They also have very few side effects. Chondroitin sulfate sometimes causes allergies. Glucosamine may occasionally cause abdominal pain, bloating, diarrhea or constipation, and very rarely - dizziness, headache, leg pain or swelling of the legs, tachycardia, drowsiness or insomnia. But in general, I repeat, these drugs very rarely cause any discomfort.
The duration of treatment with glucosamine and chondroitin sulfate may vary, but most often I suggest my patients take chondroprotectors daily for 3-5 months. After at least six months, the course of treatment must be repeated, i.e. one way or another, glucosamine and chondroitin sulfate are recommended to be taken for arthrosis (depending on the stage of the disease) approximately 90 - 150 days a year for 2-3 years.
Keep in mind! In addition to the chondroprotector drugs listed above, you can find dietary supplements containing glucosamine and chondroitin sulfate on sale: for example, Sustanorm Life formula , chondro , stoparthritis and others. These dietary supplements are not full-fledged medicines, since they have not yet been medically tested and are not registered as medicines! They have yet to undergo clinical trials to prove their clinical effectiveness!
3. Muscle relaxants - drugs used to eliminate 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.
4. 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 ointments 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.
5. 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.
It is a little more useful to inject chondroprotectors ( alflutop, chondrolone or homeopathic Target T ) through the thigh. These drugs are used in courses over 2-3 years. During a course of treatment, from 5 to 15 periarticular injections of chondroprotectors are carried out; on average, 2-3 such courses are carried out per year. The advantage of these drugs is their ability to affect the cause of the disease: like all chondroprotectors, they improve the condition of cartilage tissue and normalize metabolism in the joint. That is, unlike corticosteroids, chondroprotectors do not eliminate the symptoms of the disease, but treat arthrosis itself. However, these are rather weak drugs: they help only 50-60% of patients, and it is impossible to predict in advance whether their use will have an effect or not. In addition, the effect of these drugs, unlike hormones, develops too slowly. For this reason, periarticular injections of chondroprotectors can hardly be considered as a serious method of treating coxarthrosis
Attempts are also being made to treat coxarthrosis with intra-articular injections of hyaluronic acid (an artificial joint lubricant). For this purpose, the drugs Synvisc, Fermatron, Ostenil, Duralan and the new domestic drug Giastat .
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).
6. Manual therapy. Modern doctors who practice treatment of coxarthrosis using manual therapy most often use two types of effects on the joint: mobilization and manipulation.
Mobilization is a gentle traction of the hip joint, spreading the ends of the bones that articulate with each other. To carry out such traction, a specialist usually grabs the limb above and below the joint and begins to “loose” the bones relative to each other in the required directions. With the correct influence, the joint is “freed”, movement is partially restored in it, and muscle spasm around the joint is eliminated. All this leads to the fact that the articular cartilages are to some extent “removed from the impact,” that is, the pressure on them decreases. Accordingly, the cartilage receives a certain opportunity for self-healing.
It is precisely this versatility of the therapeutic effect that constitutes the advantage of mobilization. The disadvantages of the method include the high energy consumption of the doctor and the need for frequent and regular repetition of procedures. With coxarthrosis, up to four cycles are required annually, consisting of three to four therapeutic mobilization sessions, that is, in a year, the joint affected by coxarthrosis may need to undergo 12-15 procedures.
Unlike mobilization, manipulation is carried out in one sharp and short movement and requires a minimum of tension from the doctor. If the manipulation is carried out in a timely manner and in the right place, it immediately brings relief to the patient, reducing pain and restoring range of motion in the joint. However, this only happens in cases where we are not dealing with advanced coxarthrosis, but with the initial manifestations of the disease.
And we must understand that manual therapy is not a panacea. It can only help in combination with other procedures and only when the patient comes to the doctor on time.
When using manual therapy, you need to remember not only the benefits of such a procedure, but also its contraindications. It would be a mistake to use manual therapy for inflammatory rheumatic diseases (arthritis), for oncological lesions of the joints (that is, in the presence of benign and malignant tumors) and for fresh injuries, especially fractures. Very carefully and carefully it is necessary to carry out manipulations with those patients who have increased bone fragility, for example, with osteoporosis.
Concluding the conversation about manual therapy, I cannot help but mention the biased attitude of some doctors towards this, without exaggeration, unique method of treatment. Almost every patient who decides to undergo a course of manual therapy is usually subject to pressure from orthopedic surgeons. “What are you thinking! - the doctors exclaim. - They will make you disabled! Your situation is already not great, and after manual therapy you will be even worse!” And so on in the same spirit. Any sane person wonders whether these “horror stories” are justified, and why are doctors so scared of manual therapy?
Let’s not talk about medical “jealousy” and the irritation that chiropractors who successfully “take away their bread” cause among “rivals.” But many doctors and patients simply fall victim to misconceptions.
For example, a patient with progressive coxarthrosis attends a manual therapy session. The patient completes the first prescribed course of treatment, achieves improvement, but after six months and a year he does not come to the next courses of treatment. Naturally, during this time the disease, as it should be, progresses. And when a few years later the patient remembers that it is high time to visit the doctor again, the joint is already destroyed - too much time has passed. Who is guilty? You will be surprised, but in many cases a chiropractor will be called “extreme”! After all, supposedly after his manipulations (no matter that years later), the patient became worse.
We encounter this kind of logic almost every day. I even know of a case where a chiropractor was accused of causing a complication in a patient. 10 years (!) after manual therapy.
Finally, another reason for the sometimes widespread rejection of manual therapy is the discrediting of the method by some self-taught healers. In general, unskilled actions can discredit any, even the most remarkable method of treatment. And in our time, unfortunately, too many people who do not have any medical education and relevant knowledge are engaged in chiropractic care. Typically, such doctors present themselves as hereditary chiropractors who do not need medical education.
Among healers there really are unique nuggets, although very rarely. But for every nugget, there are ten incompetent self-taught people.
In addition, no matter how skilled a nugget is in manual manipulation, he will still lack diagnostic knowledge. I know of cases where chiropractors undertook to “set the joints” of patients with arthritis, which is absolutely ignorant and dangerous. It happened that chiropractors used a hammer (!) to try to “break the osteophyte spines” and with the same hammer “dispersed the salts in the joints.” Naturally, such a “magical” effect only made the patients feel worse. But this does not mean that the manual method of treatment is bad! Its implementation is also poor in those surrogates that are presented as manual therapy.
Therefore, it is necessary to be treated only by a competent specialist with a medical education. This is as natural as entrusting surgical intervention to a professional surgeon. And manual therapy is practically the same surgery, although without a knife.
And just as, when preparing for an operation, you make inquiries about the surgeon to whom you are going to entrust your life, try to first find out more about the chiropractor you are going to see, talk to other patients who have been treated by this doctor. Compliance with all these conditions is already a 90% guarantee that you will be satisfied with the results of manual therapy.
7. Hardware traction (extension of the hip joint). Traction is usually used in the treatment of coxarthrosis to separate the articular ends of bones and reduce the load on the cartilaginous surfaces.
The procedure is carried out on a special table. Using belts, the patient is fastened to the table (fixed), after which the device produces traction on the affected leg in the longitudinal direction (that is, along the axis of the body). The procedure lasts 15-20 minutes, and during this time the joint capsule is stretched, and overloaded areas of cartilage tissue are also given rest. A course of traction therapy consists of 10-12 procedures performed daily or every other day in combination with massage and other therapeutic measures. A patient with arthrosis of the hip joint must undergo two such courses of treatment per year.
In general, it should be noted that although hardware traction often gives a positive result, it is still inferior in effectiveness to manual therapy. After all, the device provides traction only along one longitudinal axis, while the chiropractor “develops” the joint in all directions. In addition, the device cannot sense and determine where to apply a larger load and where to apply a smaller one. The sensitive hands of a skilled doctor, on the contrary, easily determine weak or overloaded areas of the joint, which allows him to strictly dose the force of influence. And finally, when treating with manual therapy, half as many sessions are required to achieve a healing effect, which is important. However, hardware traction requires less effort from the doctor. It is much easier to fasten the patient to the table and connect the device than to work for 15-20 minutes yourself with full dedication.
If we talk about the interests of the patient, then for him competent manual therapy is preferable to hardware traction, and hardware traction is preferable to manual therapy performed by an uneducated and incompetent chiropractor.
8. Postisometric relaxation (PIR). Postisometric relaxation, also known as PIR (muscle and ligament stretching), is a relatively new treatment method that involves active interaction between the patient and the doctor. The patient is not passive during the procedure; he tenses and relaxes certain muscles. And the doctor, at the moment of relaxation of the patient, “stretches” his muscles, tendons and joints.
In the treatment of coxarthrosis, post-isometric relaxation is used to eliminate painful spasmodic muscle contractions and as a procedure preceding a session of manual therapy or joint traction. From my point of view, PIR is one of the most useful procedures in the treatment of coxarthrosis of stages I and II. At the same time, post-isometric relaxation has almost no contraindications - of course, if it is carried out correctly, clearly understanding the anatomy of the muscles and joints involved in the procedure, as well as the safe limit of their stretching.
To give you a clear idea of how this method is used in practice, I will describe one of the possible sessions. For example, a patient with stage I arthrosis of the hip joint comes to see a doctor. With arthrosis of the hip joint, there is almost always a painful spasm of the muscles of the gluteal region. To eliminate this spasm and the pain caused by the spasm, the doctor asks the patient to lie on his stomach, slowly bends his sore leg at the knee to an angle of 90° and begins to carefully turn the bent leg outward. This movement continues only until the patient reports severe pain in the leg muscles or joint. Then he will be asked to lightly press the doctor’s hands with his bent leg, that is, provide some resistance for 7-10 seconds, and then relax. At the moment of relaxation, the doctor will have the opportunity to move forward a little again and turn the patient’s leg a little further, until new pain appears. And again, at the doctor’s request, the patient will offer moderate resistance, and the whole cycle will repeat. After 3-4 repetitions, the patient is often surprised to notice that his tension disappears before his eyes.
The course of treatment consists on average of 6-10 procedures performed every other day, and a positive result is achieved in approximately 80% of patients. But to achieve the desired effect, the doctor requires a good knowledge of muscle biomechanics and a certain intuition. The specialist must have a keen sense of the limit at which it is necessary to stop when stretching muscles so as not to injure them. At the same time, it is undesirable to stop before reaching the possible limit, otherwise the necessary relaxation of spasmed or “tight” muscles will not be achieved, and it will not be possible to release the joint.
9. Therapeutic massage. Therapeutic massage is used as an additional method of therapy for coxarthrosis of stages I and II. It is clear that we will not be able to cure coxarthrosis with massage. But the benefits of massage are beyond doubt - under the influence of competent massage, blood circulation in the joint improves, the delivery of nutrients to the cartilage accelerates, the elasticity of the joint capsule and ligaments increases, and the function of the synovial membrane is restored. Massage gives a particularly good effect in combination with post-isometric relaxation, manual therapy or joint traction.
It is important to know: after inept intervention, the patient’s condition may worsen rather than improve. Pain and muscle spasms in the affected leg may increase. In addition, blood pressure may increase, nervousness and overexcitation of the nervous system may appear. This usually happens when the massage is too active and forceful, especially if the massage therapist’s manipulations themselves are rough and painful.
Normal massage should be performed smoothly and gently, without sudden movements. It should give the patient a feeling of pleasant warmth and comfort, and in no case should it provoke pain or bruising.
In general, many insufficiently skilled massage therapists justify the appearance of bruises and sharp pain from their effects by saying that they massage diligently and deeply. In fact, they are simply not qualified enough, they act with inflexible, tense fingers and at the same time seem to “tear” the skin and muscles. If you do the massage correctly, with strong but relaxed fingers, you can knead the muscles quite deeply and thoroughly, but without pain, discomfort and bruises.
Dear readers, when entrusting your joints or back to a massage therapist, try to remember that the procedure should be painless, causing warmth, comfort and relaxation. And if you find a massage therapist who achieves such an effect with his actions, consider yourself lucky. Then I recommend that you get massages from him regularly, twice a year, in courses of 8-10 sessions held every other day.
However, it is necessary to remember the standard contraindications to massage treatment.
Massage is contraindicated when:
10. Hirudotherapy (treatment with medicinal leeches). Hirudotherapy is a fairly effective treatment method for many diseases. By sucking, the leech injects a number of biologically active enzymes into the patient’s blood: hirudin , bdellins , elgins , destabilase complex , etc. These enzymes resolve blood clots, improve metabolism and tissue elasticity, and increase the body’s immune properties. Thanks to leeches, blood circulation improves and blood stagnation in the affected organs is eliminated.
Hirudotherapy is very useful in the treatment of the initial stages of coxarthrosis. The action of enzymes injected by a leech is similar to the action of soft chondroprotectors; in addition, leeches perfectly restore blood circulation in the area of the affected joint. This complex effect makes it possible to achieve tangible benefits in the treatment of coxarthrosis of stages I and II.
To achieve maximum effect, you need to conduct 2 courses of hirudotherapy per year. Each course consists of 10 sessions. Sessions are carried out at intervals of 3 to 6 days. In this case, leeches should be placed on the lower back, sacrum, lower abdomen and sore hip. In one session, 6 to 8 leeches are used. At the beginning of treatment with leeches, a temporary exacerbation often occurs (usually after the first 3-4 sessions). And improvement usually becomes noticeable only after 5-6 sessions of hirudotherapy. But the patient reaches the best form 10-15 days after completing the full course of treatment.
Contraindications to hirudotherapy treatment: this method should not be used to treat people suffering from hemophilia and persistently low blood pressure, pregnant women and young children, frail and elderly patients.
11. 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 are simply unable to “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.
13. Sufficient 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.
14. Using a cane and reducing the harmful load 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 decreases 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.
15. Dosed exercise. 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 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 capabilities, the duration of 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.
16. 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, gymnastics is almost the only method of treatment 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.
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 such 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 an improvement in the condition of your joints, general 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: