Osteoarthritis of the hip joint is a sluggish disease that manifests itself with a small number of symptoms. There is another name - coxarthrosis. The problem is quite common, since today many people experience constant high stress on the pelvic area.
In most cases, only one joint is affected. Therapy must be comprehensive and necessarily include drug treatment. The drugs are selected only by the doctor, taking into account the individual characteristics of the patient.
The presence of such a disease is indicated by pain in the groin area, hip and back. In addition, there is constraint in movement, and lameness is observed. As the muscles atrophy and weaken, sometimes there is a slight change in the length of the leg, which becomes short.
The most common reason is increased stress due to increased physical or sedentary work. Arthrosis can be triggered by inflammatory and infectious diseases, necrosis, dislocation and various injuries, for example, during a fall, blow or accident.
Treatment with medications is possible only for grade 1-2 arthrosis of the hip joint. At the third stage, only surgery will help.
In addition, it is worth noting that it is impossible to completely recover from such a diagnosis, but therapy is aimed at combating the symptoms, and the remedies do not allow the disease to develop.
Medicines strengthen the muscles of the periarticular bursa, increase mobility and improve blood circulation. They also relieve pain and improve the nutrition of cartilage tissue, which promotes its restoration. Let's consider each group of drugs separately.
This category includes Diclofenac, Indomethacin, Piroxicam, etc. They are prescribed for reactive inflammation. Such remedies help relieve pain and inflammation because they have an anti-inflammatory effect. They also effectively fight swelling.
The disadvantages include the fact that such a medicine for arthrosis of the hip joint, with long-term use, reduces the natural ability of cartilage tissue to repair itself. One cannot help but mention side effects, since such drugs negatively affect the functioning of internal organs. It is important to say that it is prohibited to treat with several anti-inflammatory drugs at the same time; for example, if the chosen drug does not relieve pain well, you should either increase the dosage or select another drug with the help of a doctor.
This group includes Trental, Teonicol, Cynaresin, etc. Their action is aimed at relaxing the walls of blood vessels and expanding their lumen. This group of drugs is very effective in treating diseases related to the hip joint. If you take them following your doctor's recommendations, then the contraindications will be minimal.
After a course of treatment, recovery occurs faster due to the normalization of blood circulation, as well as an increase in the delivery of important substances. Spasms of small vessels are also relieved, and pain symptoms that appear at night are reduced. The disadvantages of this group include the fact that the effectiveness of the drugs depends on the individual reaction. First, the dose is taken in a minimal dose, and then, if there are no side effects, the doctor will increase the amount of the drug.
These drugs help relax muscles, but if you have problems with the hip joint, they should be used with extreme caution. They help relieve painful muscle spasms and also normalize blood circulation. Disadvantages include a negative effect on the nervous system, for example, dizziness, slow reaction and a state of intoxication.
The drugs are aimed at restoring cartilage and it is best to use injections that allow you to get a good result.
This category includes Rumalon, Structum and Glucosamine. These medicines are considered the most useful and effective. They allow you to restore the structure of cartilage tissue, increasing its nutrition with useful substances. The cartilage restoration process will continue even after you stop taking the drug. This group of drugs is prohibited for pregnant women, with individual intolerance and inflammation of the joint.
Hormonal steroid drugs
They are presented in the form of injections for administration into the joint. This group includes Mitelpred, Kenalog and Hydrocotisone. These injections are effective when there are underlying problems, such as tendon inflammation. The disadvantages include the fact that injections rarely give good and long-lasting results. It cannot be said that they have a large number of side effects. No more than three injections can be given in one joint, and there should be a break of at least two weeks between each injection.
Today there is a wide range of similar means, so there are options for injection into the joint and into the muscle, blockade using novocaine, as well as ointments. At the first stage of the disease, intramuscular injections with analgesics and anti-inflammatory substances are used. If the pain is insignificant, then the result can be obtained with the help of tablets. At the second stage, for more severe and persistent pain, the doctor prescribes non-steroidal anti-inflammatory drugs. Parallel treatment can be carried out with local anesthetics.
This category of products includes ointments, lotions and compresses. Local treatment of the disease is effective only if it has a warming effect. The process of rubbing the ointment helps improve blood circulation, which sometimes helps to cope with painful muscle spasms. It is important to say that the composition of such drugs does not have a therapeutic effect.
Among the ointments presented, the following products stand out: Fastum-gel, Menovazin, Diclofenac ointment, etc. It is important to say that only 4-8% of medicinal substances reach the diseased joint. That is why local treatment can be additional to medications taken orally or administered intramuscularly. Compresses are used in the treatment of the disease, for the preparation of which various substances are used, for example, Bishofite, Dimexide (has anti-inflammatory and analgesic effects, and it also penetrates well through the skin) and medical bile, which has a warming and absorbable effect.
When treating an illness, it is important to take vitamins. They do not contribute to treatment, but are important for complex therapy. The most effective are B vitamins, which ensure normal energy metabolism and a functional nervous system. These substances also strengthen the immune system and stimulate the growth of healthy cartilage cells.
It is best to use vitamins in combination, rather than individually:
We have presented to you the most effective tablets and injections that relieve symptoms of a disease such as arthrosis of the hip joint. Remember that they should be combined with physical therapy, and only a doctor can prescribe medications.
Treatment of joint diseases usually takes a very long time. It is carried out comprehensively and is selected individually for each case, depending on the degree of damage to the joint. If you are familiar with the disease, then you understand that there will be no complete cure, but medications help maintain the joint in working condition and eliminate symptoms that negatively affect the patient’s life.
In the first and second stages of development, taking medications for arthrosis of the hip joint may be sufficient. At the third stage, the cartilage is already too much destroyed, and surgery is necessary. To prevent such serious deterioration, therapy should be started as early as possible, while the tissue can still at least partially recover.
Typically, arthrosis of this joint develops in people after 35 years of age. The disease can affect one joint or both at once. In this case, the patient will feel pain in the groin, which radiates to the thigh (its front or back surface). In the first stage, pain is sometimes felt on the buttock. They will intensify while moving, when climbing, etc. Further, as the disease develops, the person will gradually lose mobility in this joint, and a cracking noise will also be heard in it when moving. In the last stage, the leg may become shorter or longer. This causes lameness, atrophy of the thigh muscles, acute pain, etc.
To prevent the development of arthrosis, complex treatment with conservative methods is prescribed in the early stages.
Treatment of arthrosis of the hip joint is effective when carried out comprehensively and consistently.
A fairly effective approach has been developed that helps many patients improve the condition of the joint. It includes:
Drugs for the treatment of arthrosis of the hip joint can achieve fairly good results, especially at stages 1 and 2 of the disease. The best effect is achieved by taking several groups of medications in a complex manner. These include:
Each of these groups has its positive and negative influences. It is also important to understand that they must be taken strictly as directed by the doctor. If the rules are not followed, you may not get the expected result.
For example, NSAIDs quickly relieve pain, inflammation and swelling, but if used for too long, the body will not be able to repair cartilage tissue on its own. Hormonal drugs relieve even very severe pain, but they can be used without harm more than two periods a year. Chondroprotectors give a good effect, but they need to be taken for a long time. Muscle relaxants are quite useful, but using them without chondroprotectors is dangerous to health.
To draw up a correct treatment plan, you need specialized education, so you can take such medications only as prescribed by your doctor.
When treating arthrosis, the doctor prescribes tablets, injections or ointments that effectively relieve inflammation. The most common include Diclofenac, Ibuprofen, Ketoprofen, Ketorol.
Medicines in this group relieve pain and inflammation, reduce swelling in the joint area. However, in addition to the positive effect, they have a number of side effects that negatively affect the patient’s body, in particular the stomach and intestines.
Therefore, there are several rules that must be observed when taking such medications:
The drug "Movalis" has a milder effect, which allows you to take it longer. It also has much fewer side effects on the body. If prolonged exposure is necessary, doctors are increasingly leaning towards this option.
Inflammation is also relieved with glucocorticosteroids. They are inserted into the joint. These drugs are quite dangerous, so they are rarely used. If the synovial membrane is destroyed, injections cannot be administered.
Vasodilators are important in order to improve blood circulation, which will promote rapid tissue regeneration, because with increased blood flow, oxygen and nutrients will reach the tissues faster. Drugs in this category are also good at relieving vascular spasms, as blood circulation in small vessels and capillaries increases.
These medications have a small number of contraindications. The main one is the possibility of bleeding. Taking medications from this group will make it possible to eliminate pain in blood vessels and joints during sleep. This group includes drugs such as Pentoxifylline, Eufillin, Trental, Actovegin.
Medicines that relieve muscle spasms are called muscle relaxants. The use of muscle relaxants is advisable for any form of arthrosis. They often have side effects such as nausea, vomiting, and dry mouth. Many patients complain that they cause constipation, cramps, and can also cause poor concentration and enuresis.
From this group, Mydocalm, Baclofen, Cyclobenzaprine, and Tizanidine are most often prescribed.
Medicines should not be taken if there is at least one contraindication listed in the instructions. These include: kidney failure, liver dysfunction, convulsions, epilepsy, hypersensitivity to components. Muscle relaxants should not be taken with opioid-type drugs or sedatives, as this can lead to respiratory depression and hypoxia.
Taking chondroprotectors is one of the parts of traditional combination treatment with medications. For arthrosis of the hip joint, this group is simply irreplaceable. Chondroprotectors help improve metabolic processes in cartilage tissue and accelerate cell recovery. Such medications increase the elasticity and firmness of cartilage. In medicine, there are three generations of such medications. Chondroprotectors have the following effects:
This group of drugs includes such drugs as “Arthra”, “Dona”, “Structum”. Active recovery is promoted by Rumalon, Teraflex, Mukosat, Alflutop.
Any chondroprotectors should not be taken during pregnancy, lactation, renal failure, asthma, thrombophlebitis, or in childhood.
in Treatment 59236 Views
This disease is chronic and is accompanied by the destruction of the cartilage of the articular surface, as well as a decrease in its mobility.
It’s worth noting right away that treatment with medication is only possible for grades 1–2 of the disease. The third degree involves only surgical treatment.
It is almost impossible to completely cure arthrosis of the hip joint (without endoprosthetics surgery), but it is quite possible to stop its progression and alleviate the symptoms. For outpatient treatment the following are used:
It is necessary to treat the disease comprehensively; the use of any one method (not counting surgery, of course) will not bring tangible results.
To relieve muscle spasms during arthrosis, massage is used - it helps improve blood supply to the affected area, and, consequently, nutrition of the joint. It is carried out both in a hospital setting and at home. It can be performed by a specialist, or it is possible to use self-massage techniques for the thigh, lower leg and partly the lower back. Massage is recommended to be prescribed after the removal of acute symptoms and anti-inflammatory therapy - in combination with diet, therapeutic exercises, taking chondoprotectors and physiotherapy.
An alternative to massage is taking muscle relaxants (drugs that weaken muscle tone), but this increases the load on the liver and kidneys.
Hydrokinesitherapy (massage in water) has proven itself well. However, it requires special equipment, which is not available in every clinic. At home, you can do vibration massage using mechanical or electric massagers. In the postoperative period (with endoprosthetics of the third degree of arthrosis), massage is used after removal of sutures, and can only be performed by a rehabilitation specialist.
Acute purulent arthritis here
1. Non-steroidal anti-inflammatory drugs (indomethocin, piroxicam, ketoprofen, brufen, diclofenac, etc.) are indicated during the period of “reactive joint inflammation”.
Pros : They relieve joint pain very well due to their strong anti-inflammatory effect, relieve swelling and inflammation itself.
Cons : With long-term use, drugs in this group suppress the natural ability of articular cartilage to repair, and side effects often negatively affect various internal organs.
A solution was found. The anti-inflammatory drug Movalis was developed especially for long-term use. Its action is “gentler” and it produces fewer side effects with prolonged use. Many doctors recommend using Movalis when it comes to long-term exposure to an inflamed joint to relieve pain.
Important: It is not recommended to use several different anti-inflammatory drugs at the same time. If the drug used does not relieve pain enough, then you should either increase the dose or replace the drug with another one.
2. Vasodilators (teonicol, trental, nikoshpan, cinaresin, etc.) relax the smooth muscles of blood vessels and expand their lumen. For coxarthrosis, treatment with these drugs gives tangible results.
Pros : Very useful drugs for treating coxarthrosis. When used correctly, they have very few contraindications. They promote rapid restoration of the joint by improving articular blood supply, improve the delivery of “building materials” to the joint, and relieve spasm of small vessels. Vasodilator drugs also eliminate nighttime “vascular” pain.
Cons : Efficiency depends on individual tolerability of the drugs. Consult your physician before use.
Important: Before use, you should check your individual tolerance to the drug. For the first three days, take this remedy one tablet at a time, and only if it is effective and there are no side effects, switch to the recommended course of administration.
3. Drugs for muscle relaxation - muscle relaxants (mydocalm, sirdalud). In case of coxarthrosis of the hip joint, treatment with muscle relaxants should be carried out with caution.
Pros : They help relieve painful muscle spasms during coxarthrosis, improve blood supply to the joint.
Cons : May affect the nervous system - cause dizziness, intoxication and mental retardation.
4. Drugs for cartilage restoration - chondroprotectors (glucosamine, rumalon, dona, structum, chondraitin sulfate, arteparon)
Pros : The most useful drugs in the treatment of deforming arthrosis of the hip joint. Improves the restoration of cartilage structure, nourishes it with necessary elements. Regular use of chondroprotectors can stop the development of coxarthrosis. You will not notice the positive effect immediately, but it will be more noticeable in the future. Cartilage restoration will continue even after the drug is discontinued.
Cons : Almost no contraindications. The exceptions are: pregnancy, individual intolerance and joint inflammation.
5. Hormonal steroid drugs - intra-articular injections (mitelpred, kenalog, hydrocotisone).
Pros : In some cases, such injections have a good result, especially when there are concomitant diseases such as inflammation of the femoral tendons.
Cons : Such injections rarely produce lasting positive results. Have many side effects.
Important: It is not recommended to give more than three injections in one joint. The interval between each injection should be at least two weeks.
6. Topical medications – ointments, lotions, compresses.
Many naively believe that all kinds of ointments, creams, lotions are the main medicine in the treatment of joint diseases. This myth, moreover, is actively inflated by advertising. But this is just a myth. The essence of the problem is that the hip joint is located deep under the skin, fatty tissue and muscles. The likelihood that some substances will overcome these barriers and reach the joint in sufficient quantities is extremely low. But there is still a positive effect from using ointments. And it does not lie in the “miraculous” composition, but in the very process of rubbing in the ointment. Regular warming ointments are suitable for this use.
Pros : The process of rubbing the ointment improves blood circulation, and in some cases helps relieve painful muscle spasms.
Cons : The composition of the ointment does not have a therapeutic effect.
Thus, ointments such as Fastum-gel, indomethacin and butadione ointments, Menovasin, Voltaren-gel, Nikoflex-cream, Espol, diclofenac ointment and many others have proven themselves to be effective as medicinal ointments and gels for topical use.
They have a good therapeutic effect, but it is important to remember that only 4 to 8% of the medicinal substance passes through the skin to the “destination” - the diseased joint, therefore anti-inflammatory and analgesic treatment with ointments, creams and gels almost always needs to be supplemented with medications, taken orally or intramuscularly.
To prepare medicinal compresses, you can use various medicinal substances for external use. These include, for example, bischofite (a petroleum derivative that has a beneficial effect on arthrosis), dimexide (an anti-inflammatory and analgesic medicine that penetrates well through the skin), as well as medical bile, which has good warming and absorbable properties.
However, in order to keep such a complex disease as arthrosis of the knee joints under control, sometimes it is not enough just to take medications in one form or another.
Drug treatment must be combined with physiotherapeutic procedures for joint arthrosis, sanatorium-resort treatment, and also, if your doctor does not object, you can use effective folk recipes for the treatment of gonarthrosis.
And remember: for effective treatment of knee arthrosis, it is dangerous to self-medicate. If you experience joint pain, be sure to consult a doctor!
Tablets for arthrosis of the hip joint, the action of which is aimed at restoring joint cartilage. These are the ones that contain glucosamine and chondroitin. Quite a lot of them are produced by both domestic and foreign pharmaceutical industries. These drugs require long-term use (at least three months). It is ineffective to use them when there is no more cartilage left.
For a real effect, you need to take at least 1000 mg of chondroitin per day, and at least 1200 mg of glucosamine. You can take both combined drugs (which contain both components, for example, Artra) and single drugs (for example, Dona, which contains only glucosamine and is very effective, especially in injections).
There are also dietary supplements (Sustanorm, Stopartrit, Chondro) containing these two components. They are not a medicine as their clinical effectiveness has not been proven. Preparations containing chondroitin and glucosamine, marketed as an ointment for arthrosis (Teraflex ointment), have rather low effectiveness.
Vitamins for arthrosis must be present in the patient’s daily diet. By themselves, they will not cure a person from osteoarthritis, but they will make a worthy contribution to the complex treatment of this insidious joint disease. The consumption of vitamins should correspond to general standards of a healthy diet. What vitamins are especially useful for arthrosis will be discussed in this article.
B vitamins
Scientific studies of the effects of vitamins on joint diseases have given reason to believe that the B vitamins, discovered just over a century ago by Casimir Funk, have the most valuable beneficial properties. These molecular organic compounds ensure normal energy metabolism and the functionality of the nervous system, strengthen the immune system, and stimulate the growth of body cells. For cartilage tissue suffering from arthrosis, vitamins will help restore cartilage cells. With the modern high rhythm of human life, vitamins help cope with stress, emotional pressure, and illness.
Vitamin B is more effective when it acts in combination than taking vitamins individually. An unhealthy diet often leads to a deficiency of the entire group B, so they should also be consumed together. Scientists have discovered many B vitamins, but the main ones are thiamine B?, riboflavin B?, niacin PP or B?, pyridoxine B?, cyanocobalamin B??. Less known are choline, biotin, inositol, pantothenic acid B? and others.
Thiamine is essential for the normal functioning of the central nervous system. Its deficiency can lead to mental illness and pain in the legs, for example, provoke knee or ankle arthrosis. Features of vitamin B? - it does not accumulate in the body, so it cannot be stored “for future use”, therefore, it must be consumed daily.
Vitamin B? rich in protein foods, especially rice, legumes, wheat cereals, cottage cheese, hazelnuts. It can withstand cooking for no longer than two hours at 100-degree temperatures, but completely decomposes under the influence of coffee.
Riboflavin is needed by humans to stimulate metabolic processes; it is involved in the activity of almost every cell. This compound is called the “beauty vitamin”, as it actively affects skin health and muscle tone. A person diagnosed with arthrosis, vitamin B? will be useful for the restoration of cartilage tissue through accelerated delivery of nutrients to the joint and cartilage, as well as for strengthening muscle tissue, since strong muscles and ligaments are very important for relieving excess stress on affected joints.
Unfortunately, riboflavin is rapidly destroyed by light within a few hours. Therefore, dairy products containing a significant proportion of B? are packaged in opaque bags. But the vitamin tolerates the effects of high temperatures, for example, when cooking and frying meat. Rich in B? lamb, almonds, liver, wheat shoots, parsley, soy products.
Nicotinic acid (or niacin) is important for the production of hormones, in the synthesis of fats and proteins, vitamin B? also indispensable. It is also called vitamin PP - it prevents pellagra, a terrible disease caused by long-term vitamin deficiency. Niacin is as important for brain nutrition and function as calcium is for bones.
Vitamin B deficiency in the body? leads to excess body weight gain, so it is especially necessary for a patient with arthrosis to ensure daily consumption of nicotinic acid. Is vitamin B found? in yeast (bread, beer), peanuts, beef and chicken liver, in various cereals. For people suffering from arthrosis and arthritis, niacin helps relieve joint pain.
It helps synthesize the so-called happiness hormone serotonin. Vitamin B? together with calcium, it participates in the normal functioning of the heart and muscular system. Many scientists call him responsible for the origin and preservation of Life. Responsible for the balance between protein and fat metabolism.
All protein products are rich in pyridoxine; most of it can be found in yeast, sprouted wheat, and unpolished grains. Potatoes, bananas, cabbage, eggs, beans, carrots, sunflower seeds contain large amounts of vitamin B?.
Two interconnected molecular compounds. Folic acid and cyanocolabin are active participants in carbohydrate and fat metabolism in the human body. For older people, this group of vitamins is especially useful for relieving neuralgic pain, insomnia, weakness in the body, and forgetfulness. Vitamin B?? plays an important role in hematopoiesis.
These valuable elements are found in large quantities in chicken and veal liver, brewer's yeast, Brussels sprouts and boiled broccoli, sunflower seeds, orange juice, fermented milk products, raw egg yolk, and herbs.
Modern methods of relieving joint pain include intramuscular anesthetic injections, intra-articular administration of hormonal drugs, blockades using novocaine, and the application of pain-relieving ointments that contain non-steroidal anti-inflammatory drugs.
The introduction of lubricant substitutes using intra-articular injection and the application of compresses with dimexide and bischofite are aimed at a long-term therapeutic effect. It is based on slowing down or stopping the processes of destruction of the articular ligament. At almost any stage, hip arthrosis requires competent pain relief.
In the first degree of the disease, intramuscular injections of analgesics and non-steroidal anti-inflammatory drugs are performed. For the most minor pain, it is possible to use tablet medications. Administration of analgin orally or intramuscularly in some cases can relieve moderate pain.
For more severe and persistent pain and in the second stage of the disease, non-steroidal anti-inflammatory drugs are usually used. As a rule, these are drugs based on Diclofenac or Ibuprofen. Severe pain is relieved with Ketanov injections. In parallel, it is possible to use ointments or gels with these drugs.
Intramuscular injections of steroid drugs for arthrosis have a very strong analgesic effect. The complex drug Ambene has been successfully used, which allows, simultaneously with the analgesic effect, vitamin therapy according to group B. The main steroid drug in the composition is Dexamethasone.
Intra-articular injections are carried out mainly for the administration of corticosteroid drugs, most often Kenolog, Hydrocortisone, etc. The selection of steroid drugs should be carried out by a specialist. In this case, many individual characteristics of a person are taken into account, for example, previous diseases, hormonal levels, and the absence of certain diseases caused by hormonal changes. It is extremely undesirable to self-prescribe corticosteroid-type drugs, as this can lead to a significant imbalance in the body’s hormonal levels. At the same time, with an adequate assessment of the patient’s condition and the correct selection of hormonal drugs, it is possible to simultaneously relieve pain for a long time and relieve inflammation inside the joint.
Novocaine blockade for arthrosis is used with a certain frequency and allows in some cases to remove pain.
In order to reduce the pain symptoms of the disease, therapeutic massage is used. It, in turn, is divided into several types:
For massage procedures of the hip joint and foot, honey and linseed oil are actively used. Honey massage of the hip joint or foot has a thousand-year history. Over time, its technology has remained virtually unchanged. If you pay attention to the sequence of actions of the massage therapist, which are captured on video, it will become noticeable: a proper honey massage always begins with warming up the joints. A regular medical heating pad is suitable for this procedure. Honey massage does not require a large amount of honey, but the product must be natural.
To massage the hip joint, foot and other parts of the body, honey must first be heated in a water bath. Honey massage is performed with gentle circular movements. It is rubbed into the area where the affected joints are located for 15-20 minutes. Then the sore spot is covered with gauze. A wool bandage is applied on top of the affected joints. As soon as the honey massage is over, it is better for the person to lie down for 2 hours. At the end of this time, the bandage is removed. The area where the massage was performed is washed with warm water without soap. How often can you perform a honey massage of the hip and foot? Experts believe: 1 time per day. However, it is necessary to remember: the course of treatment should not exceed 2 weeks. Only after 1-2 months are you allowed to return to it.
Carrying out massage procedures also has contraindications. These include the appearance of:
Treatment methods for coxarthrosis are used depending on the degree and stage of joint damage. At the initial stages, drug treatment of coxarthrosis is used; at a later stage, surgical intervention (joint replacement) is effective.
Conservative treatment of this degenerative-dystrophic disease of the joints, which causes degeneration of the cartilage of the hip joint with further changes in the bone of the articular surface, the formation of osteophytes, and impaired movement, does not directly affect the cause of the pathology, but only eliminates the symptoms of the disease.
The treatment complex includes analgesic and anti-inflammatory therapy with the use of local and general medications. Drug treatment of coxarthrosis is effective at stages I-II of the pathological process, when the destruction in the joint is still insignificant. At these stages, medications are prescribed that differ in the method of influencing the course of the disease. These are painkillers, muscle relaxants, chondroprotectors for arthrosis and other means.
Nonsteroidal anti-inflammatory drugs (Aertal, Indomethacin, Diflunisal, Diclofenac, Naproxen, Fenoprofen, Lornoxicam and others) have a powerful analgesic effect, eliminate pain, but do not treat coxarthrosis itself and do not slow down further progression of the disease. NSAIDs have significant side effects when used over a long period of time.
If long-term use is necessary, it is recommended to use selective anti-inflammatory drugs that do not cause complications and do not have a negative effect on the structure of joint cartilage. Local NSAIDs in the form of ointments and gels (Voltaren, Diclofenac, Deep Relief, Butadione and others) also help reduce pain.
In case of low effectiveness of NSAIDs and other analgesics, intra-articular blockade of the joint with corticosteroids (Kenalog, Diprospan, Hydrocortisone and others) is performed, which reduces the manifestation of pain and slows down the development of further joint deformation.
The most effective in the treatment of coxarthrosis are chondroprotectors (Diacerein, Arthrodarin, Chondroitin sulfate and others), which improve the nutrition of cartilage in the affected joint. Chondroprotectors in the early stages of the disease give good results, but to achieve the maximum effect of treatment they must be taken in regular courses over a long period of time.
To eliminate muscle spasms, muscle relaxants are prescribed. But it should be remembered that, being a kind of protective reaction of the body, muscle spasm protects the joint from further destruction. When using muscle relaxants, it is necessary to reduce the load on the joint through the use of supporting devices, otherwise the damaged joint will be destroyed at an accelerated rate.
Various physiotherapeutic procedures, massage, special diet, and therapeutic exercises increase the effectiveness of drug treatment. If a positive result could not be achieved during treatment, endoprosthetics and special rehabilitation programs are carried out in the postoperative period.
Surgical intervention is mainly applicable at the third stage of the disease, if all conservative and medicinal treatment methods have not had the desired effect. The condition of the cartilage can worsen, provoke new inflammatory processes, and in this case a radical method of solving the problem is necessary.
Surgery for coxarthrosis of the hip joint involves replacing the joint capsule and femoral head with artificial ones. This procedure is called “endoprosthetics”.
There are three possible methods of fixing the prosthesis:
It is worth paying special attention to the preparatory stage before the operation, which includes:
The postoperative period involves physical therapy, massage, certain breathing exercises, proper wound care, and taking anticoagulants as needed.
A return to the usual pace of life is possible over the next few months. All aspects related to any physical activity (sports, heavy lifting) should be discussed in advance with your doctor.
Do not forget that before treatment with one of the hardware methods of physiotherapy, you should consult a doctor, since physiotherapeutic methods have contraindications.
If we want to try to avoid surgery treating coxarthrosis , we need to try to restore the diseased hip joint . We must 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 arthrosis of the hip joint . 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:
Non-steroidal anti-inflammatory drugs - NSAIDs . The main drugs in this group: diclofenac, piroxicam, ketoprofen, indomethacin, butadione, movalis, nimulid, Celebrex, arcoxia, and their derivatives. These medications are prescribed to relieve pain in the groin and hip.
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 . 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 constantly drinks 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 can cause significant side effects with long-term use.
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.
Note from Dr. Evdokimenko.
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. And vice versa, 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 2015) on our pharmacological market, chondroprotectors are most widely represented by the following proven drugs:
Arthra , made in the USA. Available in tablets containing 500 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full therapeutic effect, you must take 2 tablets per day, daily, throughout the entire course of treatment.
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 is important, 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!
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.
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.
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).
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 they “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.
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.
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.
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:
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.
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.
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.
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.
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.
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, Dr. Evdokimenko’s gymnastics is almost the only treatment method 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.
Probably, after such a recommendation, many of the readers will be surprised: how can you load the muscles and ligaments of a limb without forcing its joints to bend and straighten?
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:
And, of course, you can’t do gymnastics during an exacerbation of the disease. It is necessary to first eliminate the exacerbation of the disease with other therapeutic measures. Only then, in the absence of contraindications, the doctor chooses the exercises that are optimal for the patient and prescribes the mode of their implementation: sequence, number of repetitions, time to hold a certain position.
However, I am aware that not every sick person has the opportunity to consult with a competent gymnastics specialist. That is why below I present a number of exercises that are useful for arthrosis of the hip joints.
Note from Dr. Evdokimenko.
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. A jerking effort can only “tear” the muscles and will bring absolutely no benefit. And remember that even if you perform gymnastics correctly, improvement does not come immediately. As already mentioned, in the first 2 weeks of training, pain in the joints may even intensify somewhat, but after 3-4 weeks you will feel the first signs of improvement in your well-being.
I wish you the will and perseverance necessary to regain your former ease of movement.
And if you are ready to work hard for your health, then the following set of exercises is at your service:
A video of gymnastics for the treatment of coxarthrosis can be viewed here