Physical therapy for arthritis of the knee

With arthritis and arthrosis, therapeutic exercises are very important. Observing the regularity of classes and following the doctor’s instructions, you can return lost mobility, improve blood flow in the affected area, and facilitate metabolic processes. Sudden movements are contraindicated: only smooth execution helps to avoid pain.

During an exacerbation of knee arthritis, any activity can be harmful.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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The Benefits of Yoga

This ancient teaching includes gymnastic complexes that help strengthen the affected area. Before performing, a warming shower is recommended. During classes, it is important to monitor breathing, movements should be soft, smooth. You can not strain muscles: this can cause even greater harm to a sore joint. Sequencing:

Exercise therapy as a basis for treatment

Therapeutic exercises for arthritis of the knee joint are the basis of therapy and the key to recovery. Contraindicated in exacerbations and severe cardiovascular diseases. For treatment, a combination with massage and swimming is useful. It is recommended to do the following complex:

  1. Sitting position. Shake your legs alternately until fatigue appears.
  2. In the same position, raise the feet perpendicular to the body and hold for 5 seconds. Return to the starting position. 10 repetitions.
  3. Lie on your back. Raise the right foot 25–35 cm above the floor and hold for 10 s. Repeat with another limb. The feet cannot be pulled up much. 6 repetitions each.
  4. In the same position for a minute to carry out the “bike”.
  5. Lie on your stomach. Lift the leg and bend at the joint, reach with the heel to the buttock.
  6. Sit on a rug, stretching out limbs. Try to reach the tips of the feet with your hands.
  7. Lie to one side. The lower knee is bent, lies on the floor, the upper one – gradually rises and holds 3-5 seconds. Repeat on the other side.
  8. Stand up straight, back straight. Holding on to the back of a chair or window sill, stand on tiptoe, lingering at the top point for as long as possible.
  9. In the same position, to make rolls from heel to toe, the movement of the feet is directed in opposite directions.

Are aerobic loads acceptable?

This type of training includes not only fitness and aerobics. A similar load is given by dancing, intense walking, climbing stairs, elliptical trainers. They develop endurance, strengthen bones and joints, raise the general tone. Regular exercises help to reduce weight, thereby reducing the load on the affected areas. Training is recommended every other day due to the high intensity of classes.

Exercise therapy for arthritis of the knee with aerobic exercise is best performed in water. This reduces the risk of injury to the ligaments, improves blood circulation. Walking and cycling should be moderately intense: pain, sprains and injuries worsen already undermined health. It’s worth starting workouts from 5-10 minutes a day, gradually increasing their duration. The recommended limit is 0,5-1 hour at an average pace.

Calculate the intensity of the workout will help the formula: heart rate = (220 – age) * 0,6. If the load does not harm, the coefficient of 0,6 can be gradually increased to 0,8. With rheumatoid arthritis, the pulse rate should be 60-80% of the permissible upper limit.

The following types of exercises are dangerous for joints:

  • forced;
  • unstable;
  • drums;
  • with axial or angular load on the joints;
  • asymmetrical;
  • causing pain or discomfort in the knee joint.

Strength exercises and arthritis of the knee

In case of diseases of the knee joints, both limbs are evenly loaded, the Split system is not used, as this increases the load on the affected area. When exercising in the gym, it is recommended to adhere to the following rules:

  • Training begins with a warm-up, including for diseased joints.
  • Anesthetic ointments can not be used. The patient should immediately stop exercising at the slightest discomfort in the joint.
  • The selection of the load is carried out by the instructor or doctor, taking into account individual characteristics.
  • Axial loads on the joint are unacceptable, which means it is impossible to approach the bar.

A possible scheme of classes in the hall for arthritis and arthrosis (2 sets of 10-15 times):

  1. stretch the ankle or 5 minutes on a bicycle;
  2. extension of legs from a sitting and lying position;
  3. simulator “Butterfly”;
  4. upper draft, grip slightly wider than shoulders;
  5. shoulders on an inclined bench in a crossover;
  6. bench press, narrow grip;
  7. twisting and press.

Important nuances

For arthritis, the knee joint requires warming up before training and stretching after exercise. All manipulations, especially for beginners, should be performed under the supervision of a specialist. The instructor of the hall should be notified of joint problems at the client. Sick limbs are not a reason to give up sports, but safety precautions must be observed without hiding and shame.

Physical therapy for arthritis of the knee

Exercise therapy for arthritis of the knee joint plays an important role in the treatment process, and is also a guarantee of inhibition of destructive changes in the joint and prolongation of the period of remission of the disease.

A set of exercises for arthritis is selected by the attending physician individually for each patient

Experts insist on the need for controlled physical activity on the affected joints, even if there is pain in this case. Otherwise, the aggravation of the pathological process will be accelerated.

Destructive changes in the affected joints are primarily due to a violation of tissue trophism. The systematic implementation of a specially selected set of exercises helps to normalize the processes of microcirculation and lymphatic drainage in the pathological focus, which leads to faster excretion of the final metabolic products, a decrease in the intensity of the inflammatory reaction, and restoration of mobility in the joint.

With an adequate approach to the development of a complex of physiotherapy exercises, if the intensity of the loads on the inflamed joint does not exceed the permissible limits, the following positive effect is achieved:

  • improvement of tissue nutrition in the area of ​​the focus of inflammation;
  • activation of metabolic processes;
  • a decrease in the intensity of pain, not only in the affected joint, but also in the muscle fibers surrounding it;
  • relief of the inflammatory reaction, elimination of edema;
  • increased muscle tone of the affected joint;
  • restoration of the patient’s ability to work as a result of a weakening of the manifestations of pain;
  • inhibition of destructive changes in articular elements;
  • increase in the duration of the period of remission of arthritis.

The development of the inflammatory process is accompanied by the occurrence of pain in the patient, which greatly complicates the exercise. However, the exclusion of movements in the joint only contributes to the aggravation of pathology and an increase in the intensity of pain. Therefore, physical therapy is an integral element in the therapeutic process, along with the use of drugs.

Principles of exercise therapy

Performing training in water provides a gentle effect on damaged joints.

Gymnastics for arthritis of the knee joint is performed only during periods of disease remission. During an exacerbation of the pathological process, its effect on the area of ​​inflammation is replaced by another technique – treatment by position.

Initially, the selection of acceptable types of physical exercises is carried out by the attending physician, who takes into account the features of the development of arthritis in the patient and the degree of destructive changes in his joint. It is advisable to start classes in the LFK office under the supervision of an experienced and qualified instructor who will teach the correct technique for performing each exercise. In the future, the patient can continue to perform physical exercises at home, since no specialized equipment is required to complete them.

All exercises included in the treatment complex are performed at a slow pace for a couple of minutes, while the patient should feel muscle tension in the affected joint. Each type of exercise is repeated from 10 to 20 times, while the person performing them should listen to internal feelings and not bring himself to exhaustion.

Good results are obtained from physical therapy in the pool, since this reduces the external pressure on the damaged joints while maintaining the therapeutic effect from training. But you should be careful in choosing a pool – conducting classes in cold water contributes to an increase in the intensity of the inflammatory reaction.

A prerequisite before starting gymnastic exercises is the heating of the affected joint, which can be achieved by rubbing it.

To do this, the patient occupies an upright position or sits on a chair, has his feet shoulder-width apart – if this is not possible, the distance between the legs can be reduced. After that, for several minutes, he massages the patella with his hands, making circular movements in various directions, until he senses a significant influx of heat in this area.

Physical therapy classes should be supplemented by daily walks. The minimum duration of such exercises is not less than half an hour. Walking helps to stimulate metabolic processes in the focus of inflammation and improve trophic articular tissues.

Gymnastic training can be performed at any time convenient for the patient – there are no special requirements in this matter. However, physical exercises contribute to the excitation of the nervous system, therefore, to prevent sleep disorders, they are performed no later than 2-3 hours before going to bed.

Exercises for arthritis of the knee joint are performed in positions that exclude additional load on the pathological area. Therefore, the patient occupies a horizontal position (both on the back and on the stomach) or sits on a chair.

When the patient is lying on his back, the exercises are as follows:

    simultaneous stretching with arms and legs until there is a feeling of stretching of the spine, after which, having fixed the position, the patient makes circular movements of the feet;

Physical education should be carried out at a measured pace and not bring the patient to complete exhaustion.

When the patient lies on his stomach, he performs alternating bending of the legs at the knees and bringing the heel to the buttock with the help of the hands.

Sitting on a chair, patients are advised to make oscillating movements with their legs or alternately raise their legs parallel to the floor surface and fix them in this position for several seconds.

When a knee is affected by arthritis, exercise should not only be dosed intensively, but also exclude sudden movements in the affected joint. Therefore, when diagnosing this pathological condition, the patient is forbidden to engage in sports such as running or jumping (through a jump rope).

Manual therapy

Massage for arthritis of the knee joint serves as an additional therapeutic method, the use of which in combination with physiotherapeutic procedures and therapeutic exercises helps to quickly transfer the disease into a state of remission.
A local effect on the affected area when performing massage movements contributes to the following therapeutic effect:

  • prevention of atrophy of the muscle apparatus of the affected joint;
  • improvement of tissue trophism;
  • stimulation of the evacuation of effusion from the cavity of the inflamed joint;
  • normalization of microcirculation and metabolic processes in the focus of inflammation;
  • restoration of mobility in the affected joint;
  • relief of pain.

When performing a massage of the patella, it is permissible to use such techniques as kneading, stroking, rubbing, stretching and torsion. Any mechanical effects in this area should be gentle, since a large number of nerve endings are located in the popliteal fossa and intense exposure to them can provoke the occurrence of not only uncomfortable, but also painful sensations.

It is forbidden to carry out manual therapy during periods of exacerbation of the disease, in the presence of a febrile condition, damage to the integrity of the skin in the massaged area, with the development of somatic pathologies in the patient that negatively affect his general well-being.

A therapeutic technique that guarantees absolute healing of a patient from arthritis of the knee joint does not exist in medical practice today. However, the complex application of physical therapy methods, physiotherapy and massage techniques with the parallel observance of all medical recommendations allows us to achieve a stable remission of the pathological condition, as well as to prevent destructive changes in the articular elements.

A set of exercises for severe arthritis of the knee joint, contraindications, indications, benefits and potential harm

Arthritis of the knee joint is an acute or chronic inflammatory disease of the joints of the knee bones, which can lead to various complications. In the article, we will analyze physical exercises for arthritis of the knee joint.

Arthritic pathology in the knee

Attention! In the international classification of diseases of the 10th revision (ICD-10), arthritis of the knee is indicated by the code M13.

Physiotherapy

Treatment depends on the condition of the patient. As a rule, heat in the chronic phase of the disease is positively perceived by patients. It relaxes muscles, improves blood circulation and quality of life. For chronic joint inflammation and fibromyalgia, this can be a good addition to the treatment program. The spectrum is versatile and ranges from warm sand baths, infrared light and a sauna to steam jet procedures. The effect of heat is enhanced by water and active ingredients:

  • peat extracts, sulfur or radon baths;
  • healing mud;
  • plant extracts.

In cold weather, the veins narrow and the metabolism slows down. Basically it is a temperature of 0-15 ° C. The patient is recommended to cool his hands or feet in baths with ice cubes. Cold therapy is cryotherapy that uses low temperatures. In the refrigerator, the patient remains at a temperature of -110 ° C in bathing suits for about 3 minutes. In the next few hours, the pain is significantly reduced, and the patient with rheumatism will be able to move again. The disadvantage is the high cost of the method.

Why you need exercise therapy for knees with arthritis

It is recommended to constantly engage in complexes of physical exercises. Physical activity can be limited only in the acute phase of the disease. Exercise and regular training strengthens muscles and bones, and also supports the joint’s ability to move. The exercise program should be prescribed by a doctor, but a physiotherapist will help in this procedure. Physical therapy should be carried out on an ongoing basis.

All procedures must be adapted to the capabilities and limitations of the patient. Especially the pain therapist must consider.

Physiotherapy and exercise therapy help strengthen the muscles of the body, as well as eliminate severe pain. During therapy, the patient gradually improves coordination of movements and a sense of one’s own body. Sports and gymnastics are also effective against rheumatism. It can supplement physiotherapy. Suitable are, for example, walking, hiking, swimming, cycling or dancing.

Other means

Disease progression can be slowed with long-acting anti-inflammatory drugs in 75% of patients. In favorable cases, these anti-rheumatic drugs can even reduce existing joint damage. But they often have unpleasant side effects and lead only in the medium and long term to reduce inflammation.

Most drugs in this group are combined (Hydroxychloroquine, Sulfasalazine, Methotrexate, Leflunomide, Auranofin, Cyclophosphamide, Cyclosporine, Chloroquine, Azathioprine). The most common side effects are markedly increased susceptibility to infection, circulatory disorders, liver damage and skin lesion symptoms.

Cyclosporin

Corticosteroids can slow bone loss, but they do not stop the progression of inflammation. Over time, efficiency decreases. Corticosteroids can be injected directly into the joint 3-4 times a year and can temporarily significantly reduce the discomfort of severely affected joints. Medicines should not be prescribed for certain diseases (stomach ulcer, hypertension, diabetes mellitus, infections, as well as cataracts).

Side effects are significant when corticosteroids are taken not only locally, but also for more than a week. In this case, they lead to an increase in body weight, an increase in blood sugar, an increase in blood pressure, skin atrophy, and a deterioration in the body’s resistance and susceptibility to infection.

Substances that suppress the immune system significantly reduce the strength of symptoms, but these drugs are also associated with deficiencies. They sometimes cause an increased risk of carcinoma (cyclophosphamide) and have adverse reactions to the kidneys, ADD and the gastrointestinal tract.

Medicines belong to the class of proteins. They target and neutralize inflammatory messengers (e.g. Adalimumab, Anakinru, Etanercept and Infliximab). Again, side effects are possible.

Infliximab

Operative intervention

Before performing surgical procedures, the pros and cons should be carefully weighed. In the event of complete loss of joint function, an artificial joint, such as hip and knee prostheses, may be required. Surgical intervention may be required to restore arm or foot function.

Advice! Engage in physical therapy and gymnastic exercises at home with arthritic diseases is possible only after medical advice from a specialist. It is not recommended to use physical culture techniques on your own, do self-massage or take up power loads. Especially with rheumatoid arthritis, training in the gym is strictly contraindicated. Charging can and is recommended for any joint diseases outside the acute phase. Only a qualified specialist can select a child for a physiotherapeutic exercise program.

Physiotherapy exercises for the knee joint for arthritis

Physical therapy is an essential element in the treatment and prevention of knee arthritis. No treatment with drugs or folk remedies will save the immobilized joint from contractures and new exacerbations if the patient does not perform the exercises prescribed by the doctor, but regular and proper physical activity helps to maintain and improve joint health.

General principles and goals of gymnastics

There is no doubt about the appropriateness of physiotherapy exercises for arthritis of the knee joint. The fact is that it helps the full functioning and nutrition of the joint. This is due to the fact that nutrients and medications that enter through the bloodstream or through local applications (creams, ointments and compresses) are transported to the cartilage tissues of the joint using the synovial fluid surrounding them and only when moving.

Another question: when to do the exercises so that they are beneficial and not harmful, because inappropriate activity in the acute phase of the disease can provoke tissue destruction and joint deformation. So, the most important rule of physiotherapy exercises (LFK) for arthritis is the following: it is impossible to perform therapeutic exercises in the acute or chronic phase.

When can you do this? Exercises can and should be done:

  • to prevent the development of the disease in the presence of risk factors;
  • at the stage of rehabilitation after an acute form of the disease;
  • during remission with a chronic form of arthritis.

The main tasks of gymnastics as one of the methods of treating arthritis are:

  • stimulation of synovial fluid production;
  • activation of blood flow and metabolism in articular tissues;
  • the removal of spasms supporting the joint of small muscles, their strengthening;
  • restoration of normal knee mobility (or its maximum possible increase with limited mobility).

To achieve these goals, therapeutic joint gymnastics can be practiced in such forms as:

  • Individual lessons in which the specialist helps the patient, while observing the intermediate results and making adjustments to the course of therapy. There are times when the patient is simply not able to independently perform the exercises, then individual sessions of exercise therapy are the only possible option.
  • Group lessons for which patients with a similar clinical picture are selected. They are acceptable in the mild form of the disease, when the patient is sufficiently mobile, can perform exercises and control the correctness of movements independently.
  • Independent classes are prescribed for patients with arthritis of the knee joint upon discharge from the hospital to perform at home. As a rule, these are simple exercises that do not require special equipment or inventory. It is clear that with the independent implementation of the exercise therapy complex it is necessary to monitor your condition and, at the slightest discomfort, seek the advice of your doctor.

So, doing gymnastics uncontrollably or deviating from the doctor’s recommendations is unacceptable. When developing a course of exercise therapy, the doctor strictly doses the load on the joint by force and time, since too complex or lengthy exercises can lead to irreversible changes in the joint, and insufficiently intense ones will not give the desired result.

A set of exercises for the rehabilitation of the knee joint

Exercises to restore mobility and health of the knee joint are performed from three initial positions – sitting, lying on your back and stomach. Depending on the general state of health, they can be made as a single complex or performed in blocks throughout the day.

Lying on his back

These are the simplest exercises, which are convenient to perform in the morning without getting out of bed, if the bed is spacious enough and rigid, or moving to the mat:

  • Gently stretch with straight arms and legs in different directions, stretching the spine.
  • Pull socks and then pull them on yourself. You can do it immediately with two stops or alternately, delaying at the extreme points of movement for 10-15 seconds.
  • Smooth rotation of the feet out and in.
  • Sliding your feet on the floor, pull the heels to the buttocks and come back.
  • Alternately move slightly bent legs to the sides along the floor.
  • In turn, lift the bent legs down 20–25 cm from the floor.
  • Bend your legs with your feet on the floor. Straighten one leg, lay on the floor, raise to an angle of 45 degrees, lower again. Take the starting position, repeat with the other leg.
  • Raise the straight leg, as far as physical fitness allows, pull the sock on the inhale, pull it towards you as you exhale. Take the starting position, repeat with the other leg.
  • Bend the leg, grab it with your hands and pull it to the chest as much as possible, withstand a pause of 5-7 seconds. Take the starting position, repeat with the other leg.
  • Bend both legs, grab your arms and pull to the chest, and then straighten at a right angle to the floor, bend again and return to its original position.
  • Bend your legs with your feet on the floor. Dilute the knees to the side, pressing the feet.
  • To bend and unbend your legs, simulating a bicycle ride. With poor physical fitness, you can perform the exercise with one leg, putting the other on the floor. Then do the same with the other foot. With insufficient flexibility, the free leg may be bent at the knee.

Sitting on a chair

To complete this part of the complex you will need a hard chair of standard height. You need to sit on it, keeping your back straight and looking forward. The following exercises are performed:

  • Wiggle first one and then the other foot back and forth.
  • Bend the leg to the parallel with the floor, withstand a 5-second pause, change the leg.

Lying face down

Perform is on the rug:

  • Circular movements of the tibia raised perpendicular to the floor in both directions. Same with the other foot.
  • Slowly and carefully pull the heel of the leg bent at the knee to the buttock, the same for the other leg.

The exercises from the complex are given on the instruction card:

If the condition of the knees is stably satisfactory, you can go walking, gradually increasing the range of walks, carefully monitoring the reaction of the joints to additional efforts. A good option is swimming, dosed power loads. Running, jumping, aerobics are contraindicated.

Rheumatoid Arthritis Exercises

One of the most serious joint diseases is rheumatoid arthritis. This form of gonarthritis requires a thorough, thoughtful treatment, an important component of which is physiotherapy, but there are a number of contraindications. It:

  • exacerbations of the disease, characterized by severe pain and inflammation;
  • systemic phenomena – damage to the cardiovascular system, lungs, kidneys and other internal organs;
  • serious concomitant pathology.

If there are no contraindications, then physical education shows. Its main forms with rheumatoid arthritis are the same as with other types of ailment – individual, group and independent. However, due to its severe symptoms, active classes may not be available to the patient. In this case, physical education is reduced to breathing exercises and gymnastics positions.

So, most often the scheme of the course of therapeutic gymnastics includes three stages:

  • Mastering special breathing techniques – 1-2 lessons lasting 10-15 minutes.
  • Studying and performing in a hospital a basic set of exercises – 10-14 lessons of 25-30 minutes.
  • The study of a set of exercises that the patient will perform independently at home.

Exercises of the basic complex for the treatment of rheumatoid arthritis are basically the same as described above. The attending physician can give individual recommendations, exclude some exercises that are contraindicated to the patient, or supplement the complex with others.

In a severe form of rheumatoid arthritis, when the patient is practically unable to move, or with exacerbations of the disease, a kind of therapeutic gymnastics called the “position treatment” can be used. The technique is as follows:

  • The patient lies on a hard orthopedic mattress.
  • His legs must rest against the headboard or stand.
  • Every hour, the position of the body changes independently or with the help of another person.

All the necessary recommendations regarding the treatment of the situation are given by the attending physician – initiative here is unacceptable, and even impossible with such a serious condition of the patient.

Video: preventive gymnastics for the knees

Prevention of arthritis of the knee composition is needed with such occurrences:

  • you periodically notice a crunch, pain, limitation of knee mobility;
  • your work or hobbies are associated with an intense load on your legs;
  • are overweight;
  • your older relatives in a straight line suffer from arthritis (especially rheumatoid).

In order to prevent the disease, it is enough to master articular gymnastics from the video instruction:

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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