What is osteoarthrosis? When we have an X-ray and other tests, there is usually a phrase on the test report about degenerative changes somewhere. What it says is that as our bodies are used for longer periods of time, everyone will have, just to varying degrees of severity, what is called osteophytes, or bone spurs. In fact, they all refer to osteoarthrosis, or what is called osteoarthritis. The reason why it is called degenerative changes, it points out its nature, it is actually a kind of change, not “disease”. In layman’s terms, it is the aging and degeneration that occurs with age, not a disease we have, but a natural law of aging. For us, the difference is that some people degenerate more slowly and lightly, without any symptoms. Some people degenerate too quickly, and the symptoms are so severe and painful that they need a joint replacement.
X-ray changes of osteoarthrosis of the knee
X-ray changes of hip osteoarthropathy
X-ray changes of cervical spine osteoarthropathy
The so-called articular cartilage is a special layer of fibrous connective tissue that covers the surface of the joint. Its role is to protect the bones themselves from direct wear and tear, and it has a very good anti-friction function, and there is no artificial material comparable to our articular cartilage. Artificial joints will wear out in less than 20 years, but only our original cartilage can last for decades or even centuries.
When osteoarthrosis occurs, there is damage to the cartilage of the joint surfaces. For example, the cartilage is worn down to a point where it is not smooth, or a small piece of it has fallen off due to an impact, or it is worn thin, etc. There are structural abnormalities. At the same time, due to the change in force, there will be some areas of osteophytes, which is commonly known as bone spurs. On x-rays, you can also see signs such as narrowing of the joint space. These structural problems can cause an inflammatory response in the surrounding soft tissues. Patients may experience joint pain, recurrent and persistent swelling, and functional limitations, such as painful knee joints when walking up and down stairs, or even sudden weakness and falls, which can have a serious impact on daily life. Not only is it physically painful, but it can also be psychologically taxing.
This problem can create a vicious circle, that is, pain and swelling cause dysfunction, the normal activities of people are limited, the joint is used less, the muscles around the joint atrophy, so the joint produces instability, barely moving the joint friction is more powerful, joint cartilage wear more, so the osteoarthrosis will become more and more serious. In addition to giving up rest and trying not to move for a while, the pain can be relieved. However, after lying down for a few days to relieve the pain, once you start walking on the ground, the pain will soon return. The only way to relieve osteoarthrosis, or at least to keep it from getting worse, is to break this vicious cycle.
There are only three possible ways to do this.
One is to make the cartilage better, which would solve the fundamental problem, but not with the current level of science and technology. Because cartilage cells cannot be regenerated, a dead one is one less, and the worn out cartilage will not grow back. Although cartilage repair and transplantation have been carried out and can improve the symptoms to a large extent, they are not as good as the original cartilage that was born. It is also difficult for us to accept surgery when the symptoms are mild.
The second option is to just get rid of the whole joint and get a new one! This is also the only solution for severe osteoarthrosis. However, it is difficult for someone to make up their mind to do this surgery unless it is severe enough. At the same time, the replacement prosthesis has a lifespan, which varies from one prosthesis to another, between 15 and 20 years. If the prosthesis wears out, a new one will be needed.
The third way is conservative treatment. We try to eliminate the inflammation of the joint to relieve the pain and swelling, increase the nutrition of the cartilage to promote its metabolism and self-repair, and exercise the muscles to make the joint more stable to reduce further wear and tear of the cartilage. This is the first treatment option to consider, and it is also the one that must be chosen if the condition is not so severe that surgery is necessary. Even when surgery is considered, a period of conservative treatment is usually done to relieve symptoms and improve tissue conditions, which can allow the surgery to proceed more smoothly and with better results.
Common physical treatments include: drug ionization (anti-inflammatory and analgesic through the introduction of drug ions), ultrashort wave (high frequency electromagnetic field to achieve anti-inflammatory purposes), low and medium frequency electrotherapy (to improve circulation by improving the permeability of cell membranes), wax therapy (to promote local blood circulation) and so on. Of course, the specific treatment method, dosage, etc. should be arranged by a specialist physiotherapist in a specialized hospital. Home physiotherapy equipment will also have a certain role, but from the safety point of view, the power of home physiotherapy instruments are very low, the effect is naturally relatively poor. And each person suitable for which physical therapy is difficult to say, not necessarily you buy home just right for you, so some physical therapy equipment used by others particularly effective, introduced to you to make half a day is of little use, this is a very common phenomenon. Of course, if there is no suitable hospital nearby, using home physiotherapy instrument at home to do treatment is also a good way, better than leaving it alone.
There are oral medications, all of which are cartilaginous nutrients: such as Vibram, Glucophage, and so on. Of course, I am talking about what is commonly used in hospitals, there are many kinds of joint cartilage nutrition drugs on the market, I have not investigated, so I have no say. There is another category of drugs that require intra-articular injection for cartilage nutrition and lubrication of joints: such as Spironolactone and Alchemy. These drugs need to be injected directly into the joint by a professional doctor to be effective.
In addition, the most important thing is the adjustment of life activities and the related functional exercises.
Rationalization of daily life.
First of all, you should exercise moderately: you should not feel afraid of pain and not move at all, and you should not feel that practicing is better than not practicing and grit your teeth and practice hard. Sometimes, practicing too much can be counterproductive. Therefore, the amount of daily activity should be adjusted so as not to increase the swelling and pain of the joints as moderate. Avoid walking and standing for long periods of time. You can divide the distance that will hurt your joints into 3-4 sections, and rest for a few minutes in the middle of each section, so as not to reduce the amount of activity, but also to avoid excessive wear and tear on the joints. By the same token, other activities and work arrangements are also this method to adjust.
Second, try to improve the living environment. For example, reduce the opportunity to take the stairs, switch to flush toilets to avoid squatting, do not walk too far around the residence shopping, etc.. Of course, the living environment can not be changed, try to find a way to consider the whole thing is.
There is also the control and minimize weight. Especially for middle-aged and elderly women who are relatively overweight, reducing weight can significantly reduce the burden on the joints. Some sources say that a 10% weight loss can reduce the burden on the knee joint by 20-30%.
Choose appropriate sports for exercise. Long, strenuous activities such as hiking and ball games can cause further damage to joint cartilage, and are not suitable for patients with significant symptoms of osteoarthrosis. You can choose exercises that are not too strenuous and less burdensome on the joints, such as swimming, tai chi, walking, brisk walking, etc., as a way of daily exercise.
Then comes the functional exercises.
The muscles around the knee joint (especially the quadriceps on the front side of the thigh) are an important structure in maintaining the stability of the knee joint. In patients with osteoarthrosis, the quadriceps muscles are not exercised because of decreased pain and activity, and they atrophy significantly. This decreases the stability of the knee joint, causing the patellofemoral joint and femoro-tibial joint to produce unsuitable groove movements and excessive frictional impact, which can further aggravate the development of osteoarthrosis.
A common method of exercising the quadriceps is the static squat. The action requirements of the static squat are as follows: the feet are separated and shoulder-width apart, the toes and knees are forward, the upper body is straight against the wall, the center of gravity falls on the heel. Knees in the vertical direction can not exceed the tip of the foot, the angle of bending the knee can not be greater than 90 degrees. Hold this position until exhaustion, rest for 10 seconds and then repeat, 10 consecutive times / group, 2-3 groups / day. Simply put, it is the back against the wall to practice the “zama stance”!
If the symptoms are very heavy, squatting a small angle will feel pain, you can use static weighted knee extension: sit on a high chair, bed or table, below the knee joint are hanging outside the bed, tied a sandbag on the ankle, as hard as possible to completely straighten the leg, hold until exhaustion (that is, can no longer lift) count once, 5-10 times / group, 2-3 sets of daily practice. The specific exercises are described in detail in the previous blog post on static squats.
Of course, all exercises should be done gradually, from little to much, from easy to difficult, from static exercises in a stationary position to power exercises in motion, from simple to complex movements. The above introduction is only the most simple and easy, the safest basic exercises. Because too many excessive exercises not only can not relieve the symptoms, but even aggravate the damage to the cartilage. Therefore, without special guidance, it is better not to practice blindly by yourself.