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"Pain. Joints. Spine." 1 (21) 2016

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Using of physical restoration treatment methods in patients with primary gonarthrosis with low bone mineral density at sanatorium stage of rehabilitation

Authors: Bakalyuk T.G., Mysula I.R., Kvasnitska O.S., Vahnovska E.E. - Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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The article was published on p. 65-66


Actuality. Strength exercises have a positive effect on the changes of morphological, biochemical and physiological systems of human organism. Determined that the muscular hypertrophy and reducing the thickness of the fat layer is observed even in the 60–70 year old people engaged in strength exercise, and the strength of leg muscles in old age affects the ability to self-service. Generally, the programs of rehabilitation of patients with osteoarthritis include various exercises: aerobic exercise cyclic direction (increase endurance and physical working capacity), special power exercises performed in different modes with varying intensity — from moderate to high (to strengthen the muscles located around joints, to develop compensatory functions (especially at instability). Mechanical stress is the main regulator of bone mass and bone geometry. Physical activity has a positive effect on bone tissue, but mechanical load on the bone helps to prevent bone loss during muscle stretching or pressure. The main objective of the mechanical loading is to reduce resorption and increase bone formation in places where strength is the most necessary to resist the load. Thus, the use of mechanical force may be the most physiological way to increase bone strength and prevention or treatment of osteoporosis and osteoarthritis. 

Objective. To study the clinical efficacy of strength exercises techniques in patients with primary gonarthrosis (PGA) with decreased bone mineral density.
Materials and Methods. The study included 43 patients with PGA with low bone mineral density (according densitometry). Osteopathy was diagnosed in 36 (83.7 %), osteoporosis — in 7 (16.3 %) patients. Men were 6 (13.9 %), women — 37 (86.1 %), patient age — 52–74 years, the average (61.41 ± 0.74) years, disease duration 4–18 years (9.04 ± 0.68) years. The patients did not have comorbidities that could affect the metabolism of bone. Ist radiological stage of PGA was found in 30 (69.7 %) patients, and the IInd stage in 13 (30.3 %) patients (according to classification Kellgren J.N. and Lawrence J.S.) By the method of randomization, patients were divided into 2 groups. All patients with PGA received basic medical complex, which included the using of sulfurated hydrogen sulfide baths with inhalation of sulfurated hydrogen water, applique on the joints low temperature pelotherapy, method interferential therapy, massage. The difference between the medical complex is next. Patients in the control group (20 people) received traditional physical rehabilitation scheme in accordance with the clinical protocol of sanatorium treatment, approved by the Ministry of Health of Ukraine. For 23 patients in the experimental group physical rehabilitation program included the using of strength exercise for the knee joints with elastic bands 20 minutes day duration.
Results. It was marked statistically significant (p < 0.05) positive dynamics of artrological status (the amount of motion in the joints, joint pain by VAS, WOMAC and Leken indexs, and Lovett test) in patients with PGA after applying the medical complex with the inclusion of strength exercises. Compared with the control group the amount of movement in the joints has increased by 18 %, muscle tone by 29 %, pain by 14 %, joint function has improved by 21 %.
Conclusions. In patients with osteoarthritis with low bone density inclusion of the strength exercises to medical complex has not only analgesic effect but helps to stabilize and unloading the knee joints by strengthening muscle groups and ligaments. Moreover static tension of skeletal muscle leads to intensive development of muscle strength and increase hypotrophic muscle mass, with minimum strain on the affected joint during exercises.    

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