This material is intended for people without medical training who want to know more about osteoarthritis than is written in popular publications and on the websites of private clinics. The patient asks the doctor many different specialized questions, which are characteristic of a complete misunderstanding on the topic of osteoarthritis. Examples of such questions include: "why did my osteoarthritis hurt? ", "congenital osteoarthritis was detected, what should I do? "consider the indifference of such illiteracy a fairly common question: "Doctor, I have the initial signs of cartilage disease, how scary is it? "This article is intended to structureDocuments on osteoarthritis, causes, manifestations, methodsdiagnosis, treatment and prevention, and answers to the most frequently asked questions. Since all of us, without exception, are patients with osteoarthritis, this article will be useful to everyone.
What is osteonecrosis?
The name of the disease is scary when unclear. The medical suffix "-oz" means proliferation or expansion of certain tissues: hyalinosis, fibrosis. An example is cirrhosis, when connective tissue grows and the functional tissue, hepatocytes, decreases in volume. There may be pathological protein or amyloid deposits that normally should not be present. This storage disease will then be called amyloidosis. There may be significant enlargement of the liver due to fatty degeneration, known as fatty liver disease.
Well, it turns out that with osteoarthritis of the vertebrae, the cartilaginous tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" translated from Greek into Russian means "cartilage"? No, cartilage disease, or more precisely osteoarthritis, is not a storage disease. There is no actual growth of cartilage tissue in this case; We are only talking about the changes in the configuration of the cartilaginous discs between the vertebrae under the influence of physical activity over the years, and we have considered above what happens at each intervertebral disc. The term "osteonecrosis" was introduced into the clinical literature in 1933 by A. Hilderbrandt.
How does the biomechanics of a dehydrated disc change its shape? Due to excessive load, their outer edges swell, rupture and form protrusions, followed by intervertebral herniation or cartilaginous nodules protruding beyond the normal contour of the intervertebral disc. That is why cartilage disease is called cartilage disease, because cartilage nodules - herniations - arise where there should not be cartilage, behind the outer border of a healthy intervertebral disc.
The edges of the vertebrae adjacent to the intervertebral disc also enlarge, forming bone spurs or bone spurs. Therefore, mutual violation of the configuration of cartilage and bone tissue is collectively called osteoarthritis.
Chondrolysis refers to dystrophic degenerative processes and is part of the normal aging process of intervertebral discs. None of us should be surprised that the face of a 20-year-old girl would be slightly different from the face of a 70-year-old, but for some reason everyone believes that the spine, its intervertebral discs, do not undergothrough such a distinctly temporary process. changes. Dystrophy is a nutritional disorder, degeneration is a violation of the structure of the intervertebral discs after a long period of dystrophy.
Causes of osteoarthritis and its complications
The main cause of uncomplicated physiological osteoarthritis can be considered the way a person moves: walking upright. Humans are the only species on earth that walk on two legs among all mammals and this is the only way of locomotion. Osteoporosis has become the scourge of humanity, but we have freed our hands and created civilization. Thanks to walking upright (and osteochondrosis), we not only created the wheel, the alphabet, and mastered fire, but you can also sit at home in the warmth and read this article on your computer screen.
Humans' closest relatives, the higher primates - chimpanzees and gorillas, sometimes stand up on two legs, but this mode of locomotion is only auxiliary for them and most of them still move on their own. four legs. In order for osteoarthritis to disappear, like severe aging of the intervertebral discs, a person needs to change the way they move and remove constant vertical loads from the spine. Dolphins, killer whales, and whales do not get osteochondrosis, and dogs, cows, and tigers do not get it. Their spine is not subjected to long-term static and vertical shock loads because it is in a horizontal state. If humanity went to sea, like Ichthyander, and the natural way to move was scuba diving, osteoarthritis would be defeated.
An upright posture forced the human musculoskeletal system to develop in a way that protects the skull and brain from shock loads. But intervertebral discs - elastic cushions between vertebrae - aren't the only protection. A person has elastic foot arches, knee cartilage, physiological curves of the spine: two scoliosis and two kyphosis. All this allows you not to "shake" your brain even while running.
Risk factors
But doctors are concerned about risk factors that can be modified and avoid the complications of osteonecrosis, which causes pain, discomfort, limited mobility and reduced quality of life. Let's take a look at the risk factors that are often overlooked by doctors, especially in private medical centers. After all, it is much more profitable to constantly treat a person than to identify the cause of the problem, solve it and lose the patient. Here they are:
- the presence of vertical and horizontal flat feet. Flat feet cause the arch of the foot to stop being elastic, and shock forces are transmitted to the spine without softening. The intervertebral discs are significantly stretched and rapidly collapse;
- overweight and obesity - no comment needed;
- Improper lifting and carrying heavy objects creates uneven pressure on the intervertebral discs. For example, if you lift and carry a bag of potatoes on one shoulder, the heavy load will fall on one edge of the plate and may be excessive;
- physical inactivity and a sedentary lifestyle. It was said above that it is during sitting that the maximum pressure on the intervertebral discs occurs, since a person never sits straight, but always bends "slightly";
- chronic injuries, ice skating, high-intensity weightlifting, contact martial arts, wearing heavy hats, banging your head on low ceilings, wearing heavy clothes, carrying heavy bags in your arms.
Risk factors that can affect people are listed above. We intentionally did not list the diseases here - connective tissue dysplasia, scoliosis deformities, which alter the biomechanics of movement, Perthes disease and other conditions that aggravate and worsenaggravate the physiological osteoarthritis process and lead to complications. These patients are treated by orthopedists. What are the common symptoms of complicated osteonecrosis for which patients seek medical attention?
General symptoms
The symptoms described below persist outside the local area. These are common symptoms and can exist anywhere. These are pain, movement disorders and sensory disorders. There are also specific phytonutrient disorders or symptoms, such as urinary disorders, but are less common. Let's take a closer look at these signs.
Pain: muscles and roots
Pain can be of two types: radicular and muscular. Radial pain is associated with compression, or pressing on the protrusion or herniation of the disc of the corresponding root at this level. Each nerve root consists of two parts: sensitive and motor.
Depending on the exact location of the hernia and which part of the root has been compressed, there may be sensory or motor disturbances. Sometimes both disorders occur at the same time, manifesting to different degrees. Pain also belongs to sensory disorders, because pain is a special, specific feeling.
Nerve root pain: radiculopathy due to compression
Nerve root pain is familiar to many people; it's called "neuralgia". Swollen nerve roots will react violently to any shock and the pain will be very intense, similar to an electric shock. She shoots in the arm (from the neck) or in the leg (from the lower back). Such a strong and painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is lumbago, a rarer term. Such radial pain requires forced, analgesic or analgesic positions. Radial pain occurs immediately when coughing, sneezing, crying, laughing or straining. Any shock to a swollen nerve root causes increased pain.
Muscle pain: muscle tonic
But a herniated disc or herniated disc may not compress the nerve root, but when it moves, it damages the nearby ligaments, fascia and deep muscles of the back. In this case, the pain will be secondary, aching, permanent, stiff in the back and such pain is called myofascial. The source of this pain will no longer be the nerve tissue but the muscles. Muscles can respond to any stimulus in only one way: contraction. And if the stimulation is prolonged, the muscle contraction will turn into continuous spasms, which will be very painful.
A vicious circle is formed: the contracting muscle cannot be adequately supplied with blood, it is deprived of oxygen and poorly removes lactic acid, that is, the product of its own vital activity, into the venous capillaries. And the accumulation of lactic acid leads to increased pain. It is this type of chronic muscle pain that significantly reduces the quality of life and forces the patient to undergo long-term treatment for osteoarthritis, although it does not prevent the patient from moving and does not force him to stay in bed.
A characteristic symptom of such secondary myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense, painful muscle masses - "rollers" next to the spine, i. e. next to the spine. In such patients, back pain increases after several hours of "office" work, prolonged immobility, when the muscles practically cannot work and are in a state of spasm.
Diagnosis of osteoarthritis
In typical cases, osteoarthritis of the cervical and cervicothoracic spine occurs as described above. Therefore, the main stage of diagnosis remains the identification of the patient's complaints, determining the presence of concomitant muscle spasms by simple palpation of the muscles along the spine. Can the diagnosis of osteoarthritis be confirmed with an X-ray?
An "X-ray" of the cervical spine and even functional tests of flexion and extension do not show cartilage because their tissue transmits X-rays. However, based on the position of the vertebrae, One can draw general conclusions about the height of the intervertebral discs, the general straightness of the physiological curvature of the neck - lordosis, as well as the presence of marginal growth on the vertebrae when stretched. irritation of their surface by fragile and dehydrated intervertebral discs. Functional tests can confirm the diagnosis of cervical spine instability.
Since the disc itself can only be seen using CT or MRI, magnetic resonance imaging and X-ray computed tomography are indicated to clarify the internal structure of the cartilage and its components such asprotrusion and hernia. Therefore, with the help of these methods, the diagnosis will be made correctly and the results of the CT scan will be an indication, even a local guide for surgical treatment of drainage. position in the department of neurosurgery.
It should be added that no other research method than imaging, with the exception of MRI or CT, can show hernia. Therefore, if you are offered a trendy "computer diagnosis" of the whole body, if the orthopedist diagnoses you with a hernia by running his finger along your back, if the hernia is detected based onon acupuncture, a special psychic technique, or a session of honey Thai massage, then you can immediately consider this level of diagnosis as completely illiterate. Complications of cartilage degeneration due to protrusion or herniation, compression, muscle, and neurovascular conditions can only be treated by examining the condition of the intervertebral disc at an appropriate level.
Treatment of complications of osteoarthritis
Let us repeat once again that it is impossible to cure osteoarthritis, such as planned aging and dehydration of the intervertebral disc. You can simply not let things get complicated:
- If you have symptoms of narrowing the height of the disc, you need to exercise properly, not gain weight and avoid bulging and muscle pain;
- if you already have a protrusion, you need to be careful not to let it break the annulus, that is, not to turn the protrusion into a hernia and avoid the appearance of protrusions at multiple levels;
- If you have a hernia, then you need to monitor it actively, have regular MRI scans, avoid increasing its size or proceed with treatment with modern minimally invasive surgery, as all treatment methodsConservative treatment of severe osteoarthritis, without exception, leaves the hernia intact and only eliminates the temporary symptoms: inflammation, pain, soreness and muscle spasms.
But with the slightest violation of the regimen, heavy lifting, hypothermia, injury, weight gain (in case of back pain), the symptoms return. We will describe how you can cope with the discomfort, pain and limited mobility in your back caused by exacerbation of osteonecrosis and existing protrusion or hernia, secondary to social catatonia syndrome.
What to do during an exacerbation?
Because there is already acute pain (e. g. in the lower back), you need to follow these instructions at the pre-examination stage:
- completely eliminate physical activity;
- sleep on a hard mattress (orthopedic mattress or hard sofa), eliminating back sagging;
- a semi-rigid corset should be worn to avoid sudden movements and "deformations";
- You should place a massage pillow with a plastic needle tip on your lower back or use a Lyapko applicator. You need to keep it for 30 - 40 minutes, 2 -3 times a day;
- After that, ointments containing NSAIDs, bee or snake venom ointments can be rubbed into the lower back;
- After rubbing, on the second day you can wrap your lower back with dry heat, such as a belt made from dog hair.
A common mistake is to warm up on the first day. This can be a heating pad, bath procedures. At the same time, the swelling only gets worse and with it pain. You can warm up only after the "most painful point" has passed. Heat will then enhance the "reabsorption" of the bump. This usually happens in 2-3 days.
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathological treatment (affecting the mechanism of the disease). It comes with symptomatic treatment. For vertebral pain (caused by problems in the spine), it goes like this:
- To reduce swelling of the muscles and spine, a salt-free diet and restriction of fluid intake are prescribed. You can even give a mild potassium-sparing diuretic pill;
- in the acute phase of lumbar osteoarthritis, short-term treatment can be carried out with intramuscular injections of NSAIDs and muscle relaxants: daily, 1. 5 ml intramuscularly for 3 days, 1 ml also intramuscularly during5 days. This will help reduce swelling of nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming maximum pain, no more "injections" should be given, but attention should be paid to restorative drugs, for example, modern drugs of group "B". They effectively restore impaired sensitivity, relieve numbness and paresthesia.
Physical therapy measures continue, it is time to apply exercise therapy for osteoarthritis. Its job is to normalize blood circulation and muscle tone when swelling and inflammation have subsided but muscle spasms have not been completely resolved.
Occupational therapy (movement treatment) includes performing therapeutic exercises and swimming. Exercises to treat cervical spondylosis do not target the discs at all but target the surrounding muscles. Its task is to relieve tonic spasms, improve blood flow and normalize venous outflow. This is what leads to decreased muscle tone, reduced severity of pain and stiffness in the back.
Along with massage, swimming and acupuncture sessions, you should purchase an orthopedic mattress and a special pillow. Pillows to treat cervical osteoarthritis must be made of special material with "shape memory". Its task is to relax the muscles of the neck and suboccipital region, as well as prevent nighttime interruptions of blood flow in the vertebral region.
Fall is a key period in the prevention and treatment of home physiotherapy products and devices - from infrared and magnetic devices, to needle instruments and the most popular ebonite discs, which are the sourceProviding a weak electric current during massage has a beneficial effect on the body. patient.
Exercises for the treatment of osteoarthritis must be performed after a light warm-up, on warmed muscles. The main therapeutic element is movement, not the degree of muscle contraction. Therefore, to avoid recurrence, do not use weights, exercise mats, or exercise sticks. With their help, you can effectively restore range of motion.
Continue rubbing with ointment and use the Kuznetsov implant. Swimming, underwater massage, and Charcot bathing are shown. It is during the period of remission that magnetic therapy drugs and home physiotherapy are prescribed.
Usually, treatment takes no more than a week, but in some cases, osteonecrosis can present with such dangerous symptoms that surgery and emergency treatment may be required.
About Shants' collar
In the early stages, in the acute phase, it is necessary to protect the neck from unnecessary movements. Shants collars are great for this. Many people make two mistakes when buying this necklace. They do not choose it according to their size, which is why it does not perform its function and causes discomfort.
The second most common mistake is wearing it for long-term disease prevention purposes. This leads to weak neck muscles and only causes more problems. As for the collar, there are only two signs that it can be worn:
- Acute pain in the neck, stiffness and pain radiating to the head;
- If you intend to engage in physical work when you are in full health, it risks "stressing" your neck and making it worse. For example, this is fixing a car when you lie under it or cleaning windows when you need to stretch your arms and take awkward positions.
The collar should not be worn for more than 2–3 days, as wearing it longer can cause venous congestion in the neck muscles, at a time when the patient must activate it. An analogue of the Shants collar for the lower back is a semi-rigid corset purchased at a orthopedic store.
Surgical treatment or conservative measures?
Every patient, after the progression of symptoms, when complications arise, should have an MRI and consult a neurosurgeon. Modern minimally invasive operations make it possible to safely remove quite large hernias, without the need for a prolonged hospital stay, without forcing or lying for several days, without affecting the quality of life, as theyperformed using modern video endoscopy, radiofrequency, laser technology or using cold plasma. You can vaporize part of the nucleus and reduce the pressure, reducing the risk of a hernia. And you can completely eliminate the defect, that is, completely eliminate it.
There's no need to shy away from hernia surgery; This is no longer the previous type of open surgery of the 80s and 90s of the last century with its subsequent muscle dissection, blood loss and long recovery period. They are like a small puncture under X-ray control, which is then used using modern technology.
If you prefer a conservative, non-surgical treatment, then know that no one method will allow you to reduce or eliminate your hernia, no matter what they promise you! Neither hormone injections, papain electrophoresis, electrical stimulation, massage, use of leeches nor acupuncture can cope with hernia. Creams and balms, occupational therapy, and even using platelet-rich plasma don't help. And even traction therapy, or traction, despite all its benefits, can only relieve symptoms.
Therefore, the motto for conservative treatment of disc herniation can be the famous saying "minced meat cannot come back". Hernia can only be removed promptly. The prices for modern operations are not so high because they need to be paid once. But annual treatment in a sanatorium can end up costing 10-20 times more than completely removing the hernia without pain and restoring quality of life.
Prevention of osteoarthritis and its complications
Osteochondrosis, including the complications, symptoms, and treatments we discussed above, is for the most part not a disease but simply a manifestation of the aging process. avoidable and premature "shrinkage" of the intervertebral discs. Osteoarthritis needs little to never bother us:
- avoid hypothermia, especially in autumn and spring and fall in winter;
- Do not lift weights and only carry heavy objects with a straight back, in a backpack;
- drink more clean water;
- Don't get fat, your weight should correspond to your height;
- treat flat feet, if present;
- exercise regularly;
- Participate in exercises that help reduce the load on the back (swimming);
- give up bad habits;
- Alternate mental stress with physical activity. After every hour and a half of mental work, the type of activity should be changed to physical;
- You can often have a double-projection X-ray of the lumbar spine or an MRI to see if the herniation is progressing;
By following these simple recommendations, you can keep your back healthy and flexible for life.