Osteoarthritis of the knee E-Book

Wolfgang Franz

• Herausgeber: Herbig, F A
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2013

Seitenzahl: 179

Beschreibung

Hope for osteoarthritis patients - this book covers the entire range of therapies to ensure mobility and quality of life. How do I know if I have Osteoarthritis of the knee? When should I consult a doctor? Do I have primary or secondary osteoarthiritis? What does a good diagnosis consist of? Which treatment options are particularly suitable for me? What are the best ways to treat pain? How do I prevent or alleviate the further development of osteoarthritis? Knee specialist Dr. Franz explains the different types of osteoarthritis, covers the range of therapies from natural to high-tech medicine, and takes a look at recommended types of diet, exercise, and sport - and at how individuals can take action to prevent and alleviate the disease. Dr. Franz many years of indepth experience have led him t the conclusion that a multimodal approach - the coordinated combination of various therapies tailored to each individual - works best. The book included information on all diagnostic procedure, dietary guidelines for osteoarthritis patients, special tips for doctors' office hours and physiotherapy, as well as specific exercices for the knee and a self-test for Osteoarthritis of the knee.

Leseprobe

The authors and the publisher have carefully checked the advice contained in this book. No warranty can be granted, however, with respect to the efficacy of this advice. Any liability on the part of the authors or of the publisher and its agents is expressly excluded with respect to health-related damage, injury, or loss, as well as damage, injury, or loss incurred to persons, objects, or property.

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Contents

IntroductionBrief instructions for using this bookThe real wonder cure against osteoarthritisOnline doctor’s office hourSpecialist supportWhat is osteoarthritis?Interesting facts about knees and cartilagesKnees can withstand up to one ton of pressureSlick and glisteningCartilages need exerciseConstruction of the knee jointCartilage attrition in three stagesCauses of osteoarthritis: primary osteoarthritisCauses of osteoarthritis: secondary osteoarthritisBeing overweight and lack of exerciseChildhood skew footOsteochondrosis dissecans (OCD)Leg malpositionsDigression: neighboring joints: hips and feetThe knee forms part of a chain of movement • Biodynamic factors • Biostatic factors • Feet • Intoe and stiff toe • Sesamoid bones • Length of legs • Self-diagnosis • The hipSports injuries and accidentsCruciate knee ligament injuries • Contusion of the kneeLoss of the meniscusWork-related wear-and-tearMetabolismHow can you tell if you have osteoarthritis?Start-up painsTrivial traumaSwollen kneeWorn-out shoesRestricted movement, less powerNoises in the jointWhen should I go and see a doctor?What is the difference between osteoarthritis and arthritis?Inflammation the main factorSuspected osteoarthritis? First steps and diagnosisSelf-testing for osteoarthritis of the kneeSeven tips for osteoarthritisFind the right doctorThe diagnosisUltrasoundX-rayNuclear magnetic resonance tomography (NMR) ScintigraphyThermography cameraDigression: the advantages of tele-medicine for patientsArthroscopyTreating osteoarthritis of the kneeIntroductionDiscovering opportunitiesPresenting risks and limitationsInjections • OperationsDrugs against painProblematic: normal painkillersIndividual therapyCase history: Elisabeth van Lier, 84 years old, receives injections, and goes swimming every morningBetter than conventional painkillers: natural medicineOmega-3 fatty acids • Chondroitin and glucosamine • Willow bark • Devil’s Claw • Arnica • Enzymes • Bromelain • Papain • Cayenne pepper (chili) • Rose hip • FrankincenseRelaxation techniques for painAutogenic trainingProgressive muscle relaxationYogaQigong and Tai-ChiFeldenkrais methodAlexander TechniquePain therapy without drugsAcupunctureElectrotherapyA special type of therapy: TENS Therapy • IontophoresisLaser therapyPain relieving therapy using drugsStep IStep IIStep IIIAdditional ways to treat painTherapeutic local anestheticNeural therapyInfusion treatmentsTreating early-stage osteoarthritisNonoperative treatmentImproving lifestyle • AuBioMo® shoes • Vibration training • Functional Osteopathy and Integration® • Chondroitin and glucosamine • Hydrolyzed collagen • Heat and cold • Massages • Trigger point treatmentOperationsArthroscopy • Meniscus operationTreatment for medium-phase osteoarthritisNonoperative treatmentChondroitin and glucosamine • Hydrolyzed collagen • Orthokin® therapy • Hyaluronic acid • Heat and cold • Massages • Functional Osteopathy and Integration® • Continuous Passive Motion (CPM) • Vibration training • AuBioMo® shoesOperationsArthroscopy • Cultured cartilage cells • Case history: 33-year-old Patrik Kondziella copes with osteoarthritis as the result of a cartilage cell culture • Microfracture • Realigning osteotomy • A special case: osteoarthritis of the kneecapTreatment for severe osteoarthritisNonoperative treatmentAuBioMo® shoes • Vibration training • Orthokin® therapy • Osteoarthritis brace • Case history: with two braces on a surfboard: Dr. Rolf Urtel has a lot of fun in Hawaii despite osteoarthritis • Functional Osteopathy and Integration® • Soft braces • Walking sticks, walking frames, wheelchairs • A time honored method: being stretchedOperation: Microfracture methodCase history: Six weeks on crutches really paid off for bank executive Peter SemmelsbergerOperation: Unicompartmental knee arthroplasty (UKA)Case history: Soccer fan Horst Quell acts as referee with a unicompartmental knee arthroplastyOperation: total knee arthroplasty (TKA)Digression: TKA – how to make full and proper preparations for your knee operationProstheses and sportsThe new joint fits even better with exercise • Suitable types of sport • Less appropriate sportsProphylactic and secondary measuresPrevention through exerciseFitness, coordination, and strengthA focused way to build musclesIndividual types of sportGymnastics • Swimming • Nordic Walking • Cycling • Aqua-jogging • Fitness studioHow to maintain motivationHave a fixed schedule • Make arrangements to go with others • Accepting setbacks • Incorporating exercise into daily life • Set targets • Case history: Following a knee operation at the age of 76, Artur Forsch cycled the Way of St. James pilgrim route to Santiago de Compostela, Spain • Good equipment is important • Keep your sports equipment in sight at all times • Ensure variety • A little is better than nothing at allCoping with difficultiesSignificant overweight and exercise not necessarily incompatible • Acute painSimple knee exercisesStrengthening musclesSitting against the wall • Knee bends • Knee stretching exerciseMobilityKnee swinging • ‘Cycling’StretchingKnee bendsPrevention through nutritionWhat does nutrition have to do with osteoarthritis?Fight free radicalsImportant vital substancesVitamin C • Vitamin E • SeleniumEat fresh food and wholefoodsAvoiding acidityDrink a lot of fluidAppendixTips for further readingInternetScientific studiesAbout the authorsAddressesIndex

Introduction

Statistics make it quickly clear why osteoarthritis of the knee is an endemic disease. Around 10% of the population is affected by osteoarthritis, which means about 30 million people suffer from degenerative diseases of the joints. Some 90% of all people above the age of 65 struggle with osteoarthritis. Cartilage attrition is not the reserve of old age, as 17% of all 34-year-olds also suffer from osteoarthritis. While worn-out knees is the most frequent complaint of sufferers, osteoarthritis of the hip joints is also very widespread.

There are over 200 osteoarthritis therapies available on the market. In this situation, poorly informed patients run the risk of making the wrong choices, and of entrusting themselves to therapies that are of little use. Sometimes this trust is even exploited, and patients end up spending a lot of money on something that makes little difference to their problems.

This book, by contrast, offers a selection of treatment options that have been subjected to thorough medical research. It explains various therapy options, and describes the patient groups they are appropriate for.

Osteoarthritis is a quite complex process, and it’s sometimes difficult to make a really effective impact on the way it tends to develop intermittently. The main aim is to reduce pain in such situations. Basic aid is nevertheless possible, of course. This takes the form of a ‘multi-modal’ approach. ‘Multimodal’ means the treatment consists of various building blocks. Important elements include providing the patient with information about osteoarthritis itself, information about the further development of the disease, a presentation of the various treatment options, and – quite importantly – what individual therapies require of patients themselves in terms of their own initiative.

This self-help book has something quite clear to say on this subject. No doctor in the world can relieve a patient of osteoarthritis when the patient is only able to make a minor contribution to the recovery process. Neither drugs nor operations are of any help without the patient’s own input. Patients must participate actively in their recovery so their condition improves.

Nowadays, being diagnosed with osteoarthritis should no longer leave those affected in despair. A whole spectrum of tried and tested treatment methods is now available. These range all the way from ‘gentle’ natural medicines through to modern operative methods.

Brief instructions for using this book

There are lots of cross references in this book because osteoarthritis is a multi-layered disease, and treatment consists of many elements. Use the references, and try to flick backwards and forwards through the book as you read it. That way you’ll gain the greatest benefit from this self-help manual.

The real wonder cure against osteoarthritis

Please respond very skeptically to people who claim to offer the ‘one and only true wonder cure against osteoarthritis’. Such promises don’t stand up to med-ical and scientific scrutiny because, whatever you might be offered, such wonder cures simply don’t exist. People are just too different for a single therapy to be a universal panacea.

You, yes you, are the only real and genuine wonder cure for your problems! You are the only person who can do something about your problems, and bring about the improvement you’re looking for. ‘Those who can make decisions, conquer pain’ goes a quotation from the famous classical German poet, Johann Wolfgang von Goethe. This prince among poets was certainly right, because a patient’s decision to do something about a problem represents the starting point of any therapy. This is the most important pre-requisite for all good treatments. The real wonder cure consists of four elements: accept – inform – act – persevere.

You can only do something about changing osteoarthritis if you accept the unpleasant fact that you have osteoarthritis. As the next step we recommend you gather all the important facts about the disease, and successful methods of treatment. Then you need to take action yourself. Perseverance is the most important success factor because healing requires time.

Online doctor’s office hour

We are offering you the chance to put your questions about osteoarthritis of the knee to Dr. Wolfgang Franz by e-mail. His e-mail address is: [email protected]. He will try to answer your queries as quickly as possible. Please note that Dr. Franz’s first responses are simply a type of ‘long-distance diagnosis’, and can only provide you with some orientation to begin with. His replies can never replace a personal visit to a doctor if you have serious problems.

If this book helps you avoid osteoarthritis of the knee, dear reader, or if it helps you cope with your knee problems, then together we will have achieved something truly significant.

Dr. Wolfgang Franz

Robert Schäfer

Specialist support

This self-help book on osteoarthritis of the knee presents a multimodal approach. External specialists contributed to some of the modules we present, and some of those mentioned below supported the authors with ideas presented in the book:

Christina Adler-Schäfer, Graduate of Psychology, Viernheim, Germany

Dr. Alfred Baur, Gelenkzentrum Pfalz, Kaiserslautern, Germany

Dr. Johanna Michel, Dr. Hermann Schmidt, and Jutta Schultis from the MVZ Medizinisches Versorgungszentrum for interdisciplinary analgesic therapy, Neustadt an der Weinstrasse, Germany

Gunter Röhrig, owner of two physiotherapy practices in Carlsberg-Hertlingshausen and Weisenheim am Berg, Germany

Tamara Ruzek, director of the Ärztliches Gesundheitszentrum energyfarm in Kaiserslautern, Germany.

Dr. Thomas Schmidt, Orthopädische Gemeinschaftspraxis Ortho 1a, Ludwigshafen am Rhein, Germany

We would like to take this opportunity to thank all of those above for their valuable support.

What is osteoarthritis?

Interesting facts about knees and cartilages

Knees can withstand up to one ton of pressure

As with all other joints, healthy knees are characterized by the fact that the bone areas facing each other are covered in cartilage. This natural material is fascinating. Cartilages consist of 80% water (the rest is mainly made up of so-called collagen fiber), but they can still bear extreme loads. They are capable of withstanding pressure of 2000 lbs per square inch. When a person of normal weight lands on the ground after jumping up into the air, their entire knee has to bear the weight of around one ton.

This load is even greater for those who are overweight. Even if overweight people are rarely seen jumping up and down, their cartilages are nevertheless subject to great stress. Knees have to bear more pressure than nature originally intended for them. The way knees and cartilages are built means they are unsuited to sustained overloading.

Research results, and observations made in day-to-day consultations in doctors’ offices about knees, support the theory that the bodyweight of overweight individuals represents the greatest source of stress for knees. Overweight people’s knees are exposed to the same sort of pressure people of normal weight would experience if they were doing competitive sports all the time, and without a break.

Slick and glistening

Along with extraordinary capacity to act as buffers, cartilages have a unique quality of slipperiness, like that of ice on ice. In fact, there’s hardly a better example of slipperiness when material comes up against material. The expression ’running like a well oiled engine’ could just as easily be applied to a healthy cartilage.

Despite all the successes achieved in the research and development of new materials such as Teflon, there’s so far been no man-made material that offers the same combination of load-bearing capacity and slipperiness. When doctors take a look inside a knee during an ‘arthro-endoscopy’, and the cartilage is healthy, the picture is fascinating. It’s like taking a look at the massive wall of a glacier up in the mountains. Everything is as white as snow, and completely pure. You almost get the impression it’s glistening and sparkling, and covered with a delicate film of liquid.

A knee suffering from osteoarthritis presents a completely different picture. Here, nothing is left of the original beauty of a healthy cartilage. A damaged and frayed cartilage looks like a badly cared-for rug covered in lots of dark brown stains, or like an old street full of potholes.

Cartilages need exercise

Although healthy cartilages glisten like ice, they’re a lot more flexible. They can be pressed together, yet resume their original form when released. Cartilage tissue has special characteristics with regard to the supply of nutrients. All the body’s other organs are supplied directly by the bloodstream. Cartilages, on the other hand, receive their essential supplies from the so-called ‘synovial fluid’ that surrounds them. These nutrients don’t make their own way into the cartilage, however. They have to be ‘kneaded’ in. It’s the same type of movement as when flour is kneaded into dough when making bread. The only way the cartilage can feed itself well is after it has been thoroughly kneaded. That’s why taking plenty of exercise is critically important if you want to have healthy knees.

Construction of the knee joint

The knee joint is filled with the synovial fluid we talked about above. Synovial fluid is stored in the articular capsule that surrounds the entire joint. The articular capsule is covered in a special mucous membrane that produces the synovial fluid.

The lower part of the thighbone and the upper part of the shinbone meet at the knee joint. Bones in the knee joint are covered in cartilage. There’s one meniscus in the inner part of the knee (where the knees touch), as well as one in the outer part. It consists of firm fibrous cartilage, and its shape looks like a half-moon or the letter ‘C’. The meniscus provides a buffer against the impact of enormous weight. It also provides the knee with support in all its movements.

The kneecap is located at the front of the knee. It’s held in place by the tendon of the upper thigh muscle, and designed to transfer weight when stretching. It also protects the sensitive interior of the knee.

Two cruciate ligaments are located in the middle of the knee (‘cruciate’ is a Latin word meaning ‘cross-shaped’, and refers to the way the ligaments cross each other). One of these ligaments is located at the back (the ‘posterior’ cruciate ligament), and one at the front (the ‘anterior’ cruciate ligament). The cruciate ligaments are very important for the stability of the joint. The interior and exterior collateral ligaments (‘side’ ligaments) also provide a great deal of support. The importance of well-developed leg muscles is frequently underestimated. Strong leg muscles support the knee, and provide stability.

Cartilage attrition in three stages

Many factors can result in knee joint cartilages coming under attack: genes, overweight, lack of exercise, or the wrong type of exercise, bearing weight the wrong way, or injuries. People affected by cartilage wear-and-tear detect nothing at all for a long time. The condition only becomes painful when attrition has reached a certain point.

Osteoarthritis (which comes from the Greek word ‘arthros’ meaning ‘joint’) is a disease of the joints that is usually divided into four stages. In this book, we decided to divide it into just three stages: light – medium – severe. The cartilage is in a softened state in a case of light osteoarthritis. The tissue is frayed in the medium phase, and the cartilage looks like ‘crabmeat’, which explains the English definition for this phase. The cartilage already has pronounced dents or potholes in the serious phase of osteoarthritis. The slippery surface is entirely missing in the most serious cases, and the bone is bare.

The anatomy of the knee

Osteoarthritis develops intermittently. The phases when no pain is felt are referred to as ‘silent osteoarthritis’. ‘Activated osteoarthritis’ is the term used to describe the condition when the tissue has become inflamed.

Causes of osteoarthritis: primary osteoarthritis

Primary osteoarthritis refers to osteoarthritis that is assumed to be caused by genetic factors. Negative consequences become noticeable during the course of a person’s life without there being an external reason why the illness has come about. Since some of the reasons for the origin of osteoarthritis are thought to be found in a person’s genes, research into the further development of gene therapy promises to go some way to dealing effectively with cartilage degeneration.

Causes of osteoarthritis: secondary osteoarthritis

Individuals themselves are mostly responsible for secondary osteoarthritis, in contrast to primary osteoarthritis, which is due to genetic factors. The factors behind secondary osteoarthritis have a lot to do with lifestyle, choice of occupation, eating habits, and leisure activities.

Being overweight and lack of exercise

It’s now become a firmly established fact that being overweight can trigger osteoarthritis even when a knee joint is completely healthy. By contrast to lifting heavy weights for a short period, or excess sporting activity, overweight people place their knees under constant stress.

While they themselves are overweight, in other words, they are carrying too much bodyweight, their joints are quite literally ‘skinny’. This is because most heavyweights fail to take enough exercise, and their cartilages are dying of hunger. Their cartilages are chronically undernourished because nutrients from the synovial fluid (please see above on this page) are not being ‘kneaded’ into them.

Lack of exercise isn’t a risk factor for the overweight alone. Even people of normal weight tend to take a passive attitude to life, and adopt an unhealthy approach of just ‘taking it easy’. This can be the start of an unpleasant trend because slim people are no more immune from osteoarthritis than overweight people.

Childhood skew foot

Many parents become concerned when they find their children have skew feet. The heel bends in, while the front part of the foot turns out. This happens to many boys and girls. Childhood skew foot, however, belongs to the normal process of growing up for many. It disappears of its own accord in most cases, and it’s only worth treating if it persists until children are between eight and ten years old. Using arch-supports at too early a stage is never the right approach because it prevents the muscles of the feet from getting enough activity. Running around barefoot, and foot gymnastics, are a much better way forward.

A tip from the doctor’s office hour

Parents need to take an active approach if problems have failed to normalize by the time children are between eight and ten years old. A simple test shows whether action is required. The arch of the foot should be clearly visible when a child is standing on tiptoes (in other words, the arch of the foot should be clearly visible as an arch, rather than as a flat surface). The use of arch-supports should be considered if this is not the case. Only flexible models should be used in all cases. They should not provide too much support for the foot, but should instead require that the foot provides its own support. The more the supports allow the ground to be felt, the better. Stiff supports that provide a prop against everything will fail to achieve the desired effect. There’s just as little to recommend hard and firm shoes.