THE IMPORTANCE OF PHYSICAL THERAPY IN RECOVERY OF

ARTHRITIC JOINTS

Stan Mariana
Ivan Gabriela
Asist. Univ. Drd Dumitrescu Anca
Ecological University of Bucharest

Keywords: Arthrosis, joints, Kinetic treatment, Recovery, Chronic rheumatism degenerative.

Unprecedented developments in the technical field,have led to profound

transformations in the lives of the population.Both freely practiced, exercise and physical
work were reduced due to the increasing degree of comfort and civilization.But reducing the
physical effort has led to the emergence of sedentary, which nowadays has become a disease
of the human civilization. This paper aims to provide, on the one hand, issues of artrozice
diseases, on the other hand put in the foreground elements of anatomy applied in functional
recovery of hip joint arthrosis Briefly in the paper have been included as background
information in advance of the presentation theme successive phases of treatment through
medical gymnastics. During the recovery process, as the social-medical complex, physical
therapy is a therapeutic means. The importance of stemming from her extended herself so
long as the disease evolves. In the case ofarthrosis physical therapy may be extended for a
long duration of time. The treatment of the locomotor system requires the collaboration of a
team of specialists in the fields of : surgery,orthopedics, physiotherapy, physical therapy,
kinetoteraphy, technicians in the field of orthotics and prosthesis, as well as other medical and
paramedical staff, each purpose for which specialist the specific objectives of.
Arthritis are chronic arthropathies, painful sometimes shear characterized by
altering the articular cartilage and hypertrophic lesions of epifiziar bone exostoze. Arthritis are
encountered frequently in people over 50 years after this age their frequency increasing as the
passage of the years. Today ,when average life span has increased significantly compared to
previous years in many countries including in our country approximately 70 years the
proportion that is elderly is particularly high. It is natural that society to handle this part of the
population including healthcare. That's why doctors around the world deal with this type of
ailments common at this age.
It is triggered when certain protein constituents modify while others increase the
number or size of. It is in fact an attempt by the body to repair the cartilage cells proliferation
but the result of this balance between the action of destruction and that regeneration is a
cartilage which make it disappear surface smoothness of connection of bones and that allow
them to slip.
This process is accompanied by a mass production of enzymes that typically sits in
cartilage cells.The action of these enzymes cause local swelling which increases tissue
damage. In soon, small erosions occur on the surface of cartilage that now seems to be full of
small craters. So the neighbor bone will be damaged with cracks and cysts. At the same time
in an attempt to develop the contact surface of bones and thus get greater stability, bone grows
but this os is no longer one normal but is louder and more likely the micro-fractures that occur
especially when the joints supports an unusually high weight. Due to the inflammatory
process each element of the joint undergoes hypertrophy : tendons, muscles, ligaments and
joint capsule.
The progress of this disease varies from patient to patient. This condition
can develop up to the total destruction of the joint, or to stop at a time.There are patients with
deformed fingers but felt no pain, while others may invoke pain while a obvious deformity of
the joints. Arthrosis are common especially in people over 50 years. In the case of joint pains
which shows a young or young 20 years, there is another process typically pathology,
inflammatory
or
mechanical
congenital,
degenerative,
not
one.
Chronic rheumatism, degenerative joint typically affect less one, at least during the onset of
the disease. Most often be seen in the following joints: hip (coxofemoral osteoarthritis or
osteoarthritis); knee (knee osteoarthritis or osteoarthritis); Hand Joints or spine

In advanced osteoarthritis, affected joints may be deformed and increased in volume

due to growths, sometimes exuberant bone extremities. Apart from osteoarthritis pain longer
accompany the delimitation joint range of motion,for example in osteoarthritis sufferer
member not flex as before, ends harder to braid sits difficult position legs.
Arthrosis evolution is chronic, lasting for long periods of time. In the absence of
adequate treatment, degenerative lesions is increasing from year to year, with no other
alternative (once produced no lesions regress).
Arthritic patients typically have the following characteristics sociological: anxiety,
neurotic, limitation of daily activities or work , limitation of joy and personal satisfaction.
Arthrosis diagnosis is made through laboratory namely by radiological
examination that express the corresponding modifications lesions. As a result of the thinning
of the cartilage, joint space is reduced. Densification bone beneath the cartilage eroded by
emphasizing translates's opacity to X-rays and the presence of osteophytes, which appear as
horns, help shape clinical radiological picture. Other laboratory tests, such as those that reveal
an inflammatory process, acute or chronic (VSH, electrophoresis) are normal. The lack of a
biological syndrome of inflammation contributes to the differentiation in terms of laboratory
investigations of arthrosis and arthritis.
Arthrosis causes remain unknown, but it deduce that would result from the
occurrence of fractures. Some reaserchers have judged athroses wrongly, calling them
processes of aging or wear , though neither one nor the other. The process of senescense is
another pathological component. Even though arthrosis are more frequent in the elderly, the
fact that they are not present at all the people who have reached a certain age is an argument
against the theory that consider arthrosis like a simple result of aging process.
Among the factors that play a role in arthrosis are: mechanical factors (static disorders,
microtraumas), endocrine factors ( menopause, acromegaly) , metabolic factors (high
cholesterol and uric acid in the blood).
In obese patients the frequency of arthrosis is higher than those of normal weight , as a
result of some mechanisms: requiring excessive joint support, the existence of metabolic
disorders, circulatorz disorders.
Arthrossis classification, ethiologic criterion: arthrosis primitive ( no obvious cause)
and athrosis secodary ( due to a particular cause, most often a constitutional anomaly).
By palpation we followed the discovery of small subcutaneous nodules, hard, whitish,
sometimes ulcerated. Symmetric palpation allowed me algesia terrain appreciation and
registered maximum joint swelling or periarticular. Pain evaluation we performed with a
discussion he had with patients after palpation of the patella cartilage faces pressure on its top
edge and I appreciated it on a visual analogue scale from 0-10. Sensitivity assessment we
made using an object with internal tibial plateau walked in the popliteal space I asked the
patient if she or something.
The various treatments are applied with the intention of suppressing the
inflammatory process of rheumatoid and hoping to relieve symptoms and prevent joint
damage extension. Among the forms of treatment include: drug treatment, physical therapy;
(Hydrotherapy, Electrotherapy) surgery.
Kinesiology Rehabilitation Program includes:
Posture - complete program for fighting joint stiffness. It starts from the position of
maximum permissible amplitude with stiffness and long-acting external forces while
attempting to increase the amplitude of movement angles. Can be used to help some
proprioceptive neuromuscular facilitation techniques such as alternating contraction isometric
- isotonic, rhythmic stabilization. In osteoarthritis - avoiding flexum's, for deviations in the
frontal plane (varus, valgus) is immaterial direct posture, posture correction is only valid for
walking foot with shoe inserts. Joint mobilization- to maintain or increase the range of

movement.You can use all the techniques known: posture, passive motion, active,etc.
Restoring stability both analytical muscle toning exercises and closed kinetic chain exercises;
Restoration of muscle control dynamic walking (coordination, balance, ability) so as to avoid
limping .Muscle tone: in osteoarthritis muscle tone that will follow knee walking - mainly
quadriceps and hamstrings will pursue recovery extensor force for the last 20 . Restoring
stability both analytical muscle toning exercises and closed kinetic chain exercises, exercise
bike ergonomic indicated individualization for each patient provided the working parameters.
Muscle contractions can be isotonic and isometric. Kinetic treatment follows: control and pain
relief, maintaining / increasing joint mobility, maintain / increase muscle tone, fighting
deformations gait rehabilitation.

CASE STUDIES

CASE NR. 1
NAME: R.M

AGE: 70
PROFESSION: Pensioner
TOWN: Bucharest

FIRST DIAGNOSE: left secondary

gonarthrosis

SECONDARY DIAGNOSES: L5-S1

disc herniation left paralytic operated in
2007, blood pressure
REASON FOR PRESENTATION :
inflamathory
rheumatic
character,
significant weight gain, dyspnea on
minimal effort.
ANAMNESIS: difficulty walking only
with support, family history thereof
rheumatic diseases.

GENERAL CLINICAL EXAM:

PAIN ASSESSMENT: after the first
examination,
assessment
of
visual
analogue pain scale is 7.
INSPECTION: genu valgum secondary
osteoarthritis and disorders of the return
movement, partial facial swelling earlier,
accompanied by redness of the skin
PALPATION : it feels the movement of
patella,limiting flexion and extension due
to joint swelling, limitation of abduction of
the knee joint angle of the thigh with the
leg is 160 , limiting painful internal and
external
rotation
of
the
leg.
SENSITIVITY : diminished sensitivity
to the left knee and the right to a
significant deterioration in mobility
assessment - grade II gonarthrosis of the
laxity (stiffness) moderate between 10 and
20 ASSESSMENT OF MUSCLE
TONE-found strength 4 - patient may
perform a movement against gravity and
resistance against small.

CASE NR. 2
NAME: C.G
AGE: 51
PROFESSION: Unemployed
TOWN: Bucharest
FIRST DIAGNOSE: severe bilateral
gonarthrosis

SECONDARYDIAGNOSE:
amyotrophic lateral sclerosis, hypertension,
obesity grade II
REASON FOR PRESENTATION:
rheumatic pain, venous stasis,
impotence, weight gain importance: about
12 kg, minimum effort dyspnea, severe
pain and to stand upright
ANAMNESIS: impossible walking
without crutches

GENERAL CLINIC EXAM:

PAIN ASSESMENT: After the first
examination,
assessment
of
visual
analogue pain scale is 9.
INSPECTION:
return
movement
disorders, swelling severe bilateral
gonarthrosis genu flexum and of the face
earlier, with redness of the skin
PALPATION: it feels the movement of
patella,limiting flexion and extension due
to joint swelling, limitation of abduction of
the knee joint angle of the thigh with the
leg is 160 , limiting painful internal and
external rotation of the leg.
SENSITIVITY:
deterioration
of
sensitivity.
MOBYLITY: gonarthrossis grade II
with
moderate
laxity
10-20
.

ASSESMENT OF MUSCLE TONE:

found strength 3 , patient performed
movement against gravity , but not
resistance.

For a restoration close to normal, phisical therapy is esential through its tehniques and
methods which has a great value for benefic results. Applying the aproprietly treatment, the
reintegration in daily activities was quickly done. The application exercises, both physical
therapy programs practiced in institutions (hospitals, clinics) and at home, must be observed
regarding individualization methodical effort, but also the correct driving skills training (from
easy to difficult, from the known the unknown, from simple to complex).

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