PHYSICAL THERAPY OF PATIENTS WITH POST-TRAUMATIC GONARTHROSIS WITH IMBALANCE OF OSTEO-ASSOCIATED MACRONUTRIENTS

Abstract

According to modern concepts, bone remodeling disorders that are directly dependent on the imbalanceof osteo-associated trace elements play a key role in the pathogenesis of OA. Therefore, the purpose of ourstudy is to develop the program of physical rehabilitation of patients with post-traumatic gonarthrosisand to investigate its effect on the composition of osteoassociated macronutrients.To determine the metabolic function of bone tissue there were the results of the study of mineralhomeostasis by the level in the peripheral blood of phosphorus and magnesium, total calcium and itsionized form, as well as the amount of urinary calcium excretion. The processes of bone formation wereevaluated by the content of bone isoenzyme of alkaline phosphatase, bone resorption was evaluated bythe level of tartrate-resistant acid phosphatase. 42 patients with post-traumatic osteoarthritis of the kneejoints of I–II stages according to Kellgren-Lowrence were observed.The complex of physical therapy included the educational program, medical gymnastics and massage.The theoretical part of the program included 6 topics covering the main issues related to the risk factorsand prognosis for the disease, the main mechanisms of its progression, as well as the basics of differentphysical therapy use. The practical part of the program was carried out in a small-group way and includedthe gradual application of static, dynamic, active and proprioceptive neuromuscular stretching usingthe exercises with elastic bands and metered loading. As for the massage technology a combinationof segmental massage with Swedish technique was used in the program. The total duration of the complexprogram was 9 months, after which patients were advised to perform independent classes. The applicationof the developed program of physical rehabilitation had a positive effect on the processes of boneremodeling, and allowed to reduce the number of exacerbations during the year.