Conservative orthopaedic therapy refers to non-surgical treatment methods in orthopaedics. Typical conservative therapy methods include physiotherapy, physical therapy, electrotherapy and others. The most important conservative therapies for the treatment of orthopaedic diseases are briefly presented below. You can also find specialists for conservative orthopaedics here.
Physiotherapy works with active and passive exercises to
The patient performsactive exercises independently with increasing levels of difficulty. The patient can also be supported by the therapist's hand during the movements (guided movements). The difficulty is increased by the patient's own weight and later by further (dosed) resistance.
Active exercises are primarily used to improve mobility in cases of mainly muscular functional impairment.
Guided movement exercises © gewitterkind / Fotolia
Passive exercises are used for stiffness that is primarily caused by passive structures. These include
These exercises are mainly stretches and tractions. The patient can use mechanical aids, such as
Isometric, isotonic and isokinetic exercises promote muscle action:
Isokinetic exercises produce the greatest increase in performance (strength and endurance training in sport, "bodybuilding") when weights or complex exercise equipment are used on which the speed of the action changes can also be adjusted (Cybex training equipment).
Static muscle performance (holding work), on the other hand, quickly leads to a lack of blood flow with an oxygen deficit and thus to fatigue. It is therefore unphysiological.
Physiotherapy methods based on neurophysiology require special attention. They deal with special techniques of proprioceptive and developmental kinesiological control of movement sequences. They are used, for example, for young children with motor disorders. They are also used for dynamic contractures as an expression of impaired coordination (Voita or Bobath method).
Exercise programs are carried out in the form of individual and group gymnastics in the exercise room or in the exercise pool. The therapist gives instructions on how to use the training equipment and creates home programs for the patient's individual activities at home.
General physical development should be promoted through school gymnastics, gymnastics, sports, etc.; as a rule, no specific physiotherapy is required.
Specialist medical treatment as part of physiotherapy treatment, on the other hand, is required for, among other things
are necessary.
Special forms of care include special school gymnastics for children with poor posture and sports for the disabled.
Certain hand movements, such as
promote localized increased blood flow through vasodilation and current acceleration in capillaries and lymphatic channels. This results in
This is associated with relaxation, relaxation and indirect pain relief.
Trigger points are tense muscles with hardened pressure-sensitive pain points. Trigger point massage can be very useful here. Trigger points typically not only cause localized pressure pain, but also radiate into more distant regions of the body. The principle of trigger point treatment is explained in the video:
Massages can produce a positive effect from the skin to the internal organs. This activation of cutivisceral reflex mechanisms also has an effect on
Special techniques for this are connective tissue massage and reflex zone massage, for example of the feet.
Lymphatic drainage is suitable for
In general, massage has the effect of improving well-being, general relaxation and calming (parasympathetic stimulation). Massage cannot increase the strength of the muscles!
Special methods make use of equipment such as underwater jet, suction and vibration massage.
Massages stimulate blood circulation, among other things © wildworx / Fotolia
Chirotherapy is also known as manual therapy or chiropractic. This includes medical measures to mobilize fibrously stiffened joints through
Chiropractic therapy uses certain manipulations to treat functional structural disorders of limbs and vertebral joints. The manipulations are limited
In doing so, they release mechanical locking mechanisms (blockages). They also mobilize the local reflex mechanism by stretching the capsule and ligament apparatus.
Chiropractic therapy can release blockages © pololia / Fotolia
This therapy requires special knowledge and subtle mastery of its indications and techniques. Strict contraindications are
Manual therapy also includes physiotherapeutic passive movement exercises. They improve the mobility of joints and relieve chronic pain caused by tension.
Occupational therapy is a functional extension and supplement to physiotherapy.
It uses a variety of effective methods with which impaired arm and finger functions in particular can be restored in a quasi-playful manner. The methods are based on household, occupational or leisure activities.
Occupational therapy can be used to restore motor functions © shootingankauf / Fotolia
If necessary, irreversible loss of movement can be corrected by
compensated. The aids range from simple adjustments to eating utensils to complex splints and work equipment.
Thermotherapy (hyperthermia treatment) and hydrotherapy (water application) utilize the effect of, among other things
on the body.
In thermotherapy, heat or cold is used. Heat leads directly to vasodilation, hyperemia and the acceleration of metabolic processes. Cold initially causes vasoconstriction (vasoconstriction). After exposure to cold, the capillaries also dilate with "reactive" hyperemia.
In principle, heat and cold have the same biological effects, depending on the intensity and duration of their impact.
Thermotherapeutic holistic stimulus combinations include
The therapy makes use of their circulation-promoting, metabolism-stimulating and relaxing effects.
These positive effects are already described in the water therapy founded by Sebastian Kneipp and have proven themselves many times over. They also serve to prepare and support other types of treatment, such as massage and physiotherapy.
Baths have a relaxing effect on body and mind © Stavros / Fotolia
Local heat application, for example with
are particularly suitable for chronic, non-inflammatory pain conditions (e.g. arthrosis).
Local exposure to cold (cryotherapy) in the form of
On the other hand, it is more suitable for acute inflammatory processes or fresh blunt injuries.
Water is of great therapeutic importance due to its physical and chemical properties. Thermal effects are potentiated in the bath. At the same time, water serves as a vehicle for transcutaneously active pharmaceuticals (mud baths, sulphur baths, etc.).
The buoyancy of the water makes body weight and all movements easier. Exercise therapy in the exercise bath is therefore an important addition to physiotherapy.
Immobilization and relief are used in the treatment of musculoskeletal disorders.
A painful, overloaded, inflamed or infected part of the body usually requires rest. Reducing the usual strain or bed rest is often sufficient. Immobilization is carried out locally with the help of splints or bandages, and on the spine with corsets or braces.
Immobilization is always associated with stagnation of the local circulation and metabolism. Therefore, after some time it leads to tissue damage with
It should therefore only ever be carried out as a means to an end, i.e. no longer than necessary.
Relief is not the same as immobilization. For example, a diseased limb section can be immobilized with a bandage or orthosis, but mobility can be maintained.
Positioning treatment is used to maintain a certain position in order to
Aids for this include
Bandages are necessary to support limbs or the trunk
The bandaging technique therefore plays a particularly important role in orthopaedics.
Positioning treatment can alleviate pain © C. Schüßler / Fotolia
Compressive bandages are mainly used
can be considered.
Tape bandages support a joint by overlapping and aligning the bandage like a roof tile and eliminate painful movements. They are particularly useful in sports practice.
The material used is usually elastic bandages, Elastoplast or zinc paste. Ready-made bandages and support stockings made of elastic textiles are also suitable.
For fixed bandages, the plaster cast has been unsurpassed for 150 years due to its properties. It is permeable to air and easy to work with. Today, however, it is often replaced by lighter and waterproof plastic bandages.
For the fixation of fractures or as a positioning shell, the bandage is usually applied without padding. Absorbent cotton or cellulose pads protect protruding bone parts and superficial nerves (e.g. on the fibula head!).
Some swelling is to be expected after some operations and after position corrections. To immobilize the limb, more padding must be used or the bandage must be cut open (split). Alternatively, circular bandages can be dispensed with completely during the swelling period (shell bandage).
In any case, the following are essential
There are also special plaster casts or walking casts with a rubber, plastic or wooden buffer on the sole.
The purpose of the relieving plaster cast is to free certain sections of the limb from body weight. In this way, the load, e.g.
can be supported.
Other possible dressings are
An extension can also be applied to the spine:
Orthoses are aids to be worn and applied externally. They start with bandages,
and extend to splints, which have a supporting function and allow controlled mobility.
Knee supports help the muscles to stabilize the joint © Picture-Factory / Fotolia
The large number of knee braces available should be mentioned here. They are used particularly after surgical procedures such as ligament plastic surgery.
Some of these orthoses have to be worn over a very long period of time. They are also often used as a preventative measure, particularly for intensive sporting activities. However, mechanical stabilization does not provide protection.
Instead, proprioception triggers the muscular protection. This means that the pressure of the support stimulates the muscles to tense up accordingly. This also directly stabilizes the affected joint.
Orthotic treatment options are also available
Medication is used in orthopaedics primarily
The primary aim is to eliminate or reduce the symptoms of peripheral pain. Centrally acting painkillers are
are considered.
In most cases, non-steroidal anti-inflammatory drugs (NSAIDs) are used, which have an analgesic and anti-inflammatory effect. Their systemic prescription depends on the dosage and duration of the disease. The rule is: as effective as necessary, as short-term as possible.
The following groups of drugs are generally suitable for pain relief:
Non-steroidal anti-inflammatory drugs - NSAIDs
Non-steroidal anti-inflammatory drugs are medicines that can both relieve pain and suppress inflammation. Sometimes these drugs are also called non-steroidal anti-inflammatory drugs, which means that they are cortisone-free anti-inflammatory drugs. Most doctors simply abbreviate this to "NSAIDs".
Anti-rheumatic drugs are not only prescribed for rheumatic diseases. They are also used for many other painful diseases.
Medication is used in orthopaedics to treat pain and inhibit inflammation © Lyudmyla V / Fotolia
How do anti-rheumatic drugs work?
Anti-rheumatic drugs inhibit the formation of prostaglandins. Prostaglandins are messenger substances that perform various tasks in the body. Certain prostaglandins play a role, for example, in the development of
an important role. Other prostaglandins have important protective functions. For example, they protect the mucous membranes of the stomach and duodenum from aggressive stomach acid.
Two enzymes are responsible for the formation of prostaglandins: cyclooxygenases 1 and 2, COX-1 and COX-2 for short. There is a crucial difference between the two enzymes:
Development of painkillers that are gentle on the stomach
The researchers used this knowledge to develop a new generation of anti-rheumatic drugs. Until then, there were only conventional anti-rheumatic drugs that inhibited both COX-1 and COX-2. Although conventional anti-inflammatory drugs relieve joint pain, they can also lead to severe stomach problems.
It has now been possible to develop drugs that only suppress the formation of COX-2. Medication specifically inhibits only the prostaglandins that are responsible for pain and inflammation.
Injections, punctures and infiltrations
Medication is applied locally either by targeted injection of an anesthetic (Scandicain® 0.5-1%). It is usually combined with a corticosteroid preparation (prednisolone crystal suspension).
Areas of application are
Joint puncture is carried out under strict asepsis to prevent the introduction of germs into the joint capsule.
In the case of diseases of the spinal column, for example spondylosis, it is possible to inject around the spinal roots. Treatment can also be carried out by switching off vegetative functions in the area of the stellate ganglion. This interrupts the transmission of pain from a nerve node in the thoracic spine.
Systemic application of steroid-containing preparations (cortisone) is not usually necessary in orthopaedics. In addition, prolonged application would be associated with risks such as
Exceptions include chronic polyarthritis and the first stage of Sudeck's disease(Sudeck's disease or CRPS) under strict control.
Centrally acting painkillers: opioids
Some people think that pain has to be endured. But that is wrong! Modern pain therapy offers effective weapons against even the most severe pain. Opioids are among the most important weapons against severe pain.
They are similar to the body's own endorphins and inhibit pain in the brain and nerve tracts. They act via special docking sites, the opioid receptors. These are located primarily in the spinal cord and at pain conduction sites in the brain, but also in almost all organs and on tumor and inflammatory cells.
Opioids can prevent the sensation of pain from becoming established in the brain and thus create a pain memory. They also normalize hypersensitivity to pain stimuli.
Opioids are prescribed for severe and very severe pain, e.g. for
They are used in particular when pain cannot be adequately treated with simple painkillers.
Important: Opioids differ in terms of
If pain cannot be alleviated with one preparation, your doctor will try a different preparation. In this way, seemingly untreatable pain can sometimes still be successfully treated.
Side effects - not equally common with all preparations
In terms of side effects, unwanted constipation in particular often causes problems. Other side effects, especially at the beginning of treatment, include nausea and drowsiness. However, they usually disappear by themselves after three to four days, or a week at most.
Unlike simple painkillers, opioids do not damage the stomach, intestines, kidneys or liver, even if taken continuously.
If an opioid quickly reaches high levels in the blood, i.e. if it "floods" quickly, psychological dependence can develop. This is the case with some opioids that are injected into the bloodstream by drug addicts, for example.
This risk no longer exists for slow-release substances that are administered by mouth. Fears of psychological dependence are therefore unfounded if the preparations are taken in accordance with the doctor's recommendations.
Drugs to influence the skeletal metabolism are
Chondroprotectants (from chondro - cartilage) are intended to
For oral and intra-articular application are
on the market. However, the effectiveness of such "anti-arthritics" is not always scientifically proven.
Infection of joints and bones due to medical treatment (iatrogenic injury) can have catastrophic consequences. For this reason, a sterile environment during treatment with syringes and cannulas through careful asepsis is mandatory.
Preventive administration of antibiotics during surgery may be advisable in high-risk cases. Otherwise, they are generally used in a targeted manner
Medication can be administered orally, parenterally by injection or continuous infusion, but also locally by irrigation or irrigation drainage.
Long-term oral administration of several preparations with the broadest possible, overlapping spectrum of action may be recommended for
is indicated.
The control of blood coagulation processes plays a role during long periods of recumbency and operations on the lower extremities. It is primarily necessary for hip and knee joint operations.
Elderly people and women taking contraceptives are particularly at risk. Thrombosis prophylaxis with heparin and coumarin preparations in accordance with the laboratory test results is particularly important here.
Electrotherapy includes all applications of electric current for treatment purposes. Various types of current with different biological effects are used in electrotherapy.
On the one hand, the electric current causes an exchange of ions in the tissue and changes in the charge of the cell membrane with stimulation of the interstitial sap flow. On the other hand, depending on the form of current, it leads to contraction stimuli in the muscle cells. It can strengthen or weaken action impulses in the nerve cells.
The current flow is always associated with a heat effect.
Various types of current with different biological effects are used in electrotherapy:
Direct current: Its continuous flow has a calming effect on the pain receptors and promotes metabolism. The most common forms of application are galvanic baths (Stanger bath),
Iontophoresis is the application of medication through the body's surface using a galvanic current. Histamine is often used to produce strong hyperemia and pain relief in muscles and joints.
Low-frequency alternating currents (faradization, up to 1 kHz) have proven themselves as so-called stimulation current therapy for the application of nerve and muscle actions, among other things. They can be used in many different ways for both therapeutic and diagnostic purposes.
The so-called exponential current technique is very suitable for stimulating atrophic or paralyzed muscles. The healthy muscle has the ability to adapt to a slow increase in current intensity. There is no stimulation as long as excessive currents are reached.
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