Erfahrungsheilkunde 2005; 54(3): 154-163
DOI: 10.1055/s-2005-862523
Originalia

Karl F. Haug Verlag, in: MVS Medizinverlage Stuttgart GmbH & Co. KG

Physikalische Therapie der Arthrose - was ist gesichert?

C. Mucha
Further Information

Publication History

Publication Date:
17 March 2005 (online)

Zusammenfassung

Physikalische Therapieformen vermögen u.a. die pathogenetische Entwicklung der Arthrose zu hemmen, indem sie die trophischen Bedingungen des Gelenkknorpels durch Wärmeeinfluss verbessern, myalgisch-myasthenische Dekompensationssyndrome dämpfen und kompensieren. Für diese werden Schmerzbeeinflussung durch Elektrotherapie, Muskeltonusausgleich durch Massagen, gezielte Ausgleichübungen sowie Beweglichkeits-, Kraft- und Koordinationserhalt durch die spezifische Bewegungstherapie angestrebt. Auch die Synovialitis bei aktivierter Arthrose scheint durch entzündungsdämpfende, physikalisch-therapeutische Maßnahmen beeinflussbar.

Inwieweit diese Maßnahmen durch Studienergebnisse gesichert werden konnten, soll anhand einer Literaturanalyse dargelegt werden. Ihre Ergebnisse sowie Probleme in der Beurteilung der Datenlage und bei der Durchführung kontrollierter Studien zur physikalischen Therapie der Arthrose werden aufgezeigt und diskutiert.

Abstract

Physical therapy may inhibit the pathogenetic development of osteoarthritis by improving trophic conditions in the joint cartilage through heat transfer and by soothing myalgic-myasthenic decompensation syndromes. For the decompensation syndrome, analgetic treatment with electrotherapy, balancing of muscular tone through massages, and focused kinesitherapy for improving coordination, as well as maintenance of flexibility, strength and endurance are aspired to. Synovitis in active osteoarthritis can be treated with anti-inflammatory physical therapy measures.

Which physical therapy for osteoarthritis is based on scientific research in literature is reviewed and the results, as well as the problems concerning the data and the design of a controlled study to physical therapies for osteoarthritis, are presented and discussed.

Literatur

  • 01 Akai M, Shirasaki Y, Tateishi T. Electrical stimulation on joint contracture: an experiment in rat model with direct current.  Arch Phys Med Rehabil. 1997;  78 405-9
  • 02 Baker K, McAlindon T. Exercise for knee osteoarthritis.  Current Opinion in Rheumatology. 2000;  12 456-63
  • 03 Bautch J C, Malone D G, Vailas A C. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers.  Arthritis Care Res. 1997;  10 48-55
  • 04 Bellometti S, Cecchettin M, Lalli A, Galzigna L. Mud pack treatment increases serum a anti-oxidant defense in osteoarthrosic patients.  Biomed Pharmacother. 1996;  50 37.
  • 05 Bellometti S, Cechettin M, Galzigna L. Mud pack therapy in osteoarthrosis changes in serum levels of chondrocyte markers.  Clinica Chimica Acta. 1997;  268 101-6
  • 06 Brandt K D. Nonsurgical management of osteoarthritis, with an emphasis on nonpharmacologic measures.  Arch Fam Med. 1995;  4 1057-64
  • 07 Chard J A, Tallon D, Dieppe P A. Epidemiology of research into interventions for the treatment of osteoarthritis of the knee joint.  Ann Rheum Dis. 2000;  59 414-8
  • 08 Easton B T. Evaluation and treatment of the patient with osteoarthritis.  J Fam Practice. 2001;  50 791-7
  • 09 Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R, Fishel B, Yaron M. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis.  J Rheumatol. 1991;  18 (12) 1799-1803
  • 10 Engel J M. Schmerztherapie der Arthrose.  Internist. 1994;  35 41-8
  • 11 Ernst E, Pittler M H. Wie effektiv ist die Kur? Eine systematische Übersicht randomisierter Studien.  Dtsch Med Wschr. 1998;  123 273-7
  • 12 Ettinger W H, Afable R F. Physical disability from knee osteoarthritis: the role of exercise as an intervention.  Med Sci Sports Exer. 1994;  1435-40
  • 13 Falconer J, Hayes K W, Chang R W. Effect of ultrasound on mobility in osteoarthritis of the knee.  Arthritis Care Res. 1992;  5 29-37
  • 14 Fisher N M, White S C, Yack H J, Smolinski R J, Pendergast D R. Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation.  Disability Rehabil. 1997;  19 47-55
  • 15 Forestier R. Magnitude and duration of the effects of two spa therapy courses on knee and hip osteoarthritis: an open prospective study in 51 consecutive patients.  Joint Bone Spine. 2000;  67 296-304
  • 16 Goddard R, Dowson D, Longfield M D, Wright V. Steifheit des Knies bei Gesunden und bei Arthrosepatienten.  Schweiz med Wschr. 1970;  100 862-7
  • 17 Gür H, Cakin N, Akova B, Okay E, Kücükoglu S. Concentric versus combined concentriceccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthritis of the knee.  Arch Phys Med Rehabil. 2002;  83 308-16
  • 18 Hulme J, Robinson V, DeBie R, Wells G, Judd M, Tugwell P. Electromagnetic fields for the treatment of osteoarthritis. Cochrane Library, Issue 2 2002 Oxford; Update Software 1-11
  • 19 Hurley M, Walsh N. Physical, functional and other non-pharmacological interventions for osteoarthritis.  Best Practise Res Clin Rheumatol. 2001;  15 (4) 569-81
  • 20 Hurley M V, Scott D L. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime.  Bri J Rheumatol. 1998;  37 1181-7
  • 21 Jacobi E, Wolf J, Jäckel W, Krüskemper H L. Untersuchungen zur physikalischen Therapie der Coxarthrose.  Akt Rheumatol. 1982;  7 14-8
  • 22 Jan M-H, Lai J-S. The effects of physiotherapy on osteoarthritic knees of females.  J Formosan Med Assoc. 1991;  90 1008-13
  • 23 Leivseth G, Torstensson J, Reikeras O. Effect of passive muscle stretching in osteoarthritis of the hip.  Clin Sci. 1989;  76 113-7
  • 24 Linsheng W, Yanli J. Treatment of bony gonarthritis with herbal medicine and by massotherapy - Analysis of 121 cases.  J Tr Chin Med. 1997;  17 32-6
  • 25 Madsen O R, Bliddal H, Egsmose C, Sylvest J. Isometric and isokinetic quadriceps strength in gonarthrosis; inter-relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain.  Clin Rheumatol. 1995;  14 (3) 308-14
  • 26 Mangione K K, McCully K, Gloviak A, Lefebvre I, Hofmann M, Craik R. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis.  J Gerontol Med Sci. 1999;  54 A M184-M190
  • 27 Marks R, De Palma F. Clinical efficacy of low power laser therapy in osteoarthritis.  Physiother Res Int. 1999;  4 141-57
  • 28 McKinney R H, Ling S M. Osteoarthritis: no cure, but many options for symptom relief.  Cleveland Clin J Med. 2000;  67 665-71
  • 29 Nyholm A, Johannsen F. Ultrasound therapy in musculoskeletal disorders: a meta-analysis.  Pain. 1995;  63 85-91
  • 30 Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Library, Issue 2 2002 Oxford; Update Software 1-14
  • 31 Penninx B W J H, Messier S P, Rejeski J, Williamson J D, DiBari M, Cavazzini C, Applegate W B, Pahor M. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.  Arch Int Med. 2001;  161 2309-16
  • 32 Perkins P J, Doherty M. Nonpharmacologic therapy of osteoarthritis.  Curr Rheumatol Rep. 1999;  1 48-53
  • 33 Puett D W, Griffin M R. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis.  Ann Int Med. 1994;  121 133-40
  • 34 Quirk A S, Newmann R J, Newmann K J. An evaluation of interferential therapy, shortwave diathermy and exercise in the treatment of osteoarthritis of the knee.  Physiother. 1985;  71 55-7
  • 35 Quittan M, Schuhfried O, Wiesinger G F, Fialka-Moser V. Klinische Wirksamkeiten der Magnetfeldtherapie - eine Literaturübersicht.  Acta Med Austr. 2000;  27 (3) 61-8
  • 36 Schmidt K L. Physikalische Therapie und Balneotherapie der Arthrosen.  Ther Umsch. 1991;  48 46-51
  • 37 Stamm T A, Machold K P, Smolen J S, Fischer S, Redlich K, Graninger W, Ebner W, Erlacher L. Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial.  Arthr Care Res. 2002;  47 44-9
  • 38 Stelian J, Gil I, Habot B, Rosenthal M, Abramovici I, Kutok N, Khahil A. Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy.  JAGS. 1992;  40 23-6
  • 39 Sukenik S, Flusser D, Codish S, Abu-Shakra M. Balneotherapy at the Dead Sea area for knee osteoarthritis.  IMAJ. 1999;  1 83-5
  • 40 Svarcova J, Trnavsky K, Zvarova J. The influence of ultrasound, galvanic currents and shortwave diathermy on pain intensity in patients with osteoarthritis.  Scand J Rheumatol. 1988;  67 83-5
  • 41 van Baar M E, Assendelft W J J, Dekker J, Oostendorp R A B, Bijlsma J W J. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee.  Arthr Rheum. 1999;  42 1361-9
  • 42 van Baar M E, Dekker J, Oostendorp R A B, Bijl D, Voorn T H B, Bijlsma J W J. Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months` follow up.  Ann Rheum Dis. 2001;  60 1123-30
  • 43 Verhagen A P, de Vet H C W, de Bie R A, Kessels A G H, Boers M, Knipschild P G. Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Library, Issue 2 2002 Oxford; Update Software 1-15
  • 44 Vuori I M. Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis.  Med Sci Sports Exerc. 2001;  S551-S610
  • 45 Welch V, Brosseau l, Peterson J, Shea B, Tugwell P, Wells G. Therapeutic ultrasound for osteoarthritis of the knee. Cochrane Library, Issue 2 2002 Oxford; Update Software 1-10
  • 46 Wigler I, Elkayam O, Paran D, Yaron M. Spa therapy for gonarthrosis: a prospective study.  Rheumatol Int. 1995;  15 65-8

Korrespondenzadresse

Univ.-Prof. Dr. med. C. Mucha

Med. Rehabilitation und Prävention Deutsche Sporthochschule Köln

Carl-Diem-Weg 6

50933 Köln

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