Blog written by the Dr. Matias Fernandez Viña, Medical Director of the Stem Cell Therapy in Argentina.
Rehabilitation after the treatment of regenerative medicine for osteoarthritis of the knee.
I was fortunate to receive a scholarship in 2018 for the World congress of Regenerative RehabilitationWorld Congress of Regenerative Rehabilitation at the University of Virginia, aiming to optimize the therapeutic response for my patients.
The Regenerative rehabilitation,is a concept we have been strongly promoting as a complementary therapy to Regenerative Medicine strategies, and it is one of the fundamental pillars of our therapeutic protocols.
Regenerative rehabilitation methods are strategies we have been promoting for many years, and in fact, most of our Regenerative Medicine students now implement them in their clinics.
These programasdeben focus on facilitating the regeneration and functional strength. The gradual progression of the load plays an important role in the framework model of rehabilitation. It is recommended that the cardiovascular training to maintain and improve aerobic capacity, along with the training neuromuscular to maintain muscle strength general, the flexibility and the functional control.A sufficient load will result in changes in the force through adaptation.
The osteoarthritis (OA) is a degenerative disorder common that affects the articular cartilage and the underlying bone, and is characterized by a degeneration of the structural and functional chronicle of a joint. OA tries to repair damaged joints, but chronic levels of inflammation affect this cycle, and the result is a tissue degradation progressive and chronic. More recently, the OA has been defined as a disorder of complex and multifactorial, including genetics, aging, obesity, biomechanics, joint laxity, and poor alignment. Studies show that excessive stress can upset the balance in the joint and, ultimately, result in damage to the cartilage.
During the early stages of OA, there is an initial increase in inflammation, which causes the body's natural immune system to recognize the presence of damage. This results in an influx of inflammatory mediators, ultimately, affect the repair process and lead to a further degradation.
The regenerative medicinewith the use of products ortobiológicos driven from Stem Cell Therapy Argentina, is a field in rapid growth and it is very important that rehabilitation protocols are understood and adopted by the full. The treatment of osteoarthritis using various methods of rehabilitation is extremely important to control and reduce the symptoms of pain and, ultimately, improve the quality of life. The ultimate goal of regenerative medicine is to support and promote effectively the natural mechanisms of the body's healing. The interventions of regenerative rehabilitation involving the treatment of all the structures that surround the affected joint to achieve the relief of pain and prevention of further deterioration.
This article will provide an understanding of the restorative treatment we do from Stem Cell Therapy Argentinafor osteoarthritis of the knee after the treatments in regenerative medicine. Outlining current best practices for the methods of rehabilitation and non-surgical treatment with an emphasis on the promotion of the healing of the tissue and the restoration of the natural functions.
Manual therapy
Manual therapy is the best I like for my patients (those who know me, surely I have heard mention multiple times) and consists of manual techniques specialist that are commonly used to treat pain and dysfunction. Manual therapy is used to treat injuries of the soft tissue and joint dysfunction by increasing mobility, reducing pain and inflammation and increasing the circulation and dynamics of the fluids, which ultimately improves the function and movement. Patients with osteoarthritis of the knee treated with manual therapy and exercise rehabilitation experience improvement clinically enduring the pain, stiffness and functional ability. The mechanisms of manual therapy are to improve the repair, the stability and functions of the tissues.
- Exercise, strengthening and weight control
Moderate physical exercise and well-controlled is associated with a lower risk of knee osteoarthritis serious. The physical exercise will stimulate the production of synovial fluid in the joint, which has a protective effect against cartilage degradation. It has been shown that an exercise program that combines work of endurance and strength in arthritic patients increases the function and reduces pain. In addition, patients with osteoarthritis often experience weakness and muscle atrophy, so that it is necessary to a strength training appropriate. Other benefits include an improvement in bone mineral density, lower risk of falls, increased walking speed, better balance and increased ability to climb stairs.
Although it has been shown that physical exercise is beneficial, the right exercises should involve a trickle charge and be specific for each individual. The mechanical stress is excessive, you can directly damage the cartilage and affect the balance of the joints. The decrease of the body weight also has huge benefits. A complete program of therapy and rehabilitation exercises usually focuses on strengthening the muscles of the knee, the hip and the pelvis. It is strongly recommended that a protocol of regenerative medicine/rehabilitation after a procedure of regenerative medicine.
- Stability, balance and control
The majority of patients older than 60 years with osteoarthritis of the knee reported instability of the knee joint, which is commonly associated with pain and poor function. The reductions in the control and the force associated with patients with osteoarthritis of the knee can often result in a deterioration of the balance and, therefore, you need a training neuromuscular oriented to the control of balance.
The initial training of stabilization of the knee to provide a value added on top of the standard exercises (i.e., strength training/functional). Patients with muscle weakness around the knee and instability should focus on muscle strengthening, whereas in patients with knee instability and strong muscles, the initial training of stabilization of the knee can be beneficial. A combination of strengthening of the lower extremities and training of balance control is essential in patients with osteoarthritis. As with strength training, the mechanical stimulation of articular cartilage generates biochemical signals that increase the activity of growth of cartilage cells.
It is recommended that a combination of strength, stability, balance training and neuromuscular rehabilitation interventions/regenerative medicine later because of the role in the stimulation of cartilage cells and their role in the improvement of the feature.
Acupuncture and dry needling
Acupuncture musculoskeletal and dry needling are treatment modalities that are often used in the treatment of the affections of muscle pain. Clinical trials conducted by Scharf et al. and Chen et al. they concluded that acupuncture in combination with exercise in the treatment of osteoarthritis of the knee has benefits for improving pain and function, at the same time that it reduces the sensitivity.
- Bandages and Theraboots of Therabody Technology
Technologies Therabody and Theraboots are used to provide support, increase local circulation, reduce pain, reduce swelling and provide sensory information; however, not much use in osteoarthritis, although we found good results. The technological devices orthopedic knee have been recommended as an effective device for the treatment of osteoarthritis of the knee in order to achieve changes in the balance sensory, muscle activation, and the reduction of pain that stems from the discharge of the joint. It has been shown that the braces effectively reduce the symptoms of degradation of the medial compartment of both short-term (6 weeks) and medium term.
- Rehabilitation program corrective
Phase 1 should start immediately after the procedure and can last up to a week depending on the pain and the inflammation. In the acute phase, it is advantageous to begin to bear weight and load as soon as it is tolerable. This is because the mobility exercises gentle early and the burden of tissue will have positive benefits in the remodeling and healing of the tissues.
The rehabilitation program for osteoarthritis of the knee should fully incorporate the strength, stability and balance-muscular core, hips, and joints surrounding. The early implementation of these corrective exercises prepare the body for a greater progression of exercises burden to articulate. The exercises will progress to exercises functional multijoint focused.
Phase 1) will focus on reducing pain and inflammation, as well as in the exercises of early loading, according to the tolerance. The exercises weight load full functional should include squats, lunges, dips with a single leg bridges buttocks and lifting dead weight to one leg. The progressions of the exercises will depend on the neuromuscular control and functional mobility.
Phase 2) can begin once the pain and swelling are much lower, and the neuromuscular control and the static stability to reach adequate levels.
Phase 3) can begin once the individual has reached the full mobility.
The phase 4) can be started when the individual to achieve a range of motion is not painful. The consensus statement 2016 on return to the sport was used to inform the rehabilitation protocols and return-to-sport (see the table below). The main treatment modalities included were active rehabilitation to promote healing of the tissues along with PRP or stem cell therapy. Mobilization early and, in the acute stages, load as permitted by the pain. It is recommended that a progression of trickle charging and cardiovascular exercise.
Conclusions
Conventional methods for knee osteoarthritis, mild to moderate focus on the symptomatic relief in the short term and do not promote the regeneration. The regenerative treatments focus more specifically stimulate the regenerative potential. The regenerative treatments involve the use of procedures based on blood and platelet-rich plasma (PRP), stem cells, and procedures for cell-based or bio-engineered tissue. That said, in order to maximize the clinical success of these procedures, regenerative, the standardization in the preparation, administration and monitoring of treatment protocols is imperative. Our rehabilitation program from Stem Cell Therapy for Argentina is proposed and is based on the current evidence and clinical experience related to the rehabilitation of people suffering from osteoarthritis.. There are some interventions that appear promising to support the joint until the regeneration or restoration.
