patmedfarПациентоориентированная медицина и фармацияPatient-Oriented Medicine and Pharmacy2949-1924LLC Izdatelstvo OKI10.37489/2949-1924-0055YHJLXEpatmedfar-99Research ArticleФИЗИЧЕСКАЯ И РЕАБИЛИТАЦИОННАЯ МЕДИЦИНАPHYSICAL AND REHABILITATION MEDICINEПочему лечебная физкультура является лучшим методом лечения остеоартрита коленных суставов?Why is therapeutic exercise the best treatment for knee osteoarthritis?https://orcid.org/0000-0003-3456-9409НосковС. М.NoskovS. M.

Носков Сергей Михайлович — д. м. н., проф., зав. кафедрой госпитальной терапии с профпатологией

Ярославль

Sergey M. Noskov — Dr. Sci. (Med.), Prof., head of the department of hospital therapy with professional  pathology

Yaroslavl

noskov03@gmail.comМаргазинВ. А.MargazinV. A.

Маргазин Владимир Алексеевич — д. м. н., проф.,  кафедра медико-биологических основ спорта и теории физической культуры

Ярославль

Vladimir A. Margazin — Dr. Sci. (Med.), Prof., Department of Medical and Biological Foundations of Sports and  Theory

Yaroslavl

V.Margazin@yandex.ruhttps://orcid.org/0000-0002-0675-0967БашкинаА. С.BashkinaA. S.

Башкина Александра Сергеевна — д. м. н., доцент, кафедра медицины

Ярославль

Alexandra S. Bashkina — Dr. Sci. (Med.), Associate  Professor, Department of Medicine

Yaroslavl

SashaSN@mail.ruhttps://orcid.org/0000-0002-6623-6230ШепеляеваЛ. С.ShepelyaevaL. S.

Шепеляева Людмила Сергеевна — ассистент, кафедра поликлинической терапии, клинической, лабораторной диагностики и медицинской биохимии

Ярославль

Lyudmila S. Shepelyaeva — assistant department of polyclinic therapy, clinical laboratory diagnostics and medical biochemistry

Yaroslavl

shepel17511751@gmail.comhttps://orcid.org/0009-0007-3655-2172ПаруляО. М.ParulyaO. M.

Паруля Олеся Михайловна — к. м. н., ассистент  кафедры госпитальной терапии с профпатологией

Ярославль

Olesya M. Parulya — Cand. Sci. (Med.), Assistant of the department of hospital therapy with professional  pathology

Yaroslavl

karabaska1@yandex.ruhttps://orcid.org/0000-0001-9803-0037НагибинР. М.NagibinR. M.

Нагибин Роман Михайлович — к. м. н., ассистент  кафедры госпитальной терапии с профпатологией

Ярославль

Roman M. Nagibin — Cand. Sci. (Med.), Assistant of the department of hospital therapy with professional pathology

Yaroslavl

nagibinrm@gmail.comФГБОУ ВО «Ярославский государственный медицинский университет»РоссияYaroslavl State Medical UniversityRussian FederationФГБОУ ВО «Ярославский государственный педагогический университет им. К. Д. Ушинского»РоссияYaroslavl State Pedagogical University named after K. D. UshinskyRussian FederationФГБОУ ВО «Ярославский государственный медицинский университет»РоссияYaroslavl State Medical University, YaroslavlRussian Federation202431102024232128Copyright © Носков С.М., Маргазин В.А., Башкина А.С., Шепеляева Л.С., Паруля О.М., Нагибин Р.М., 20242024Носков С.М., Маргазин В.А., Башкина А.С., Шепеляева Л.С., Паруля О.М., Нагибин Р.М.Noskov S.M., Margazin V.A., Bashkina A.S., Shepelyaeva L.S., Parulya O.M., Nagibin R.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pomph.ru/jour/article/view/99

Остеоартрит коленных суставов (ОА КС) имеет высокую социальную значимость и, соответственно, является актуальной патологией для научных исследований. Авторами предложена оригинальная гидравлическая теория патогенеза ОА КС. В её основе лежит представление о первичном механическом повреждении внутренних связочных структур и синовиальной оболочки, сопровождающимся посттравматическим отёком с синовиальной гиперволемией и гипертензией.

Авторы доказывают, что только применение регулярных физических нагрузок на всех стадиях заболевания патогенетически обосновано и позволяет улучшать лимфатический и венозный отток и, таким образом, противостоять  нарастающему фиброзу. Улучшение артериального кровотока при этом будет уменьшать тканевую гипоксию. Любые виды симптоммодифицирующей терапии могут быть вредны, снижая защитную роль болевых рефлексов в предохранении КС от избыточных нагрузок с повреждающими последствиями. Подчёркивается необходимость поддержания больными скорости ходьбы более 4,3 км/час с увеличением каденса, как с точки зрения снижения статического напряжения при ходьбе, так и удлинения продолжительности жизни.

Osteoarthritis (OA) of the knee joints (KJ) has a high social significance and is therefore a relevant pathology for scientific research. The authors have proposed an original hydraulic theory for the pathogenesis of OA in KJ. This approach is based on the notion of primary mechanical damage to the internal ligamentous structures and synovial membrane accompanied by posttraumatic edema, synovial hypervolemia, and hypertension. The authors demonstrated that regular physical activity at all stages of the disease is pathogenetically justified and allows the patient to improve lymphatic and venous outflow and thus resist increasing fibrosis. Improved arterial blood flow will reduce tissue hypoxia. Any type of symptom-modifying therapy can be harmful because it reduces the protective role of pain reflexes in protecting the KJ from excessive loads, leading to injury. The necessity of maintaining a walking speed of more than 4.3 km/h with an increase in cadence is emphasized from the perspective of reducing static stress during walking and extending life expectancy.

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The authors declare that there are no conflicts of interest present.