Treatment with leeches can be considered for knee osteoarthritis. This is supported by positive experiences from practice and from individual studies. In her guest contribution, the Berlin naturopath Simone Max von Maxen presents the method in more detail and explains how a treatment of knee osteoarthritis with leeches can be meaningfully supplemented.
Complementary therapy options for knee osteoarthritis
Osteoarthritis is the most common joint disease worldwide. Her symptoms include pain in the affected joints and stiffness and restricted range of motion. The arthrosis is (from a medical point of view) not curable.
The likelihood of developing osteoarthritis increases with age. A genetic predisposition to osteoarthritis has been demonstrated. The factors that favor the development and progression of osteoarthritis, especially in the lower extremities, include above all a lack of exercise and obesity as well as malpositions (X or O legs, flat feet, hip dysplasia) and overloading of the joints, for example in the Sport or work. Joint trauma from injuries or surgery also increases the risk of developing osteoarthritis.
Osteoarthritis is characterized by the destruction of the cartilage in the joint. The cartilage layer on the contact surfaces of the bones is there to elastically buffer loads and protect the bones. The cartilage is supplied solely by the synovial fluid, so it is necessary that the joint is moved and stressed, only through movement the joint fluid is kept flowing and the cartilage is supplied with water and nutrients, as well as waste materials are disposed of. The cartilage has only a low ability to regenerate, which also diminishes with age and soon reaches its limits under permanent heavy stress.
If the load is too high in the long run, the cartilage is first replaced by an inferior cartilage until it is no longer sufficient and the cartilage shrinks. In addition, there is often inflammation of the other joint parts such as the joint capsule, ligaments and tendons. And it is these inflammations that cause pain and cause swelling of the joint and make movement difficult.
This also explains why many arthrosis are barely visible on the x-ray, but cause great pain. The cartilage is still there, but the inflammatory activity is high. On the other hand, many arthrosis are discovered as a coincidence, the joint gap is reduced (the cartilage has become thinner), but the joint does not hurt because the surrounding joint structures keep the joint functioning.
Not every osteoarthritis is the same. And the diagnosis says little about the quality of movement and the treatability of the disease.
Therapy of knee osteoarthritis: that's what conventional medicine does
In conventional medicine, arthrosis is mainly treated with the following measures.
1. Pain relief topically and orally, especially with NSAIDs and COX-2 inhibitors
2.Inflammatory inhibition mainly through corticosteroids (intra-articular)
3. Physiotherapy, occupational therapy
4. Orthopedic aids (such as shoe insoles)
5. "Cartilage protection" hyaluronic acid (intra-articular), glucosamine (oral)
The guideline recommends a thorough patient education and the creation of an individual care plan by means of joint decision-making by the doctor and patient.
In fact, most patients are given generous amounts of pain relievers (often in combination with proton pump inhibitors to protect the gastric mucosa). Physiotherapy and occupational therapy are prescribed or used very sparingly. Weight control and sporting activities are rarely discussed. Syringes with cortisone and hyaluronic acid, however, are very popular as a private service.
The topic of surgery is usually brought up very quickly.
Germany has been world champion in the frequency of knee surgery for decades, unfortunately with rather moderate long-term success.
Additional therapy options for knee osteoarthritis
Considering the rather older clientele and the risk of long-term use of pain relievers, alternative or additional therapy options should be considered, and not only when all other options have been exhausted. The guideline names numerous complementary therapeutic approaches, but due to the lack of large-scale studies, these are only recommended if nothing else is possible.
It is therefore very surprising that no (recommendable) statement is made about leech therapy "due to the study situation", but at the same time the strong evidence for short-term effects on pain, functionality and stiffness, as well as the moderate to strong evidence for long-term effects, is pointed out . The reason for the "non-recommendation" is that the studies are too small, and of course cannot be blinded and placebo-controlled.
Treatment of knee osteoarthritis with leeches
Leech therapy is a procedure that has been proven for centuries. Among other things, leeches are used to treat varicose veins. Recent research, for example carried out at Charité Berlin by Professor Michalsen and his team, has been able to demonstrate their effectiveness in osteoarthritis (especially in knee osteoarthritis and thumb saddle arthrosis).
Leech therapy works through various mechanisms. On the one hand, blood withdrawal (up to 50 ml per leech, including subsequent bleeding) removes the “old blood” from the tissue. The numerous substances that the leech simultaneously releases into the bite site can accelerate the lymphatic flow, dissolve small blood clots, and reduce blood clotting. The intercellular tissue is cleaned. There is direct pain relief through the secretion of the gel and, moreover, long-term pain relief through the cleaning and decongesting of the tissue. The inflammation in the joint can be brought to an end, the joint gap, in which cartilage debris is often deposited, can be cleaned, which can be used to prevent future inflammation. The nutrition of the remaining cartilage (it takes place via the synovial fluid) can be improved. All of this, and this is the highlight, with the help of the body's immune system and not against it, because the egg substances regulate the body's immune cells. Without injuring the joint capsule and with comparatively few side effects.
The treatment takes 1.5 to 2 hours and after a few days the joint can be fully loaded again.
However, the patient and his therapist should not sit back and relax. Rather, the pain reduction / freedom from pain and mobility regained should be used to take further measures to maintain the newly gained quality of life. This definitely includes exercise such as cycling, swimming and dancing. Physiotherapy or occupational therapy can be used to point out and correct incorrect posture and stress.
In any case, the patient should listen to the signals from his body and take a break if the pain reappears.
The leech therapy with the Feldenkrais method is a useful addition
I personally recommend the Feldenkrais method. They make it possible to become aware of your own movement patterns and to learn new movement variants (which are often easier and less strenuous). This learning is done by experiencing your own physical possibilities and functional relationships: the knee in connection with the ankle and foot, the metatarsal with the fibula. The fibula with the hip joint, the pelvis, the spine, etc. The functionality of a damaged knee can be supported via many elements. The Feldenkrais method works very gently and painlessly with very small and pleasant movements.
Joints are moved by muscles and an unfavorable interaction between the synergists and the antagonists can maintain painful conditions. The activity of the muscles is controlled via the nervous system, and this is where the Feldenkrais method comes in, because the “improvement” in the functioning of the nervous system is done through learning.
It was a lengthy knee injury that inspired the method's inventor, Moshe Feldenkrais, to develop his method when his second knee was badly injured in an accident. He remained active in sports and mentally into old age without ever undergoing surgery.
What else can be helpful
Osteoarthritis rarely comes on its own, and there are many indications that a general improvement in the metabolic situation can slow down the development and progression of the arthritis.
Obesity not only contributes to the formation of arthrosis through its high body weight, but it is also the fat cells themselves that promote the degeneration of the connective tissue and thus the cartilage through the release of inflammation-promoting cytokines.
A generally poor supply of nutrients and fluids to the joints can also be promoted by increased uric acid in the blood and by a general chronic acidification of the tissue.
It is therefore imperative to also focus on the diet and to ensure an adequate, healthy diet.
Here too, phytotherapy (herbal medicine) makes a valuable contribution by having a lasting effect on the metabolic state. Excess acid is removed and the intercellular tissue is cleaned. The healing of inflammation is promoted, swelling can disappear more quickly. The function of the kidneys, liver and intestines is supported, this is especially important if medication (painkillers, sleeping pills, cortisone etc.) is already being taken.
Numerous plants, such as rosehip and devil's claw, are known to work directly on the joints and should be considered when treating osteoarthritis.
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