Everyone has heard of this disease. It attacks suddenly, thwarting people’s life plans and speeding up the process of the body’s decay. It is a block on the extension of the life cycle. It is a brake that prevents people from attaining eternal youth, and science is still yet to puzzle it out. But now doctors and research centres are at the forefront of first-hand knowledge of this disease, and are close to eliminating the illness called arthrosis.
We met Christian Schlegel MD after his working day. Christian Schlegel is the head of the Swiss Olympic Medical Center in Bad Ragaz and a major specialist in this area. His schedule is organized down to the last minute. He treats current and future Olympic champions, as well as anyone who wants to look and feel better. He knows almost everything there is to know about bone and joint diseases.
– Dr. Schlegel, what are the main reasons for this disease?
– A predisposition to arthrosis depends on many factors. First, we should take into account people’s hereditary predispositions; arthroses of the knee-joints, hip joints and hand joints are to some extent family diseases. I would put nutrition in second place. People who eat a lot of acidic food, meat and only a small amount of fruit and vegetables are the most vulnerable. Excess weight could also be a predisposing factor, because it puts pressure on joints, and fatty tissue stimulates factors that provoke inflammation. Arthrosis also develops gradually after one severely injures a joint, such as rupturing the cruciate ligaments, meniscus injuries or arthrodial cartilage. Age also plays an important role; the older the person is, the greater the risk of these diseases.
– Which joints are usually damaged by arthrosis?
– Arthrosis most commonly occurs in the areas of the knee joints, hip joints, and back zygapophysial joints in the lumbosacral and cervical vertebrae, which is the most difficult case to diagnose.
– How can a lay person recognize this disease? What are the most common symptoms?
– If you find a swollen joint, then you need to work out why it has swollen up. If the joints seem red and hot, it means that they are inflamed. Occasionally, this inflammation is accompanied by a lump or swelling. The restricted mobility of joints with an acute onset should be cause for alarm. This is often observed in the knees, when you unexpectedly cannot bend or extend the joint completely. If you shake it or turn it, the feeling seems to disappear. Another point, which relates mostly to young people and children, is that if you feel pain in your joints for more than 2–3 weeks you should consult a doctor immediately.
– What if I don’t have any spare time? What if my desk is overflowing with paperwork, my head is full of problems, and I cannot do it right now? Is arthrosis really dangerous if it is not treated?
If you have normal arthrosis, which is just a slight inflammation, then it does not matter. But if you have a really warm and swollen joint, don’t hesitate to see a doctor. There might also be an infection of your joint, and this would be a really urgent situation.
Despite progressive joint changes, many people who suffer from arthrosis may live normally and continue with their usual physical activities.
Therefore, you may be able to fix it yourself and the inflammation will soon disappear. But I would advise anyone (not only patients) to be active, without taking this to extremes. Cycling, walking, swimming and fitness training is perfect, as well as of course watching your weight. It is recommended that you change your eating habits, and eat less meat and choose natural food, fruit and vegetables. But if your disease progresses, then you must not delay going to the doctor. You can come and see us, and I will examine you myself.
– Then the patient will be operated on, right?
Not necessarily. Those who suffer from arthrosis often want to find out about the options for treating it without surgery and about the advisability of joint replacement. But even if joint replacement is inevitable, whilst waiting for surgery you can use therapeutic methods of treatment and even self-treatment.
– What kinds of therapy are available?
– In the initial stages it is important to optimize joint statics, if possible. These could be special supinators, splints or building up the muscles. The joint should also be in constant motion, but not carrying anything heavy, because arthrodial cartilage can be nourished only during motion. If necessary, joints should be mobilized using physiotherapy, muscles should be relaxed and stretched, and ligaments and their fixtures should be treated locally. Since arthrosis is not a consequence of wear and tear alone, and is often caused by inflammation of the surrounding tissues, medication can also be used. There are remedies that stabilize arthrodial cartilage, block inflammation or relive pain. Injections in a joint can also reduce inflammation and improve the joint’s lubrication; a broad range of medical products, both natural and synthetic, is available here.
– Is Bad Ragaz’s famous thermal water part of the therapy?
Yes, the special and unique composition of Bad Ragaz’s thermal waters works well on the joints. The thermal baths and their effect on joints and the back are very famous around the world and have been for hundreds of years. But you need to know the right amount of time to be immersed in the water. We recommend 20–30 minutes, and a quarter of an hour for sensitive people. There is no danger, as you cannot get ill from «overdosing» on it. You should also move around when you are in the water. We even have physiotherapists who are specially educated in water therapy, for example in the «Ragazer ring method».
– I think that the most difficult part is working with a person, isn’t it?
Yes, but this is also the most interesting part. We have good therapists and a solid understanding of how to treat people. It is fundamental to provide an individual approach and to treat the patient in light of his own personal situation and adapt our methods to his goals. It is very important that people trust their therapists and doctors and that they feel that we are interested in his or her personal situation and not only in looking at their X-rays or MRI.
– But how fast can they improve in reality? What is the minimum treatment period?
– Marked improvements occur within the first 3 weeks, but you cannot completely get rid of the disease within such a short time period. However, even after only 2 weeks you will start seeing positive results. Many people want to reduce the amount of time they stay at the clinic, but they should be aware that the longer they stay, the more opportunities for different treatments they will have and the better they will feel. One week is good for deep diagnosis, a first recommendation and the beginning of a treatment.
How do you work psychologically with athletes at a national level who know that this disease could sentence them to a life that would destroy their future careers?
Yes, this can be a real problem. There are athletes who take these twists of fate in their stride, but there are others who think that their whole world has been ruined. Their personal inner state does not always depend on the magnitude of their injury. In any case, they behave like they are unable to overcome it. I usually help them to overcome it by working with a coach and a psychologist.
A positive attitude is important for any patient, as it means that the recovery process is much better and much quicker. They should start to feel as though the process of restoration has already begun, and that it gets better each day. They should try to avoid having negative thoughts, even if this is not so easy.
– What do you do if a patient comes to you but you think that another doctor should treat them? For example, if surgery is needed, but you do not do operations?
– That depends on what the patient asks for, and so I refer them to the clinic they want to go to, if this seems advisable. If they don’t have any preferences, I offer them my recommendations. Some clinics are better to go to for upper or lower extremites, other places are better for spine problems. I just want to refer patients to the clinic where they would best be treated, because in a way I feel mentally responsible for them. This is important when working with athletes, because they expect a lot from us in elite sport, and I should not fail them. If something were to go wrong, the blame could be placed on me if I had referred the patient to the wrong doctor. However, nobody can ever guarantee 100% success.
– Dr. Schlegel, athletes from different countries come to you with different injuries… How do you draw up a treatmant plan?
– First, I ask the patient about their personal situation, exercise and their lifestyle. I do a full clinical examination and then make a final diagnosis (the primary diagnosis is made on the basis of a detailed interview and a clinical/manual examination). The next step is technical visualisation, using an X-ray or MRI scan. I also use a functional ultrasound examination that allows me to examine the ligaments «in action», and to observe how the joints move. Then we determine how the patient’s treatment is going to go and what we can offer them.
For example, problems with joints and ligaments are often treated with physiotherapy, electrotherapy, medications and shockwave therapy. These methods are very important in first-line treatment but treatment with injections is also very important in most cases. We use a relatively new method, where we inject an anesthetic and autogenous agents which are made using the patient’s own blood; the thrombocytes or other humeral factors in them induce the process of restoration. We also inject them using an X-ray or ultrasound, which helps me to see the precise place where the needle goes in. Injections are made into different joints: the spine, nerve terminals or intervertebral. I can see the liquid going into the tissues and how it spreads. Therefore, thanks to this, I can provide the patients with accurate and targeted treatment.
– Is this type of therapy suitable only for professional athletes?
– No, I can offer it to any patient with the same diagnosis. Top athletes are humans like anybody else. This method is applied in the treatment of arthrosis, joint and muscle injuries, inflammation of the spine’s zygapophysial joints, nerves, ligaments, tendons and rheumatoid arthritis.
– Is it possible for an athlete who is undergoing treatment to continue with their training? Sometimes this is the only way to stay in shape.
– During sport physiotherapy we can offer our patient the opportunity to do adapted alternative training and to gradually increase the weight they can bear. Our therapists, those who specialize in rehabilitation from trauma and disease, have solid new understandings of how to restore an athlete’s physique in the best possible way. There are different means of restoration, during both treatment and exercise.
An athlete’s treatment and recovery is our main task at the Swiss Olympic Medical Center, and the Swiss Olympic Committee controls this activity because they trust us with their best athletes. The Swiss Olympic Medical Center is a prestigious brand and a guarantee. Many large, wealthy clinics hope to achieve the same status that we have, but they lack deep specialist knowledge of sports medicine, of longterm practice in treating athletes, and in specialized sports physiotherapy or infrastructure. You cannot buy this badge, you have to earn it through good quality work and experience.
Sometimes it is difficult to get access to our clinic. According to the rules of the Swiss Olympic Medical Centers, we must admit all athletes that are sent to us by the Swiss Olympic Federation within 24 hours. Therefore, sometimes we have backlogs when we cannot find time to admit other patients at their exact desired time. But we always try to find a good solution for everyone.
– It is said that even the top public officials go to you.
– I cannot comment on this, as I do not have the right, and we must protect the privacy of our clients, who appreciate anonymity.
Christian Schlegel MD
Dr. Schlegel has a great deal of experience in preparing athletes for international contests. Since 2005, he has been working in Bad Ragaz as head of the Swiss Olympic Medical Center. Christian Schlegel was chief doctor in sports medicine for the Swiss National Olympic winter team for eight years (2006–2014). Dr. Schlegel’s Swiss Medical Association specialization is in physical medicine and rehabilitation with a subspecialty in sports medicine, manual medicine and mountain medicine.
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