Combination of medicinal uses physical exercise with other therapeutic agents and methods.
Therapeutic physical culture should be fully combined with all main types of treatment: surgical intervention, treatment regimen, therapeutic nutrition, physiotherapy, drug therapy, etc. Combined use of all indicated for a particular disease medicinal products and methods should be based on knowledge of the mechanisms and essence of the influence of their simultaneous or sequential use.
Data on the combination of therapeutic physical culture with surgical interventions, which have very large specific features for various types of pathology, are presented in each of the subsequent chapters.
The content of treatment regimens is determined based on ideas about the protective and tonic effect of individual components of the regimen and about fluctuations in the state of physiological functions due to the patterns of the daily dynamic stereotype. The concept of “therapeutic regimen”, along with the daily routine, includes measures: preventing the adverse effects of individual factors on the patient external environment(noise, loud conversations, bright lights, uncomfortable bed, etc.); deepening protective inhibition in the indicated cases (medicinal and physiological extended sleep, etc.); toning the patient (an external environment that creates positive emotions, the use of specially organized broadcasts on local radio, etc.). According to the predominance of individual components, the regimes are divided into therapeutic-protective and protective-tonic.
An integral part of the treatment regimen is the entire complex motor activity sick, or motor mode. If it is necessary to eliminate the effects of excessive activity, strict bed rest, light bed rest, ward and free rest are prescribed in a hospital setting. In sanatorium-resort institutions and in outpatient treatment settings, regimens with limited, low, medium and significant muscle load are prescribed.
An appropriate motor regimen should provide a tonic effect on the body and the prevention of pathological phenomena that can develop when the patient’s motor activity is limited (constipation, congestion in the lungs muscle atrophy, contractures, etc.). Motor mode when making the right choice can be used to consolidate compensation or normalize the functions of organs involved in the disease process.
If recovery proceeds vigorously, motor modes with medium and large muscle loads can be of a training nature, for example, in a patient who has undergone abdominal surgery. A regime of low or medium muscle load can contribute to the formation of compensation in the event of an irreversible decrease in the functional usefulness of an organ (for example, a condition after lung surgery).
Therapeutic physical culture is used both in therapeutic-protective and protective-tonic regimes.
It is carried out: under strict bed, light bed and ward conditions (and, accordingly, under conditions with limited and low load) in the form of therapeutic and hygienic gymnastics; in ward and free modes (and modes with medium and significant physical activity) in the form of therapeutic and hygienic gymnastics and therapeutic walking, and in conditions sanatorium-resort institutions In addition, walks and exercise.
When combining physical exercises with therapeutic nutrition, they take into account: increasing the effectiveness of enhanced protein nutrition in combination with physical exercises for dystrophies of a nutritional nature; a more effective effect of physical exercise on tissue regeneration processes with a diet rich in complete proteins; increasing the effectiveness of enhanced fortification when combined with physical exercise; greater activation of glycogen synthetic function of muscles with food rations rich in carbohydrates.
When determining the ratio of the time of physical therapy exercises to the time of meals, one should proceed from the fact that significant muscle load immediately preceding a meal can have an inhibitory effect on the secretion of juices in the stomach and intestines; exercise, even with a moderate load, but carried out shortly after eating, can sharply accelerate its evacuation from the stomach and increase intestinal motility.
The simultaneous use of physical therapeutic agents and physical exercises can either increase or decrease the effect of their isolated use. For example, the hardening effect of air baths and general physiological changes during them are more pronounced when used in isolation than when used in combination with physical exercise; swimming has a greater effect on increasing energy expenditure and metabolism than the sum of separately used fresh baths of the same temperature and gymnastic exercises, similar in muscle load to swimming movements.
Staying patients in a hospital disrupts adaptation to the combined influence of muscle loads and climatic factors and leads to loss of hardening. The immediate use of physical exercises and hardening physical agents restores both adaptation to muscle loads and the body’s hardening to unfavorable microclimatic conditions.
The combination of physical exercises with physical and balneological therapeutic agents should provide a combination that increases their overall effectiveness therapeutic effect- For paralysis and paresis, the combination with electrical stimulation and electro-gymnastics is of particular importance.
The effectiveness of the therapeutic effect of physical exercises is significantly increased by their combination with psychotherapeutic effects. The psychotherapeutic effect is based on the fact that a word for a person is the same real conditioned stimulus as everyone else. Suggestion forms foci of irritation and contributes to the creation of new temporary connections. Verbal influence also affects the subcortex, reticular formation and all somatic and endocrine-vegetative functions. The combined effect of verbal suggestion with a stimulus that provides the unconditioned reflex effect referred to in the suggestion is higher than the sum of their influence when used separately.
In order to combine suggestion and the direct effect of physical exercises, the essence of the therapeutic effect of physical exercises is explained to the patient in a previous conversation, and during the subsequent exercises and at the end of the classes, individual aspects of their beneficial effect are repeatedly verbally confirmed. This technique is called psychotherapeutic mediation of the therapeutic effect of physical exercise.
In the preoperative period special indications learning exercises in a hypnoid state can be used. In acute postoperative period these same exercises are used after taking painkillers, and sometimes during medicated sleep. At the same time, the tonic effect of exercises on the cortical part of the central nervous system and the protective effect of narcotic substances is not impaired.
Ed. V. Dobrovolsky
“Combination of exercise therapy with other treatment methods” - article from the section
Used in modern medicine Treatment methods are widely combined with the therapeutic use of physical exercise.
Therapeutic physical culture is integral integral part all motor modes. The selection of physical exercises, the form of their implementation and the load in classes in each individual case must correspond to the physical activity allowed by individual modes.
On strict bed rest therapeutic exercises are used as a means of preventing the adverse effects of adynamia (congestion in the lungs, vascular thrombosis, impaired activity gastrointestinal tract and etc.). Special exercises, mainly breathing, are included in some cases in the complex of methods of the so-called intensive care or resuscitation measures(for example, after severe injuries, after operations on the heart, lungs and abdominal organs, with damage to the central nervous system and cerebral hemorrhages, with extensive myocardial infarction).
Therapeutic gymnastics provides preparation for the expansion of strict bed rest: for changing (independently or with the help of medical personnel) position in bed, for sitting in bed without lowering your legs, for eating, washing, etc.
In ward mode during therapeutic and hygienic gymnastics, which provides general tonic, trophic and formative compensation, the patient is prepared to move to a sitting position in bed with his legs down, to move to a chair or armchair, to stand up and slowly walk within the ward.
In free mode based on observations of the patient’s reactions during therapeutic and hygienic gymnastics and therapeutic walking, his physical activity is dosed: length and pace of walking, going up and down stairs, total duration being on the move, etc. In some cases, the issue of the patient’s participation in certain types of protozoa can be resolved. sports games and entertainment (table tennis, croquet, etc.).
With a gentle motor regimen in sanatorium-resort and outpatient clinic conditions loads in therapeutic physical training should not exceed the patient’s reduced adaptability to muscle activity and at the same time should counteract the unfavorable manifestations of physical inactivity. With a tonic regimen during physical exercise, the patient’s motor activity gradually expands. Loads are applied that contribute to subsequent supercompensation of energy costs and improvement of the functions and morphological structures of the body. In a training regime, therapeutic physical training should ensure restoration of performance and serve as one of the main means of rehabilitation.
Therapeutic physical education should be combined with patient care. There are various ways to do this. It is necessary to produce ventilation wards and rooms of therapeutic physical culture before classes.
Most patients have impaired adaptation to the combined influence of muscle loads and climatic factors. Simultaneous use of physical exercises and hardening physical factors better restores both adaptation to muscle loads and the body’s hardening. Classes under appropriate climatic conditions and indications are conducted with open vents, windows or on verandas and platforms. In the cases shown, patients exercise in light tracksuits or naked to the waist.
In bed rest it is necessary prepare the patient's bed for classes: throw back the blanket, straighten the sheet, correctly place or remove excess pillows, etc. With appropriate clinical data at the end of classes the patient should be placed in a position that has therapeutic value: put on straps for traction in case of a spinal fracture, bandage a temporarily removed splint in case of a fracture of the forearm bones, transfer a patient who has suffered a myocardial infarction to a sitting position on a chair (chair), help move to a lying position (for example, after walking a patient with a hip fracture if there is high plaster cast), etc. It is necessary to lead monitoring your condition and well-being each student before, during, and after classes. In case of adverse reactions, the load should be reduced, the time of training should be reduced (if possible, unnoticed by the patient). In these cases, the therapeutic physical education instructor must inform the attending physician about the observations and activities carried out on the same day.
Combination of physical exercises with physical and balneological treatments should ensure an increase in their overall effectiveness. For example, for paralysis and paresis, the combination of physical exercises with electrical stimulation of muscles and electro-gymnastics is of particular importance; Exercises in water, and especially swimming, increase energy expenditure and metabolism more than the sum of separately applied water baths of the same temperature and gymnastic exercises, similar in muscle load to swimming movements. The correct sequence or simultaneous use of physiotherapeutic procedures and therapeutic exercises is extremely important. For example, thermal procedures(paraffin or mud applications, Sollux, etc.) used for contractures must precede therapeutic exercises. Iontophoresis of the majority medicinal substances should be used with some break after doing therapeutic exercises. In some cases, it is advisable to use therapeutic exercises during a physiotherapeutic or balneological procedure (for example, in a mineral bath for polyarthritis; in a local thermal bath for the hand and fingers with a sharp limitation of movements in them).
When combining therapeutic physical training with therapeutic nutrition under the influence of exercise, the effectiveness of enhanced protein nutrition for dystrophy increases; tissue regeneration processes occur more quickly with a diet rich in complete proteins; the effectiveness of enhanced fortification increases; The activity of muscle glycogen-forming function increases with food rations rich in carbohydrates. When determining the time of physical therapy exercises, it should be taken into account that significant muscle load immediately preceding a meal can have an inhibitory effect on the secretion of juices in the stomach and intestines; exercise, even with a moderate load, carried out shortly after eating, can sharply speed up its evacuation from the stomach and increase intestinal motility.
The effectiveness of the therapeutic effects of physical exercise increases significantly at their combination with psychotherapeutic influence.
With the combined use of suggestion and physical exercises (potentiation), the patient should explain the essence in a previous conversation therapeutic effects physical exercises, and during subsequent exercises and at the end of classes - repeatedly confirm certain aspects of their beneficial effect.
For special indications you can exercise while in a hypnoid state. In this case, the effect of exercise on the cortical part of the central nervous system is eliminated or sharply reduced and motor-visceral reflexes are activated.
Medicinal the use of physical exercise must be combined with occupational therapy. For example, when restoring the normal range of motion in individual joints, therapeutic exercises can be combined with the performance of individual labor operations. It is advisable to combine therapeutic physical education with various types labor activity, culminating in the production of certain products of labor or the completion of specific tasks.
The total muscle load when combining therapeutic physical education and occupational therapy should not exceed the level of motor activity corresponding to the motor regimen prescribed to the patient. Successes in restoring functions and forming motor and autonomic compensations; achieved during physical exercises are expanded and consolidated in the process of occupational therapy and contribute to the rehabilitation of patients.
Full combination of drug therapy with exercise ensures an increase in the effectiveness of the therapeutic effect of the latter. Possible various options such a combination. After obtaining some effect, the course of drug therapy is supplemented by the therapeutic use of physical exercises. For example, after using cardiac medications for some time for circulatory failure of stages I-II, therapeutic exercises are prescribed. As a result, the degree of circulatory failure decreases in most cases faster than with the isolated use of these drugs. If blood circulation improves significantly, drug therapy is discontinued with continued use of physical therapy.
Exercise can be done soon after taking medications. For example, in a patient with spastic paresis after a decrease in muscle tone, which occurred under the influence of taking appropriate medications, special exercises that activate intestinal motility are carried out 1 1/2 -2 hours after taking a saline laxative (they enhance the effect of its action); Therapeutic gymnastics classes are carried out soon after the analgesic effect of the medication taken appears in a patient with neuritis.
With the appropriate training method, the effect of the medicinal substance and at the same time the corresponding effect from the therapeutic use of physical exercises are preserved. For example, when using sleeping pills and painkillers to a patient who has suffered major surgery on the stomach, simple breathing and other gymnastic exercises can be prescribed. IN in this case Activation of respiration, intestinal motility and blood circulation is ensured while preserving what has developed under the influence of drugs protective braking.
Wide combines the therapeutic use of physical exercise with surgical interventions. In the preoperative period, therapeutic exercises are carried out, preparing for the use of postoperative exercises and promoting best effect from surgery. In the early postoperative period immediately following the operation, therapeutic exercises for a number of interventions can be one of the means of special intervention that is resuscitative in nature (heart surgery, lung surgery, etc.). Postoperative gymnastics is very important for the prevention of various complications, especially in older people. In the long-term postoperative period, therapeutic physical culture activates the processes of healing, restoration of impaired functions or the formation of compensation and promotes the fastest rehabilitation of patients.
In case of injuries, it is necessary, since prolonged restriction of movements in injured patients causes a number of disorders of both the musculoskeletal system and internal organs.
What changes in the body when treating injuries?
Long-term use of bed rest, forced positions, traction and immobilization slow down the regeneration processes and make them less complete. In the absence or insufficient axial load, the epiphyseal ends of the bones undergo rarification. The nutrition of cartilage carried out by osmosis and diffusion sharply deteriorates. The elasticity of cartilage decreases. In areas where there is no contact and mutual pressure of the articular surfaces, gradation of cartilage is formed. In places of intense mutual pressure of cartilage, bedsores may appear. The amount of synovial fluid produced decreases. In areas of duplication synovial membrane gluing occurs. Subsequently, fusion of the articular cavity with the formation of connective tissue adhesions, even ankylosis, is possible. In the joint capsule, elastic fibers are partially replaced by collagen. Immobilized muscles undergo atrophy.
The benefits of exercise therapy for injuries
Immobilization with plaster, while ensuring retention of fragments, maintaining immobility in the joints, faster healing of the wound, does not at the same time exclude the possibility of straining the muscles under the plaster, performing various movements with the immobilized limb, and early to begin axial loading when walking in plaster cast and thus help improve regeneration processes and restore function.
The tonic effect of exercise therapy for injuries becomes great importance. It is especially important in conditions of bed rest, as it ensures the activation of all vegetative functions and processes of cortical dynamics, prevents the development of various complications (congestive pneumonia, atonic constipation) and mobilizes the body's defensive reactions. It should be taken into account that when protective inhibition manifests itself, for example after a shock, even small muscle loads can be excessive and cause its deepening. The tonic effect of exercise in these cases should be used with caution.
In the presence of a cast (traction), systematically carried out movements under the cast reduce the degree of inhibition in nerve centers muscles and balance the inhibitory-excitatory processes in them. Under the influence of muscle contractions in the damaged area, metabolic processes in tissues are gradually normalized. It should be noted that if exercises are used too early after an injury, they can worsen tissue trophism. Contraction of the symmetrical muscles of a healthy limb can to some extent influence the improvement of trophic processes in tissues subjected to injury.
The stimulating effect of exercise therapy exercises for injuries on regeneration processes is reduced to improving metabolism in the regeneration zone and ensuring the formation of a complete structure of regenerating tissue. By selecting exercises in accordance with the characteristics of clinical manifestations, it seems possible to interfere with the course of regeneration processes, for example, by turning off or changing the nature of the load on the callus depending on the location of the fracture and the position of the fragments. Excessively early and powerful functional irritation can slow down or distort the regeneration process.
When using influence on trophic processes after reconstructive ones, functional stimulation is very important, commensurate with the progress of adaptation of the morphological structures of tissues to new conditions of function. Excessively early and strong load, for example, during arthroplasty, can lead not to the transformation of tissue interposed between the articular surfaces into articular cartilage, but to its partial death and the development of arthrosis.
Restoration of impaired functions using exercise therapy for injuries
Gradually increasing impulses to tension in damaged muscles help restore their full active contraction. A full plaster cast, traction, or sutures placed on the damaged muscle or tendon provide a faster recovery of this ability. In case of a poorly immobilized fracture or in case of violation of fixation of one of the ends of the muscle, for example. tendon rupture or rupture, it becomes very difficult or impossible to restore the tension.
The physiological patterns of “transfer” of strength, speed of movement and endurance of the muscles of a healthy limb to the damaged one that increase as a result of exercise begin to appear somewhat later.
To normalize muscle function, restoring the ability to relax is very important. Special exercises used for these purposes help to simultaneously increase the range of motion.
For contractures caused or accompanied by pain, it is advisable to first relieve pain through blockades, after which the range of movements can be significantly increased using the usual training methods. In addition to relieving pain, this effect is also due to the infiltration of the anesthetic solution into the altered tissues, leading to an increase in their ability to stretch.
Immediately after removal of plaster immobilization or traction, the ability of the muscles to tense is significantly reduced. This is caused by a change in the nature of muscle-articular and skin-tactile impulses from a limb freed from fixation and the appearance of pain when moving it.
It should be noted that when using exercise therapy for injuries, muscle strength increases much faster than atrophy is eliminated. This is explained by the fact that physical exercise, improving the cortical regulation of movements, provides short terms restoration of the maximum functional mobilization of all tissue elements of muscles during tension.
To preserve everyday and industrial motor skills, their early use, at least in a modified and simplified form, during the period of immobilization is of utmost importance. This applies to walking, movements when eating, when writing.
Normalization of autonomic functions (especially vascular system, respiratory, digestive organs) should be provided in cases where they are persistently changed under the influence of injury, bed rest, forced positions, plaster immobilization.
Formation of compensation using exercise therapy for injuries
The formation of temporary compensations in the treatment of a traumatic disease concerns unusual motor skills (standing up in the presence of a cast). If a new movement, for example, walking with crutches in a plaster cast, temporarily replaces the usual motor act, one should strive to preserve the basic structure of the latter (for example, avoid walking with a leg sharply rotated outward, or walking with an extended step). Once the need to use temporary compensation has passed, one should strive to restore the full technique of the motor skill that was compensated. In some cases (for example, during muscle transplantation), a movement that is old in external form can essentially be a permanent compensation, requiring the formation of a new complex structure for controlling it.
Combination of exercise therapy with other methods
The use of exercise therapy for injuries should be combined with all other treatment methods. When combined with treatment regimens Particularly important is the careful dosage of stimulating functional irritation on regeneration processes through exercises and movements performed in the process of everyday self-care, for example, when using therapeutic walking and walking associated with self-care.
The use of exercise therapy for injuries before surgery can prepare the tissues in the area of the intended intervention for it, mobilizing their mobility, improving elasticity and blood supply. Therapeutic physical education can contribute to the psychological preparation of the patient for the upcoming operation.
In the postoperative period, therapeutic physical culture should facilitate the rapid elimination of acute manifestations of the traumatic disease that developed after surgery, and then more rapid and complete implementation of the morphological and functional results of the operation.
The use of exercise therapy for injuries is widely combined with non-bloody methods of orthopedic treatment in the form of one-stage and staged redressal, traction, and fixation devices.
The combination of exercise therapy for injuries with physiotherapeutic treatment is carried out taking into account their joint stimulating effect on regeneration processes, the elimination of contractures and the restoration of joint mobility.
The combined use of exercise therapy exercises for injuries and natural or preformed natural factors is carried out in the form of air baths during exercises at room temperature and at low air temperatures, by conducting exercises with solar insolation (it is possible to use artificial sources of ultraviolet radiation) and by conducting exercises in water (in the bath, in the form of bathing and swimming).
Indications and contraindications for exercise therapy for injuries
Indications for the use of physical exercises for injuries are as follows:
- damage to the skin, ligamentous-articular apparatus and muscles caused by mechanical (bruises, ruptures and tears, wounds and crushing), thermal (burns and frostbite) and chemical (burns) agents; bone fractures;
- surgical interventions on soft tissues(skin and tendon plastics, skin grafts); on bones (osteotomies, osteosynthesis and bone grafting, resections, amputations and reamputations) and on joints (arthrotomies, plastic surgery of the ligamentous apparatus, surgical reduction of dislocations, removal of menisci and intra-articular bodies, resections, arthrodeses, arthroplasties).
Temporary contraindications to exercise therapy for injuries are as follows:
- condition after shock, large blood loss, the presence of severe reactions to infection in the area of injury or to a generalized infection;
- risk of bleeding due to movements;
- foreign bodies in tissues and bone fragments located close to large vessels, nerves, and important organs;
- presence of severe pain.
Taking into account the influence of physical exercise should reflect changes in both general manifestations and the course of local processes during a traumatic disease.
Results of exercise therapy for injuries
With pronounced general manifestations of traumatic disease, a beneficial effect exercise therapy classes in case of injuries, it manifests itself in a change in an indifferent attitude towards exercise to a positive one, in a decrease in motor and speech inhibition, in the appearance of more mobile facial expressions and greater sonority of the voice, in an improvement in the course of autonomic reactions (improved filling and slowing of the pulse during tachycardia, deepening and slowing of breathing, decreased pallor or cyanotic).
With moderate general manifestations of a traumatic disease, the general tonic effect of fully carried out exercise therapy complexes for injuries is reflected in improved well-being and mood, a slight pleasant fatigue, a positive verbal assessment of the impact of exercises, the establishment of good contact with those conducting the exercise, increased pulse pressure, small shifts in increased heart rate and respiration. The beneficial tonic effect of the exercises continues to be felt for several hours (improved well-being, decreased irritability and complaints about the interfering bandage and the inconvenience of the forced position, smooth, not rapid breathing, good filling and moderate pulse rate).
When assessing the effect of exercise therapy for injuries on local processes and the state of function of the damaged musculoskeletal system, the tension of the muscles under the bandage (determined by palpation or tonometer), the degree of displacement of the patella when the quadriceps extensor of the tibia is tense, and the ability to raise the injured limb in a plaster cast are taken into account. , the amount of pressure (in kilograms) that causes the appearance of pain during load along the axis of the limb, pain and its intensification during exercise, the time during which the pain lasts after exercise, the range of movements in individual joints in degrees, the strength of individual muscles, the ability to perform individual integral movements (putting on clothes, combing one's hair) and the nature of adaptive compensations (walking with an extended step, raising the shoulder when moving the hand). Clinical data are taken into account (according to the characteristics of the injury): the intensity of development and quality of granulations, the progress of epithelization, the nature of the wound discharge, the progress of callus formation (clinical and radiological data), the severity of secondary changes (atrophy, limited mobility, vicious positions).
In accordance with the data obtained and their dynamics, the selection of exercise therapy exercises for injuries and the training methods are changed, the intensity of the load is reduced or increased, and sometimes classes are temporarily canceled.
The article was prepared and edited by: surgeon
Manual therapy includes anti-gravity, mobilization, post-isometric and other methods of muscle relaxation. These methods can be used in patients with diseases of the spine and joints at any stage of the disease, combined with any medications and carrying out any physiotherapeutic procedures.
Methods of mobilization and joint manual techniques are used after relieving severe pain. This is achieved through the use of analgesic treatment, which can be combined with the use of minor tranquilizers, sedatives and antihistamines. If the sympathalgic component predominates in the symptoms of the disease, ganglion blockers and neurotropic drugs are prescribed. To improve microcirculation in the absence of hernial protrusions, patients are injected with a solution of nicotinic acid according to the scheme. To relieve edema and swelling of tissues, dehydration drugs are used.
In some cases, it is effective to carry out intradermal, subcutaneous, paravertebral, epidural blockades, and sometimes blockades of sympathetic nodes, nerve trunks, and individual muscles.
Traction therapy should be prescribed differentiatedly, since it may be contraindicated in severe pain, with pronounced deforming spondylosis, spondyloarthrosis, stepped multisegmental instability of the spine with spondylolisthesis, when it appears during traction acute pain radiating in nature along the roots. After traction therapy, the patient is recommended to rest for 40-60 minutes. Massage for patients with vertebral diseases of the spine must be prescribed strictly differentiated, taking into account physiological curves. Techniques cannot be used manual therapy for flexion with hyperlordosis in the lumbar and cervical regions spine and extension when kyphosis is smoothed in thoracic region spine.
The combination of manual therapy with physical therapy is effective in patients with vertebral syndromes of spinal osteochondrosis if it is prescribed purposefully and strictly differentiated, depending on disorders of dynamic posture and pathological motor stereotype.
When physiological curves are smoothed, physical therapy should be aimed at increasing them, and when increasing, at reducing them. Unfortunately, few physical therapy doctors prescribe physical therapy taking into account physiological curves. Under our supervision was patient K., 18 years old, who came after hospital treatment for vertebrobasilar insufficiency. From the age of 6 he was involved in sports and played on the hockey team. The appearance of symptoms of vertebrobasilar insufficiency occurred while lifting the barbell. Treatment in hospital without effect. Upon objective examination Special attention draws attention to himself straightened spinal column with two longitudinal muscle cords of pronounced tonic tension of the spinal erector muscles from the back of the head to the sacrum on both sides. After 8 manual therapy procedures, the clinical symptoms of vertebrobasilar insufficiency were stopped. The patient is a professional hockey player. It was allowed to practice professional activity subject to the exclusion during training of physical exercises for extension in the thoracic spine, in the cervical and lumbar spine - for flexion. According to the 9-year follow-up, the patient is healthy and continues to play hockey.
In patients with vertebral syndromes of spinal osteochondrosis, peripheral afferentation coming from the spine as a result of the formation of functional blockades constantly strengthens the pathological motor stereotype. As a result of compensatory processes occurring in the body, there are no clinical manifestations of spinal osteochondrosis. The pathological motor stereotype adapts and makes the patient more resistant to the disease. During physical therapy exercises, the patient replaces the muscles that we want to strengthen with others - substitution. As a result, the patient exercises his lack of coordination instead of eliminating it and thereby reinforces the pathological motor stereotype.
The use of therapeutic exercises is absolutely contraindicated in patients with clinical manifestations osteochondrosis of the spine. Functional blockades that are not immediately eliminated by special targeted techniques of manual therapy and support a stable pathological motor stereotype with peripheral afferentation cannot be removed by therapeutic exercises. With peripheral afferentation, all the patient’s movements and his posture are distorted, so it is impossible to determine even the true strength of the muscles and establish which symptoms are a consequence of a vertebrogenic disease and which are associated with disorders of central regulation.
We recommend that patients with vertebral syndromes of osteochondrosis of the spine undergo therapeutic exercises for 2 months after manual therapy in the initial lying position, without movements in the spine. Special exercises on the spine that the patient himself performs - automobilization - can only be prescribed by a doctor who knows the methods of manual therapy.
Restructuring a pathological motor stereotype in a person is a multi-stage and difficult process, therefore it is more promising to engage in physical therapy with patients more young with a still plastic nervous system. In the future, indications for active, targeted preventive therapeutic exercises in children and young people will be of increasing importance.
Thus, with expressed pain syndromes spine and joints in acute stages treatment of diseases should begin with joint technique in positions remote from the lesion and from other, less specific methods, which include immobilization, manual muscle relaxation, drug therapy, blockades, massage, reflexology.
In the acute period of the disease in patients with vertebral syndromes of osteochondrosis of the spine, the appointment of massage, physical therapy, physiotherapy, especially in thermal dosages, can lead to an increase in edema in the tissues surrounding the spinal root and to an exacerbation of the disease.
At chronic course For diseases, manual therapy can be carried out in combination with courses of radon, carbon dioxide, chloride, sodium, sulfide, turpentine baths, naphthalan therapy, mud therapy (mud at low temperatures), massage, exercise therapy.
Reflexology is recommended for patients with neurological syndromes of spinal osteochondrosis, starting with acute period. The choice of treatment method depends on clinical form disease, its stage, presence of concomitant diseases.
Therapeutic physical education (PT)- a method that uses means of physical culture for therapeutic and prophylactic purposes for faster and more complete restoration of health and prevention of complications of the disease. Exercise therapy is usually used in combination with other therapeutic agents against the backdrop of a regulated regimen and in accordance with therapeutic objectives.
At certain stages of the course of treatment, exercise therapy helps prevent complications caused by prolonged rest; accelerating the elimination of anatomical and functional disorders; maintaining, restoring or creating new conditions for the functional adaptation of the patient’s body to physical activity.
The active factor of exercise therapy is physical exercise, that is, movements specially organized (gymnastic, applied sports, games) and used as a nonspecific stimulus for the purpose of treatment and rehabilitation of the patient. Physical exercise helps restore not only physical but also mental strength.
A feature of the exercise therapy method is also its natural biological content, since for medicinal purposes one of the main functions inherent in every living organism is used - the function of movement. The latter is a biological stimulus that stimulates the processes of growth, development and normalization of the body. Any physical therapy complex includes the patient in active participation in the treatment process, as opposed to other treatment methods, when the patient is usually passive and healing procedures performed by medical personnel (for example, a physiotherapist).
Exercise therapy is also a method of functional therapy. Physical exercises, stimulating the functional activity of all major systems of the body, ultimately lead to the development of functional adaptation of the patient. But at the same time, it is necessary to remember the unity of the functional and morphological and not limit the therapeutic role of exercise therapy to the framework of functional influences. Exercise therapy should be considered a method of pathogenetic therapy. Physical exercises, influencing the patient’s reactivity, change how general reaction, as well as its local manifestation. Training a patient should be considered as a process of systematic and dosed use of physical exercises for the purpose of general improvement of the body, improving the function of one or another organ disturbed by the disease process, development, education and consolidation of motor (motor) skills and volitional qualities (see table).
Participation of organs in oxidative processes at rest and during physical activity
(in cm 3 oxygen per hour according to Warcroft)
Note: The stimulating effect of physical exercise on the body occurs through neurohumoral mechanisms. When performing physical exercises, tissue metabolism increases.
Most patients are characterized by a decrease in vitality. It is inevitable under conditions of bed rest due to a decrease in physical activity. At the same time, the flow of proprioceptive stimuli is sharply reduced, which leads to a decrease in the lability of the nervous system at all its levels, the intensity of vegetative processes and muscle tone. With prolonged bed rest, especially in combination with immobilization, a distortion of neurosomatic and autonomic reactions occurs.
Disease (injury) and physical inactivity lead to significant changes in homeostasis, muscle atrophy, functional disorders endocrine and cardiorespiratory systems, etc. Therefore, the use of physical exercises for the prevention and treatment of diseases is pathogenetically justified:
- Therapeutic and prophylactic effect of physical therapy
- Nonspecific (pathogenetic) effect. Stimulation of motor-visceral reflexes, etc.
- Activation of physiological functions (proprioceptive afferentation, humoral processes, etc.)
- Adaptive (compensatory) effect on functional systems(tissues, organs, etc.)
- Stimulation of morpho-functional disorders (reparative regeneration, etc.)
- Results (effectiveness) of the effects of physical exercise on a sick person
- Normalization psycho-emotional state, acid-base balance, metabolism, etc.
- Functional adaptability (adaptation) to social, everyday and labor skills
- Prevention of disease complications and disability
- Development, education and consolidation of motor skills. Increasing resistance to environmental factors
Physical exercises have a tonic effect, stimulating motor-visceral reflexes, they help accelerate tissue metabolic processes and activate humoral processes. With the appropriate selection of exercises, it is possible to selectively influence motor-vascular, motor-cardiac, motor-pulmonary, motor-gastrointestinal and other reflexes, which makes it possible to increase primarily the tone of those systems and organs in which it is reduced.
Physical exercise helps normalize acid-base balance, vascular tone, homeostasis, metabolism of injured tissues, and sleep. They promote the mobilization of the patient’s body’s defenses and the reparative regeneration of damaged tissues.
The use of physical exercises in patients is the main means of active intervention in the process of formation of compensation.
Spontaneous compensation is formed in the form of correction of the respiratory function of operated patients with the help breathing exercises, lengthening exhalation, diaphragmatic breathing, etc.
Consciously formed compensations, for example, when immobilizing the left hand, the formation of everyday skills for the right hand; walking on crutches for fractures of the lower limb(s); walking on a prosthesis with lower limb amputations.
Compensation is required when various kinds reconstructive operations that replace lost motor function. For example, mastering full movements of the hand and fingers after surgical interventions and muscle transplants, or amputations with the subsequent use of a bioarm prosthesis.
Formation of compensation for impaired autonomic functions. The use of physical exercises in this case is based on the fact that there is not a single autonomic function that, through the mechanism of motor-visceral reflexes, would not be influenced to one degree or another by the muscular-articular apparatus.
Specially selected physical exercises consistently provide the necessary reactions from the internal organs to compensate; activate afferent signaling from internal organs consciously involved in compensation, combining it with afferentation coming from the muscles involved in movement; provide the desired combination of motor and autonomic components of movement and their conditioned reflex consolidation. These mechanisms are most easily used in lung diseases because respiratory function can be consciously regulated during exercise. For diseases of one lung (or after surgical intervention) it is possible, for example, to form a compensatory strengthening of the function of another, healthy lung due to slow and deep active exhalation.
At cardiovascular diseases Forming compensation is not easy to achieve. However, if a patient with circulatory insufficiency performs careful (slow) movements lower limbs in combination with deep breathing, it is possible to form some compensation for the blood supply to tissues and organs. In case of hypotension, an appropriate selection of exercises contributes to a persistent compensatory increase in vascular tone.
With diseases of the gastrointestinal tract, kidneys and metabolism, it is difficult to form compensation. But using special physical exercises, it is possible to activate, for example, insufficient or inhibit excessive motor or secretory function of the gastrointestinal tract in order to compensate for disturbances in its activity. This compensation may be effective against food-induced changes in secretory and motor function ( dietary food), mineral water(depending on acidity), medicinal substances, etc.
The use of physical exercise for therapeutic purposes is a means of conscious and effective intervention in the process of normalizing functions. For example, in patients with diseases of the cardiovascular system, performing special exercises causes a flow of impulses from the vessels, heart muscle, lungs and other organs, and thereby normalizes blood pressure, blood flow speed, venous pressure, improves blood supply to muscles, etc.
