RU2034530C1 - Method of rehabilitation treatment of neurologic manifestations of vertebral osteochondrosis - Google Patents

Abstract

FIELD: medicine; neurology. SUBSTANCE: method involves complex exposure of an organism to classic massage and point massage treatment applied in inhibitory mode to detected painful reflexogenic points and dolorous biologically active points followed by generally supporting action applied in stimulating mode to biologically active points located on the extremities. Functional blocks in joints of the vertebral column are detectable with their subsequent elimination by means of manual therapy methods. Specially developed complex of exercise therapy is applied in combination with definite kind of breathing on the background of some color-and-music accompaniment selected for each period. The method is applicable both in patient and out patient mode. The patient can use the proposed exercises in the remission period as the prophylaxis of vertebral osteochondrosis. EFFECT: prevented complications, simplified treatment, prolonged remission period; the method is applicable both in inpatient and outpatient mode; the patient can use the proposed exercises in the remission period as a prophylaxis of vertebral osteochondrosis.

Description

 The invention relates to medicine, namely to neurology, and can be used in the treatment of neurological manifestations of osteochondrosis of the spine during the rehabilitation period or as a preventive treatment package for this disease.

 A known method of treating neurological manifestations of osteochondrosis of the spine, which consists in massage using a special device in the area of the paravertebral zones of the spine with a gradual increase in the force of exposure [1] However, this method can cause complications, for example, in the form of bruises, requires a special device for its implementation, not can be carried out by the patient himself, relieves only acute pain syndrome that occurs in the acute period of the disease.

 There is a method of rehabilitation of patients, which consists in massage of the hands, back, neck, chest, followed by exercise on a bicycle ergometer [2] However, this method is used only for the rehabilitation of patients with neurological manifestations of osteochondrosis of the spine.

 There is a method of rehabilitative treatment of patients with intervertebral osteochondrosis, which consists in medical treatment, apparatus physiotherapy, peloidal therapy, manual therapy and various methods of reflexology, including various types of reflex effects (acupuncture, cauterization, pressure, electropuncture, laser puncture, etc.). locally segmental biologically active points (BAP), as well as conducting physical exercises [3] However, the method is complicated in its execution, for e implementation requires special equipment, and the use of techniques such as exposure to acupuncture points with needles, or the use of mud therapy and physiotherapeutic procedures, which can lead to various complications: infection of the body during acupuncture, the occurrence of various allergic reactions when using drugs and physiotherapy .

 There is a method of treating osteochondrosis of the spine, which consists in massage the back, front chest wall using classical massage techniques (stroking, rubbing, kneading), as well as palpation of areas of hyperesthesia, including the impact on biologically active points (BAP) of restorative and segmental reflex action, breathing exercises) [4] However, this method cannot be implemented without a specialist in massage and reflexology, does not use a complex effect on the face Ganism, does not prepare the patient to fulfill his professional duties at the workplace, cannot be used for independent performance by the patient.

 There is a method of acupressure for diseases and injuries of the nervous system, which consists in influencing the points of heperesthesia and biologically active points (BAP) with various methods of acupressure and linear massage using the hands of a masseur, or special pressers [5] However, this method allows you to stop the pain only insignificant period of time.

 There are various ways of using light music in production, in medicine and pedagogy in conjunction with a set of physical exercises [6] However, all the described methods of using light music in the psychophysiological unloading system in production are aimed at improving performance, relieving fatigue, it should be noted that " the complex harmonic effect of color and music has so far been poorly studied "(ibid., p. 45), and moreover there is no data on the treatment of the light and music of neurological manifestations of oste chondrosis spine during rehabilitation.

 A known method of rehabilitation in the treatment of neurological manifestations of osteochondrosis of the spine, including a variety of treatments and rehabilitation in accordance with the identified pathogenetic and sanogenetic mechanisms of the development of the disease, taking into account the period of development of the disease: drug therapy, various types of physiotherapy, manual therapy, various types of massage, the use of physical exercises [7] However, the known method does not offer a detailed method of rehabilitation treatment, co ION based pathogenic effects on the pathogenetic mechanisms of the disease during the rehabilitation treatment of neurological manifestations of osteochondrosis. This method is taken as a prototype.

 The present invention is directed to the implementation of a comprehensive therapeutic effect on the patient’s body during the rehabilitation period for the treatment of neurological manifestations of spinal osteochondrosis, taking into account the pathogenetic effects of the techniques used on the pathobiomechanical disorders of central and peripheral origin that occur in patients during this period.

 The essence of the invention lies in the complex effect on the patient’s body, including the use of classical massage techniques, acupressure of detected pain points in trigger zones, hyperesthesia zones and painful biologically active points (BAP) using the inhibitory method, followed by exposure to BAT with a general strengthening effect by acupressure using an exciting method , the identification of functional blocks (FBs) in the joints of the spinal column and their subsequent elimination by manual therapy methods, my set of exercises of physiotherapy exercises, carried out first in the position of the patient lying on his back, then lying on his stomach, and then standing, with a certain type of breathing for each period of the complex (lower, upper, middle or mixed), against a background specific for each the period of color and musical accompaniment, composed, taking into account the individual characteristics of each patient, as well as the ongoing period of the complex of physiotherapy exercises. The developed complex of therapeutic measures allows to influence all pathogenetic links involved in the formation and development of this disease, to develop a specific motor stereotype in relation to both postures and movements, to consolidate the positive results due to the impact on both peripheral and central links of pathogenesis of this disease, to form a positive motor stereotype that allows us to maintain the patient in good physical condition, sufficient for us dulling remission and contributing to a faster return of the patient to work, especially to work associated with performing heavy physical exertion, for example, in the metallurgical industry, construction, etc., while significantly increasing the duration of remission to 1.5-2.0 years old.

 The present invention includes a comprehensive therapeutic effect on the patient’s body, offers developed modes of exposure to various therapeutic measures, their specific sequence and combination, includes methods of the method previously not used in the treatment of this pathology, contains a detailed description of all methods of the method, the technical result achieved is not due to the total the effect of the used methods of the method, and achieved through the development and implementation of previously unknown exposure modes and and combinations, and techniques have not previously used in the treatment of this pathology. All of the above suggests that the proposed invention is new, has an inventive step, is industrially applicable.

 The method is as follows.

 Treatment begins with a reflex effect on the patient’s body, consisting in back massage along the spine with a gradual increase in pressure until the patient experiences pain, and first, a classic massage is performed, including stroking, kneading, rubbing, performed by the hands of a massage therapist, or using various massaging devices, mass-produced, exposure time 5-10 minutes Then they begin to exert influence on the lesion area and reflex zones with the help of pressers, which makes it possible to identify trigger zones, pain points and painful biologically active points (BAP) located both in the lesion area and segmentally-reflex. The impact is carried out for 2-5 minutes with a gradual increase in the pressure force of the acting presser from 1-2 to 10-35 kg during the entire course of treatment. After this, acupressure of the identified points of trigger points hyperesthesia and painful biologically active points (BAP), both local and segmental-reflex, with subsequent exposure to BAT of general strengthening action located on the limbs, is performed, and when the cervical or thoracic spine is affected on BAP of general strengthening action, located mainly on the lower extremities, and in case of damage to the lumbar or sacral spinal column on BAP of general strengthening effect Actions located mainly on the upper limbs. The impact on all of the above points is carried out either by the fingers of the hands, or using known point pressors, and the detected pain points are affected in the braking mode, including the rotational movements of the finger or presser at the treated point, combined with pressure from 1.0 to 3.0 kg, for 3.0-5.0 minutes per point, and for BAT of general strengthening action located on the limbs, in an exciting mode, including alternating rotational and vibrational movements and pauses, for 1.0-2.0 minutes per point. In one session, affect 2-10 points. The correct and accurate implementation of the above techniques leads to the complete removal of the existing pain syndrome, relaxation of the muscles involved in the formation of pathobiomechanical disorders in the corresponding sections of the segmental apparatus, which allows us to begin to identify the patient’s functional blocks (FBs) in the joints of the spinal column and to eliminate them with using various techniques of manual therapy, carried out depending on the types of detected pathobiomechanical disorders and their severity, using relaxation phases mobilization and manipulation.

 The complex of physiotherapy exercises carried out after this, including special physical exercises, first performed in the patient’s position while lying on his back, then lying on his stomach, and then standing, while holding the lower (abdominal), upper (chest), middle (mixed) breathing on the background of color music accompaniment allows not only to develop an optimal motor stereotype in relation to both poses (static component) and movements (dynamic component) in everyday life and at work, but also to obtain and close Protect the positive results obtained by acting not only on the peripheral, but also on the central links of the pathogenetic components involved in the development of neurological syndromes of spinal osteochondrosis. Each of the periods of physiotherapy exercises must be carried out with a certain type of breathing and carried out against a background of specific color and music accompaniment: when performing physiotherapy exercises carried out while lying on the back, the patient must perform lower (abdominal) breathing, and the color and music background includes the sound of pieces of light instrumental music moderate pace with moderate color lighting in blue and white tones, the pace of the music has a steady rhythm corresponding to the rhythm of exercise, this It allows one to remove tension, improve joint mobility; when performing physical exercises while lying on his stomach, the patient must perform upper (chest) breathing, and the color-music background includes the sound of light music, with an increase in its tempo, the character of the music is light, creating a feeling of lightness, color accompaniment in clear, pleasing eyes of sky-blue , light green, light pink colors, this allows you to bring the body out of a state of relaxation, configure it to conduct increased physical activity; when performing physical exercises performed while standing, the patient should perform medium (mixed) breathing, and the color-musical background includes the sound of the works mainly at the pace of the march, major music, activating the musculoskeletal system, color accompaniment in invigorating, bright red-yellow tones, this allows you to mobilize the whole organism, remove it completely from a state of relaxation, set up for the upcoming work. In the final period of a set of exercises for physiotherapy exercises, it is necessary to increase the emotional mood of the patient, which is facilitated by bright, emotional music (P. Tchaikovsky, M. Glinka, D. Shostakovich, etc.), the color scheme gradually switches to normal lighting. It is necessary to take into account the musical tastes of patients in order not to get negative psychological effects due to improperly chosen musical accompaniment, it is also necessary to take into account the individual effect of the color scheme. It is necessary to find out this information from each patient before the start of treatment. When practicing physical therapy with a group of patients, programs of color and music accompaniment should be drawn up taking into account the common color and musical tastes of patients included in it.

 The following set of exercises of physiotherapy exercises is carried out, including twenty exercises, and exercises from the first to fifth are carried out lying on the back, exercises from the sixth to the eighth are lying on the stomach, and, starting from the ninth, the exercises are carried out while standing.

 Exercise N 1. Starting position lying on your back. Straightening is performed in all joints, outstretched arms behind the head should completely touch the surface on which the patient lies, which is a criterion for the normal mobility of the joints of the upper extremities. If this cannot be done, for example, with shoulder-shoulder periarthritis, then in the same position the hands are connected “into the lock”, straightening the joined hands upwards, they gradually try, bringing them behind the head, to touch the support on which the patient lies. Abdominal breathing, on exhalation exercise muscle tension, and on exhalation, relaxation. The exercise is performed in a sparing mode, the patient should not feel any pain, only minor breaking, stretching sensations.

 Exercise N 2. The initial position is lying on your back, arms are extended along the body, legs are bent at the knees at a right angle, the patient's feet rest on the support on which he lies. On inspiration, a gradual, phased elevation of the sacral, then the lumbar, followed by the thoracic and cervical spine is carried out, additional support on the head. On exhalation, a gradual lowering of each department is carried out in the reverse order. At the time of the exercise, the patient should focus on the spine, imagine and try to lift each vertebra, and then lower it in the reverse order, it is necessary to imagine mentally that the intervertebral joints are stretched, the vertebrae are "moving away" from each other. It must be remembered that at the beginning of the physiotherapy exercises complex the patient should not try, overpowering the appearance of pain, “tear” the entire spine from the support, and achieve such success gradually, from exercise to exercise.

 Exercise N 3. Starting position lying on your back, arms bent at the elbows at right angles, inseparably lie on the horizontal surface of the support, the heel of one leg is located on the toe of the other leg. On inspiration, the feet are smoothly turned at the same time in one direction, and the head in the opposite direction, trying to touch the surface of the support. On exhalation, they return to their original position. Then they change the position of the legs and carry out the inspiration of the simultaneous rotation of the legs and head in the opposite direction.

 Exercise N 4. Starting position lying on your back, legs bent at the knees at right angles, stand on a horizontal support, pressed to each other, hands bent at the elbows at right angles lie on a horizontal support. On inspiration, at the same time, the legs smoothly turn in one direction, and the head in the other, trying to touch the horizontal surface of the support. Then the exercise is carried out with turns in the opposite direction.

Exercise N 5. Starting position lying on your back, legs bent at the knees at an angle of 90 ^about , put the heel of the left foot on the knee of the right leg, perform turns similar to exercises 3 and 4.

 Exercise N 6. Starting position lying on the stomach, arms extended forward. On inhalation, at the same time lift the arms and legs upward from the support, hold for 1-2 seconds in the position of the maximum possible rise, and then slowly lower them on the exhale. After a pause, after 2-4 seconds the exercise is repeated.

 Exercise N 7. Starting position lying on the stomach, arms at rest at the level of the middle part of the chest. Perform the "spin", tearing the body and lifting it, the pelvis lies fixed. Gently turning the head, we fix the gaze of the heel of the opposite leg. After returning to the starting position, the exercises are repeated, turning the head in the opposite direction.

 Exercise N 8. Starting position lying on your stomach. Using the emphasis on arms bent at the elbow joints, a smooth transition is made to the sitting position on the knees with a deflection in the spine.

 All subsequent exercises are performed while standing.

 Exercise N 9. Starting position of the leg shoulder width apart, arms spread apart to the side at shoulder level. Rotate the hands with the maximum amplitude of rotation, and on the inhale, the palms are turned up, on the exhale down.

 Exercise N 10. The initial position of the legs shoulder width apart, arms bent at the elbow joints, lie on the shoulders. Rotate in the shoulder joints three to four times in each direction.

 Exercise N 11. Feet shoulder width apart, arms hanging freely along the torso. Rotate the shoulder girdle with maximum amplitude, trying to reach the level of the auricles.

 Exercise N 12. Starting position is similar to the previous exercise. Perform alternate rotation of each half of the shoulder girdle three to four times in each direction.

 Exercise N 13. Starting position of the leg shoulder width apart, arms raised up. Circular rotations are carried out alternately with the right and left hand, first in one and then in the other direction.

 Exercise N 14. The initial position of the legs shoulder width apart, arms are behind the back, bent at right angles.

 a) Carry out smooth head turns, first in one, then in the other direction.

 b) The head is tilted first to one side and then to the other side, touching the corresponding shoulder with the ear.

 c) The head is tilted back, then forward, touching the chest with the chin, after which, without tearing the chin, they turn the head first to one side, then to the other side.

 Particular attention should be paid when performing this exercise in elderly people: do not require from the first lessons to perform exercises with a full amplitude of rotation, pay attention to a gradual increase in the amplitude of rotation during the course of classes by one or two degrees, if dizziness occurs, reduce the amplitude.

 Exercise N 15. The initial position of the legs is slightly wider than the shoulders, arms are bent at the elbows, hands are located on the belt. On inspiration, the body is tilted back to physiological fixation, then the body is tilted to the left, the body is tilted and rotated to the right, the exhalation is completed at the maximum tilt position, and breathing is performed, gradually rising through the opposite side. After a pause of 1-2 seconds, the body is tilted and rotated to the other side.

 Exercise N 16. The initial position of the leg is shoulder-width apart, the hands are locked "in the lock" behind the back, lift them up as much as possible, while the torso can lean slightly forward.

 The hands are raised above the head, closed "into the lock", carry out lateral tilts of the body alternately to the right and left two or three times.

 Exercise N 17. Starting position of the leg shoulder width apart. The arms are raised through the sides upwards, while simultaneously making circular movements in the wrist joints, connecting at the top, the hands begin to rotate in the opposite direction, the body gradually tilts forward, the hands touch the feet, the legs are straight, then the patient should sit down, touching the buttocks of the heels, and the knees of the shoulders, having exhaled maximally, the feet should be fully supported on the support with all their parts.

 Exercise N 18. The starting position of the legs is slightly wider than the shoulders, slightly bent at the knees. Rotate the bent knee joints first inward, then outward.

 Exercise N 19. The legs are slightly wider than the shoulders, slightly bent at the knee joints. The body is rotated simultaneously with the rotation of the legs in the knee joints.

 Exercise N 20. Walking with the maximum lift of the leg bent at the knee joint, up, the heel put on the width of the foot, gradually the whole weight of the body is moved to the walking foot, the entire size of the foot is uniform, the movement is similar to “paperweight”. They carry out three to four minutes of walking in combination with harmonious breathing.

 An example of a specific implementation of the method.

 Patient N.P. R., 46 years old. He was admitted for treatment with a diagnosis of osteochondrosis of the lumbar spine, rehabilitation period.

 Complaints upon receipt of minor pain in the lumbar spine that occurs when bending, turning the body.

 From the anamnesis. Works at a construction site as a bricklayer. Over the past eight years, he was repeatedly treated for annual exacerbations of osteochondrosis of the lumbar spine both in the hospital and on an outpatient basis. Real construction is associated with weight lifting at work. Within two weeks he was treated in a hospital, was discharged with an improvement for rehabilitation treatment on an outpatient basis.

 Objectively upon examination: satisfactory condition, proper physique, moderate nutrition, skin and visible mucous membranes of normal color, no edema. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, heart rate of 76 per minute, blood pressure 120/80 mm RT. Art. The abdomen is soft, painless, there are no symptoms of peritoneal irritation.

 Neurological status. Cranial nerves without features. On examination, there is a slight scoliosis to the right, muscle tension of the lumbar region. On palpation, pain in the L2-L3 region is more on the right along the paravertebral line, pain in the biologically active points of the bladder meridian: V23, V24, V51, V52 on the right. The symptom of Lasega is positive on the right. Pain on palpation in the gluteal fold and popliteal fossa on the right, decreased sensitivity along the posterior thigh on the right.

 On the radiograph of the lumbar spine: a slight narrowing of the intervertebral gap between the vertebrae L2-L3.

 During the survey, the patient said that he prefers pop music of Soviet composers (A. Pakhmutova, V. Solovyov-Sedogo, A. Petrov), the colors are green, blue, orange.

 The treatment was carried out by the proposed method. After a classical massage, including rubbing, kneading, stroking, pressure was performed, pain points in the lumbar region, in the region of the posterior thighs were revealed, painful biologically active points, while the pressure was gradually increased from 1.0 kg to the course of treatment 35.0 kg At the end of the course of treatment, pain points and painful BAP were not detected.

We performed acupressure of the revealed painful points located in the lumbar region, more on the right and on the back of the thigh, as well as BAP V ₂₃ , V ₂₄ , V ₅₁ , V ₅₁ , V ₃₆ on the right in the braking mode: they acted on each point with a rotational movement of the finger in combined with a pressure of 1.0-3.0 kG for 4.0 minutes, and the general strengthening BAPs located on the upper extremities (GL ₄ GL ₁₁ ; MC ₆ , P ₇ ) were acted upon in an exciting mode: alternating rotational movements and vibrational movements with pauses, acted on each t point within 1.5 minutes, symmetrical points were used. During the session, they affected 2-10 points. At the beginning of the course of treatment after acupressure, one session of manual therapy was performed, eliminating the revealed functional block in the lumbar spine, between L ₂ -L ₃ . A set of therapeutic exercises was carried out accompanied by the sound of songs by A. Pakhmutova ("Tenderness", "Hope", "Geologists"), the colors: blue, then green, then yellow, then switched to normal lighting.

 The course of treatment included 12 daily procedures.

 After the treatment, the condition is good. There are no complaints, all movements are painless, with palpation of pain zones and points not detected. Symptoms of tension are negative.

 Discharged to work in good condition. It is recommended to conduct this treatment on their own as a prophylaxis 1-2 times a year, especially the implementation of physical exercises.

 Over the past 1.5 years, the patient did not seek medical help. Six months ago he was called for a follow-up examination, did not present any complaints. After the examination, a conclusion was made about the ongoing stage of remission.

 The proposed method treated 150 patients aged 20 to 65 years, of which 30 with osteochondrosis localization in the cervical spine, 108 people in the lumbar spine, 10 people in the thoracic spine, 2 people with widespread osteochondrosis. After the treatment, 147 patients achieved complete remission, which lasts 1.5-2.0 years, while all previous treatments allowed to achieve remission for a period of no more than 0.6-12.0 months. The effect of the treatment did not occur in three patients, further examination of which revealed the presence of tumor and tuberculous lesions of the spine, which was due to the absence of a positive effect from the treatment. Post-treatment deterioration was not observed in any of the patients.

 The present invention is simple in execution, does not cause complications, acting on all links of the pathogenesis of the disease and the levels of the nervous system, it allows you to prepare the body for work related to the implementation of physical activity due to the development of a positive dynamic stereotype. It increases the duration of remission in two to four times. The method can be used both inpatiently and on an outpatient basis, as well as by the patients themselves, the proposed exercises can be used during remission for the prevention of the disease.

Claims (11)

 1. METHOD OF REHABILITATION TREATMENT OF NEUROLOGICAL MANIFESTATIONS OF OSTEOCHONDROSIS OF THE SPINE, consisting in a comprehensive therapeutic effect, including classical and acupressure, the use of manual therapy methods depending on the nature of the pathobiomechanical manifestations, the severity, the manifestations of the local characterized in that after the classical massage is carried out acupressure pressure and reflex zones to identify painful points and painful biologically active points located locally and locally-segmentally, and they are affected by acupressure in the braking mode with subsequent exposure to biologically active points (BAP) of a general strengthening effect located on the limbs in an exciting mode , and a set of exercises of physiotherapy exercises, carried out after the identification and elimination of manual therapy techniques of existing functional blocks, is carried out with certain breathing and position and with simultaneous color and music accompaniment, the course of treatment is 12 14 sessions.  2. The method according to claim 1, characterized in that the pressure pressing is carried out with a gradual increase during the course of treatment of pressure from 1 2 to 10 - 35 kg  3. The method according to claim 1, characterized in that the acupressure in the brake mode is carried out by the rotational movement of a finger or presser, combined with a pressure of 1 to 3 kg, with an exposure time of each point for 3 to 5 minutes.  4. The method according to claim 1, characterized in that the acupressure in the exciting mode is carried out by alternating rotational and vibrational movements and pauses at the time of exposure to each point for 1 2 minutes  5. The method according to claim 1, characterized in that the exercises are carried out first in a supine position, then lying on his stomach, and then standing.  6. The method according to claims 1 and 5, characterized in that the exercises carried out while lying on the back are performed with simultaneous lower (abdominal) breathing, the exercises carried out while lying on the stomach, while the upper (chest) breathing is performed, and the exercises carried out while standing with mixed breathing.  7. The method according to PP.1 and 5, characterized in that the complex of exercises carried out lying on the back is carried out with simultaneous color and music accompaniment, including the sound of pieces of light instrumental music at a moderate pace, with moderate color lighting in white and blue tones.  8. The method according to claims 1 and 5, characterized in that the complex of exercises carried out while lying on the stomach is performed with simultaneous color and music accompaniment, including the sound of works of light instrumental music of an optimistic nature while enhancing its sound and increasing tempo, with color accompaniment in the sky blue, light green, light pink colors.  9. The method according to claims 1 and 5, characterized in that the set of exercises carried out while standing is performed while playing musical works, mainly at the pace of the march, with color accompaniment in bright red and yellow colors.  10. The method according to claim 1, characterized in that in the final period of the complex of exercises, bright, emotional music sounds, and the color accompaniment gradually switches to ordinary light.  11. The method according to PP. 1, 5 10, characterized in that the complex of exercises is carried out in color music accompaniment, in a rhythm corresponding to the rhythm of the exercises.