RU2163475C1 - Method for treating vertebral column osteochondrosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying manual treatment of the vertebral column on the area from S1 to C7 using base phalanges of the fifth fingers on physician hands. The hands are placed in symmetrical position on both sides of the vertebral column near the base of the spinous process of the vertebra to be dislocated at an angle of 0-40 deg with force of 0.3-10 ml/kv.sm. The manipulations are repeated within 3-9 sessions. Rotation of the dislocated vertebra is corrected as follows. The physician hand palm pressure is applied to the iliac bone crest in the vicinity of the wing on the side the angular deflection of the dislocated vertebra takes place. Patient leg is lifted to the outmost superior position with the other hand by holding the lower one-third of the leg on the same side. The patient leg is brought down to a certain degree and hand palm is used for applying pressure to the iliac bone crest in the vicinity of the wing. Force of 0.4-0.6 kg/kv.sm is applied. The patient leg is returned to the outmost superior position where horizontal swinging is applied in 10-70 deg sector. EFFECT: eliminated compression syndrome of intervertebral nerve radices. 2 cl

Description

 The invention relates to medicine, namely to manual therapy, and can be used to treat osteochondrosis of the spine in the lumbosacral, lumbar and thoracic regions.

 The level of development of the manual therapy technique is characterized by methods that include diagnostic and therapeutic manual techniques aimed at identifying and treating disorders of the musculoskeletal system, manifested in the form of functional joint blocks, hypermobility and regional postural muscle imbalance (see, for example, RU patents in the class A 61 H 23/00, NN 2000100 from 09/07/93; 2038066 from 06/27/95; 2040925 from 09/09/95; 2100996 from 10/01/98 and 2121332 from 10/11/98, which include the dosage effect of the doctor’s hands on the displaced vertebra of the vertebral-motor the patient’s normal segment lying on his stomach, repeated multiple times to a characteristic crunch or click.

 According to the number of matching signs, the closest analogue is the method of treatment of degenerative-dystrophic diseases of the spine according to a. from. 1331509, A 61 H 23 23/00, publ. 08.23.87 in bull. N 31, including the methods of manual therapy, carried out by means of the dosed force of strokes by the edge of the palm of a doctor’s hand, applied to the area of the affected vertebrae through the fingers of the hand of the other hand, located between the spinous processes of the vertebrae of the vertebral-motor segment. Manual actions are carried out repeatedly and with the patient lying on his stomach, after which they rotate up to 5 degrees simultaneously with shaking the patient in an upright position.

 First, the doctor puts one hand on the affected area, while the spinous processes of the affected vertebrae are located between the second and third fingers at the level of the middle phalanges, which lie on the transverse processes and fit snugly to the spine. Then, with the edge of the palm of the other hand or its proximal edge, the doctor applies metered strokes to the middle phalanges of the fingers.

 These manipulations are repeated three times in two days. The result of treatment: in a shortened time, a significant improvement in the restored functions of the affected vertebral-motor segment of the spine is achieved, the pain syndrome is eliminated.

 However, the known method has limited application due to the fact that strokes in the area of the affected vertebrae can damage their bone structure, for example during osteoporosis, after surgical interventions, and during rotation, there may be damage to the spinal cord in the presence of herniated discs of the vertebral-motor segments, osteophytes in lumen of the spinal canal, etc.

 The objective underlying the present invention is to expand the technological capabilities of a more reliable and functional method of treating osteochondrosis.

This result is achieved by the fact that in the known method for the treatment of osteochondrosis of the spine, which includes repeated manual manipulation of the vertebral-motor segment from the side of the displacement of the vertebra, on the base of its spinous process, in the patient’s position on the stomach, with fingers of the doctor’s hands with dosed effort and subsequent derotation of the displaced vertebra to a characteristic click, at the suggestion of the author Nikolaeva S.L. manual impacts on the spine from S ₁ to C _{7 are} carried out by means of the main phalanges of the fifth fingers of the hands of the doctor, located symmetrically to the axis of the spine at the base of the spinous process of the displaced vertebra, at an angle in the range of 0 ... 40 degrees with an effort of 0.3 ... 0 , 5 kg / sq.cm, and these actions are repeated for 3 ... 9 sessions, despite the fact that the rotation of the displaced vertebra is carried out as follows: the palm of the doctor’s hand is placed in the crest of the ilium in the wing area from the side of the angular deviation of the displaced vertebra, and raised with his second hand dissolved leg of the patient on the same side as the lower third of the femur to the uppermost position, after which the leg of the patient is partially lowered and pressed against palm of the hand on the iliac crest by a wing with a force of 0.4. . . 0.6 kg / sq.cm, while returning the patient’s leg to the highest position, where horizontal swaying of the legs in the sector of 10 ... 70 degrees is carried out.

Distinctive features have provided the expansion of the use of an effective method for the treatment of osteochondrosis of the spine from S ₁ to C ₇ and functionally related diseases of the internal organs and systems of human organs.

 The implementation of manual effects on the displaced vertebra of the vertebral-motor segment by means of the main phalanges of the fifth fingers of the hands of a doctor placed symmetrically to the axis of the spine on both sides at the base of its spinous process, provides pressure distribution on unevenly loaded own muscles and ligaments of this vertebral-motor segment, and also on the bone structure of the displaced vertebra.

 From the point of view of mechanics, the doctor’s hands, resting on both sides at the base of the spinous process by means of the main phalanges of the fifth fingers of the clenched hands, are a kind of pantograph in which different shear forces are applied in the articulated arms of the hands. This allows you to reduce pressure on the displaced vertebra, eliminating bone-traumatic injuries, including operated vertebrae after microneurosurgical removal of hernias of discs of different localization.

 The proposed kinematic scheme for applying manipulation efforts in a confidential technological range of values is guaranteed to ensure the displacement of the vertebrae in their natural position.

 The application of shear forces at an angle to the axis of the spine in the range of 0 ... 40 degrees is determined almost as follows. In the case of segment hypermobility, the effect on the displaced vertebra is applied parallel to the axis of the spine, that is, at a zero angle, which is sufficient for shear with minimal effort. The application of the efforts of the doctor’s hands at an angle of 40 degrees guarantees the displacement of the vertebra with the rise above the second vertebra of the segment.

 The lower limit of the optimized range of vertebral displacement efforts of 0.3 kg / cm2 allows the use of manual exposure for the treatment of diseases that are functionally associated with the spinal-motor segments with postoperative bone structure disorders. With less effort, it is impossible to overcome the elasticity of one's own muscles and ligamentous apparatus of the segment.

 With shear forces above 10 kg / cm2, mechanical injuries of the spine are possible.

 The minimum repetition of manual actions according to the proposed method is sufficient for the operated vertebrae, because a compressing agent, a herniated disc, has been removed in them.

 The maximum number of sessions is determined by the maximum number of repetitions of manual effects, after which there is an exacerbation, plus two days of fixing the achieved physiological form of the vertebral-motor segment in alignment with the spine.

 The proposed method of derotation is the sum of the so-called "short and long levers", the use of which ensures the angular rotation of the displaced vertebra to a natural place, as evidenced by a characteristic click.

 Horizontal swaying of the patient’s legs in the highest position - “long lever” with a fixed position of the other hand of the doctor with a palm on the iliac crest in the wing area - “short lever” (see Levit K., Manual therapy in the treatment of articular pathology, Leipzig, 1983, p. 548) provide scanning of the application vector of the rotation force relative to the longitudinal axis of the displaced vertebra for its painless rotation into the natural physiological position in the structure of the vertebral-motor segment.

 The angle of the horizontal swinging sector of the "long lever" of less than 10 degrees does not guarantee the rotation of the offset vertebra.

 Horizontal swaying of the patient’s legs in the highest position in a sector of more than 70 degrees does not increase the effectiveness of the achieved rotation result, but can be painful for the patient.

 The pressure on the crest of the ilium in the wing area with the palm of the hand of a doctor during derotation of the displaced vertebra (“short lever”) is less than 0.4 kg / sq. cm does not provide fixation of the second vertebra of the spinal motor segment to achieve the necessary rotation of the displaced vertebra relative to the longitudinal axis of the spine.

 If the palm of the doctor’s hand presses the crest of the ilium in the wing area more than 0.6 kg / cm2 during ligation, damage to the ligaments can occur (separation of the sacroiliac ligament from the spinous process of the corresponding vertebra or from the iliac crest).

 Therefore, each essential feature is necessary, and their stable relationship in the aggregate is sufficient to achieve the novelty of quality, a new super-effect that is not inherent in the signs of disunity, and not the sum of the effects.

 The proposed method is as follows.

 The patient is laid on his stomach on a medical couch, his arms are extended back along the body, the head is turned in the direction convenient for the patient, the muscles of the limbs and body are relaxed as much as possible.

Manipulations of the doctor are performed sequentially from S ₁ to C ₇ from the bottom up to verify diseases, revealing the displacement of the spinous processes from the midline of the spine. The combination of listezas with or without rotation in any direction and knowledge of the segments of the spine where this or that pathology of organs, organ systems are localized, is the essence of vertebrodiagnosis performed by a doctor.

 The doctor is located on the side of the patient at the level of his pelvis, hands clenched into fists are installed on both sides of the spinous process of the displaced vertebra of the vertebral-motor segment to be treated with manipulations, with the support of the main phalanges of the fifth fingers at its base.

 Depending on the elasticity of the resistance reaction to the shear force that the doctor applies to the displaced vertebra, the hands are rotated from 0 to 40 degrees relative to the axis of the spine.

 Then, with a dosed effort, the vertebra is displaced relative to the second motionless vertebra of the vertebral motor segment. In this case, the displaced vertebra rises and sets in its natural position, and under the action of the asymmetric load of the ligamentous apparatus, it occupies a habitually inclined position relative to the axis of the spine.

 To eliminate this position defect, the displacement of the displaced vertebra is further carried out, for which the palm of the doctor’s hand is placed in the iliac crest, in the wing area from the side of the angular deviation of the displaced vertebra (“short lever”). With the second hand, the doctor lifts her to the highest upper position, to the maximum tension of the ligaments, on the lower third of the thigh of the patient’s legs from the same side, then partially lower the leg and press with the palm of the other hand with a force of 0.4. . . 0.6 kg / sq.cm on the wing of the iliac crest, returning the patient’s leg to its highest position (“long lever”). In this position, horizontal leg swings are carried out in a sector of 10 ... 70 degrees.

 The described manipulations are repeated for 3 ... 9 sessions. As a result of the combined action of the “short” and “long” levers, the displaced vertebra rotates relative to the axis of the spine and occupies its physiological place of interaction in the vertebral-motor segment, as evidenced by a characteristic click.

 The manipulation of the spinal segment restored by the method described above is then completed.

 The combination of the described manipulations eliminates the mechanical compression of the roots of the spinal cord and, as a consequence, their deformation, which leads to normalization of the shape in the cross section, where they were deformed when the vertebra was displaced. This ensures the normal passage of nerve impulses along the roots adjacent to the displaced vertebra in full, which entails the restoration of the functions of the associated internal organ or system of human organs.

 From practice, the required number of proposed manipulations in the range of 1 ... 7 sessions has been established, as a result of which a compulsory exacerbation occurs - an indicator of the release of the roots of the spinal cord from physical pressure.

 After eliminating mechanical compression, the restoration of the root shape is delayed in time, which is the cause of the pain syndrome during the passage of nerve impulses from the spinal cord, the number of which was restored to a normal level, but passes through a smaller cross section of the roots.

 In order for the roots to regain their shape and cross section at the site of eliminated compression, two additional sessions of the above manipulations are performed, in total - 3 ... 9 sessions.

 The invention is illustrated by clinical examples.

 Example 1. Patient C., 32 years old, was admitted to MGNHTS on 10.11.96 with complaints of non-stopping pain in the right gluteal region with irradiation on the outer surface of the right leg, the so-called "strip", walking difficulties, expressed in fatigue of the right lower limb , a feeling of numbness in the right lower leg and foot ... Received to address the issue of surgical treatment.

From the anamnesis: in 1993 he was operated on at the MHC for a disc herniation L ₄ -L ₅ , was discharged in satisfactory condition.

On computed tomography from 11/01/96: no narrowing of the spinal canal was detected, marked degenerative changes in the discs L ₃ -L ₄ , L ₅ -S ₁ were noted.

Objectively: displacement L ₅ posteriorly with rotation to the right, displacement S ₁ posteriorly with rotation to the left.

 Conducted 3 sessions of manual therapy according to Nikolaev S.L. Listez and rotation eliminated. Within 2.5-3.0 hours after the fifth session, the intensity of pain decreased significantly. Over the next two days, the patient was under the supervision of a manual therapy doctor. Subtotal regression of symptoms was noted. The patient was discharged on November 30, 1996 under the supervision of a local neuropathologist.

 Example 2. Patient S., 43 years old, was admitted to the MHHC on 12/04/96 complaining of pain in the lumbar region of a pulling character, inability to walk upright due to intensifying pain radiating to both thighs and perineum, constant urination.

On a computer tomograph from 12/01/96: signs of degenerative-dystrophic changes in disks from L ₄ to S ₁ .

Objectively: posterior displacement L ₄ , L ₅ with rotation to the left, retrolisthesis S ₁ with rotation to the left.

 Conducted 9 sessions of manual therapy. The above complaints are fully stopped. There are no pains, urination is free, painless.

 Two days later (12.24.96), the patient was discharged for outpatient aftercare in a satisfactory condition.

 Example 3. Patient N., 26 years old, complained of a sharp violation of the menstrual cycle. Pauses between menses reached 135 days.

On ultrasound of the uterus from 04/03/99 sizes:
- longitudinal 42 mm
- front-rear 29 mm
- transverse 33 mm.

Analysis of the hormonal spectrum from 03/29/99:
- testosterone 13.46 (3.2 ... 14.0)
- androgens total 9.45 (4.3 ... 9.2)
- androgens free 1.84 (0.7 .... 2.5)
Noteworthy is the rise in total androgens and a sharp decrease in the transverse size of the uterus.

Objectively: on palpation, paravertebral points from L ₂ to S ₁ on both sides are painful, more to the right, L ₅ -S ₁ rotation to the left, dorsal spondylolisthesis L ₅ with rotation to the left.

 Three courses of manual therapy were carried out for 8-9 sessions from 04/06/98 to 12/28/98.

 Objective research. Ultrasound of the uterus from 05.01.00.

Dimensions:
- longitudinal 43 mm
- front-rear 27 mm
- transverse 42 mm.

Analysis of the hormonal spectrum from 06.01.00:
- testosterone 11.34,
- androgens total 8.45,
- androgens free 2.47.

 Menses for three months, from October to December 1999, after 21-23 days.

 Example 4. Patient P., 12 years old, turned 20.04.97 with complaints of pain in the right hypochondrium after a diet violation (ate sweet, fatty).

 On examination: slight yellowness of the sclera, tongue with a yellowish coating.

 On ultrasound from 06/11/97: torsion of the gallbladder with a violation of the outflow of bile.

Objectively: the rearward shift of Th ₇ -Th ₉ with the rotation of Th _{7 to the} left, Th ₈ -Th _{9 to the} left.

 Two courses of manual therapy were carried out for 7-8 sessions with an interval between them of 1.5 months.

 On examination: no sclera was found in jaundice, the tongue is clean.

 Ultrasound from 09/18/97: a slight torsion of the gallbladder, impaired outflow of bile is not determined.

 Follow-up examination 10/20/97: there is no sclerosis of yellowness, the tongue is clean, discomfort after taking milk, sweet, fatty, etc. denies.

 Example 5. Patient Sh., 44 years old, was admitted to MGNHTs 04/10/97 with complaints of constant aching pain in the lumbar region, "sticking" of the left foot.

On a computer tomograph from 04/05/97: protrusion of the intervertebral disc L ₃ -L ₄ up to 12 mm, protrusion of the intervertebral disc L ₂ -L ₃ up to 4 mm.

On examination: rotation L ₂ to the right with a slight rearward displacement L ₃ with rotation to the left, rearward displacement S ₁ with rotation to the left.

Two sessions of manual therapy were carried out every other day: displacements and rotations were completely eliminated. On microneurosurgical operation, a hernia of the L ₃ -L ₄ disc was removed and the spinal canal was revised from L ₂ to L ₄ .

 Restoring the functions of the radiculoischemic foot during the first days after surgery.

 On the 10th day, after removing the sutures, the patient was discharged for outpatient aftercare under the supervision of a neuropathologist and surgeon with subtotal regression of symptoms.

 Example 6. Patient L., 21 years old, was admitted to MGNHTS 13.11.96 transfer from STB No. 13 with complaints of weakness of the back flexors of the right foot.

 Anamnesis morbi: this condition arose sharply in early October 1996, when it noted weakness in the distal parts of the right foot, the impossibility of dorsiflexion of the right foot.

 Conservative therapy was not successful.

 St. nevrologicus paresis of the back flexors of the right foot of a high degree of achilon reflexes on the right is less than the left on average liveliness.

 Locally: hypotrophy of the muscles of the right thigh and lower leg.

Magnetic resonance imaging from 11/31/96: herniation of the intervertebral disc L ₃ -L ₄ with its posterior protrusion and compression of the dural sac.

After preoperative preparation, 11/21/96, a L ₃ -L ₄ flavotomy was performed _{on the} right, and a herniated disc was removed. The postoperative period is without complications. Complaints about the sharp weakness of the extensors of the right foot.

Vertebrodiagnostics 02.12.96, objectively: rotation S _{1 to the} left, rearward displacement L ₂ -L ₃ , compensatory displacements Th ₅ -L ₁ .

 A manual therapy session was conducted. Displacements and rotations are eliminated. There were vague sensations of "running" along the back of the right thigh.

 12/03/96: satisfactory condition, sensitivity along the outer surface of the right foot slightly reduced. The amplitude of the movements of the right foot and the strength of the fingers of the right foot increased.

Objectively: slight rotation of S _{1 to the} left.

 A manual therapy session was conducted. Displacement and rotation eliminated.

 The patient was discharged from the clinic with subtotal regression of symptoms of loss and tension.

 Control examination 07.05.97: Achilles reflexes on the left and right are the same, the function of the extensors of the right foot is fully restored.

 A method for the treatment of osteochondrosis of the spine according to Nikolaev S. L., provides an expansion of technological capabilities and the field of its application, and also increases functional reliability in the rehabilitation of the musculoskeletal system of a person and diseases of organs associated with it.

 The proposed invention is unknown from available sources of information on the level of medical technology, from which it does not explicitly follow for doctors of neurology and manual therapy, and can be serially reproduced clinically, that is, meets the criteria of patentability.

Claims (2)

1. A method of treating osteochondrosis of the spine, including the impact on the vertebral-motor segment from the side of the displacement of the vertebra, on the base of its spinous process, in the position of the patient lying on his stomach, with the fingers of the doctor’s hands with dosed effort and subsequent derotation, characterized in that they carry out manual action from S ₁ to C ₇ vertebrae through the main phalanges of the fifth fingers of the doctor’s hands, located symmetrically to the axis of the spine at the base of the spinous process of the displaced vertebra, at an angle in the range of 40 ^o with an effort of 0.3 up to 10 kg / cm ² . 2. The method according to claim 1, characterized in that the displacement of the displaced vertebra is carried out by the palm of the doctor’s hand, which is rested in the crest of the ilium from the side of the angular deviation of the vertebra, and the second hand lifts the patient’s leg from the same side, from the lower third of the thigh to the extreme upper position, after which the leg is partially lowered and the palm is pressed onto the crest with a force of 0.4 to 0.6 kg / cm ² , while returning the patient’s leg to its highest position, where horizontal swaying is performed in the sector from 10 to 70 ^o .