RU2237459C2 - Method for applying manual treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying postacativation comprising four stages like preliminary passive tension, dynamic and static activation, and repeated considerable passive stretching. The second, the third and the fourth stages are carried out by patient in cooperation with physician under moderate force intensity and with physician body weight being used in combination with eye-moving and breathing synergies of patient. Treatment application objects are muscles, fasciae, ligaments, articulation capsules, brain dura mater, commissures and intervertebral disks. Patient carries out dynamic activation during 4-5 s after applying passive muscle stretching done by the physician. The physician concurrently does conceding work and the patient does static activation during 4-5 s during which the physician fixes the achieved state and then repeatedly carries out considerable passive muscles, fasciae, ligaments, articulation capsules, brain dura mater, commissures and intervertebral disks stretching to reach new movement volume of moderate patient pain feeling when relaxing. The action is accomplished with 2-3 swinging movements in the direction of applied tension. The action is done from both sides with more intensive stretching on the lesion side. Repeated cycle number is equal to 3-5 depending on motor vertebral segments and extremity articulations blockage.

EFFECT: enhanced effectiveness of treatment; increased movement volume.

Description

The invention relates to medicine, namely to manual therapy, and can be used as an independent method, as well as in combination with other methods for treating the musculo-ligamentous apparatus with degenerative-dystrophic lesions of the cervical, thoracic and lumbar spine, pelvis and joints of the extremities.

The main purpose of the techniques of manual therapy is to restore the normal range of motion of the musculoskeletal system and eliminate pain.

The techniques are based on muscle contractions of two types - static (isometric) and dynamic (isotonic). A muscle contraction in which it develops tension but does not change its length is called isometric. Muscle contraction with a change in its length and movement in the joint is called isotonic. According to the degree of activity, technical actions can be active and passive. Active are performed by the patient himself, and passive ones are performed with the help of a doctor, without volitional and muscular efforts of the patient [1].

After isometric tension, the relaxation phase begins, when the muscle is not able to contract, and its hypotension, hypoalgesia and lengthening occur. This physiological effect is used in many mobilization techniques of manual therapy.

Currently known and widely used the following manual effects:

1. Postisometric relaxation (PIR) is a technique that is used in modern manual medicine as one of the methods of independent treatment or in combination with manipulations on the vertebral-motor segments and joints of the limbs. Indications for the use of PIR are spasmodic contraction and muscle tension. Technique: the doctor sets the patient’s body part or limb to its original position and determines the initial volume of movement. In this case, there should be no forced muscle strain and pain. The patient performs isometric work of minimal intensity against the same external effort of the doctor for 10-30 seconds. If in the future the muscles relax well, then the phase of the isometric tension is performed within 10 seconds; if the muscles relax poorly, then the duration of this phase lengthens up to 30 seconds. Subsequently, the patient relaxes and a relaxation phase lasts 10 seconds or more. In this phase, the doctor conducts a smooth movement in the direction of its limitation and, sensing minimal muscle resistance, stops. Thus, due to the lengthening of the muscle in the relaxation phase, an increase in the range of motion occurs and a new initial position is established. From this starting position, a new relaxation cycle is conducted. The main condition for PIR is the minimum load intensity. The procedure is performed 3-6 times. As a result, persistent hypotension occurs in the muscle and pain disappears. The authors believe that no passive stretching occurs during the procedure. The main therapeutic effect is to relax tense muscles.

There are two modifications to this method:

1) synergistic tension and muscle relaxation that occurs when the gaze changes direction;

2) synergistic muscle tension that occurs during inhalation and relaxation during exhalation.

The best effect is achieved with the simultaneous use of respiratory and oculomotor synergies [2].

Criticism: due to the minimal intensity of the load, there is a weak effect on the fascia, ligaments, joint capsules, and, as a result, insufficient increase in range of motion. There is no effect on adhesions, dura mater and intervertebral discs.

2. Post-reciprocal relaxation (PRR). Technique: after preliminary passive muscle stretching by a doctor, the patient performs isometric work of minimal intensity against the external efforts of the doctor for 7-8 seconds. In the future, the doctor does not make movement in the direction of its restriction, as in PIR. This is done by the patient himself due to the active tension of the antagonist muscle. The role of the doctor during a pause is to control the degree of antagonist activity and the direction of movement. The patient should be focused on the following points:

1) provide minimal resistance to the doctor during isometric stress;

2) independently energetically do the work in the opposite direction in the same plane of movements.

Changing the direction of movement significantly reduces the therapeutic effect. During the patient’s active work, the doctor does not exert external resistance [3].

Criticism: the disadvantage is that the active work of antagonistic muscles does not give such an increase in range of motion as with passive stretching under the influence of an external significant effort. This fact has found wide application in orthopedics in the treatment of contractures and arthrosis (passive kinesitherapy with weights) [4]. With some positions of the body or limb and severe pain, an increase in range of motion with the help of PRR is almost impossible (for example, when performing a universal mobilizing technique for the spine, when relaxing the piriformis, pelvic muscles and ligaments, quadriceps femoris). Most patients, especially those without motor talent, cannot correctly select the force and direction of movement, and it takes a lot of time to learn their PRR technique.

3. The postisotonic relaxation technique (PITR) is the opposite of PIR. The essence of the method is to perform isotonic work against the external efforts of the doctor. The patient performs dynamic work of considerable intensity against the inferior effort of the doctor. The lead time is 15-30 seconds. The number of repetitions is 1-3. After the procedure, muscle hypotension occurs, their lengthening and hypoalgesia [3].

The method is used in kinesitherapy of orthopedic patients, in particular with coxarthrosis. The main task of exercises is to increase muscle strength, endurance and muscle performance [4].

Criticism: The disadvantage is that the patient performs the movement with maximum force. This leads to increased pain, the inclusion of unnecessary muscle groups in the work with a violation of the trajectory of movement. Subsequently, passive or active stretching of the musculo-ligamentous apparatus is not carried out.

It is known that pain is accompanied by the emergence of functional (reversible) blockades, and subsequently organic (irreversible) blockades of the vertebral-motor segments and joints of the limbs. A convenient classification of blockades by degrees was proposed by A.Stoddart.

0 degree - no movement, ankylosis of the joint, there is no indication for manipulations;

1 degree - pronounced blockade, only one mobilization technique is possible;

2 degree - a rough blockade; manipulation and mobilization techniques are possible;

Grade 3 - normal mobility, does not need treatment;

Grade 4 - hypermobility, does not need mobilization [3].

Most doctors use manual therapy for the 2nd degree of blockade, when manipulations can be carried out immediately or after the preliminary use of soft techniques. With 1st degree blockages, which often occur in patients with degenerative-dystrophic lesions of the spine: osteochondrosis (protrusion or prolapse of the intervertebral disc, Schmorl's hernia), spondylosis, spondylarthrosis, spondylolisthesis, secondary lumbar stenosis, as well as scoliosis, arthrosis of the end, As a result of which there is a general shortening and fibrous degeneration of muscles, fascial-ligamentous structures and the development of connective tissue contractures, soft techniques are ineffective, and manipulations are impossible. Thus, the range of patients who are shown manual therapy is significantly limited.

The ineffectiveness of soft techniques in the above cases is explained by the fact that their main point of application is muscle fiber, which is tried passively in the PIR technique by a doctor or actively by the patient in the PIR technique after an isometric voltage of minimal intensity. To overcome the contraction of fibrously altered muscles, fascial ligamentous structures, adhesions, connective tissue contractures of the joints, more significant effort is required.

Currently, the great importance of fascial ligamentous structures in the formation of pain is proven. Algic syndromes are known associated with shortening (hypertonicity) of the pelvic ligaments (sacrospinous and sacral-tuberous), sacroiliac joint, lumbodorsal fascia, fascia of individual muscles. Moreover, hypertonicity - trigger points - can also form in the periosteum, where, as you know, muscle tissue is not represented [3].

It is also known that degenerative-dystrophic lesions of the spine and joints of the extremities are accompanied by aseptic inflammation, edema and the development of adhesions inside the joint, between the dura mater and the walls of the spinal and radicular canals, which leads to compression of the neurovascular structures, intensification of pain and blocking [ 5, 6].

The circulation of blood in the spinal canal has its own characteristics. Almost every intervertebral foramen enters along the arterial branch, which divides in the spinal canal and supplies the spinal cord, the roots of the spinal nerve and their sheath. Venous outflow of blood from the spinal cord occurs through the internal and external venous plexuses, which anastomose with each other and with the large veins of the bone substance of the vertebral bodies. There are no valves in the veins of the spinal cord, and they are not surrounded by muscles, so there are prerequisites for the development of venous stasis in the spinal canal. Venous outflow from the spinal canal is significantly hampered at the site of blocking of the arcuate joints of the vertebral motor segments, which leads to increased compression of the neurovascular structures located here and to a slowdown in the removal of metabolic products from the vertebral bodies and intervertebral discs [6].

It is known that an increase in venous intraosseous pressure in the vertebrae is one of the most powerful pain factors, since there are pain sensitivity receptors in the bone tissue of the vertebrae. At the same time, a reflex narrowing of the arteries occurs, which prevents a sharp increase in venous pressure. This leads to a decrease in the amount of arterial blood flowing to the spinal cord and the development of hypoxia. In this case, conditions are created for the occurrence of edema, impaired cell metabolism, and the accumulation of under-oxidized products. As a result, the function of the spinal cord and its roots suffers [7].

Severe osteoarthritis of the joints of the limbs causes constant dull pain. There is evidence that these deep bone pains may be due to increased intraosseous venous pressure ("articular migraine"). In such cases, a decrease in venous pressure can serve as the mechanism by which pain is weakened after osteotomy with coxarthrosis. Finally, a clear reduction in pain after reconstructive operations on damaged pineal glands of the bones also indicates the importance of increasing intraosseous venous pressure [8].

The objective of the invention is to provide the possibility of effective treatment of patients with degenerative-dystrophic lesions of the spine and joints of the extremities with blockade of the 1st and 2nd degree (according to Stoddart) by manual exposure to all tissue structures involved in the formation of pain and blockade, a significant increase in range of motion , activation of arterial inflow, improvement of venous outflow from the spinal canal and joints of the limbs.

The problem is solved in that in the claimed method of manual exposure according to V.K. Kalabanova perform post-activation stretching (PA), which consists of four stages, namely, preliminary passive stretching, dynamic and static activation and repeated significant passive stretching, with the second, third and fourth stages being performed by the patient and the doctor with medium strength using the physician’s body weight in combination with the patient's oculomotor and respiratory synergies, the target is muscles, fascia, ligaments, joint capsules, dura mater, adhesions and intervertebral disks, and after preliminary passive muscle stretching by the doctor, the patient performs dynamic activation for 4-5 seconds, the doctor simultaneously performs inferior work, then the patient performs static activation for 4-5 seconds, during which the doctor fixes the position, then the doctor within 8-10 seconds conducts repeated significant passive stretching of muscles, fascia, ligaments, joint capsules, dura mater, adhesions and intervertebral discs to a new range of motion with moderate pain feeling in the patient when he relaxes and finishes the action with 2-3 swaying movements in the direction of the performed stretching, the effect is performed on both sides with a stronger stretching on the sore side, the number of repeated cycles is 3-5 depending on the degree of blocking of the vertebral-motor segments and joints of limbs. The proposed method meets the criterion of “novelty”, since in the process of patent information research no sources were found discrediting the novelty of the invention.

The present invention meets the criterion of “inventive step”, since the search process did not reveal technical solutions with essential features of the proposed method.

The proposed method allows to obtain the following positive effect.

The preliminary passive stretching performed by the doctor at the first stage allows you to establish the initial range of motion in the PDS or joint of the limb. It is carried out to the limit of the range of motion and the pain limit.

Dynamic activation with moderate force acts as a muscle-venous pump, which, due to repeated contractions of the muscles of the spinal column, contributes to the outflow of blood from the external venous plexuses of the spine, and due to movements in the arcuate joints of the vertebral-motor segments, from the internal venous plexuses. The elimination of venous stasis leads to a faster absorption of inflammatory edema and a decrease in the compression of neurovascular structures. Similar work on the limbs also improves venous outflow, which leads to a decrease in intraosseous venous pressure. At the same time, arterial flow increases, hypoxia of the nervous tissue is eliminated, and degenerative-dystrophic processes in the intervertebral discs and articular cartilages slow down.

Static activation with medium strength also significantly increases the flow of arterial blood, and there is a preliminary "warming up" of the muscles and fascial ligamentous apparatus. This is necessary for the subsequent effective and non-traumatic stretching of the musculo-ligamentous apparatus. After isometric tension, the phase of the absolute refractory period always occurs, when the muscle is not able to contract and can be stretched.

Repeated significant passive stretching is performed by a doctor with medium strength using his own body weight to a new range of motion in the spine or pathological joint. This allows you to stretch not only tissue with a normal structure, but also fibrotic muscles, fascia, ligaments, joint capsules, as well as adhesions, dura mater, intervertebral discs. This leads to a significant increase in the range of motion in the vertebral motor segments and joints of the limbs, the elimination of blockades, the elimination of pain, as well as the possible reduction of the prolapse of the intervertebral disc, provided that it remains contractile. At the end of this stage, the doctor performs 2-3 swaying movements that enhance the effect of stretching.

In PIR, the patient's voluntary effort should be minimal - about 5% of the maximum possible, the doctor’s efforts are accordingly also minimal [3]. PAIR is performed with medium effort. According to the author, the concept of the average impact force is individual for each patient. It is 50% of the maximum possible for the patient and depends on his age and physical development. The efforts of the doctor in this case should correspond to the efforts of the patient in magnitude. Maximum efforts should not be applied, as this leads to increased pain, the inclusion of unnecessary muscle groups in the work with a violation of the trajectory of movement. Minimal efforts, according to the author, do not provide sufficient activation of blood supply to the musculo-ligamentous apparatus for its subsequent effective and non-traumatic stretching. Despite the fact that the method uses an effect with medium strength, patients tolerate it quite easily. This is because in the method there is an alternation of the stages of dynamic, static activation and passive stretching and the patient is not in a forced position for a long time.

The method is performed from two sides, both on the sick side and on the healthy side, and on the sick side with a stronger stretch than the healthy one. Performing the action on both sides allows to increase the proprioceptive flow into the segment of the spinal cord corresponding to the lesion, which causes a reflex decrease in tone in the affected muscles and ligaments and an analgesic effect.

The doctor’s use of his own body weight allows him to carry out the steps of the method without physical overstrain, to resist the patient during dynamic, static activation and to effectively perform repeated significant passive stretching. To do this, the doctor shifts his center of gravity due to the tilt of the body forward, backward or sideways, while his legs, bent at the hip and knee joints, can also move. Through his hands and other reference points, the doctor transfers the force of his body to the patient. The doctor can lean with one hand on the table. If necessary, a front bench is used.

According to the author, the duration of each stage during the execution of the method is associated with the duration of respiratory synergies. The optimal breathing regime is a smooth breath during dynamic activation for 4-5 seconds, breath holding during static activation for 4-5 seconds and a smooth exhale during the repeated significant passive stretching stage with additional swaying movements for 8-10 seconds . This breathing rhythm is in many ways similar to respiratory synergies during PIR, where a gentle inhalation and breath holding take from 10 to 30 seconds. However, at PIR efforts of minimal intensity are used, so the patient can withstand a long breath and breath holding. A couple uses medium-intensity efforts during which more energy is expended, and the total duration of inspiration and breath holding during dynamic and static activation should not exceed 10 seconds. In PIR, the relaxation phase, accompanied by a smooth exhalation, lasts 10 seconds or more, with minimal effort. A medium force is used in the PAR, therefore, the duration of the stage of repeated significant passive stretching, accompanied by a smooth exhalation, should not exceed 10 seconds.

Along with respiratory, oculomotor synergies are also used (Gaymans P., 1980). It is known that when looking upwards, the extensor muscles of the neck and back are tensed, when looking downwards, the flexors of the neck and body, to the right are rotators that turn the head and body to the right, and vice versa, when the view is directed to the left. When performing PIR of the muscles of the lower half of the body (pelvis and lower limbs), oculomotor synergies are ineffective [3]. According to the author, this statement is true only in the case of minimal effort. In PAR, oculomotor synergies for the muscles of the neck and trunk are performed according to the principles described above. When working with the muscles of the pelvis and lower extremities, the author also uses oculomotor synergies, which help the muscles to more clearly “engage” in the work and retain the necessary effort.

In PAR, oculomotor synergies for the lower half of the body are performed as follows. In the supine position, the face and gaze of the patient are directed straight up, his hands are behind his head. Do not use a pillow under your head. During dynamic activation, the patient looks up to the forehead, while the neck extends backward, the head tilts slightly. In the supine position, the patient’s forehead is on his hands crossed in front of him, his gaze is directed down to the table. During dynamic activation, the patient looks up to the forehead, while the neck extends backward, the head rises. The shoulders and chest remain in place. During static activation in both positions, the direction of looking up to the forehead is maintained. This causes tension of the extensors of the neck, which potentiates the tension of the muscles of the pelvis and lower extremities. During repeated significant passive stretching in both positions of the body, the patient’s gaze and head return to their original position, and the extensor muscles of the neck and muscles of the lower half of the body relax.

The number of repeated PAR cycles per session depends on the degree of blocking and how easily this blocking is eliminated. If during this procedure the doctor manages to transfer the blocking from the 1st degree to the 2nd or from the 2nd to the 3rd, then the number of repetitions is 3. If the doctor does not succeed, then the number of repetitions increases to 5. If it is impossible to transfer blocking to a lighter degree for a given session; sessions are repeated on the following days until the 3rd degree of blocking is reached. The average course of treatment is 10 sessions.

The author suggests calling this method of manual exposure post-activation stretching (PAR), since the main stages in it are the dynamic and static activation of the musculo-ligamentous apparatus and its subsequent repeated significant passive stretching.

Thus, the main differences of the proposed method from all existing influences are:

1) a new technique for performing techniques of manual exposure;

2) sequential execution of dynamic and static activations in one way;

3) isometric tension (static activation) of the musculo-ligamentous apparatus is performed after movement in the joint and contraction of the muscle with a change in its length, in contrast to PIR and PRR, where isometric tension is carried out at the same muscle length without making movement in the joint;

4) the implementation of the second, third and fourth stages and the patient and the doctor with average strength using the body weight of the doctor;

5) performing not relaxation, but repeated significant passive stretching with additional swaying movements that enhance this effect;

6) the implementation of oculomotor synergies when working with the muscles of the pelvis and lower extremities.

Contraindications to the use of the proposed method are: absolute contraindications for manual therapy, as well as a pronounced pain syndrome, conditions after acute cerebrovascular accident and myocardial infarction; heart disease accompanied by circulatory failure; lung diseases accompanied by respiratory failure in a patient.

The proposed method was applied in 500 patients with pain syndrome of varying severity and blocking of the 1st and 2nd degree (according to Stoddart) with the following pathologies: osteochondrosis, shoulder-shoulder arthrosis and coxarthrosis of 1-2 degrees, scoliosis of 1-2 degrees. Of these, 200 people with protrusions and a hernia of the intervertebral disc, which, due to the ineffectiveness of conservative treatment, were offered neurosurgical surgery. In 85%, an excellent and good effect was obtained, in 15% without positive dynamics, there were no negative results.

Thus, the application of the proposed method allows to expand the group of patients who are shown manual therapy, namely to include in this group of patients with severe blockade (1-2 degrees) of the vertebral-motor segments of the cervical, thoracic and lumbar spine, pelvis, and also joints of the limbs many of which have been shown only surgical treatment. The method allows to increase the efficiency and reduce the treatment time, can be applied both as an independent technique and in combination with other methods of manual therapy in the treatment of certain pathologies (osteochondrosis, scoliosis, arthrosis, hernia between the vertebral disc).

The method is as follows.

I. Post-activation stretching of the musculo-ligamentous apparatus of the cervical and upper thoracic spine in flexion.

Stage 1 - preliminary passive stretching.

Starting position: the patient sits on the table, the doctor stands behind him. To make it easier for the doctor to work, it is necessary to bring his center of gravity closer to the patient. To do this, one doctor’s leg, bent at the knee and hip joints, is placed on the table on the side of the patient, and the other leg is on the floor or front bench. The patient joins his hands in the lock and puts them on the back of the head. In this case, the patient’s head drops forward under its own weight and the weight of its arms crossed. The doctor fixes the patient’s head and hands with his own hands and then makes a preliminary smooth stretching of the muscles and ligaments of the cervical and upper thoracic spine in the direction of forward bending. Stretching is carried out until reaching the limit of the range of motion and the pain limit.

Stage 2 - dynamic activation.

The patient looks up, takes a smooth breath and at the same time performs an extensor movement of the head and neck with medium strength. In this case, the cervical and thoracic spines are straightened to a vertical position, the patient's head is slightly thrown back. At the same time, the doctor leans forward on the patient and, using the weight of his body, performs inferior work. Exposure lasts 4-5 seconds.

Stage 3 - static activation.

The patient holds his breath, his gaze is directed upwards. Due to the resistance of the doctor’s hands and the patient’s tension, the vertical position of the spine in isometric mode with an average force is held for 4-5 seconds. In this case, the doctor leans forward on the patient and, using the weight of his body, fixes this position.

Stage 4 - repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, and at the same time the doctor performs the flexion movement of the patient’s head and neck with the fingers of the hands mounted on the corners of the lower jaw. Upon reaching the limit of range of motion, the doctor conducts a smooth significant stretching of the musculo-ligamentous apparatus of the spine with medium strength to a new range of motion with moderate pain in the patient. To do this, the doctor sets his hands on the back of the head, and the forearms - on the shoulder joints of the patient, leans forward and, using the weight of his body, smoothly stretches his neck and shoulders. You must strive to put the patient's chin on his chest. At the end of this stage, the doctor performs 2-3 swaying movements in the direction of the performed stretching to enhance the effect. Exposure lasts 8-10 seconds. The number of repeated cycles (3-5) depends on the degree of PDS blocking.

II. Post-activation stretching of the musculo-ligamentous apparatus of the cervical, upper thoracic spine and shoulder girdle in lateroflexion.

1. Preliminary passive stretching. Starting position: the patient sits with his back to the doctor. The doctor puts one leg, bent at the knee joint, with his foot on the couch on the side of the patient, the patient throws his hand over the doctor’s thigh, leaning on it. If the patient rests with his right hand, then the work is done on the left half of the neck, and vice versa. The doctor puts one hand on the lateral surface of the patient’s head, the second - on top of his shoulder joint. The doctor performs a preliminary smooth stretching of the cervical spine to the side, and the shoulder girdle down, until reaching the limit of the range of motion and the pain limit.

2. Dynamic activation.

The patient looks up, takes a smooth breath and simultaneously performs a movement in the opposite direction with medium strength, overcoming the inferior resistance of the doctor’s hands. In this case, the patient’s ear and shoulder joint are moving towards each other and should be as close as possible. At the same time, the doctor leans forward on the patient and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed upwards. The patient’s ear and shoulder are close together. Due to the resistance of the doctor’s hands and the patient’s tension, the final phase of the movement in isometric mode is held for 4-5 seconds with an average force. In this case, the doctor leans forward on the patient and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, and at the same time the doctor moves in the opposite direction. Upon reaching the limit of range of motion, the doctor, using the weight of his body, conducts a smooth significant stretching of the musculo-ligamentous apparatus of the cervical and upper thoracic spine sideways with medium strength to a new range of motion with moderate pain in the patient. To do this, the doctor fixes the patient’s jaw with one hand, while his forearm lies on the side of the head, and the forearm of the other hand fixes the patient’s shoulder joint from above and in front. It is necessary to strive to bring the head closer to the opposite shoulder joint. At the end of this stage, the doctor performs 2-3 swaying movements in the direction of the performed stretching, reinforcing this effect. Exposure lasts 8-10 seconds.

The number of repeated cycles is 3-5.

III. Post-activation stretching of the musculo-ligamentous apparatus of the cervical and upper thoracic spine in rotation.

1. Preliminary passive stretching.

Starting position: the patient sits with his back to the doctor. The doctor puts his hand on the side surface of the patient’s face and turns his head in the direction opposite to the hypertonicity, making preliminary smooth stretching of tense muscles and ligaments of the spine until reaching the limit of range of motion and pain limit.

2. Dynamic activation.

The patient looks towards the other shoulder, takes a smooth breath and at the same time rotates the head in the same direction with medium strength to overcome the inferior resistance of the doctor’s hand. The rotation is made to a position in which the patient's face is looking straight ahead. At the same time, the doctor leans back slightly and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed towards the other shoulder. The face is looking forward. Due to the resistance of the doctor’s hands and the patient’s tension, the final phase of the movement in isometric mode is held for 4-5 seconds with an average force. In this case, the doctor slightly deviates back and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks away, relaxes the muscles, exhales smoothly, and at the same time the doctor moves the patient’s head and neck in the opposite direction. Upon reaching the limit of range of motion, the doctor conducts a smooth significant stretching of the musculo-ligamentous apparatus of the spine in rotation with medium strength to a new range of motion with moderate pain. To do this, the doctor fixes the lateral surface of the patient’s head with one hand, and the shoulder joint in front with the forearm of the other hand, and, using the weight of his body, slightly deviates back, stretching the patient’s neck and shoulder girdle. It is necessary to strive for maximum rotation of the head, cervical and upper thoracic spine sideways. At the end of this stage, the doctor performs 2-3 swaying movements in the direction of the performed stretching. Exposure lasts 8-10 seconds.

The number of repeated cycles is 3-5.

IV. Post-activation stretching of the musculo-ligamentous apparatus of the cervical, thoracic, lumbar spine in flexion.

1. Preliminary passive stretching.

Starting position: the patient sits on the couch, the doctor stands behind. To make it easier for the doctor to work, it is necessary to bring his center of gravity closer to the patient. To do this, one doctor’s leg, bent at the knee and hip joints, is placed on the table on the side of the patient, and the other leg is on the floor or front bench. If the patient has a lateral curvature of the spine, then during the exercise the doctor fixes his body on the side with his knee, trying to straighten the spine. If the patient has increased kyphosis of the thoracic region and it is difficult for him to straighten the spine, then the doctor’s knee is installed behind the patient, focusing on the spinous processes of the thoracic region. The patient joins his hands in the lock and puts them on the back of the head. In this case, the patient’s head drops forward under its own weight and the weight of its arms crossed. The doctor fixes the patient’s head and hands with his own hands and makes a preliminary smooth extension of the cervical, thoracic and lumbar spine in the direction of forward bending. It is necessary to strive to bring the patient's elbows closer to their own knees.

2. Dynamic activation.

The patient looks up, takes a smooth breath and at the same time performs a movement with medium strength in the opposite direction. In this case, the lumbar region is first unbent, then the thoracic region, and the cervical spine is the last. At the end of the movement, all parts of the spine are straightened to a vertical position, the patient’s head is slightly thrown back.

At the same time, the doctor leans forward and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed upwards. Due to the resistance of the doctor’s hands and the patient’s tension, the vertical position of the spine in isometric mode with an average force is held for 4-5 seconds. In this case, the doctor leans forward on the patient and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, performs a smooth exhalation, and at the same time the doctor moves in the direction of forward bending. First, the cervical, then the thoracic and last lumbar spine of the patient is bent. Upon reaching the limit of range of motion, the doctor conducts a smooth significant stretching of the musculo-ligamentous apparatus of the patient’s spine with medium strength to a new range of motion with moderate pain. One must strive to put the patient's elbows on his lap. To do this, the doctor fixes the patient’s shoulders with his hands or forearms, leans forward and, using the weight of his body, smoothly bends his spine. After that, the doctor performs 2-3 swaying movements in the direction of the performed stretching. This stage lasts 8-10 seconds.

The number of repeated cycles is 3-5.

V. Post-activation stretching of the musculo-ligamentous apparatus of the thoracic and lumbar spine in lateroflexia.

1. Preliminary passive stretching.

Starting position: the patient sits on the edge of the table with his back to the doctor. One leg of the patient is on one side of the table, the other on the other. Hands closed in a lock on the back of the head. The doctor fixes with his body the chest and lumbar spine of the patient's back. One of his hands extends between the patient’s shoulder and neck, holding the cervical spine from the opposite side with his palm. The other hand of the doctor fixes the patient’s elbow with the palm of his hand. The doctor makes a preliminary passive smooth stretching of the patient's body exactly to the side until reaching the limit of the range of motion and the pain limit. If the neck is fixed with the doctor’s left hand, then tilt to the left (if with the right hand - to the right).

2. Dynamic activation.

The patient looks up, takes a smooth breath and at the same time performs a movement with medium strength in the opposite direction. In this case, all parts of the spine are straightened to a vertical position. At the same time, the doctor deviates in the opposite direction and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed upwards. Due to the patient's tension and the resistance of the doctor’s hands, the vertical position of the spine in isometric mode with an average force is held for 4-5 seconds. In this case, the doctor uses the weight of his body, moving it sideways to a slightly bent leg, and fixes this position.

4. Repeated significant passive stretching.

The patient looks towards the performed movement, relaxes the muscles, makes a smooth exhalation, and at the same time the doctor moves in the opposite direction. Upon reaching the limit of range of motion, the doctor deviates to the side and, using the weight of his body, conducts a smooth significant stretching of the muscular-ligamentous apparatus of the patient’s spine with medium strength to a new range of motion with moderate pain. You must strive to perform the movement exactly to the side. At the end of this stage, the doctor performs 2-3 swaying movements in the same direction, enhancing the effect of stretching. Exposure lasts 8-10 seconds.

The number of repeated cycles 3-5 - depends on the degree of blocking of the PDS.

VI. Post-activation stretching of the musculo-ligamentous apparatus of the thoracic, lumbar spine, pelvis and ileo-lumbar ligament in rotation.

1. Preliminary passive stretching.

Starting position: the patient lies on a table on his back, the doctor stands on the side. The patient’s leg closest to the doctor remains straight, the distant bends at the knee and hip joints. The doctor turns the patient on his side, facing himself. The patient's overlying leg is bent, her foot lies in the popliteal fossa, resting the head of the 1st metatarsal bone on the table. The patient body is rotated away from the doctor. The far arm is set aside, and the next lies with the palm under the back of the head. The doctor fixes the upper half of the chest by the forearm of his hand, presses on the shoulder joint of the same name of the patient. The other hand rests with the palm of the hand on the table, supporting the patient’s pelvis with the forearm from behind. The doctor’s knee fixes the patient’s knee from above. The patient's body and lower straight leg are in one line, and its lumbar - in a neutral position. If it is necessary to move the occlusion level of the PDS cranially or caudally, to achieve the position of kyphosis or lordosis in the lower back, then the well-known principle of "steel tape" according to Maigne is used. The doctor conducts a preliminary passive stretching of the musculo-ligamentous apparatus of the spine in rotation until the limit of range of motion and pain limit is reached.

2. Dynamic activation.

The patient looks towards the doctor, takes a smooth breath and at the same time carries out a rotational movement of the body with medium strength. The chest and head rotate at the doctor; overlying leg and pelvis - from the doctor, leaning on the head of the 1st metatarsal bone. In the final phase of the movement, the head and upper part of the patient’s body are deployed to the doctor, and the knee of the overlying leg and pelvis are from the doctor. At the same time, the doctor leans forward and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed towards the doctor. The doctor leans forward and, using his weight, fixes the final phase of the patient's rotational movement in isometric mode with an average force for 4-5 seconds.

4. Repeated significant passive stretching.

The patient looks up, relaxes the muscles, exhales smoothly, and at the same time the doctor rotates the patient’s body in the opposite direction. The doctor leans forward and, using the weight of his body, smoothly significantly stretches the patient’s muscular-ligamentous apparatus with medium strength, achieving a new range of motion with moderate pain. In this case, it is necessary to strive so that the knee of the overlying leg and upper shoulder are pressed against the table. At the end of this stage, the doctor performs 2-3 swaying movements in the same direction, enhancing the effect of stretching. Exposure lasts 8-10 seconds.

The number of repeated cycles is 3-5.

VII. Post-activation stretching of the posterior group of the musculo-ligamentous apparatus of the lower leg and ankle joint.

During the exercise, the patient’s legs gradually rise, so the initial position of the patient and the doctor will change several times.

1. Preliminary passive stretching.

Starting position: the patient lies on his back, his face and gaze are directed straight up, his hands are behind his head. One doctor’s leg, bent at the knee and hip joints, lies on the table with his lower leg. The patient’s straight leg lies on the thigh of the doctor’s Achilles tendon. The doctor holds the patient’s hip or pelvis with one hand, and fixes his foot with the other. Performing extension of the foot, the doctor performs a preliminary passive stretching of the musculo-ligamentous apparatus of the lower leg and ankle joint to reach the limit of the range of motion and the pain limit.

2. Dynamic activation.

The patient looks up to the forehead, takes a smooth breath, while his head slightly tilts back, and at the same time with medium strength begins to press the foot on the doctor’s hand, producing plantar flexion, the patient’s straight leg presses down on the doctor’s thigh. At the same time, the doctor performs inferior work, resisting the hand and transferring the weight of his body in the opposite direction. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed up to the forehead, his head is slightly thrown back. The final phase of plantar flexion of the foot and tension of the ischiocrural group of muscles and ligaments in isometric mode with an average force is maintained for 4-5 seconds. In this case, the doctor exerts resistance with his hand, transferring the weight of his body in the opposite direction, and fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, while his head falls, while the doctor moves the foot in the direction of extension. Upon reaching the limit of the range of motion, the doctor deviates to the side and, using the weight of his body, conducts a smooth significant stretching of the musculo-ligamentous apparatus of the lower leg and ankle joint. The impact is carried out with moderate force to a new range of motion with moderate pain. At the end of this stage, the doctor performs 2-3 swaying movements in the same direction, enhancing the effect of stretching. Exposure lasts 8-10 seconds.

To further raise the leg up, the initial position of the doctor in relation to the patient changes: his thigh moves under the middle of the patient's calf muscle. Subsequent stages of PAR are performed as described above.

The following starting position: the patient lies the same way, and the doctor puts his foot on the table with his foot. The patient’s leg lies on the doctor’s thigh with an Achilles tendon. With one hand, the doctor rests on the table, transferring body weight to it, with the other hand fixes the patient’s foot. Subsequent stages of PAR are described above.

The following starting position: the patient lies the same way, and the doctor moves his thigh under the middle of the patient's calf muscle. Subsequent stages of PAR are described above.

Viii. Post-activation stretching of the posterior group of the musculo-ligamentous apparatus of the thigh, lower leg, hip, knee and ankle joints.

1. Preliminary passive stretching.

With further raising of the patient’s legs to 45 ° and above, the initial position of the doctor changes again. The patient lies on his back, his face and gaze are directed straight up, his hands are behind his head. Standing on one leg, with the other knee, the doctor fixes the thigh of the patient’s lying leg to the table. This is important to enhance stretch marks. The patient’s developed leg is bent at the hip and knee joints and the Achilles tendon lies on the doctor’s shoulder girdle. The doctor extends and fixes the patient’s foot with one hand and leans forward, bringing the patient’s thigh closer to his costal arch. There is a preliminary passive stretching of the musculo-ligamentous apparatus of the posterior thigh and lower leg.

2. Dynamic activation.

The patient, looks up to the forehead, takes a smooth breath, while his head slightly tilts back, and at the same time with average strength begins to press his foot on the doctor, straightening it in the knee joint and bending the foot in the ankle joint. One doctor’s hand lies on the sole of the patient’s foot, resisting it, the other presses on the knee joint, helping the patient’s leg straighten. Tension of the ischiocrural muscle group and ligaments occurs. At the same time, the doctor leans forward and, using the weight of his body, counteracts. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed up to the forehead, his head is slightly thrown back. The final phase of leg straightening and plantar flexion of the foot in isometric mode with an average force is maintained for 4-5 seconds. In this case, the doctor leans forward and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, while his head drops to its original position. At the same time, the doctor leans forward and, using the weight of his body, smoothly significantly stretches the muscles and ligaments of the back of the thigh and lower leg with medium strength to a new range of motion with moderate pain in the patient. In this case, the patient’s leg extends in the ankle and bends in the knee and hip joints. It is necessary to strive to ultimately put the front surface of his thigh on his stomach and costal arch. This stage lasts 8-10 seconds. To enhance the stretching of the muscles and ligaments of the posterior thigh, the doctor, using the weight of his body, presses the patient's leg bent in the hip and knee joint to his stomach and costal arch. After that, the doctor leans back and, due to pressure on the knee joint, straightens the patient's relaxed leg to a vertical position. To enhance the effect of stretching the muscles and ligaments of the lower leg, the doctor fixes the straightened knee joint with the hand of the other hand at the extreme point of vertical lifting of the patient’s relaxed leg, and the heel and sole of the foot with the other hand and makes 2-3 additional stretching movements due to increased extension of the foot. The number of repetitions is 2-3.

The number of repeated cycles is 3-5.

IX. Post-activation stretching of the anterior group of the musculo-ligamentous apparatus of the thigh and knee joint.

1. Preliminary passive stretching.

Starting position: the patient lies on his stomach, his forehead is on his hands crossed in front of him, his gaze is directed down to the table, his sore leg is bent at the knee joint at an angle of 90 °. The doctor fixes the patient’s ankle joint with one hand, puts the other hand on the wrist joint of the working arm and makes a preliminary passive smooth stretching of muscles and ligaments, bringing the heel closer to the buttock. The doctor can fix the patient’s foot with his shoulder joint.

2. Dynamic activation.

The patient looks up, takes a smooth breath, while his head rises, and at the same time performs extension of the leg in the knee joint with medium strength to an angle of 75-80 ° (between the leg and thigh). At the same time, the doctor leans forward and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed upward, his head is raised. The final phase of the movement in isometric mode with an average force is maintained for 4-5 seconds. The angle of 75-80 ° between the lower leg and the hip of the patient allows the doctor to effectively use his body weight for resistance and spend less energy. In this case, the doctor leans forward and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, puts his head in his hands, and at the same time the doctor moves his lower leg in the opposite direction. Upon reaching the limit of the range of motion, the doctor leans forward and, using the weight of his body, conducts a smooth significant stretching of the muscles and ligaments with medium strength, trying to put the heel on the buttock of the patient. After that, to increase the effectiveness of stretching, the doctor performs 2-3 swaying movements in the direction of the performed stretching. This stage lasts 8-10 seconds.

The number of repeated cycles is 3-5.

X. Post-activation stretching of the sacro-tuberous ligament, the muscles of the gluteal region and the capsule of the hip joint.

1. Preliminary passive stretching.

Starting position: lying on your back, the patient’s stretched leg is bent at the knee and hip joints. The face and gaze are directed straight up, the hands are behind the head. The doctor is standing on the side and with the forearm of one hand presses on the patient's knee, bringing him closer to the chest in the direction of the shoulder of the same name. The palm of the doctor’s other hand rests on the lower third of the thigh of the patient’s lying leg, preventing her from bending.

2. Dynamic activation.

The patient looks up to the forehead, takes a smooth breath, while his head is slightly thrown back, and at the same time performs a knee movement in the direction from the shoulder of the same name, extending the leg in the hip joint with medium strength. At the same time, the doctor leans forward and, resisting his weight, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed up to his forehead, his head is slightly thrown back. The final phase of movement in isometric mode with an average force, during which the angle between the patient’s hip and the horizontal plane is 75-80 °, lasts 4-5 seconds. In this case, the doctor leans forward and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, while his head drops to its original position, while the doctor moves the patient's knee in the opposite direction. Upon reaching the limit of range of motion, the doctor leans forward and, using the weight of his body, conducts a smooth significant stretching of the musculo-ligamentous apparatus with medium strength to a new range of motion with moderate pain for the patient. It is necessary to strive to put the patient's hip on the costal arch from the same side. The doctor performs 2-3 swaying movements in the direction of the performed stretching. This stage lasts 8-10 seconds.

The number of repeated cycles is 3-5.

Xi. Post-activation stretching of the sacroiliac, sacrospinous ligaments, gluteal muscles and capsules of the hip joint.

1. Preliminary passive stretching.

Starting position: the patient lies on his back, his face and gaze are directed straight up, his hands are behind his head. The doctor brings his knee to the opposite shoulder and fixes it with his forearm. The doctor fixes the foot of this leg with the brush of his other hand, and presses the hip of the patient’s lying leg with his knee.

2. Dynamic activation.

The patient looks up to the forehead, takes a smooth breath, while his head slightly tilts back, and at the same time performs a knee movement in the direction from the opposite shoulder, extending the leg in the hip joint with medium strength. At the same time, the doctor leans forward and, using the weight of his body, exerts resistance, and also helps to correctly implement the trajectory of movement by fixing the foot. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed up to his forehead, his head is slightly thrown back. The final phase of movement in isometric mode with an average force at which the angle between the patient’s hip and horizontal plane is 75-80 °, and the lower leg and foot are rotated inward, lasts 4-5 seconds. In this case, the doctor leans forward and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, while his head drops to its original position, while the doctor moves the patient's knee in the opposite direction. Upon reaching the limit of range of motion, the doctor leans forward and, using the weight of his body, conducts a smooth significant stretching of muscles and ligaments with medium strength to a new range of motion with moderate pain. The doctor tries to bring the knee of the stretched leg closer to the opposite half of the chest. Then the doctor performs 2-3 swaying movements in the direction of the performed stretching. This stage lasts 8-10 seconds.

The number of repeated cycles is 3-5.

XII. Post-activation stretching of the piriformis muscle and musculo-ligamentous apparatus of the hip and knee joints.

1. Preliminary passive stretching.

Starting position: the patient lies on his stomach, his forehead is on his hands crossed in front of him, his gaze is directed down to the table, his legs are bent at the knee joints at right angles. The legs are tilted to the maximum, the knees are brought together. The doctor sits down on the table, fixes the patient’s internal ankles with his hands and performs a preliminary passive stretching of the musculo-ligamentous apparatus, spreading the legs and feet out.

2. Dynamic activation.

The patient looks up, takes a smooth breath, while his head rises, and at the same time performs a movement with medium strength to reduce the legs and feet to each other. At the same time, the doctor leans forward and, using the weight of his body, performs inferior work. This stage lasts 4-5 seconds.

3. Static activation.

The patient holds his breath, his gaze is directed upward, his head is raised. The final phase of movement in isometric mode with an average force at which the knees are closed, the legs and feet are close to each other, while the legs are bent at the knee joints at right angles, lasts for 4-5 seconds. In this case, the doctor leans forward on the patient and, using the weight of his body, fixes this position.

4. Repeated significant passive stretching.

The patient looks down, relaxes the muscles, exhales smoothly, puts his head in his hands, while the doctor moves his legs and feet in the opposite direction. Upon reaching the limit of range of motion, the doctor leans forward and, using the weight of his body, conducts a smooth significant stretching of the musculo-ligamentous apparatus with medium strength to a new range of motion with moderate pain in the patient. It is necessary to strive to bring the feet closer to the table. Then the doctor performs 2-3 swaying movements in the direction of the performed stretching. The stage lasts 8-10 seconds.

The number of repeated cycles is 3-5.

Stretching of other muscle-ligamentous groups is carried out by analogy with the above technique.

Examples of specific performance are given in the form of extracts from medical records.

Example 1. Patient Kulkova T.E., 50 years old. Received December 29, 2001 with a diagnosis of discogenic radiculopathy L5-S1 root on the right, severe pain with muscle-tonic manifestations and moderate paresis of extensor feet, recurrent course. Sick since 1996, when with the same diagnosis was on the sick leave for 4 months. CT study of the intervertebral discs of LIV-LV, LV-SI vertebrae dated 08/28/1996 No. 3421-22: at the level of the LV-SI disc, a local protrusion of the disc is noted to the right of the median line with a depth of 7.8 × 11.4 mm with squeezing of the dural sac in front and the right lateral root. There are no local protrusions of the disc LIV-LV.

In subsequent years - exacerbation 2 times a year. According to the patient, 2 years ago, urinary incontinence was noted for 2 months. In November 2000, during a regular hospitalization in the neurological department, an ultrasound scan of the posterior disc space of the lumbar spine was performed: at the LV-SI level, the posterior mid-lateral disc hernia was 7 mm high.

Before admission to treatment 2 times was on the sick leave with an interval of 1 month. On admission: complaints of severe pain in the lower back with radiation to the right foot to the toes. Examination revealed: positive symptoms of tension (Wassermann, Neri), Laseg symptom from an angle of 45 ° to the right, right Achilles reflex was absent, weakness of the extensors of the right foot and 1st finger, hypesthesia in the innervation zone L5-S1 of the roots on the right, blockade of the 1st degrees in LIII-SI motor segments in all directions. The patient was treated according to the proposed method of manual exposure. After elimination of severe pain and blockade of the vertebral-motor segments from the 1st degree to the 2nd, manipulations were performed at all levels of the spine. A good clinical effect was achieved: the pain syndrome was completely stopped, the range of motion in the spinal-motor segments was fully restored, and there were no symptoms of tension. The strength of the extensors of the foot and 1st finger was restored, the Achilles reflex appeared, and the sensitivity in the innervation zone L5-S1 was normal.

On the control CT scan dated January 30, 2002 No. 23454 - LIV-SI segments - data for a herniated intervertebral disc was not revealed.

Example 2. Patient Krupnova MM, 42 g was admitted for treatment on September 25, 2001 with a diagnosis of discogenic radiculopathy of L5-S1 roots on the left, severe pain syndrome with muscular-tonic manifestations, severe paresis of the foot. Sick since 1997, when for 3 months she underwent inpatient and outpatient treatment in the Central District Hospital for discogenic radiculopathy of L5-S1 roots on the left with a protracted recurrent pain syndrome and muscular-tonic manifestations. Last exacerbation of 08.23.2001 after physical exertion and hypothermia during rain.

Upon receipt of a complaint of severe pain in the lower back, left buttock, left leg, weakness in the left foot, numbness of the 3-4-5th toes. The severity of the pain syndrome is such that even movement with the eyes to the side intensifies the pain.

On examination: forced antalgic posture with the body tilted forward at an angle of 45 °. Positive tension symptoms (Neri, Wasserman), Laseg symptom on the left from an angle of 30 °, weakness of the flexors and extensors of the left foot and 1st finger, hypesthesia in the innervation zone S1 of the spine on the left, left Achilles reflex was absent, 1st degree blockade in the motor segments LIII-SI in all directions. CT of segments LIV-SI dated September 13, 2001 No. 21422 - at the LV-SI level, local hernial protrusion of the disc posteriorly is noted medially with a protrusion width of 19 mm and a depth of 14 mm to the left with deformation of the anterior epidural tissue and suppression of the dural sac. LIV-LV - a small diffuse protrusion of the disc posterior medially up to 3 mm.

The patient was treated according to the proposed method of manual exposure. After elimination of severe pain and blockade of the vertebral-motor segments from the 1st degree to the 2nd, manipulations were performed at all levels of the spine. The pain syndrome has been completely stopped, the strength of the muscles of the foot has been restored, parasthesia and hypesthesia of the 3-4th finger have passed, they remain on the 5th. The range of motion in the spinal motion segments has been fully restored.

On the control CT scan of the LIV-SI segments dated 01.29.02 No. 22984 at the LV-SI level, the posterior descending paramedial hernia of the disc on the left with a transverse size of 14 × 6 mm is not clearly defined. No protrusion was detected at the LIV-LV level.

After this, several more sessions were conducted on the proposed method of manual exposure. The treatment is over. Achilles reflex appeared, sensitivity of 3-5th fingers of the left foot was completely restored.

On the control CT of 21.03.2002 No. 513 at the LV-SI level, a hernial protrusion of 12 × 5 mm is not clearly defined, at the level of LIV-LV there are no local protrusions.

Example 3. Patient Baranov SV, 34, Saransk, was admitted for treatment on September 23, 2000 with a diagnosis of discogenic radiculopathy of C6-C7 roots on the right, severe pain syndrome with muscular-tonic manifestations, pectalgic syndrome on the right. Sick for a month. Complaints of severe pain in the neck with radiation in the right hand to the fingers, numbness of the 1-2-3th fingers of the right hand, pain in the right half of the chest.

On examination: the forced position of the head, significant restrictions on movements in the cervical spine, especially when leaning forward, hypesthesia in the innervation zone of C6-C7 roots on the right, sharp pain on palpation of the spinous process of the CV vertebra and the right pectoral muscle. There are no tendon reflexes from the triceps of the shoulder muscle, the strength in the extensors of the forearm and hand is reduced, blockade of the 1st degree in the motor segments CIII-ThI in all directions. On the radiograph of the thoracic region - Schmorl's hernia of Th W vertebra. The treatment was carried out according to the proposed method. In the middle of the course of treatment - 10.24.2000, an NMR study of the cervical and upper thoracic spine was performed in Penza. Conclusion:

- dorsodextralateral hernia of the CV-CVI disc 7.1 × 3.6 mm with a slightly pronounced compression of the spinal cord at this level and the spinal cord at the level of CV-CVI disc;

- central hernia CVI-CVII disk 2.2 mm with anterior moderately pronounced compression of the dural sac;

- protrusion of the CIV-CV disk 1.4 mm with slight compression of the dural sac;

As a result of treatment, the pain syndrome in the neck, in the pectoral muscles and the right arm was completely stopped, the range of motion in the spinal-motor segments of the neck was restored, the muscle strength of the extensors of the forearm and hand, and tendon reflexes returned to normal. Parasthesia and hypesthesia of the 2nd finger of the right hand are preserved.

Example 4. Patient Chichenya T.V., 57 years old, was admitted to treatment on 10.04.2002 with a diagnosis of right-sided coxarthrosis of the 1st degree. On admission, complaints of morning stiffness and pain in the right hip joint when walking. On examination - an antalgic gait, restriction of passive movements and pain, especially with internal rotation of the hip joint to the right up to 20 ° (left -35 °), restriction of abduction of the right thigh (Patrick symptom). Surveys:

1. Radiography of the right hip joint - compaction of subchondral plates, sharpening of the radiological angles of the acetabulum, marginal osteophytes. Conclusion: deforming arthrosis of the right hip joint 1-2 degrees.

2. Radiography of the lumbar spine - non-fusion of the posterior arch S1, LIV antibody by 0.5 cm, disk instability LII-III, LIII-IV, LIV-V.

After the treatment according to the proposed method, the patient underwent morning stiffness in the hip joint, the pain during walking disappeared, the range of movements increased to normal. The sum of the external and internal rotation of the right hip joint when bending the leg at right angles in the hip and knee joints is 80 °, the internal rotation is 35 °.

Sources of information

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2. Levit K., Zahse J., Yanda V. Manual medicine: Trans. with him. - M .: Medicine, 1993 .-- 512 p.

3. Ivanichev G.A. Manual medicine. - M .: MEDpress, 1998 .-- 470 p.

4. Belova A.N., Schepetova O.N. (ed.). Guidelines for the rehabilitation of patients with motor disorders. Volume II - Moscow: MBN, 1999 .-- 648 p.

5. Nazarov V. M., Bogomolov S. D., Troshin V. D., Zhilyaev E. A. Epidural pain pharmacotherapy. - N. Novgorod .: Publishing house of the Novosibirsk State Medical Academy, 2001. - P.121-134.

6. Sitel A.B. Manual therapy. - M.: Publishing Center, 1998 .-- 304 p.

7. Skoromets A. A., Thyssen T. P., Panyushkin A. I., Skoromets T. A. Spinal cord vascular disease. - S. - St. Petersburg: Sotis, 1998 .-- S. 41-48.

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Claims (1)

The method of manual exposure, characterized in that they perform post-activation stretching (PA) of the musculo-ligamentous apparatus, joint capsules and adhesions of the joints or muscle-ligamentous apparatus, joint capsules, intervertebral discs of the vertebral-motor segments and simultaneously the dura mater and adhesions in the spinal canal using the body weight of the doctor in combination with the oculomotor and respiratory synergies of the patient, and after a preliminary passive stretching by the doctor of the musculo-ligamentous apparatus, of the capsules and adhesions of the joints or the musculo-ligamentous apparatus, articular capsules, intervertebral discs of the vertebral-motor segments and simultaneously the dura mater and adhesions in the spinal canal, the patient performs isotonic activation of the muscular-ligamentous apparatus with an effort equal to 50% of the maximum possible for 4-5 s, at the same time the doctor performs inferior work, then the patient performs isometric activation of the musculo-ligamentous apparatus with an effort equal to 50% of the maximum possible, for 4-5 s, during during which the doctor fixes the achieved position with the same effort, after which the doctor conducts repeated passive stretching of the musculo-ligamentous apparatus, joint capsules and adhesions in the joints or muscle-ligamentous apparatus, joint capsules, intervertebral discs of the vertebral-motor segments for 8-10 s and at the same time, the dura mater and adhesions in the spinal canal to a new range of motion with moderate pain in the patient when he relaxes and completes the effect with two or three swaying movements in When performing the performed stretching, the effect is carried out from two sides with stronger stretching on the diseased side, the number of repeated cycles is 3-5.