RU2284176C2 - Method for treating patients with myofascial pain dysfunctional syndrome - Google Patents

Abstract

FIELD: medicine, neurology, physiotherapy.

SUBSTANCE: it is necessary to carry out parallel courses of manual, medicinal and physiotherapeutic impact upon trigger points at the quantity of about 5-10 seances. Before implementation and in the course of the seance of manual therapy it is necessary to heat the area of active trigger with an ointment application and hypertonic compress, correspondingly. In case of its organic alterations during the séances of manual therapy, directly before implementation of postisometric relaxation one should additionally introduce steroid and/or analgesic preparations, and all trigger points should be affected physiotherapeutically with ultrasound. The innovation provides activation of metabolic processes in area of muscular lesion and reconstruction of its functional activity.

EFFECT: higher efficiency of therapy.

2 cl, 1 ex, 3 tbl

Description

The invention relates to medicine, in particular to neurology and physiotherapy, and can be used in the treatment of patients with myofascial pain dysfunction syndrome of various localization.

There is a method of treating myofascial pain syndrome (1), which includes courses of manual and drug therapy, providing for relaxing massage, muscle compression with gradually increasing effort, passive and active muscle tension with additional traction of the joint to which the reflected pain is transmitted, and introductions into trigger corticosteroid points.

However, this method does not take into account the staged state of the trigger points, which negatively affects the results of a direct impact on them; the implementation of manual therapy of trigger points without first preparing them for such an effect is associated with increased reflected pain, which, in turn, leads to contractility of the muscles, causes autocompression of the joint located in the projection of this muscle and to the development of degenerative-dystrophic changes in it.

There is a method of treating myofascial pain syndrome (2), which provides for cryotherapy on trigger zones before performing manual therapy. However, this kind of effect causes a violation of microcirculation and spasm of blood vessels in the area of the trigger point. The consequence of this is the compaction of soft tissues, which prevents manual exposure to the trigger zone and reduces the effect of such exposure.

The objective of the invention is to develop a method for the treatment of myofascial pain dysfunction syndrome, which provides increased treatment efficiency and prevents relapse of the disease due to the activation of metabolic processes in the area of muscle damage and the restoration of its functional activity.

This problem is solved by the fact that in the method of treating myofascial pain dysfunctional syndrome, which includes parallel courses of manual, drug and physiotherapeutic effects on trigger points in the amount of 5-10 sessions, before performing and during the manual therapy session, the active trigger zone is heated with ointment and respectively with a hypertonic compress, with its organic changes during one or two sessions, steroid and / or analgesic drugs are additionally administered s, and physiotherapeutically affect all trigger points with ultrasound. It is provided that

- warming up the active trigger point before performing manual therapy is carried out by applying for 5-7 minutes on the skin surface in its projection ointment containing iodine-bromine, vasodilating and warming components;

- warming up the muscle with the help of a hypertonic compress during a manual therapy session is carried out after ischemic compression of the active trigger points for 10 minutes.

The invention is illustrated by a description and an example of practical use.

The method is as follows.

Upon admission to the clinic, the patient undergoes a comprehensive clinical examination to determine the localization of active trigger points and the stage of their development. Based on the examination data, the patient is prescribed appropriate parallel courses of manual, medical and physiotherapy.

Performing manual therapy, as a rule, includes 5 sessions, during which ischemic compression of active trigger points is performed for three minutes, a hypertonic compress is applied to the area of the problem muscle for 10 minutes and its subsequent stretching using post-isometric relaxation for 3-5 minutes .

Moreover, before each session, the trigger zone is preheated by applying an ointment application containing iodine-bromine, vasodilating and warming components for 5-7 minutes on the skin surface in its projection. As such an ointment, a composition can be used that includes 1 part of Capsicam ointment and 3 parts of Po-chicken cream ointment.

Cream "Po-hens" is produced by the scientific and production center "Siberian Mineral Waters" (Tomsk). It is prepared on the basis of natural iodine-bromine mineral water, does not contain artificial preservatives and dyes, has a resolving and anti-inflammatory effect.

1 g of Capsicam ointment contains benzyl nitinate - 20.0 mg, vanillylnonamide - 2.0 mg, racemic camphor - 30.0 mg, gum turpentine - 30.0 mg, dimethyl sulfoxide - 50.0 mg and ointment base, including bronitrol , polysorbate - 80, sodium cetyl stearyl sulfate, cetyl stearyl alcohol and purified water. Manufacturer - Tallinn Pharmaceutical Plant JSC, Estonia. The ointment has a warming, relaxing and analgesic effect.

The specified composition provides relaxation and warming up of the zone of manual exposure, which contributes to the efficiency of the performed manipulations.

The ischemic compression of trigger points performed during manual therapy involves the following manipulations. The active trigger point (TT) is pressed against the nearest bone protrusion with the small pillow of the first finger and is pressed by kneading circular and swaying movements with gradually increasing efforts to pain transferred by patients. Manipulation with each TT is continued for three minutes. With the correct conduct of this procedure, the pain begins to become dull and a decrease in local muscle tension is determined by palpation.

Immediately after ischemic compression, manipulations are performed aimed at stretching the corresponding problem muscle.

Before stretching, secondary warming of the problem muscle is carried out by applying a hypertonic compress to its projection for 10 minutes (1 glass of hot salt and 1 drop of iodine per glass of hot water with a temperature of 40-45 ° C). A small terry towel is moistened with this solution, then squeezed, applied to the problem muscle, covered with polyethylene, and on top with a warm blanket. The application of a hypertonic compress to the area of the problem muscle causes an additional deep warming of the soft tissues, improves blood flow, which facilitates further work aimed at stretching this muscle.

After removing the compress, the problematic muscle is stretched using postisometric relaxation. At the same time, 2 obligatory steps are performed: during the first 10 seconds, the problematic muscle is tensioned, and then, within 30 seconds, it is stretched.

At the same time, during the sessions of manual therapy, immediately before the post-isometric relaxation, with organic changes in the active trigger points, steroid and / or analgesic drugs are introduced into the latter. As such, diprospan with novocaine administered in therapeutic doses (1-2 injections after 14 days) or novocaine 0.5% 3-5 ml can be used. (2-3 injections after 2 days on the 3rd).

Along with the courses of manual and drug therapy, after performing the latter, all trigger points of the affected area have a physiotherapeutic effect by ultrasound. Ultrasonic exposure is performed according to the contact method, using a 4 cm ² emitter with a frequency of 880 kHz and a radiation intensity of 0.2 W / cm ² , pulse mode 10 ms, duration 3 minutes for each trigger point. In one session, 3-4 trigger points are voiced. The number of sessions is 10 procedures.

In especially neglected cases, with insufficient treatment effectiveness, the course described above can be repeated after 6 months.

The practical implementation of the method is illustrated by the following clinical observation.

Patient S., 48 years old, turned to the RTC “WTO” on 10/29/2001 complaining of constant intense pain along the front-lateral surface of the left shoulder joint, sharply aggravated by performing rotational movements, night pains, inability to lie on the left side; an increase in pain after a few minutes when lying on the right side and back. Self-service was much more difficult: I could not get dressed without help, put my hand back, tie a belt, etc.

The pain appeared in October 2000 after a sharp wave of the hand in the fall, while trying to maintain balance. The pain has significantly intensified since April 2001, and has become constantly pronounced.

The following treatment was carried out in the city polyclinics: electrophoresis with novocaine on the shoulder joint area - 2 courses of 10 procedures, shoulder laser therapy - 20 procedures, paraffin applications on the front surface of the shoulder joint - 2 courses of 10 procedures. Ultrasound with hydrocartisone on the front surface of the shoulder joint 10 procedures; inductotherapy - 10 procedures, massage of the right shoulder girdle and shoulder No. 20, injections: orthofen 3.0 v / m No. 5, diclofenac 3.0 v / m No. 5. After the ineffectiveness of the above treatment, Kenalog - 40 in the amount of 1.0 ml was introduced into the acromioclavicular joint - 3 injections with an interval of 10 days. An increase in pain was noted.

Objectively: slight coherence of the contours of the left shoulder joint along the front surface. The movements in the shoulder joints were characterized by the following data (Table 1):

Table 1
The amplitude of the movements of the left shoulder joint of patient C. at the time of admission Function Actively passively Muscle strength Shoulder joint Flexion 80 ° 120 ° 4b Extension 5 ° 40 ° 4b Cast Up to 0 ° Up to 0 ° 4b Abduction 90 ° 120 ° 4b Ext. Rotation 5 ° 5 ° Sharply painful Outdoor rotation 5 ° 40 ° 3b

In the right shoulder joint movement in full, with muscle strength of 5 points.

During muscle testing, sharp pain was revealed when trying to include in the active work or to perform stretching of the infraspinatus and small round muscles. Palpation in these muscles was determined sharply painful TT (a symptom of a "jump" is sharply positive), according to kinesthetic characteristics - I functional stage. The active trigger points of the second organic stage were determined in the trapezius muscle.

According to the data of arbitrary electromyography with the maximum functional effort, the following indicators were recorded (Table 2):

The patient was diagnosed with: Shoulder-shoulder periarthrosis on the left, pain. Combined contracture of the left shoulder joint.

In order to eliminate pain and restore muscle function of the patient, according to the proposed method, a course of treatment was carried out, including sessions of manual, drug and physiotherapy.

Before each session of manual therapy, the trigger zone was preheated by applying for 5-7 minutes on the skin surface in its projection an ointment composition of 1 part of Capsicam ointment and 3 parts of Po-chicken cream ointment.

table 2
Electromyographic characteristics of the functional activity of the muscles of the upper limbs of patient C. at the time of admission Muscle tested Left upper limb Right upper limb Amplitude, mV frequency Hz Amplitude, mV frequency Hz m.deltoideus 0.4 Reduced 1.8 90 m.biceps 0.15 120 1,2 130 m.triceps 0.15 140 0.65 130 m.extensor dig. 0.8 360 1,0 260 m.flexor car. rad. 0.2 170 0.3 280 m.flexor car. Uln. 0.25 180 0.4 320 m.m.thenar 0.7 280 0.3 90 m.m.hypothenar 1,0 160 1,0 200

After that, ischemic compression of trigger points was performed, and then the problematic muscle was stretched. Moreover, before stretching, secondary heating was carried out by applying a hypertonic compress for 10 minutes.

During the second session, diprospan 0.5 + novocaine 0.5% - 2 ml was additionally introduced into the active TT of the organic stage.

Simultaneously with the courses of manual and drug therapy, a course of physiotherapeutic treatment was conducted - ultrasound with hydrocortisone for active TT - 10 sessions. Ultrasound exposure was carried out according to the standard scheme on all TT of the infraspinatus, small round and trapezius muscles of the left hand.

Sessions of manual therapy were performed two days later on the third, physiotherapy - daily; In total, 5 sessions of manual therapy and 10 sessions of physiotherapy were performed.

As a result of the manipulations after the first sessions of manual and physiotherapy, a decrease in the intensity of pain in the shoulder joint was noted. After the second session of manual therapy, the first session of drug therapy and the fourth session of ultrasound scoring of TT, night pains stopped, sleep normalized. By the end of the course of treatment (after three weeks) the pain is not disturbed, the movements in the shoulder joint in full with muscle strength of 5 points.

EMG indicators at the time of discharge amounted to (table 3):

Table 3
Electromyographic characteristics of the functional activity of the muscles of the upper limbs of patient C. after a course of treatment Muscle tested Left upper limb Right upper limb Amplitude, mV frequency Hz Amplitude, mV frequency Hz m.deltoideus 0.9 one hundred 1.8 130 m.biceps 0.2 one hundred 1,2 180 m.triceps 0.3 120 0.6 160 m.extensor dig. 1,0 220 1,5 200 m.flexor car. rad. 0.4 170 0.7 180 m.flexor car. Uln. 0.4 200 0.8 280 m.m.thenar 2.0 300 1,0 90 m.m.hypothenar 1,5 200 1.3 300

At the follow-up examination 1 year after the treatment, its result is fully preserved, there are no signs of a relapse of the disease; the patient does not show complaints; the function of the left upper limb in full, pain is absent.

Thus, the use of the proposed method for the treatment of myofascial pain dysfunctional syndrome improves the effectiveness of treatment and prevents the relapse of the disease due to the activation of metabolic processes in the area of muscle damage and restoration of its functional activity.

Sources of information taken into account

1. RF patent No. 2181995, publ. 10/05/2002.

2. Travelell JG, Simone DG Myofascial pain: in 2 volumes - M .: Medicine, 1989. / 1 volume - S.78-154.

Claims (3)

1. A method of treating patients with myofascial pain dysfunctional syndrome, including parallel courses of manual, drug and physiotherapy effects on trigger points in the amount of 5-10 sessions, characterized in that before the execution and during the manual therapy session, the active trigger zone is heated, respectively, ointment application and hypertensive compress, while with its organic changes during manual therapy sessions, immediately before postisometric steroid and / or analgesic drugs are injected into the active trigger zone, and ultrasound is applied to all trigger points physiologically. 2. The method according to claim 1, characterized in that the heating of the active trigger point before performing manual therapy is carried out by applying for 5-7 minutes on the skin surface in its projection an ointment containing iodine-bromine, vasodilating and warming components. 3. The method according to claim 1, characterized in that the heating of the muscle with the help of a hypertonic compress during a session of manual therapy is carried out after ischemic compression of the active trigger points for 10 minutes