RU2324464C2 - Method of rehabilitation of patients with functional abnormalities of small pelvis organs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: training of the pelvic floor muscles, caudal spine muscles and ligaments, and hip joints is performed The original technique is applied.

EFFECT: method increases treatment efficiency due to improved blood supply in small pelvis organs, caudal spine muscles and ligaments, and hip joints.

5 clr

Description

The invention relates to medicine, in particular to physical therapy, and can be used to treat women with dysfunctions of the pelvic organs and the genitourinary system due to age-related hormonal changes in the body.

With hormonal rearrangement of the female body, occurring at the age of 45-60 years, stagnation in the pelvic organs and degenerative-destructive processes in the lumbosacral spine and in the hip joints appear. These phenomena are often accompanied by the prolapse of the internal organs (uterus, bladder), urinary incontinence with tension, which is explained by weakening of the muscles of the pelvic floor. For training and strengthening the pelvic floor muscles, physiotherapy exercises have long been used.

A known method of restoring the correct anatomical position of the internal organs, which consists in the gradual training of weakened muscles of the small pelvis. The complex of therapeutic exercises is given in the book of Professor Epifanov V.A. Therapeutic physical education and sports medicine, M., 2004, p. 522-523. The main attention in this complex is given to leg movements in the initial lying position on the back: alternating cross movement of straight legs, alternating bending of the legs at the knees, pressing the bent legs to the chest, leg movement that imitates cycling, crossing and raising the legs to the sides. Only two exercises, in our opinion, are aimed at effective training of the muscles of the pelvic floor, when the patient should strain the muscles of the thigh, buttocks and contract the muscles of the perineum in the initial position lying on its side.

A known method of restoring the function of the pelvic organs according to US Pat. RF №2263496 dated 07/11/2003, which is intended for the rehabilitation of patients with impaired function of the pelvic organs, genitourinary system, intestines due to damage to the nervous system, postoperative complications regarding the removal of tumors and hematomas, operations on the spinal cord and brain.

This method provides for the training of the muscles of the pelvic floor, diaphragm, back muscles and muscles that have attachment points in the pelvic area, while muscle contraction is performed in fractional mode to avoid straining so as not to provoke an increase in intracranial pressure. A fractional muscle contraction regimen improves blood flow of denervated muscles. In other words, the method allows you to gradually, carefully, without strain to rehabilitate the organs of patients after operations.

For patients who have not undergone such complex operations, for which isometric (stress) exercises are not contraindicated, it is recommended to use another method of training the pelvic floor muscles (Physiotherapy Physical Training. Handbook edited by V. Epifanov, M., 1987, p. 326-331).

This method, according to the author, is more effective and closest to the claimed.

In the known method proposed exercises for the muscles of the pelvic floor in isotonic and isometric modes. Special exercises consist in alternating the retraction of the perineum with subsequent relaxation of the muscles. Any movement of the legs, lifting and turning the pelvis is accompanied by a reduction in the muscles of the pelvic floor and buttocks.

However, in the complex of exercises there are no special exercises for training the muscles and ligaments of the caudal department (coccyx and sacrum) of the spine and hip joints.

It is known that the condition of the muscles and ligaments of the caudal spine determines the intensity of lymphatic blood flow in the pelvic organs and, therefore, affects pathological deviations in them. If you do not affect the mechanism of cerebrospinal fluid exchange and cerebrospinal fluid dynamics in this department, it becomes impossible to get rid of pathologies in the organs, as well as phantom pains in the sacrum, which are complained by patients who underwent surgery on the internal organs, even distant in time, or chronic injuries. Training only the pelvic floor muscles provides only a temporary improvement in the patient's condition.

The author, who has been teaching physical therapy for women aged 45 to 65 for many years, has set herself the task of developing such a set of exercises that could help women get rid of dysfunctions in the case of urinary incontinence or straining, and to eliminate congestion in the organs of the small pelvis, including in the rectum, get rid of adhesions and phantom pains in the sacral region, as well as prevent functional disorders in the area of the hip joints.

The problem was solved by the fact that in the known method of healing patients with impaired function of the pelvic organs, including training the muscles of the pelvic floor, according to the invention, training of muscles and ligaments of the caudal spine and hip joints is additionally introduced.

The essence of the proposed method is as follows.

As mentioned above, the female body at a certain age (45-60 years) experiences hormonal changes, which is accompanied by congestion in the pelvic organs, painful sensations in them, as well as psychological instability, sleep disturbances, headaches, depression. However, modern methods of dealing with such disorders in the female body during and after menopause are usually reduced to hormonal treatments for many years, and in cases of problems with the hip joints (for example, osteoporosis), painkillers, ointments and medicines containing hard to digest calcium.

Physical therapy is a more accessible and safe method of treatment, however, in the well-known sources of patent and scientific information, no set of exercises has been found that would solve this problem as a whole, and the above methods are aimed at solving narrower problems and do not provide healing for a long time.

At the same time, the proposed set of exercises includes not only training the muscles of the pelvic floor of a woman, but also exercises for the muscles and ligaments of the lumbosacral spine, the caudal spine and hip joints proper, which contribute to more efficient blood supply to the pelvic organs and prevent violations in the hip joints.

We list the main special exercises.

1. Starting position (PI) lying on your back, legs straight, apart, arms bent at the elbows. At the expense of 1-2, a breath through the nose and a slow bend in the lumbar spine with support on the shoulder blades and sacrum. At the expense of 3-4, a long exhale through the compressed lips, press the lower back to the support, lean on your legs and tighten the muscles of the lower abdomen, draw in the crotch. Exercise is a warm-up, performed within 1-2 minutes with a gradual increase in pace.

2. PI lying on his back, legs bent, apart. At the expense of 1 - breath, deflection in the lumbar spine. At the expense of 2 - exhale, press the lower back to the support, tighten the muscles of the lower abdomen and retract the perineum. At the expense of 3 - keep the muscles in tension; on account 4 - relax.

3. PI lying on his back, legs straight, apart, hands are located on the stomach: one is above the navel, the other is below the navel. At the expense of 1-2 breath, tighten the gluteus and abdominal muscles, tightly press your hands to your stomach, draw in the crotch. At the expense of 3-4 exhale, relax all the muscles.

4. PI lying on his back, legs straight, apart, hands placed under the gluteal muscles. At the expense of 1 - strain the right gluteal muscle, at the expense of 2 - relax. At the expense of 3 - strain the left gluteal muscle, at the expense of 4 - relax. Gradually increase the pace to 1 movement per second.

Exercises 2, 3, 4 affect the muscles of the pelvic floor and increase blood flow to the pelvic organs due to the tension of the gluteal and perineal muscles.

5. PI lying on his back, legs bent, apart to the width of the shoulders. Alternate movement of the knees inward to the support and back. The second knee is motionless. At the expense of 1-2-3 - the inclination of one knee inward to the support, at the expense of 4 - the reverse movement, take the knee outward as much as possible. Repeat the movements of the second knee.

6. FE lying on his back, hands behind his head, legs bent crosswise ("in Turkish"). At the expense of 1 - inhale, tighten the gluteal muscles and spread the knees to the sides - down to the support. At the expense of 2 exhale, relax the muscles, return the knees to their original position. Repeat the exercise by changing the position of the legs in a crossed position.

7. PI lying on his back, legs bent. Focusing on one leg, with a straightened free leg, perform a slow circular motion in one and the other direction, each time ending the movement by pressing the hips to the stomach, bending the leg at the knee. The same is based on the other leg.

Exercises 5, 6, 7, giving a load on the gluteal muscles, affect the ligaments and muscles of the hip joints, and when doing exercise 7, additional stimulation of the intestines is performed.

8. PI lying on his back, legs straight together. At the expense of 1-2, pull one leg toward you, the other - pull (“lengthen”), at the expense of 3-4, reverse the legs.

9. PI lying on his back, legs bent, apart to the width of the shoulders. At the expense of 1-2 breath, pull one leg toward yourself, without tearing the gluteal muscle from the support, sliding along it and not turning the pelvis. At the expense of 3-4 exhale, pull the other leg towards yourself, gliding the gluteal muscle along the support and without turning the pelvis.

10. SP sitting, legs straight, heels pressed to the support. Bending the legs, with a sliding movement to move on the gluteal muscles to the heels, avoiding jumps. Extending your legs, with a sliding motion to go back.

Exercises 8, 9, 10 are aimed at increasing blood supply in the ligaments and muscles of the sacrum and tailbone (caudal spine).

11. SP sitting. Legs are straight, arms are bent at the elbows. At the expense of 1-8, alternately push straight legs forward, working with your hands as if running and leaning forward as much as possible. At the expense of 9-16 - backward movement, the back is straight, circular movements with the shoulders back.

12. IP sitting, legs straight, straight back. At the expense of 1-8, the movement on the gluteal muscles to the side, rolling along the thigh and pulling the other leg. At the expense of 9-16 - the same in the other direction.

13. FE lying on his side, head on the lower outstretched arm, upper arm resting on the floor, lower leg bent. At the expense of 1-8, perform the “bicycle” forward movement with the upper leg, and at the expense of 9-16, perform the “bicycle” movement backward. Repeat on the other side.

14. IP is the same. Movement "bike" with both legs at the same time.

Exercises 11, 12, 13, 14 strengthen the muscles of the pelvic floor, increase blood supply to the pelvic organs and hip joints.

15. PI lying on his side, lean on the elbow of the lower arm, lower leg straight, upper leg straight in weight. Bend the upper leg and perform 3 movements with the knee in the direction of the support, without touching it. Leg straighten. The movements are slow. Pace gradually increase to tilt and straighten the legs in each account. Same on the other side.

16. FE lying on his back, legs bent, apart, pelvis on a support. Alternately raise the right (left) buttock, resting on the other leg. The movement is smooth, slow, gradually increasing pace. Complication: the pelvis is raised, the movement is the same.

17. FE lying on his back, legs bent. At the expense of 1, slowly squeeze the knees, tighten the gluteal muscles and retract the perineum. At the expense of 2, relax all the muscles. Perform the exercise up to 20 times, after which relax, straighten and shake the legs.

Exercises 15, 16, 17 contribute to the training of the muscles of the pelvic floor and increase the blood supply to the pelvic organs and hip joints.

18. PI lying on his stomach, one leg straightened, the other bent at the knee and hip joint at an angle of 90 ° (if possible) and extended to the side - up. At the expense of 1-2, press the bent leg to the support, at the expense of 3-4 - relax. The complication of movement: at the expense of 1-2 raise the knee of the bent leg, resting on the foot, at the expense of 3-4 - lower the knee, relax the muscles. Repeat the same with the other leg.

Exercise 18 is complicated, slow. Its action is aimed at increasing blood supply to the ligaments and muscles of the caudal spine (sacrum and tailbone).

As patients become more trained, the pace and duration of exercise increases.

The total duration of one session is 1 h 15 min.

The number of classes is from 16 to 24.

At the end of the therapeutic gymnastics course, under the guidance of an instructor, each patient can repeat any group of exercises daily at home according to her sensations: these can be exercises to strengthen the muscles of the pelvic floor or special exercises for the muscles and ligaments of the hip joints. But the exercises for the caudal spine are most effective, since they help to eliminate stagnation in the pelvic organs, increase blood circulation and venous blood outflow in them.

Experience with patients has shown that women who have undergone medical gymnastics, by the end of the course feel much better physically, receive a boost of energy, become alert and emotionally stable. Those who prefer classes in a group and with an instructor periodically (in spring and autumn) return to repeat the course, especially since the exercises are modified, varied and complicated. And the result, as a rule, is the same - women restore their health and lead an active lifestyle.

Thus, the therapeutic effect of the claimed method of healing consists in improving blood circulation in the pelvic organs, increasing the tone of the muscles of the uterus, normalizing the functions of the genitourinary organs, eliminating adhesions, correcting the pathological positions of organs, and eliminating constipation.

Under the influence of directed exercises, blood circulation in the hip joints and lumbosacral spine is improved, which helps the resorption of residual phenomena of inflammatory processes, salt deposits. The joints become more mobile, gait and posture are corrected.

Claims (5)

1. A method of healing patients with impaired pelvic organs, including a set of exercises: 1) starting position (PI) lying on your back, legs straight, apart, arms bent at the elbows, at the expense of 1-2 breath through the nose and slowly perform a deflection in the lumbar spine, resting on the shoulder blades and sacrum, for 3-4 long exhalation through the compressed lips, press the lower back to the support, rest on the legs and tighten the muscles of the lower abdomen, retract the perineum, the exercise is performed for 1-2 minutes with a gradual increase pace; 2) FE lying on his back, legs bent, apart, at the expense of 1 breath, deflection in the lumbar spine, at the expense of 2 exhalation, press the lower back to the support, tighten the muscles of the lower abdomen and retract the perineum, at the expense of 3 keep the muscles in tension, on score 4 relax; 3) FE lying on his back, legs straight, apart, hands are located on the stomach: one is above the navel, the other is below the navel, 1-2 breaths are counted, the gluteus and abdominal muscles are strained, the hands are pressed tightly to the stomach, the crotch is pulled, counted 3-4 exhale, relax all muscles; 4) FE lying on your back, legs straight, apart, hands placed under the gluteal muscles, strain right gluteus muscle on count 1, relax it on count 2, strain left gluteus count on 3, relax left gluteus count 4, gradually increase pace up to 1 movement per second; exercises 2, 3, 4 affect the muscles of the pelvic floor and increase blood flow to the pelvic organs due to the tension of the gluteal and perineal muscles. 5) FE lying on his back, legs bent, apart to the width of the shoulders, alternately moving his knees inward to the support and back; the second knee is motionless, at the expense of 1-2-3 the tilt of one knee inward to the support, at the expense of 4 reverse movement, the knee is pulled outward as much as possible, the movements of the second knee are repeated, 6) FE lying on his back, hands behind his head, legs bent Turkish ”, at the expense of 1 breath, strain the gluteal muscles and spread the knees side down to the support, at the expense of 2 exhale, relax the muscles, knees return to their original position, repeat the exercise, changing the position of the legs in a crossed position; 7) FE lying on his back, legs bent, focusing on one leg, straightened free leg perform a slow circular motion in one and the other direction, each time ending the movement by pressing the hips to the stomach, bending the leg at the knee, the same exercise is carried out based on the other leg; 8) FE lying on his back, legs straight together, at the expense of 1-2, one leg is pulled over, the other is pulled, at the expense of 3-4 they perform the movement of the legs on the contrary; 9) FE lying on his back, legs bent, apart to the width of the shoulders, at the expense of 1-2 breaths, pull one leg towards himself, without tearing the gluteal muscle from the support, sliding along it and not turning the pelvis, at the expense of 3-4 exhale, the other leg is pulled over by sliding the gluteal muscle along the support and without turning the pelvis; 10) FE sitting, legs straight, heels pressed to the support, bending the legs, moving with gliding muscles on the buttocks to the heels, avoiding jumps, unbending legs, sliding motion back; 11) sitting PI, legs straight, arms bent at the elbows, at the expense of 1-8 alternately push straight legs forward, working with your hands as if running and leaning forward as much as possible, at the expense of 9-16 the back is straight, perform backward movement and circular movements with shoulders back ; 12) FE sitting, legs straight, back straight, at the expense of 1-8 they perform movement on the gluteal muscles to the side, rolling along the thigh and pulling the other leg, at the expense of 9-16 - the same exercise in the other direction; 13) FE lying on his side, head on the lower outstretched arm, upper arm resting on the floor, lower leg bent, at the expense of 1-8 the slow motion “bicycle” forward is performed with the upper leg, at the expense of 9-16 - “bicycle” movement back, repeat the exercise on the other side; 14) The IP is the same, they perform the “bicycle” movement with both legs simultaneously; 15) FE lying on his side, lean on the elbow of the lower arm, lower leg straight, upper leg straight on weight, bend the upper leg and perform 3 movements with the knee toward the support, without touching it, straighten the leg, while the movements should be slow, pace it is necessary to gradually increase to tilt and straighten the legs in each account, the same exercise is performed on the other side; 16) FE lying on his back, legs bent, apart, pelvis on a support, alternately lift the right or left buttock, leaning on the other leg, the movement should be smooth, slow, gradually increasing the pace, 17) FE lying on his back, legs bent, on score 1 slowly squeeze the knees, tighten the gluteal muscles and retract the perineum, count 2 relax all the muscles, perform the exercise up to 20 times, then relax, straighten and shake the legs; 18) FE lying on his stomach, one leg is straightened, the other is bent at the knee and hip joint at an angle of 90 °, if possible, and is carried out upwards, 1-2 bent leg is pressed to the support, 3-4 are relaxed. 2. The method according to claim 1, characterized in that the total duration of one session is 1 hour 15 minutes, and the number of lessons is from 16 to 24. 3. The method according to claim 1, characterized in that as the training of patients increases, the pace and duration of the exercise increases. 4. The method according to claim 1, characterized in that for complication when performing exercise 16, the pelvis is raised. 5. The method according to claim 1, characterized in that for complication when performing exercise 18, at the expense of 1-2 lift the knee of the bent leg, resting on the foot, at the expense of 3-4 - lower the knee, relax the muscles, repeat the same exercise foot, perform the exercise slowly.