RU2358676C2 - Hip joint unload technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: hip joint unload technique aims at prevention and treatment of hip arthropathy ensured by complex exercise therapy and at prevention of hip arthrosis and arthritis provided by complex exercise therapy of lower limbs while lying on the back or stomach on a horizontal medical couch, involving loading and/or unloading of joint muscles with occasional exercises providing to exercise the muscles of rehabilitated lower limb. Besides positioning the patient in a certain way there are various auxiliary means applied, e.g. wall bars, while the limb is fixed with Martens elastic bandage and elastic bandage, splints, mustard plasters and supports.

EFFECT: method provides strengthening and recovery of hip muscles, increased range of motions, normalised blood circulation, reduced or managed pain syndrome, recovered vegetative functions and adaptable capabilities of the organism as a whole and hip joints particularly.

10 dwg, 1 ex, 2 cl

Description

The invention relates to medicine, in particular to orthopedics and traumatology, namely to physiotherapy exercises, and is intended for the prevention and treatment of diseases of the hip joint by performing a set of exercises of the hip joints.

A known method of decompression mobilization of the hip joint, including cross-sectional dissection of the ileo-tibial tract, radial dissection of the middle and minor gluteal muscles above the apex of the greater trochanter, cutting of the tendons of the sarticular muscle close to the anteriostal ilium, the mobilization of the joint to restore movement to the tunic tunnel, , knitting needles and laying limbs on skeletal traction (RF patent No. 2198614. Publ. 02.20.2003).

However, in the known method, surgical intervention is used to ensure stretching of the capsule and periarticular tissues, increasing the range of motion and restoring blood circulation in the bone structures. When it is completed, there are no techniques for performing elements of physiotherapy exercises.

There is also known a method of surgical transposition of the tendon-skeletal-muscular complex of the trochanteric region with intraoperative elimination of pathological external rotation of the thigh during hip joint endoprosthetics, access to the hip joint, dissection of the tendon-muscular complex of the greater trochanter, its mobilization, removal of the thigh from the vicious position, restoration of length shoulders ”of the hip joint and the elimination of vicious external rotation of the thigh (RF patent No. 2139004. Publ. 10.10.1999).

However, in the known method, methods of surgical intervention are used to restore the biomechanics of the hip joint. It is not intended for passive prevention and treatment of diseases of the hip joint.

The known method of Sobolev therapeutic and recreational effects on humans, including the implementation of a set of techniques aimed at tissues and articular intervertebral motor segments by flexural-tensile and multidirectional efforts of the hands of the operator or patient, as well as the impact of these efforts under the patient’s own weight in horizontal and vertical positions, respiratory procedures and diagnosis of the functional state of the spine and back muscles in the supine position with bent knees, in which echenie certain time sequence of exercises aimed at the creation of two opposing forces at different muscle tension (patent RF №2005122540. Publ. of 20.01.2007).

However, the known method is intended to restore the strength of the muscles of the spine and is not intended for the prevention and treatment of diseases of the hip joint.

A known method for the differentiated purpose and control of physiotherapy for inflammatory joint diseases, including assessing the functions of the upper and lower extremities, the spine using a questionnaire and verifying the rating of the criteria of the questionnaire using a visual analogue scale and taking into account the pain of the patient, after which the pain area of the musculoskeletal system is noted and perform on it the methods of physiotherapy exercises (RF patent No. 2286124. Publ. October 27, 2006).

However, the known method is not intended for the prevention and treatment of diseases of the hip joint.

A known method of healing a person, including arching the spine forward, stretching the muscles of the legs by straining the muscles of the thighs and calf muscles, performing rotational movements in the hip joints (RF patent No. 2234301. Publ. 20.08.2004).

However, the known invention does not allow passive effects on the hip joint for the prevention and treatment of its diseases.

Inertial gymnastics for the hip joint is known, including moderately sharp movements of the pelvis, trunk, hips and the use of inertial energy arising in the joint sphere from sudden movements of these parts of the body, based on the following gymnastic techniques: swing legs, swing the trunk, legs, hips, jerks and the pelvis, lowering the torso to the hip joints, turning the torso, walking sideways (RF patent 2186556. Publ. 10.08.2002).

However, the well-known gymnastics is based on sharp movements by parts of the body and is intended for active procedures of exercise therapy and does not provide for passive loading of the hip joint for the prevention and treatment of its diseases.

The present invention is the ability to implement soft tissue traction by unloading the head of the hip joint of a diseased limb.

The task is carried out by the fact that in the method of unloading the hip joint, which includes performing the physiotherapy exercises of the lower extremities, the patient is laid with his back on the horizontal plane of the medical couch, with the feet on the support side, fixed, laying a splint on the outer and inner surfaces of the rehabilitated lower limb, the Martens bandage is placed between the tire and foot, leaving its ends free, fix the lower rehabilitated limb from the foot, capturing the ankle the top joint, to the groin, with an elastic bandage, creates artificial shortening, placing sandboxes between the healthy limb and the external support, and load and / or unload the joint muscles, periodically performing exercises aimed at the muscles of the rehabilitated lower limb.

It is advisable to fix the position of the rehabilitated lower limb as a support to use the Swedish wall.

To increase the amplitude of movements for the abduction of the hip joint of a diseased limb, the patient is placed on the horizontal plane of the medical couch, the location of the intact lower limb is aligned along its edge, while the trunk and the diseased lower limb are maximally deflected to the opposite edge of the medical couch, after which the diseased limb in the knee joint and the legs are fixed with a “sandbox” until the patient experiences pain.

When creating internal rotation by stretching the middle gluteal muscle, it is advisable to firmly fix the diseased limb with a splint from the groin to the lower leg, including the knee joint, after which the healthy limb should be bent in the knee joint, and the foot of the diseased limb should be deflected inwards.

To fix the internal rotation due to the muscles, the diseased and intact limbs are placed at an angle to each other, shifting them outwards, then they are carried out without tearing the heels of both feet off the horizontal surface, displacing inward the front of the foot until the big toes touch, maintain this position 5- 7 minutes and repeat it 8-10 times.

It is advisable to fix the internal rotation without loading the middle gluteal muscle of the patient, to lay in a free position, fix the knee joint of the intact limb with a “sandbox”, flex the limb as much as possible in the knee joint, maintain the created position until pain occurs. Then return to the starting position, rest for 1-2 minutes and repeat the maximum flexion of the diseased limb in the knee joint from 3 to 10 times, depending on the subjective pain of the patient.

It is advisable to develop hip flexion to place the patient on the horizontal plane of the medical couch in the abdomen position, while positioning the knee joints at the level of the hinges of the head of the medical couch, raise the head restraint to an angle of 40-45 °, lay the “sandboxes” on the gluteal muscles and deflect the lower limbs apart from each other by 80-90 ° until pain occurs.

It is advisable to strengthen the extension muscles of the hip joint of the diseased lower limb, extend the lower limbs in a free position, then put a “sandbox” on the lower third of the thigh until the maximum angle of displacement of the diseased limb from the horizontal plane of the medical couch until pain occurs and maintain this position from 4 to 10 minutes.

In the variant of the extension of the hip joint of the patient, it is advisable to use the fixation of the pelvis "sandbox".

When creating a functional unloading of the hip joint, it is advisable to place the patient vertically with the body resting on the Swedish wall, put an emphasis under the foot of a healthy limb, while the diseased limb rests on the forefoot, in this position the patient stands from 4 to 10 minutes until pain occurs.

The present invention is illustrated by a detailed description, diagrams and photocopies in which:

Figure 1 depicts the laying of a patient to unload a patient lower limb;

Figure 2 illustrates a subsequent increase in the load on the intact limb by enclosing sandboxes;

Figure 3 depicts the laying of the patient to increase the amplitude of movement on the abduction of the hip joint of a diseased limb;

Figure 4 depicts the laying of the patient when creating internal rotation by stretching the middle gluteal muscle;

5 depicts a patient stack for securing internal rotation at the expense of muscles;

Fig.6 depicts the laying of the patient when bending the hip joint;

Fig.7 depicts the laying of the patient during extension of the hip joint;

Fig. 8 depicts a patient laying during extension of the hip joint of a diseased lower limb;

Fig.9 illustrates the laying of the patient during extension of the hip joint during fixation of the pelvis;

Figure 10 illustrates the location of the patient for functional unloading of the hip joint.

The method is carried out in the following way.

The patient carries out the procedures of therapeutic and preventive measures in the presence of an exercise therapy instructor in the office of physiotherapy exercises or performs them at home under the supervision of relatives.

The patient is laid on the horizontal plane of the medical couch in the supine position. Then fix the diseased leg (rehabilitated limb) (Fig.1, 2). To do this, from the groin along the inner surface of the lower limb, covering the middle part of the foot, bring the tire to the outer surface to the greater trochanter. Martens bandage is placed between the tire and the plantar surface of the foot, leaving its ends free. Then fix the lower rehabilitated limb to the groin, capturing the ankle joint with an elastic bandage of medium tensile strength.

After this, fixation of the diseased limb with tension is carried out. At the same time, the ends of the Martens bandage are fixed to the support, in particular to the crossbars of the Swedish wall.

The shoulder, pelvis and rehabilitated limb are placed in one line to create unloading of the head of the hip joint in one direction along the axis.

For support between the plantar side of the foot of a healthy limb and the Swedish wall, “sandboxes” are placed to the sensations of a tolerable pulling pain. If necessary, gradually increase the load. The more sandboxes are laid, the more they create the conditions for shortening a healthy limb and, accordingly, create the unloading of a rehabilitated limb.

Laying in the created position can withstand from 4 to 10 minutes, focusing on the pain of the patient.

Then the actions are performed in the reverse order to create the initial position of the patient on the medical couch, gradually freeing the intact and rehabilitated (sick) limbs from sandboxes, bandages and support.

The laying is repeated several times, namely 6-8, with depreciation of the rehabilitated limb, i.e. returning it to its original state.

After styling, the rehabilitated limb should be functionally longer due to the unloading (skew) of the hip joint.

As a support for fixing the position of the rehabilitated lower limb using the Swedish wall.

To increase the amplitude of movements on the abduction of the hip joint of a patient limb, the patient is placed on the horizontal plane of the medical couch (Figure 3). Then align the location of the intact lower limb along its edge. The body and the diseased lower limb are at the same time deflected to the opposite edge of the medical couch. After that, the diseased limb in the area of the knee joint and lower leg is fixed with a “sandbox” until the patient experiences pain. Withstand this position of the patient from 4 to 10 minutes. If unpleasant pain occurs, the exercise therapy procedure is stopped.

To create internal rotation using the method of stretching the middle gluteal muscle (Figure 4). For this, a strong fixation of the cuff of the knee joint of the diseased limb is carried out. After that, a healthy limb is bent in the knee joint, the foot of the diseased limb is deflected inside.

To fix the internal rotation due to the muscles, the diseased and intact limbs are positioned at an angle to each other, shifting them outwards (Figure 5). Then they carry out, without tearing the heels of both feet off the horizontal surface, displace inward the front of the foot until the big toes touch, maintain this position for 4 to 10 minutes and repeat it 8-10 times.

For conducting exercises on the bending of the hip joints of the patient is placed in a free position on the horizontal plane of the medical couch in the supine position (Fig.6). The knee joint of the intact limb is fixed with a “sandbox”. The diseased limb is maximally bent in the knee joint, and the created position is maintained until pain occurs. Then rest 1-2 minutes in a free position. This exercise is repeated 5-10 times depending on the pain of the patient.

The development of the extension of the hip joint is carried out by placing the patient on the horizontal plane of the medical couch in a position on the abdomen (Fig.7). In this case, the knee joints are located at the level of the hinges of the headrest of the medical couch. Then the headrest is raised to an angle of 40-45 °, laying a “sandbox” on the gluteal muscles, and the lower extremities are deflected outward from each other by 80-90 ° until pain occurs. The exercise is repeated several times, namely 5-10.

Strengthening the muscles of the extension of the hip joint of the patient lower limb is as follows (Fig. 8). The lower limbs of the patient are pulled in a free position. A sandbox is placed under the lower third of the thigh until the maximum angle of displacement of the diseased limb from the horizontal plane of the medical couch to the onset of pain is created. Withstand this position from 4 to 10 minutes.

When performing exercises for extension of the hip joint of the patient often use fixation of the pelvis "sandbox", which prevents its separation from the horizontal plane (Fig.9).

Functional unloading of the hip joint is achieved as follows. The patient is placed vertically with the body resting on the Swedish wall. Place emphasis under the foot of a healthy limb. In this case, the diseased limb rests on the forefoot. In this position, the patient should stand for 4-10 minutes before the onset of pain (Figure 10).

An example of the method

Patient A., 42 years old, went to the clinic with complaints of pain in the hip joints with long walking, after physical exertion. Outpatient card number 145. On examination, the diagnosis was made: bilateral coxarthrosis of the first degree of hip joints.

Examination by a doctor showed the need for therapeutic measures to strengthen the muscles of the hip joint.

The patient lies in a supine position on the horizontal plane of the medical couch. A sore leg (rehabilitated limb) was recorded. To do this, from the groin along the inner surface of the lower limb, covering the middle part of the foot, brought the tire to the outer surface to the greater trochanter. A Martens bandage was placed between the tire and the plantar surface of the foot, leaving its ends free. Then, the lower rehabilitated limb was fixed to the groin, grabbing the ankles with an elastic bandage of medium elongation.

After that, the fixation of the diseased limb was carried out with tension. At the same time, the ends of the Martens bandage were fixed for support, in particular for the crossbars of the Swedish wall.

The shoulder, pelvis and rehabilitated limb were placed in one line to create unloading of the head of the hip joint in one direction along the axis.

Between a healthy limb and a support, a sandbox was laid to support the plantar side of the foot. The size of the "sandbox" was chosen to be tolerable pulling pain. Gradually increased the load, creating conditions for a rehabilitated limb. The more sandboxes were laid, the more conditions were created for shortening a healthy limb and unloading a rehabilitated limb.

Laying in the created position was maintained for 40-60 minutes, focusing on the pain of the patient.

Then, the actions were carried out in the reverse order to create the initial position of the patient on the couch, gradually freeing the intact and rehabilitated (sick) limbs from the sandboxes, bandages and supports.

The laying was repeated several times, namely 6-8, with depreciation of the rehabilitated limb, i.e. focusing on returning it to its original state.

After styling, the rehabilitated limb should be functionally longer due to the unloading (skew) of the hip joint.

The Swedish wall was used as a support for fixing the position of the rehabilitated lower limb. At home, it is possible to use any suitable support for fixing the ends of the bandage.

To increase the amplitude of movements for the abduction of the hip joint of a patient limb, the patient was placed on the horizontal plane of the medical couch. Then aligned the location of the intact lower limb along its edge. In this case, the trunk and the diseased lower limb deviate to the opposite edge of the medical couch as much as possible. After that, the diseased limb in the area of the knee joint and lower leg was fixed with a “sandbox” until the patient experienced pain. Maintained this position of the patient from 5 to 10 minutes. When unpleasant pain occurred, the exercise therapy procedure was stopped.

To create an internal rotation, use the method of stretching the middle gluteal muscle. For this, a firm fixation of the diseased limb with a cuff from the groin to the lower leg, including the knee joint, was carried out. After that, the healthy limb was bent at the knee joint, the foot of the diseased limb was deflected inward.

To fix internal rotation due to muscles, the diseased and intact limbs were positioned at an angle to each other, displacing them outwards. Then carried out, without tearing the heels of both feet from the horizontal surface, the displacement inward of the front part of the foot to the contact of the big toes. Maintained this position for 5-7 minutes and repeated it 8-10 times.

To fix the internal rotation without loading the middle gluteal muscle, the patient is laid in a free position. The knee joint of the intact limb was fixed with a “sandbox”. The diseased limb was maximally bent in the knee joint, and the position was maintained until pain occurred. Then the patient was given 1-2 minutes rest in the free position. The repetition of the maximum flexion of the diseased limb in the knee joint was performed 5-10 times, depending on the pain of the patient.

The development of hip flexion was carried out by placing the patient on the horizontal plane of the medical couch in a position on the abdomen. In this case, the knee joints were located at the level of the hinges of the headrest of the medical couch. Then the headrest was raised to an angle of 40-45 °, placed on the gluteus muscles of the “sandbox" and the lower extremities were deflected from each other outward by 80-90 ° until pain occurred. The exercise was repeated several times, namely 4-10.

Strengthening the muscles of the extension of the hip joint of the patient lower limb was carried out as follows. The lower limbs of the patient were pulled in a free position. A sandbox was placed under the lower third of the thigh until the maximum angle of displacement of the diseased limb from the horizontal plane of the medical couch to the onset of pain was created. Maintained this position from 4 to 10 minutes.

When performing exercises to extend the hip joint used fixation of the pelvis "sandbox". This prevented his separation from the horizontal plane.

Functional unloading of the hip joint was achieved as follows. The patient was placed vertically with the body resting on the Swedish wall. An emphasis was placed under the foot of a healthy limb. In this case, the diseased limb rested on the forefoot. In this position, the patient stood 5-8 minutes before the onset of pain. After a short rest, the exercise was repeated 5-8 times.

The proposed method of unloading the hip joint allows you to strengthen and restore the function of its muscles. It affects the muscles of both the hip joint and the muscles of the spine. With its use, metabolic processes in the hip joint improve, the range of movements increases, blood circulation normalizes, and the pain syndrome decreases or disappears.

The application of the proposed method restores the autonomic functions and adaptive capabilities of the body as a whole and of the hip joints in particular.

The use of auxiliary means in the form of “sandboxes”, langets, bandages and the Swedish wall make it possible to give the musculoskeletal system the necessary position for conducting a set of therapeutic exercises.

In addition, the application of the proposed method is intended for the prevention and treatment of diseases of the hip joint by performing exercises aimed at the rehabilitation of the muscles of the hip joints.

The proposed method is used in the clinic and the department of physiotherapy exercises Federal State Institution “RTC“ WTO ”named after Academician G.A. Ilizarov Rosmedtehnologii.

Claims (2)

1. The method of unloading the hip joint, including the implementation of a physiotherapy exercise complex of the lower extremities, characterized in that the patient is laid with his back on the horizontal plane of the medical couch, with the feet on the support side, the rehabilitation of the lower limb is fixed by laying a splint on its outer and inner surfaces, the Martens bandage is placed between the tire and foot, leaving its ends free, fix the lower rehabilitated limb from the foot, capturing the ankle joint, until and an elastic bandage and create artificial shortening, positioning between the healthy limb and external support "Sandpipers", carried out the loading and / or unloading of the joint muscles, periodically performing exercises aimed at the muscles of the lower limb rehabilitated; then align the location of the intact lower limb along its edge, while the trunk and the diseased lower limb are maximally deflected to the opposite edge of the medical couch, after which the diseased limb in the area of the knee joint and lower leg is fixed with a “sandbox” until the patient experiences pain; then, the sick limb is firmly fixed with a splint from the groin to the lower leg, including the knee joint, after which the healthy limb is bent in the knee joint, and the foot of the diseased limb is deflected inward; then the diseased and intact limbs are positioned at an angle to each other, shifting them outwards, and carried out, without tearing the heels of both feet off the horizontal surface, moving inward the front of the foot until the big toes touch, maintain this position for 5-7 minutes and repeat it 8 -10 times; then the patient is laid in a free position, the knee joint of the intact limb is fixed with a “sandbox”, and the diseased limb is maximally bent in the knee joint, kept in the created position until pain occurs, after which the patient rests for 1-2 minutes in a free position, and the maximum flexion is repeated a sick limb in the knee joint 5-10 times; then the patient is placed on the horizontal plane of the medical couch in the abdomen positioning the knee joints at the level of the hinges of the headrest of the medical couch, the headrest is raised to an angle of 40-45 °, and the “sandboxes” are placed on the gluteal muscles and the lower limbs are deflected 80 -90 ° until pain occurs, then the lower extremities are pulled in a free position, and a “sandbox” is placed under the thigh near the knee joint until the maximum angle of displacement of the diseased limb from th izontalnoy medical couch plane before the pain and kept in this position for 4-5 minutes, while the pelvis is fixed "Sandpiper"; then the patient is placed vertically with the torso support, an emphasis is placed under the foot of a healthy limb, while the diseased limb focuses on the forefoot, in this position the patient stands 5-8 minutes before the onset of pain. 2. The method according to claim 1, characterized in that the Swedish wall is used as a support.

Images