RU2452493C1 - Method of treating myofascial pain accompanying spine osteochondrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, orthopaedics, reflexotherapy, physiotherapy exercises, recreation therapy and is applicable in integrated treatment of myofascial pain accompanying spine osteochondrosis. Pain management procedures are followed by a complex of exercises with using the HUBER apparatus consisting of seven staticodynamic exercises aimed at strengthening and activation of muscles of upper limb girdle, greater pectoral muscle, pelvic floor muscles and gluteal muscles. It is combined with loading and coordination improvement of left broadest muscle of back, left obliques, left lumbar quadrate muscle. Upper shoulder anchors, broadest muscle of back and rhomboid muscle are relaxed, and postural muscles are coordinated. Lumbar spine muscles are relaxed. Tone in upper extremity and back muscles is strengthened. It is followed by making exercises for activation of muscles of upper limb girdle, pectoral muscles, pelvic floor muscles, gluteal muscles. Then, the exercises for strengthening of lumbar muscles for the purpose of improving the body position coordination, relaxation of back ground of femoral and hip muscles, strengthening of abdominal wall muscles.

EFFECT: method improves support ability of feet, normalises position of the centre of gravity, forms an optimum motor conditions.

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Description

The invention relates to medicine, namely to neurology, orthopedics, reflexology, physiotherapy, rehabilitation, and can be used in the treatment of myofascial pain syndromes in osteochondrosis of the spine

A known method of treating myofascial pain syndromes in osteochondrosis of the spine by stretching it using a dosage tensile load (patent RU No. 2163108, “A method of treating osteochondrosis in its clinical manifestations”) or by acting on the spine simultaneously in the transverse and longitudinal directions: in the transverse direction affect the bone -muscular apparatus in vibration mode, and at the time of forced stretching of the lumbar and thoracic spine - with the vibration disabled (patent RU No. 2092148, “Sp GSS stretching the patient's body ").

The disadvantage of this method is the uncontrolled stretching of muscles and ligaments as a result of treatment and, as a result, weakening of the muscle corset and hypermobility of the vertebral-motor segment. The method does not have an active targeted effect on the weakened muscles of the upper shoulder girdle, pectoral muscle, pelvic floor muscles, and gluteal muscles. After treatment, violations of the motor stereotype and postural balance persist.

There is a method of influencing the spine using a wellness chair by creating multiple cycles of moderate stretching and compression of the intervertebral discs, providing their internal massage (Patent RU No. 2069061, "Wellness chair").

The disadvantage of this method is the inability to dose the optimal load on the spinal motor segment, which can be the cause of spondylolisthesis and weakening of the muscle corset. In addition, there is no active targeted effect on the weakened muscles and the pathological motor stereotype remains.

Thus, the listed treatment methods do not contribute to the formation of an optimal motor stereotype, the violation of which is the main cause of myofascial pain syndromes in osteochondrosis of the spine and inevitably leads to their relapse.

Closest to the claimed is a method of active kinesitherapy using the Huber technology (HUBER, LPG Systems, France) (Medical technology "The use of the HUBER hardware complex in clinical practice"; registration certificate FS-2007/162, valid 07.08 .2007-11.11.2014: Esthetic LLC). A feature of the method used in this technology is the effect on all muscle chains of the human body from the feet to the hands simultaneously with active or passive isotonic and isometric muscle effort. During the treatment and rehabilitation session, a multisensory effect is exerted on the musculoskeletal and neuro-receptor apparatus, which is manifested by the restoration of static and dynamic stereotypes, muscle tone, and an increase in range of motion.

The HUBER device is equipped with a motorized platform with a variable speed and amplitude of rotation, which creates an unstable support for the patient, and a dynamic vertical column on which a system of horizontal arms with touch sensors is installed, which correspond to different zones of the human body.

The patient acts on the handle of the column (pulls or pushes) with a certain force, while adapting to the instability of the support. The real-time feedback screen shows the patient the magnitude of the impact, allowing you to coordinate your efforts and regulate the activity of various muscle groups. The motorized platform makes the muscle groups responsible for spinal mobility and coordination work in concert.

Thus, the method allows for balanced in strength and coordination of movement and postural control of muscles for active correction of posture and stabilization of the spinal motor segment.

However, this method cannot be fully used in the treatment of patients with severe myofascial pain syndrome, since the pathological pain impulse generated by the trigger points formed in the postural muscles does not allow the patient to fully work out balanced in strength and coordination of movement and makes him “spare” the zone pains.

The objective of the invention is to develop a method for the treatment of myofascial pain syndrome in osteochondrosis of the spine by affecting the pathogenesis of myofascial pain and active kinesitherapy to maximize the restoration of optimal postural balance.

The problem is solved due to the fact that the pain is stopped by the simultaneous introduction of 1 ml of reopoliglukin and 1 ml of a 2% lidocaine solution 30 minutes before the start of the complex of exercises into the trigger points; carry out a set of exercises consisting of seven static-dynamic exercises, in the initial positions shown in Figs. 1-7, aimed at strengthening and activating the muscles of the upper shoulder girdle, pectoralis major muscle, pelvic floor muscles and gluteal muscles, creating a load and improving coordination the work of the left latissimus dorsi, the left oblique abdominal muscles, the left square muscle of the lower back; relaxation of the upper fixators of the scapula, latissimus dorsi and rhomboid muscle, coordination of postural muscles; muscle relaxation of the lumbar spine, strengthening muscle tone of the upper limbs and back; conducting exercises to activate the muscles of the upper shoulder girdle, pectoral muscle, pelvic floor muscles, gluteal muscles; Then they carry out exercises to strengthen the muscles of the lower back, to improve coordination of the position of the body in space, to relax the rear muscle group of the thigh and lower leg, and to strengthen the muscles of the abdominal wall. Conducted 8-10 sessions, each of which consists of 7 exercises.

The solution of this problem allows us to form the optimal motor stereotype.

The technical result is achieved due to the impact on the pathogenetic mechanism of the occurrence of myofascial pain - local hypertonicity by inactivation of trigger points formed in the area of hypertonicity. Temporary inactivation of trigger points in postural muscles is carried out by correction of the hypotonic space of the trigger zone by the introduction of rheopolyglucin and anesthesia of this zone. Thus, the generation of pain impulse is interrupted, and this allows the patient to repeatedly work out the movements balanced in strength and coordination that are part of a specially developed set of static-dynamic physical exercises on the Huber apparatus. The complex allows to improve the support ability of the legs, normalize the position of the center of gravity and actively form the optimal motor stereotype in the patient, which prevents a relapse of the disease.

Figure 1 presents the position of the patient’s body when performing exercise No. 1, aimed at strengthening and activating the upper shoulder girdle, pectoral muscle, pelvic floor muscles and gluteal muscles.

Figure 2 presents the position of the patient's body when performing exercise No. 2, aimed at creating a load on the left latissimus dorsi, the left oblique abdominal muscles and the left square muscle of the lower back, and to improve coordination of muscle work.

Figure 3 shows the position of the patient’s body when performing exercise No. 3, aimed at relaxing the upper fixators of the scapula (trapezius muscle, muscle that raises the scapula), latissimus dorsi, and rhomboid muscle and coordination of the work of predominantly postural muscles.

Figure 4 presents the position of the patient’s body when performing exercise No. 4, aimed at relaxation and relaxation of the muscles of the lumbar spine and to strengthen the tone of the muscles of the upper limbs and back.

Figure 5 presents the position of the patient’s body when performing exercise No. 5, aimed at activating the muscles of the upper shoulder girdle, pectoral muscle, pelvic floor muscles, gluteal muscles.

Figure 6 presents the position of the patient's body when performing exercise No. 6, aimed at strengthening the muscles of the lower back and improving coordination of the position of the body in space.

Figure 7 presents the position of the patient’s body when performing exercise No. 7, aimed at relaxing the back of the thigh and lower leg muscles, strengthening the muscles of the abdominal wall.

The method is as follows.

30 minutes before the start of the procedure, the patient identifies active trigger points in the postural muscles and muscle-tendon structures by palpation and manual muscle testing. Then a medical-medical blockade is carried out for the temporary inactivation of the trigger points of the interested muscles and muscle-tendon structures by the simultaneous injection of 1 ml of reopoliglukin and 1 ml of a 2% solution of local anesthetic lidocaine. Then, for 20-40 minutes (depending on the patient’s muscle corset and the number of sessions performed), active kinesitherapy is performed on the HUBER apparatus, which includes seven physical exercises that allow for balanced and coordinated movements and muscle control to form a postural balance and optimal motor stereotype.

Before the main exercises, a warm-up is performed, which is maintaining balance with open and closed eyes on a rotating platform with different positions of the upper and lower limbs in order to passively and actively increase the range of motion in all joints of the body and stimulate the effects of natural gravity on the main axial joints. Conducting exercises begins in a limited volume with a gradual increase in load and amplitude. A patient with lumbar osteochondrosis performs all movements while maintaining a vertical position, which avoids excessive loads on the spine.

During the exercise, the speed and amplitude of rotation of the platform is set individually and is maintained throughout the course of treatment. The information screen of the device reminds the patient the position of his arms and legs, the direction of action and the direction of movement of the platform. Each phase of the action is followed by a pause for rest, which allows the patient to prepare for the next exercise.

Exercise number 1

1. The initial position of the patient (Figure 1). The patient is in the center of the platform, the legs are slightly bent at the knee joints, are located at shoulder width, the feet are parallel, the position of the pelvis is extensional. Type of abdominal breathing.

2. Description of the exercise. During inspiration, the hands move down and towards each other, while the large pectoral muscles are tensed. During exhalation, the hands relax. In this case, simultaneous static-dynamic tension of the muscles of the pelvic floor and gluteal muscles during inhalation and their relaxation during exhalation are carried out. The angle of the platform is constantly changing.

Exercise number 2

1. The initial position of the patient (Figure 2). The patient carries out the transfer of the center of gravity of the body to the left leg. The right leg is set back to maintain balance during platform operation. The left hand is in the lower position of the bar, the right - in the upper.

2. Description of the exercise. When the platform moves, the bar is pressed with the left hand down to create a load on the left latissimus dorsi, the left oblique abdominal muscles and the left square muscle of the lower back.

Exercise number 3

1. The initial position of the patient (Figure 3). The patient transfers the center of gravity of the body to the right leg and focuses on it. The left leg is offset from the center of the platform in the opposite direction in order to maintain balance. Hands are fixed on the bar in the middle position at chest level.

2. Description of the exercise. Hands exercise pressure on the principle of "pull". In this case, the scapulae are maximally lowered in the lower position, which contributes to the relaxation of the upper fixators of the scapula (trapezius muscle, muscle that raises the scapula), the latissimus dorsi and the rhomboid muscle and coordination of the work of mainly postural muscles.

Exercise number 4

1. The initial position of the patient (Figure 4). The legs are on the front surface of the platform. The feet are parallel to each other, bent at the knees. The knees do not extend forward from the vertical of the fingertips. The pelvis is in extension. Hands are fixed on the upper end of the bar - in the maximum position.

2. Description of the exercise. During the movement of the platform, the hands hold the upper crossbar so that the load on the legs becomes minimal, which creates maximum relaxation of the lumbar spine during the exercise.

Exercise number 5

1. The initial position of the patient (Figure 5). The initial position is similar to exercise No. 1 - the body is centered, the feet are parallel to the surface, the pelvis is extensible, however, the hands are located on the lower bar of the bar. Type of abdominal breathing.

2. Description of the exercise. During inspiration, the hands exert pressure down (towards the floor), accompanied by tension of the pectoralis major muscles. During exhalation, the hands relax. This exercise also exerts tension on the pelvic floor muscles and gluteus muscles during inspiration and relaxation during exhalation.

Exercise number 6

1. The initial position of the patient (Fig.6). The right leg is located in front of the platform, the left is maximally removed; the right hand holds the lower left handrail of the bar, the left - the upper right.

2. Description of the exercise. Exercise is performed in two ways. In the first and second variant, the initial position of the patient is the same. At the time of the effort, the patient takes a breath, while relaxing - exhale.

In the first embodiment, the pressure with the hands is carried out concentrically clockwise - towards the tilt of the body. At the time of the effort, the patient takes a breath, while relaxing - exhale.

In the second embodiment, pressure with the hands is made concentrically counterclockwise.

Exercise number 7

1. The initial position of the patient (Fig.7). The patient is in the center of the platform. The feet are parallel, the legs are straight and located in the middle of the platform. Hands are fixed in neutral position at the level of the middle bar of the bar. During the exercise, breathing is free.

2. Description of the exercise. During the exercise, the hands move in a “pull” type. The legs are straightened, located in the center of the platform - emphasis on the heels. Feet stretch as much as possible to themselves. The body is tilted as far back as possible.

The course of treatment consists of 8-10 sessions. The course duration depends on the time of stabilization of all parameters and the termination of positive dynamics. Clinical observations showed that a distinct positive dynamics is observed in patients after the first sessions, however, in the future it becomes less pronounced and stops after 8-10 sessions.

Examples of clinical use.

Patient V., 42 years old, a housewife (outpatient card 032), was on an outpatient treatment with a diagnosis of osteochondrosis L3-L4-L5, intradiscal dystrophy, chronic recurring non-progressive course, exacerbation, stationary phase, lumbar ischialgia syndrome on the right, stage III, grade 3 clinical manifestations.

Objectively: a normostenic, moderate nutrition, moderate muscle development, heart sounds are clear, rhythmic, the stomach is soft, painless. Gait gentle. Hyperlordosis in the lumbar spine with an apex L4-L5 - 1 tbsp. enlargement and soreness of the interspinous gap L4-L5, movements in the spinal-motor segment L3-L4-L5 are limited in all directions: extension - 2 tbsp., flexion - 2 tbsp., lateroflexion - 2 tbsp. to the right and left, the gluteal muscles are tense and painful, the square muscle on the right, the tensor of the broad fascia of the thigh. Stabilography revealed a deviation of the center of gravity dorsolaterally to the left.

Treatment: before each session, palpation muscle testing was performed to identify trigger points. Medical-medical blockades by the simultaneous administration of 1 ml of reopoliglukin and 1 ml of a 2% lidocaine solution were performed in the interspinous ligament at the level of L4-L5, L3-L4, in the trigger point of the square muscle on the right and the lumbar-iliac ligament on the right. After 30 minutes, the patient began to perform the complex of developed exercises on the apparatus "HUBER". The entire complex of exercises was performed with a gradual increase in the duration of the session due to an increase in the number of repetitions. Conducted 10 sessions.

Evaluation of the results of the treatment: significant improvement, incomplete remission of type A, 1 level of rehabilitation. Stabilography after 5 and 10 sessions revealed a consistent improvement in the support ability of the legs and the normalization of the center of gravity by the end of treatment.

In the follow-up, after 6 months he notes good health, which can be assessed as complete remission.

Patient S., 38 years old, profession - accountant, was on outpatient treatment with a diagnosis of osteochondrosis L4-L5. Spondylolisthesis, uncovertebral arthrosis, chronically recurring, non-progressive course, exacerbation, stationary phase, pupartic ligament syndrome on the right, stage II syndrome, 3rd severity of clinical manifestations. Related: autonomic dystonia syndrome of hypertonic type.

Gait gentle, scoliosis C-shaped, apex at the level of Th6-7 to the left, shortening of the left limb by 0.7 cm, shortening of the upper oblique muscle of the head to the right. Pain in the projection of the pupartic ligament on the right, pain in the projection L4-L5 on both sides is noted. Abdominal muscles, short scalp flexors, regional postural muscle imbalance - upper crossed syndrome are relaxed. Stabilography revealed a sharp deviation of the center of gravity ventro-laterally to the left.

Treatment: before each session, palpation muscle testing was performed to identify trigger points. Medical-medical blockades by the simultaneous administration of 1 ml of reopoliglukin and 1 ml of a 2% lidocaine solution were performed paravertebrally at the level of L4-L5, at the trigger point of the pupartic ligament on the right and in the lumbar iliac ligament on the left. After 30 minutes, the patient began to perform the complex of developed exercises on the apparatus "HUBER". The entire complex of exercises was performed with a gradual increase in the duration of the session due to an increase in the number of repetitions. Conducted 10 sessions.

During the course of treatment, pain in the inguinal region completely stopped, there is some restriction of mobility in the lumbar in the direction of extension, a slight restriction of rotation of the neck to the right, lateroflexion to the left.

Stabilography after five and ten sessions revealed a consistent improvement in leg support ability and normalization of the center of gravity by the end of treatment.

Evaluation of the result: significant improvement, incomplete remission of type A, 1 level of rehabilitation.

In the follow-up history after 8 months - persistent remission, occasionally during physical exertion there is discomfort in the lumbar region. Periodically engaged in charging.

Patient M. 54 years old, a teacher (outpatient card No. 074), was on an outpatient treatment with a diagnosis of osteochondrosis L4-L5, internal disk dystrophy, uncovertral arthrosis, chronically recurring, non-progressive course, exacerbation, stationary phase, lumbalgia syndrome, stage II, 3rd degree of clinical manifestations. Concomitant diseases: polycystic breast cancer on the right, chronic gastritis.

Gait sparing, scoliosis S-shaped, apex at the level of Th6-7 to the right, shortening the right limb by 0.6 cm, shortening the upper oblique muscle of the head to the right. Soreness in the projection L4-L5, soreness of the divided muscle on the left and iliac-costal on the right is noted. Abdominal muscles, ischiocrural muscles, and short flexors of the head are relaxed. Stabilography revealed a deviation of the center of gravity dorso-laterally to the right.

Treatment: before each session, palpation muscle testing was performed to identify trigger points. Medical-medical blockades by the simultaneous administration of 1 ml of reopoliglukin and 1 ml of a 2% lidocaine solution were carried out in the interspinous ligament at the level of L4-L5, in the trigger point of the multisection muscle on the left and on the lumbar-iliac ligament on the right. After 30 minutes, the patient began to perform the complex of developed exercises on the apparatus "HUBER". The entire complex of exercises was performed with a gradual increase in the duration of the session due to an increase in the number of repetitions. Conducted 10 sessions.

During the course of treatment, pain in the lumbar spine completely stopped, there is a certain restriction of rotation of the lower back to the right, lateroflexion to the left and right. Stabilography - after five and ten sessions revealed a consistent improvement in the support ability of the legs and the normalization of the center of gravity by the end of treatment.

Evaluation of the result: significant improvement, incomplete remission of type A, 1 level of rehabilitation.

In the follow-up history after 12 months - persistent remission, occasionally during physical exertion there is discomfort in the lumbar region.

Claims (1)

A method of treating myofascial pain syndromes of lumbar osteochondrosis by active kinesitherapy on the HUBER hardware complex, characterized in that they stop the pain syndrome by simultaneously injecting 1 ml of reopoliglukin and 1 ml of a 2% solution of lidocaine into the trigger points 30 minutes before the start of the exercise complex; carry out a set of exercises consisting of seven static-dynamic exercises in the initial positions shown in Fig. 1-7, aimed at: strengthening and activation of the muscles of the upper shoulder girdle, pectoralis major muscle, pelvic floor muscles and gluteal muscles; creating a load and improving coordination of the work of the left latissimus dorsi, left oblique abdominal muscles, left square muscle of the lower back; relaxation of the upper fixators of the scapula, latissimus dorsi and rhomboid muscle, coordination of postural muscles; muscle relaxation of the lumbar spine, strengthening muscle tone of the upper limbs and back; conducting exercises to activate the muscles of the upper shoulder girdle, pectoral muscle, pelvic floor muscles, gluteal muscles; then they carry out exercises to strengthen the muscles of the lower back, to improve coordination of the position of the body in space, to relax the back of the muscles of the thigh and lower leg, to strengthen the muscles of the abdominal wall.

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