RU2458666C1 - Method of treating patients with chronic fatigue syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, neurology and restorative medicine, and may be used in treating patients with chronic fatigue syndrome. Hip (HJ), sacroiliac (SIJ) and shoulder joints, shoulder blades, a backbone, extremity muscles, a back, a thorax and a neck are sequentially exposed. In the beginning, the patient is laying on back to carry out external rotation of the HJ to relax an articular bag; it is followed by circular rotation of the extremity and SIJ traction, L5 to Th4 vertebral rotation; external rotation and traction of the shoulder joint, external rotation and traction of the shoulder blades. Then the same manoeuvres are carried out on other side of the body. When involving the left side of the body, right-side vertebral rotation is performed, while the right-side exposure requires left-side rotation. After 6-9 rotations in each of the manoeuvres specified above, the rotation amplitude is increased. Then the patient is exposed while laying on one side: traction of the patient's paravertebral back muscles C7 to 1.5 combined with lifting and lowering the patient's head to complete muscular relaxation, then external rotation of the shovel to complete romb-like muscular relaxation, at first from one side, then on the other side, then traction of the neck muscles using conventional muscular-power techniques; traction of the suboccipital muscles increasing the traction amplitude every time, C0-C1 vertebral traction within an external occipital aperture. The therapeutic course is 4-6 sessions, 1 session a week.

EFFECT: method provides correction of the emotional condition in the form of improving a degree of reduction of trapezoid muscle tone, enhancing the psychological status, such as manifestations of anxiety, depression, pain syndrome relief, and reducing length of treatment.

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Description

The invention relates to medicine, namely to neurology and rehabilitation medicine, and can be used in the treatment of patients with chronic fatigue syndrome.

Over the past decade, chronic fatigue syndrome (CFS) has become increasingly relevant. The disease, described in detail by the English doctor A. Lloyd in 1984, currently covers at least 5% of the adult population of developed countries and has a tendency to increase the number of cases. In Russia, the first article describing CFS in people with occupational pathology working in environmentally adverse conditions appeared in 1991.

The main characteristic of CFS is chronic fatigue, which is permanent. The main difference between chronic fatigue and “typical” is the absence of a tendency to the complete disappearance of its symptoms after a long rest. Often, after a long rest, a patient with CFS suffers the impression of complete recovery, but within the next 3 days after returning to the main labor activity, the symptoms of the disease return.

The danger of CFS is connected, first of all, with a significant decrease in the working capacity of a sick person - both mental and physical. There is a quick exhaustion of the patient after physical and especially intellectual work. This symptom is the main difference from the so-called "typical" fatigue, which is temporary in nature and eliminated by short-term rest.

The large symptom complex includes a feeling of prolonged fatigue for an unknown reason that does not pass after rest, and a decrease in more than half the motor regimen. Minor symptoms include muscle discomfort, fever, sore lymph nodes, arthralgia, decreased memory, and depression.

Other symptoms of chronic fatigue syndrome include chest and back pain, headaches, pain in the lymph nodes, confusion in thinking, dizziness, anxiety, and other unspecified symptoms of unknown origin.

The causes of chronic fatigue syndrome are unknown. The pathogenesis of CFS is unknown. Some authors attach importance to various viruses, nonspecific activation of immune responses and mental factors. At the same time, the majority indicates that the disease is associated with environmentally unfavorable conditions and that it is a “middle class disease”, thus giving social factors an important role (however, without detailing the latter).

Among objective indicators, they primarily describe changes in the immune status: a decrease in IgG due, first of all, to the G1 and G3 classes, a decrease in the number of lymphocytes with the CD3 and CD4 phenotype, a decrease in natural killer cells, an increase in the level of circulating complexes and antiviral antibodies of various types, and an increase in beta endorphin, interleukin-1 (beta) and interferon, as well as tumor necrosis factor - all this, together with a 5-8-fold increase in the frequency of allergic diseases in such patients, indicates nonspecific activation and system imbalance immunity, the causes of which are not clear. Special studies of muscle tissue biochemistry and energy metabolism showed no changes.

In the treatment of CFS, no particular success has been obtained to date. The only proposed pathogenetic method of treatment - intravenous administration of IgG preparations is now abandoned due to the large number of complications (phlebitis in 55% of cases).

Known methods and treatment schemes for CFS, consisting in the use of various pharmacological drugs (tranquilizers, antidepressants, antipsychotics, etc.), which leads to an increase in the number of side effects and are effective only for a short period of time (coping), and psychotherapeutic methods that are quite common do not give the desired results due to the reluctance to build verbal communication with a psychotherapist (Ballint groups) [1, 2, 3].

There is a comprehensive method for the treatment of CFS, including a gentle or gentle-training regimen of motor activity, diet No. 5, ingestion of low-mineralized, low-carbonate sulfate-bicarbonate calcium-sodium mineral water and conducting low-carbonate sulfate-bicarbonate calcium-sodium mineral baths. Additionally, electrophoresis of 2% succinic acid solution to the trigeminal innervation region in the form of a half mask is carried out for 15-20 minutes. Alternate on the days of treatment the left and right half of the face. The treatment course is 12 procedures [4].

The disadvantages of this method include existing contraindications to the use of electrophoresis, such as current intolerance, drug allergy, and skin sensitivity disorder [5].

There is also a comprehensive approach to the treatment of CFS [6], which, in addition to unloading and dietary therapy (RDT), drug therapy, including tranquilizers, also general body massage 1 time per day or segmental massage of the collar zone and, without fail, paravertebral massage with elements of manual therapy, which eliminates chronic subluxations, normalizes inverse afferent nervous information about the state of internal organs and systems, has a relaxing and simultaneously activating effect. The therapeutic effect of this treatment complex, according to the authors of the method, was persistent and long-lasting: in 20% of patients up to a year or more, in 50% for 8 months, in 30% for up to 5 months the symptoms of chronic fatigue did not resume. In the future, a prophylactic course of treatment 3 times a year was recommended to such patients as a day hospital.

According to the authors of the proposed method, the main disadvantage of the above treatment method is the need for the patient to be in the hospital for the treatment period. In our opinion, the method also includes mutually exclusive methods, that is, RDT and drug therapy, since RDT involves cleansing the body of toxins, and taking tranquilizers contributes to the occurrence of side effects associated with the use of drugs. The massage technique used in this method is primarily aimed at the muscles, thereby achieving a relaxing effect, which, as a rule, is short-lived. Used paravertebral massage with elements of manual therapy eliminates only chronic subluxations without affecting the neuro-sympathetic ganglia.

As a prototype, we have chosen a method of treating CFS, which consists in a group psychotherapeutic technique according to Balint. The group consisted of 8-10 people working in medical institutions. Work in the group can be carried out for 2-3 years (classes are held several times a month) or short-term (classes are held daily or with an interval of several days). The subject of analysis in the group is the discussion of cases from the practice of its members: “difficult” episodes from the past that continue to bother the doctor; current cases and possible therapeutic situations. Each lesson is dedicated to a specific case, which is reported by a group member. The group and the speaker try to determine the essence of the doctor-patient relationship through comments and free associations of ideas about the case under discussion. Work in such a group is aimed at increasing competence in professional interpersonal communication, awareness of personal “blind spots”, psychoprophylaxis of group members based on the possibility of working out “unsuccessful” cases in a situation of collegial support.

Classes in Balint groups help to understand the uncertainties and ambiguities of medical and advisory practice, while reducing professional stress and increasing job satisfaction, and allow you to understand your style of relationship with patients. When working with psychologists in Balint groups on the problem of “burnout”, the effectiveness of using groups reaches 30% of the initial state [7]. When examining psychiatrists, it was found that the effectiveness of classes in Balint groups reduces the manifestation of LDS from 30% to 24% [1]. According to Felton J.S. work in Balint groups for at least two years reduces the manifestations of “burnout syndrome” by 8-12% of the original [2, 3]. Thus, the methodology of the Balin groups does not adequately meet the task of a complete and dynamic relief of the professional maladaptation syndrome.

The disadvantages of the prototype, in our opinion, include an insufficiently effective correction of the patient’s emotional state, manifested in an insufficiently high degree of decrease in the tone of the trapezius muscles, in insufficient improvement of indicators of psychological status, such as manifestations of anxiety, depression, as well as the presence of patients' complaints about persistent pain syndromes. In addition, the implementation of the prototype method is long, since it takes 2-3 years.

The technical result of the invention is to increase the effectiveness of the treatment of patients with chronic fatigue syndrome by improving the correction of the patient’s emotional state, which manifests itself in an increase in the degree of decrease in the tone of the trapezius muscles, improvement of psychological status indicators, such as manifestations of anxiety, depression, as well as the removal of pain syndromes and reduction of treatment time .

The technical result is achieved by sequentially affecting the hip, sacroiliac and shoulder joints, shoulder blades and spine, as well as muscle groups of the lower and upper extremities, back, chest and neck. First, in the patient’s supine position, the external rotation of the hip joint is performed until the joint bag relaxes, then the limb is rotated in a circular manner with traction of the sacroiliac joint, the vertebrae are rotated from L5 to Th4; external rotation and traction of the shoulder joint, then external rotation and traction of the shoulder blade. After that, all similar techniques are performed on the opposite side of the body, and when exposed to the left half of the body, right-side rotation of the vertebrae is performed, and when exposed to the right half of the body, left-side rotation. After performing 6-9 rotations in each of these methods, the amplitude of rotation is increased. Then, impacts are carried out in the patient's position, lying on their side, and first they act by traction on the paravertebral muscles of the patient's back from the level C7 to L5 with the simultaneous raising and lowering of the patient's head until the muscles are completely relaxed. Then they act on the scapula with external rotation until the rhomboid muscles are completely relaxed. The described techniques are performed first from one side, then from the other side. Then they act on the neck muscles by traction, using standard techniques of muscle-energy techniques. Carry out traction on the suboccipital muscles, each time increasing the amplitude of the traction on the vertebrae C0-C1 in the region of the external occipital foramen. The course of treatment is 4-6 sessions per 1 session weekly.

The method is as follows.

Back manipulation technique

Before performing the impact on the hip joint, the individual rhythm of the patient is evaluated.

1. Assessment of the individual rhythm of the patient

The patient lies on his back on a high couch. The height of the couch is determined by the distance from the floor to the fingertips of the lowered hand of the operator. The doctor is facing the patient and to the side of the couch. The doctor puts his hands on the patient’s right lower leg and smoothly without pressure turns the patient’s lower leg inward, then removes his hands and estimates the speed of returning the limb to its original position. The technique is repeated several times in order to determine the speed at which the limb returns to its original position. This determines the speed of the individual rhythm [8] of the patient.

2. Conducting external rotation of the hip joint

The patient lies on his back on the couch. The doctor is facing the patient on the side of the couch at her leg end. The patient's leg is bent at the knee and hip joints at an angle of 90 °. The doctor with the palm surface of one of his hands supports the lower leg of the patient from below in the calf muscle (the arm should be parallel to the lower leg), with the other hand grasp the patella region. The operator begins to rotate the patient's thigh in the frontal (horizontal) plane, first against, and then clockwise until the joint bag relaxes. The pace of rotation is determined by the rate of return of the lower leg to its original position after rotation (see paragraph 1). After performing 6-9 rotations, the amplitude of rotation is increased.

3. Circular rotation of the limb with traction of the sacroiliac joint

The patient lies on his back on the couch. The doctor sits on the couch on the side of the patient. With one hand, the doctor grasps the patient’s thigh with the maximum bent knee joint in the area of his axillary cavity, the doctor’s hand wraps the palm with his palm up under the patient’s back and puts his fingers into the groove of the sacroiliac joint. At the same time as the limb rotates outward, the doctor carries out pulling movements of the bent fingertips in the groove of the sacroiliac joint towards himself. After performing 6-9 rotations, the amplitude of rotation is increased.

4. Vertebra rotation from L5 to Th4

The patient lies on his back on the couch. The doctor sits on the couch on the side of the patient. With one hand, the doctor grasps the patient’s thigh with the maximum bent knee joint in the area of his axilla; the doctor’s hand wraps the palm upwards under the patient’s back at the L5 level of the vertebra by the spinous processes and, bending the fingertips, captures the spinous processes of the vertebrae. At the same time as the limb rotates outward, the doctor carries out pulling movements of the bent fingertips toward himself, rising along the spine to the Th4 vertebra. After performing 6-9 rotations, the amplitude of rotation is increased.

Pulling the spinous processes with bent fingertips - the doctor performs the appropriate rotation.

When performing left-side rotation of the vertebrae, the doctor sits to the right of the patient facing the patient at the level of the patient's knee joints. With his right hand, the doctor grasps the patient's right thigh with the maximum bent knee joint in the area of his right axillary cavity, the doctor wraps the palm of the left hand upwards under the patient’s back at the L5 level of the vertebra, going with the fingertips behind the spinous processes and bending the fingertips, captures the spinous processes of the vertebrae. At the same time as the limb rotates outward, the doctor carries out pulling movements with the bent fingertips of the left hand toward himself, which allows for left-sided rotation of the vertebrae. Gradually rises along the spine to the Th4 vertebra. After performing 6-9 articulations, the amplitude of rotation is increased.

When performing right-side rotation of the vertebrae, the doctor sits to the patient’s left side of the patient at the level of the patient’s knee joints. With his left hand, the doctor grabs the patient’s left thigh with the maximum bent knee joint in the area of his left axillary cavity, the doctor wraps the palm of the right hand upwards under the patient’s back at the L5 level of the vertebra, using the fingertips behind the spinous processes and bending the fingertips, captures the spinous processes of the vertebrae. At the same time as the limb rotates outward, the doctor carries out pulling movements with the bent fingertips of the right hand towards himself, which allows for right-sided rotation of the vertebrae.

Gradually rises along the spine to the Th4 vertebra. After performing 6-9 rotations, the amplitude of rotation is increased.

5. External rotation and traction of the shoulder joint

The patient lies on his back on the couch. The doctor, located to the right of the patient, takes the patient’s right hand by the wrist joint with his left hand and fixes it on his left half of the chest under the collarbone, puts his other hand on the patient’s right shoulder so that his fingers grab the entire shoulder joint from above. In this case, the operator’s feet are parallel to the couch, the operator’s back is straight. After that, the operator begins to rotate the patient’s shoulder in the joint counterclockwise, pulling the joint up and using the transfer of the weight of his body from one leg to another. Then, intercepting the patient’s hand, the doctor brings the patient’s right hand to his left axillary cavity, supporting the patient’s right hand with his left hand above the elbow joint. The doctor’s right hand covers the patient’s right shoulder joint from above. After performing 6-9 rotations, the amplitude of rotation is increased.

6. External rotation and traction of the scapula

The patient lies on his back on the couch. The doctor is standing to the right of the patient facing him and his feet are perpendicular to the couch. The doctor puts the fingers of his left hand under the patient’s back, palm up so as to grasp the patient’s right shoulder blade. The patient’s right hand is located in the doctor’s left armpit. The fingers of the doctor’s right hand are held under the back of the patient below his left hand and palpate the corners of the ribs. Pulling the scapula to itself with the tips of bent fingers and at the same time palpating the corners of the ribs, starting from about the level of Th4 and going down, the doctor crouches in a circular motion in the shoulder-scapular joint. After performing 6-9 rotations, the amplitude of rotation is increased.

Side Manipulation Technique

1. The impact on the paravertebral muscles of the back from C7 to Th4 level of the vertebrae by traction while raising and lowering the patient’s head until the muscles are completely relaxed

Perform a sliding pressure on the fibers of the paravertebral muscles, starting from the lower cervical spine and descending down the spinal column while raising and lowering the patient's head until the muscles are completely relaxed.

The patient is on the couch in the position on the right side facing the doctor, the legs are bent at the knee joints. The doctor is facing the patient and his feet are perpendicular to the couch. The doctor passes the right hand under the patient’s left hand, grabbing the paravertebral muscles at the C7 level above the lateral processes of the spinous processes with the fingertips, and puts the left hand on the front surface of the patient’s left shoulder. Then maximally shifts the paravertebral muscles up to their complete relaxation. Reception is repeated by successively shifting the pads of the fingers down. It is advisable to perform muscle traction due to straightening the back, and not the strength of the fingers.

2. Impact on the scapula by external rotation until complete relaxation of the rhomboid muscles

The patient is on the couch in the position on the right side facing the doctor, the legs are bent at the knee joints. The doctor is facing the patient and his feet are perpendicular to the couch. The doctor passes his right hand under the patient’s left hand, which is located behind the patient’s back, and puts his fingertips under the medial edge of the scapula, and grabs the patient’s left shoulder joint with his left hand. Leaning forward, the doctor with his sternum slightly presses on the shoulder joint of the patient, thereby contributing to even more penetration of the fingers under the scapula. After that, circular movements are carried out counterclockwise in the sagittal plane until the rhomboid muscles are completely relaxed, thus effecting external rotation on the left shoulder blade. When acting on the right shoulder blade, the direction of circular movements is changed, that is, they are produced clockwise.

The described techniques are performed first from one side and then from the other side.

Technique of manipulations on the neck, corresponding to the standard performance of muscle-energy techniques

1. The impact of traction on the muscles of the neck

The patient lies on his back on a high couch. The doctor sits at the head end of the table and takes the patient’s head in his hands under the auricles, without covering them. The patient turns his head to the left with medium pressure, and the doctor tries to hold the patient's head in its original position, making it difficult to make a turn, while counting up to three. After which the patient completely relaxes, and the doctor turns his head in the opposite direction until a barrier is felt. And so three times in each direction, each time gently increasing the amplitude of the movements. At the maximum rotation point, the patient’s head is held for 1-2 seconds.

2. The impact of traction on the suboccipital muscles

The patient lies on his back on a high couch. The doctor stands at the head end of the table and places the crossed forearms of his hands behind the patient’s head, putting his palms on the patient’s shoulders, and then gently bends the patient’s head with the crossed forearms. Asks the patient to press the back of the head on the forearm of the doctor with medium strength for three seconds, and then relax. At the time of relaxation, the doctor each time gently increases the amplitude of bending the head forward. And so three times, and then returns the patient's head to its original position.

3. The impact of traction on the vertebrae C0-C1 in the area of the external occipital foramen

The patient lies on his back on a high couch and looks at the ceiling. The doctor sits at the head end of the table and places his hands so that the fingers (2-4) fix the suboccipital muscles in the area of the external occipital foramen. Relying on the outside of the lower third of the forearms, the doctor traces (pulls) the patient’s head with his fingertips on his exhale, in time with the patient’s breathing, and on the patient’s breath holds the resulting tension for 3-5 seconds.

Distinctive essential features of the proposed method and a causal relationship between the essential distinctive features and the achieved result

- Sequential effects on the hip and shoulder joints, shoulder blades and spine, as well as the muscles of the lower and upper extremities, back, chest and neck.

The invention is based on:

- the assumption put forward by E. Jacobson in 1929 that the body responds to stress through muscle tension, the development of which exacerbates anxiety and stress, closing the vicious circle. The author hypothesized that muscle relaxation, reducing stress, contributes to a significant reduction in anxiety;

- developed in 1864 by E.T. Still, the doctrine according to which the human body is a single integral mechanism, one of the characteristic features of which is the balanced tension of the muscular-fascial and articular mechanism, which is consistent with the theory of biotensing later advanced by J. Levin.

Based on these theoretical assumptions, we have proposed a consistent effect on the hip, sacroiliac and shoulder joints, shoulder blades and spine, as well as muscle groups of the lower and upper extremities, back, chest and neck, responsible for maintaining the axis of gravity of the human body.

- Initially affect the hip joint, performing external rotation of the joint until the joint bag relaxes.

This technique allows you to act on the muscle-fascial cases of the thigh, lower leg and knee joint. The initial effect on the hip joint by external rotation technique is explained by the fact that the vector of the axis of gravity of the human body is directly related to the vectors going through the hip joints to hold the body in an upright position.

Carrying out external rotation of the hip joint, maximum joint opening is achieved, which leads to relaxation of the joint bag, and in addition, mobility of the joint and surrounding soft tissues is restored, which contributes to the drainage of soft tissues, thereby reducing stress and inflammation (if any).

- Immediately after exposure to the hip joint, rotate the limb with traction of the sacroiliac joint.

By acting on the sacroiliac joint with traction and performing circular rotations of the limb, we improve the mobility of the sacroiliac joint, thereby affecting the structures located in the pelvic cavity. The pelvic celiac nerves of the parasympathetic nervous system exit the sacral opening, they correspond to the 2-4th sacral segments of the spinal cord. The sacroiliac joints are located at approximately the same level (S1-S3), therefore, any mechanical dysfunction can affect the corresponding segment of the spinal cord and, through facilitation, lead to disruption of nerve reflexes from this level. In addition, at the level of these joints there is an attachment of the sacroiliac ligaments, as well as on the inner surface of the piriformis muscles, which play an important role in transmitting movement from the legs to the trunk and in maintaining vertical balance.

- Immediately after exposure to the sacroiliac joint, the vertebrae are rotated from L5 to Th4.

This technique allows you to act on the muscle-fascial cases of the lumbar spine, thoracolumbar junction and hip joint. Given the attachment to the spine of the lumbar muscle, which is attached to the small trochanter of the femur with the second end, this technique allows you to synchronize the work of the hip joint and spine, which optimizes both vertical balance and the entire muscle stereotype.

Rotation of the vertebrae through the feedback mechanism has a positive effect on proprioception, improving the biomechanical balance of the whole body. In addition, normal motor activity in the vertebral motor segment is restored, which improves segmental mobility of the spine at a segmental level. The rotation of the thoracic spine, starting from Th9 and above, improves the mobility of not only the thoracic vertebrae, but the ribs, the heads of which are articulated at the back at the place of their articulation with the transverse processes and vertebral bodies. The sympathetic nodes of the paravertebral ganglion chain are located directly under the heads of the ribs; therefore, articulation of the heads of the ribs positively affects the sympathetic ganglia. Rotation of the upper spine, starting from Th9, improves the mobility of not only the thoracic vertebrae, but also the heads of the ribs, which are articulated posteriorly at the point of their articulation with the vertebral bodies. In this area there are sympathetic nodes of the paravertebral ganglion chain, which contributes to the effect on the sympathetic ganglia. The presence of restrictions between the vertebrae at this level can affect the innervation of many somatic and visceral structures, including paravertebral muscles.

- After rotation of the spine, external rotation and traction of the shoulder joint are performed.

This technique allows you to act on the muscle-fascial cases of the upper limb. By acting by external rotation and traction on the shoulder joint, we improve its mobility, thereby affecting the structures located nearby: the thoracic lymphatic duct, clavicle, brachial plexus, including the nerve, artery and vein and joints: acromioclavicular and shoulder-scapular. In addition to relaxing the joint bag and restoring the mobility of the joint itself, lymphatic and venous drainage in the chest improves.

- After external rotation and traction of the shoulder joint, external rotation and traction of the shoulder blade located on the same side of the patient’s body are performed.

This technique allows you to influence the muscular-fascial cases of the back (the area of the scapula and the paravertebral region of the spine). External rotation and traction of the scapula allows you to increase the amplitude of the chest excursion, which reduces congestion and improves venous and lymphatic drainage.

- Then they carry out all the same tricks on the opposite side of the body.

The impact on the second hip and sacroiliac joints, spinous processes, shoulder joint and shoulder blade on the opposite side of the patient's body is necessary to ensure balance with respect to the central axis of gravity of the body.

- When exposed to the left half of the body, right-side rotation of the vertebrae is performed, and when exposed to the right half of the body, left-side rotation is performed.

Since the rotation of the vertebrae is carried out by pulling them by the spinous processes, when exposed to the right half of the body, left-side rotation is performed, and on the left - right-hand.

- After performing 6-9 rotations in each of the above techniques, the amplitude of rotation is increased.

An increase in amplitude is necessary to obtain better freedom of movement. They start with a small amplitude so as not to miss any movement restrictions, and gradually increase to the full physiological amplitude possible for this type of movement. Usually 6-9 rotations, after which the amplitude of rotation is increased, is enough to achieve the full amplitude of the movement.

- After external rotation and traction, the shoulder blades perform impacts in the patient lying on their sides, first they act by traction on the paravertebral muscles of the patient’s back from level C7 to L5 while raising and lowering the patient’s head until the muscles are completely relaxed.

This technique allows you to act on the muscular-fascial cases of the upper thoracic spine and neck.

Considering that the pavertebral muscles attach on one side to the transverse processes of the vertebrae (almost the entire length of the spine), and on the other to the ribs, we act both on improving mobility in the vertebral costal joints and joints with transverse processes, i.e. . in the transverse costal joints, which contributes to a positive effect on the sympathetic nodes of the paravertebral ganglion chain.

The simultaneous raising and lowering of the patient’s head allows maximum stretching and subsequent relaxation of the paravertebral muscles.

- After exposure to the paravertebral muscles of the back, the scapula is affected by external rotation until the rhomboid muscles are completely relaxed.

This movement allows you to relax the rhomboid muscles as quickly as possible, and also positively affects the remaining muscles that attach to the scapula. Synergistic relaxation of the rhomboid muscles will additionally have a positive effect on the condition of the trapezius muscles and the muscles that straighten the spine.

- In the position of the patient lying on his side, the described techniques are performed first from one side, then from the other side.

The implementation of the described techniques, first with one, then with the other hand, is necessary to ensure balance with respect to the central axis of gravity of the body.

- Affect the muscles of the neck by traction, using standard techniques for conducting muscle-energy techniques. Traction on the suboccipital muscles is carried out, each time increasing the amplitude of movements, traction on the vertebrae C0-C1 in the region of the external occipital foramen.

This technique allows you to act on the muscle-fascial neck cases. The effect is aimed at restoring the mobility of the cervical spine and thereby reducing the flow of distorted proprioreceptive information coming through the nerve pathways from excessively strained muscles, given the output of the vagus nerve through the jugular opening adjacent to this area, and, in addition, can positively influence (balance) on the state of the sympathetic and parasympathetic nervous system and all structures innervated by the vagus nerve.

In addition, the balancing of the sympathetic and parasympathetic systems is achieved, taking into account the fact that the vagus nerve has an outlet in the suboccipital region.

- The impact on the hip and sacroiliac joints, vertebrae, shoulder joints is carried out in the position of the patient lying on his back, and the impact on the muscle groups of the back is carried out lying on his side. Impact on the scapula is carried out both in the patient’s supine position and in the supine position.

The patient is in these positions of the body ensures the achievement of maximum efficiency of the method.

- The course of treatment is 4-6 sessions per 1 session weekly.

The indicated course of treatment is sufficient to achieve a positive effect. The interval of one week between sessions was chosen as corresponding to the circoseptic rhythm of repair processes in the body and mitotic activity, as well as in accordance with the circoseptic rhythm of the adrenal glands, which play one of the leading roles in the body's response to stress, which is especially important in patients with CFS.

The combination of distinctive essential features in comparison with the method we have chosen as a prototype increases the effectiveness of treatment by improving the correction of the patient’s emotional state, which manifests itself in an increase in the degree of decrease in the tone of the trapezius muscles, improvement of psychological status indicators, such as manifestations of anxiety, depression, and also removal pain syndromes. The inventive method also significantly reduces the treatment time.

Examples of clinical application of the proposed method

Example 1. Outpatient card No. 15/96. Patient M., 38 years old. Anaesthesiologist-resuscitator, work experience - 15 years.

Associated chronic diseases denied. On average, he drinks strong alcohol once a week. Complaints of sleep disturbance, aching pain in the cervical spine for four months, periodic headaches without clear localization, a feeling of "tiredness from life." Repeatedly turned to a neurologist, somatic dysfunction was not detected. Diagnosed with astheno-neurotic syndrome, twice treated with tranquilizers phenosepam, sanapax. She noted improvement in well-being while taking drugs and within a week after treatment, then the condition worsens again. The psychotherapist in the neuropsychiatric clinic (day hospital) categorically refused the proposed treatment. On the proposal to use the author’s technique, she agreed to try it without much enthusiasm.

Before treatment and after treatment, indicators of psychological status were determined. Tests on Spielberg scales - 48 points, Beck - 27 points, Toronto alexithymic scale - 72 points. After the course (6 sessions for 1 session weekly), these indicators were 35, 14 and 55 points, respectively.

Electromyography data characterizing the degree of tension of the trapezius muscle before treatment is 14 μV, after treatment - 1.6 μV.

Dynamics of indicators according to the visual analogue scale (YOUR), filled by the patient himself. In this case, the minimum value of the symptom corresponds to - 0, the maximum - 100. The severity of pain: before treatment - 80, after treatment - 0.

According to the Roland-Morris questionnaire, “Pain in the lower back and disability” notes 9 out of 18 statements as positive, after treatment - 0.

Subjectively notes the absence of back pain and headache for two months after treatment, improved sleep, became much calmer.

After the treatment, she refused to drink alcohol.

Example 2. Ambulatory card No. 15/112. Patient A., 42 years old. Reanimatologist anesthetist, work experience 18 years.

Chronic concomitant disease denied. Smokes one pack of cigarettes a day. Complaints of sleep disturbance for two months (can not fall asleep for a long time, and when he falls asleep, wakes up several times in the middle of the night) and pain in the lumbar region. Repeatedly turned to a neurologist, neurological pathology was not detected. When contacting a therapist, somnol was prescribed. The sleep returned to normal, but only while taking the drug. Before bedtime, I tried to take strong alcohol to drink (an average of 100 ml of cognac), I began to fall asleep better, but still waking up at night. I agreed to the proposal to use the author’s method in the form of an experiment.

Before treatment and after treatment, indicators of psychological status were determined. Tests on Spielberger scales - 46 points, Beck - 24 points, Toronto alexithymic scale - 74 points. After the course (5 sessions for 1 session weekly), these indicators were 34, 16 and 54 points, respectively.

Electromyography data characterizing the degree of tension of the trapezius muscle before treatment is 12.8 μV, after treatment - 0.8 μV.

Dynamics of indicators according to the visual analogue scale (YOUR), filled by the patient himself. In this case, the minimum value of the symptom corresponds to - 0, the maximum - 100. The severity of pain: before treatment - 60, after treatment - 0.

According to the Roland-Morris questionnaire, “Pain in the lower back and disability,” notes 11 out of 18 statements as positive, 0 after treatment.

Subjectively, there is no back pain for six months after treatment, sleep has improved.

Example 3. Outpatient card No. 15/76. Patient R., 54 years old, Doctor surgeon, work experience 28 years.

Of the concomitant somatic diseases, gastric ulcer is noted. Smokes one pack of cigarettes a day. Complaints of increased irritability, poor sleep (often waking up at night), pain in the sacral region, increased anxiety and fatigue. It independently takes phenozepam (0.1 mg per day and phenibut 0.5 mg). Notes improvement in well-being only at the time of taking the drugs. He categorically refused from psychotherapeutic counseling. As an experiment, I agreed to try the author’s technique.

Before treatment and after treatment, indicators of psychological status were determined. Tests on Spielberger scales - 52 points, Beck - 28 points, Toronto alexithymic scale - 82 points. After the course (4 sessions of 1 session weekly), these indicators were 32, 12 and 56 points, respectively.

Electromyography data characterizing the degree of tension of the trapezius muscle before treatment is 13.1 μV, after treatment - 2.1 μV.

Dynamics of indicators according to the visual analogue scale (YOUR), filled by the patient himself. Moreover, the minimum value of the symptom corresponds to - 0, the maximum - 100. The severity of pain: before treatment - 70, after treatment - 0;

According to the Roland-Morris questionnaire, “Pain in the lower back and disability,” notes 11 out of 18 statements as positive, 0 after treatment.

According to the claimed method, 38 patients were examined. In the control group (prototype method - 14 patients).

A comparison of the proposed method and the prototype method showed that the use of both methods is accompanied by a significant decrease in anxiety levels (Spielberger scale), depression (Beck scale) and alexithymia (Toronto alexithymia scale). However, the degree of decrease was more pronounced in patients who applied the inventive method. So, in the main group, the level of anxiety decreased by 44.6%, in the control - 30.0% (P <0.01), the level of depression in the main group decreased by 18.0%, in the control - by 11.2% ( P <0.01), alexithymia - by 21.4% and 13.4% (P <0.01), respectively.

Electromyography data characterizing the degree of tension of the trapezius muscles are presented in Figure 1. White color indicates data by the claimed method, and black - by the prototype method. Tension (μV) of the trapezius muscles (1 - initial data, 2 - mid-course, 3 - end of course).

Against the background of the proposed method, already in the middle of the course, muscle tone compared to the original decreased by 44.0% (P <0.01), and upon its completion - by 90.8% (P <0.001). In the control group, these indicators were 25% (P <0.01) and 67.6% (P 0.01), respectively. The level of decrease in muscle tone in the middle of the course and at the end of it was significantly more pronounced when using the proposed method compared to the control (P <0.01).

The severity of pain according to the visual analogue scale (VAS) according to the claimed method after treatment is 0 in 98% of cases, and by the prototype method - 0 in 48% of cases.

According to the Roland-Morris questionnaire "Pain in the lower back and disability" after treatment - 0 in 100% of cases, and by the prototype method - 0 in 76% of cases.

The duration of treatment according to the prototype method is 2-3 years, according to the claimed - 1-1.5 months.

Thus, the claimed method of treating patients with chronic fatigue syndrome, compared with the method that we have chosen as a prototype, increases the effectiveness of treatment by improving the correction of the patient’s emotional state, which manifests itself in an increase in the degree of decrease in the tone of the trapezius muscles, improvement of indicators of psychological status, such as manifestations anxiety, depression, as well as the removal of pain syndromes. The inventive method also significantly reduces the treatment time.

Literature

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2. Felton J.S. Burnout as a clinikal entity its impotance in health care workers. // Occupational medicine. - 1998 .-- vol. 48. - p. 237-250.

3. Kahill S. Interventions for burnout in the helping professions: A review of the emperical evidence. // Canadian Journal of counseling review. - 1988 .-- v.22 (3), p. 310-342.

4. Patent RU 2305570, C2, 2007 A method for the treatment of patients with chronic fatigue syndrome.

5. Physiotherapy: Nat. leadership. Ed. G.N. Ponomarenko. - M .: GEOTAR - Media, 2009 .-- 864 s, S.95,100.

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Table 1 The results of the application of the proposed method in comparison with the prototype method (M ± m, n = 52) Treatment methods Scales anxiety according to spielberger depression back Toronto scale of alexithymia Initial values After the course Initial values After the course Initial values After the course Proposed Method (n = 38) 46.2 ± 2.7 36.9 ± 1.9 * ^, ** 25.8 ± 4.1 14.3 ± 2.1 * 72.8 ± 1.9 59.7 ± 2.1 * ^, ** Prototype method (n = 14) 47.6 ± 2.3 41.2 ± 2.1 * 26.2 ± 1.4 18.3 ± 1.8 * 73.5 ± 3.1 ** 65.3 ± 1.9 * * - P <0.01 - in comparison with the initial indicators. ** - P <0.01 - compared with the control group.

Claims (1)

A method of treating patients with chronic fatigue syndrome, characterized in that they consistently act on the hip, sacroiliac and shoulder joints, shoulder blades and on the spine, as well as on muscle groups of the lower and upper extremities, back, chest and neck, while first when the patient is lying on his back, the external rotation of the hip joint is performed until the joint bag relaxes, then the limb is rotated in a circular manner with traction of the sacroiliac joint, the vertebrae are rotated from L5 to Th4; external rotation and traction of the shoulder joint, then external rotation and traction of the shoulder blade, after which all similar techniques are performed on the opposite side of the body, and when exposed to the left half of the body, they perform right-side rotation of the vertebrae, and when exposed to the right half of the body, left-side rotation is performed 6-9 rotations in each of these methods, the amplitude of rotation is increased; then they carry out impacts in the patient’s supine position, and first they act by traction on the paravertebral muscles of the patient’s back from level C7 to L5 while raising and lowering the patient’s head to completely relax the muscles, then they act on the scapula by external rotation until the rhomboid muscles are completely relaxed; the described techniques are performed first from one side, then from the other side; then they act on the neck muscles by traction, using standard techniques of muscle-energy techniques; effect traction on the suboccipital muscles, each time increasing the amplitude of movements, traction on the vertebrae C0-C1 in the region of the external occipital foramen; the course of treatment is 4-6 sessions per 1 session weekly.