RU2779455C1 - Method for treatment of diseases of the spine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely reflexology, manual therapy, and can be used in the treatment of spinal diseases caused by injuries, overloads or degenerative-dystrophic processes. To do this, the presence of subluxations in the facet joints of the affected vertebral-motor segments and the direction of displacement of the lower articular processes, as well as the place of increase in the width of the articular gap, are preliminarily detected. At the same time, only the lower articular processes are corrected relative to the upper articular processes below the located vertebra. When performing blows, the pad of the middle finger of the supporting hand is placed on the spinous process of the displaced vertebra, the index or ring finger of the same hand is placed paravertebral. In this case, the nail phalanges of these fingers are directed caudally. After that, a blow is performed with the edge of the palm, clenched into a fist, hitting the nail plate of the middle finger at an angle. At the same time, in the lumbar spine, blows are performed in the cranial, medial and lateral directions not only from the side of their displacement, but also from the opposite side. In the thoracic spine, blows are performed in the caudal and lateral directions from the displacement side and from the opposite side. In the cervical spine, blows are performed only from the side of the displacement of the lower articular processes and only in the medial-ventral direction.

EFFECT: method provides effective treatment in this group of patients with a simultaneous reduction in trauma when exposed, due to the absence of additional compression and traumatic blows to the area of edema, painful dislocated joint and pinched nerve root.

3 cl, 3 dwg

Description

The invention relates to medicine, namely to reflexology, to methods of manual exposure in the treatment of diseases of the spine, as well as pathological conditions and diseases of the musculoskeletal system, nervous system, respiratory, circulatory, pelvic organs, etc., associated with a violation of its functional state .

A known method of manual impact on the spine in diseases of the hip joint (Patent RU 2040925, class IPC: A 61 H 23/00, 1995), which consists in the fact that the impact is carried out from the second lumbar to the second sacral vertebra by striking the hypotener with the collected into the fist of the hand between the transverse and spinous processes of the displaced vertebra, then the proximal interphalangeal joint of the bent third finger of one hand is placed at the base of the spinous process of the vertebra from the side of the displacement, a push blow is applied to the area of the metacarpophalangeal joint of this finger towards the anatomical axis of the spine to the side, opposite to the displacement of the vertebra.

A positive result in the known method is achieved by returning the position of the spinous process of the displaced vertebra to the anatomical axis of the spine. However, orientation to the spinous process is not always justified and is subjective, since the spinous process often has various kinds of deformities, including congenital ones, which does not allow one to accurately establish the correct position of its position relative to the axis of the spine. In addition, striking directly on the bone structures of the spine can lead to their damage.

There is also known a method for the treatment of diseases of the spine (Patent RU 2100996, class IPC: A 61 H 23/00, 1998). The method includes determining the affected side of the spine and palpation determination of the intervertebral space along the paravertebral line, where the nail phalanx of the finger is pressed tightly. Repeated dosed blows are applied to the tip of the phalanx or its middle part with the edge of an open or clenched hand. Procedures are carried out 1-3 times in 3-4 days. If necessary, they are repeated until the residual effects are eliminated.

The disadvantage of this method is its low efficiency, since it is not aimed at eliminating subluxation and restoring the anatomical position of the vertebra, but at relieving pain by relaxing tissues in the intervertebral space of altered vertebral motor segments (VMS) by striking and improving it in this way blood supply. The method cannot be used in the treatment of diseases of the spine associated with a significant displacement of the vertebrae.

A known method for the treatment of degenerative-dystrophic diseases of the spine according to the method of Kasyan N.A. (Patent RU 2100996, IPC class: A 6 H 23/00, 1998). The method consists in the fact that the patient is placed on the couch in the prone position. After determining the affected area by visual inspection and palpation of the spine, manual therapy is started. First, the doctor puts one hand on the area of the affected area, while it is better if the spinous processes of the affected vertebrae are between the second and third fingers at the level of the middle phalanges, which lie on the transverse processes and fit snugly against the spine. Then, with the edge of the palm of the other hand or its proximal edge, the doctor delivers dosed blows to the middle phalanges with a force of 1-60 N repeatedly for 5-10 seconds. After this, the doctor shakes the patient in a vertical position with a force of 60-130 N repeatedly for 5-10 seconds with simultaneous rotation.

This method has a number of disadvantages. The impact on the bone structures of the vertebrae, although indirectly - the blow is applied to the middle phalanges of the fingers, however, its direction and strength cannot be controlled and corrected. As a result of such an impact, damage to the transverse processes of the vertebra is possible. In addition, the method involves repeated shaking of the patient with simultaneous rotation. This procedure is complex, time-consuming, requires a lot of effort from the doctor and, therefore, cannot always be implemented.

The closest analogue is the method according to patent RU 2180826, according to which the presence of subluxations in the facet joints of the affected vertebral motor segments and the direction of displacement of the lower articular processes are preliminarily detected, the pad of the nail phalanx of the third finger of the hand is placed above the spinous process of the affected vertebra, and the pads of the nail phalanges of the second and fourth fingers - on the projection area of the displaced lower articular processes, ensure continuous contact of the fingertips with the processes, strike the nail phalanges, focusing it on the third finger, in the direction opposite to the displacement of the lower articular processes, with simultaneous pushing of the third finger on the spinous process, and the second and the fourth fingers - on the lower articular processes, aimed at restoring the position of the vertebra. When one lower articular process is displaced, the pad of the third finger is placed over the spinous process of the affected vertebra, and the second or fourth, depending on the side of the displacement, respectively, on the projection area of the displaced lower articular process, the spinous process of the adjacent vertebra is additionally fixed.

The disadvantage of the latter method is both the insufficient elaboration of the technique of striking with the striking hand, and, more importantly, not the best choice of the direction of striking. The previously proposed method was reduced to a vertical impact in the direction perpendicular to the patient's body, which effectively shifted the vertebra - the lower articular process of the vertebra in the right direction, but caused the patient unnecessary pain. Another disadvantage of this method is that the impact is carried out both on the spinous process, which is correct, but also on the articular processes, which creates pain for the patient, and contusion of the joint and irritation of the nerve root under the joint. With a pronounced pain syndrome, this leads to a short-term increase in pain along the course of the nerve.

The objective of the invention is to create a less painful method of manual therapeutic effect on the spine in its diseases caused by degenerative-dystrophic processes, which makes it possible to obtain a stable and pronounced therapeutic effect and prevent possible complications.

The technical result of the claimed method consists in reducing trauma and increasing efficiency, due to the exclusion of additional compression and traumatic blows to the area of edema, painful displaced joint and strangulated nerve root, while restoring joint mobility is faster, and compression of the nerve root from the side of displacement during manipulation is excluded. At the same time, the reduction or elimination of radicular syndrome is achieved with a high probability even after the first session. As a result, the maximum number of sessions is also reduced by about half, for example, from 10 to 5 sessions. On average, the course of treatment includes from 2 to 5 procedures once a week.

The specified technical result is implemented through the following methods.

Manual therapy techniques are performed, for this, fingers are placed on the area of the affected vertebra, followed by blows, while preliminarily identifying the presence of subluxations in the facet joints of the affected spinal motion segments and the direction of displacement of the lower articular processes, as well as the place of increasing the width of the joint space (we can conditionally name her - "open" joint space). It should be noted that the correction is performed only on the lower articular processes relative to the upper articular processes below the located vertebra, due to the anatomical features and the most convenient access to the joints, their palpation and diagnosis. After that, the pad of the middle finger of the supporting (for right-handers - left) hand is placed on the spinous process of the displaced vertebra, the index or ring finger of the same hand is placed paravertebral, while the nail phalanges of these three fingers are directed caudally (hereinafter: caudal - caudal, located closer to the tail or to the posterior end of the body; cranial or cervical - the antonym of the caudal - head, located closer to the head or to the front end of the body; medial - median, located closer to the median plane), after which they strike with the edge of the palm clenched into a fist striking (for right-handers - right) of the hand along the nail plate of the middle finger at an angle in the cranial-medial direction in order to push, spread the articular surface of excessively approached adjacent vertebrae within the boundaries of one joint (on one side of the vertebra) and reduce the joint space on the other side of the vertebra. An expanded gap can always be on one side only.

If necessary, each of the blows can be replaced by several blows of the same or lesser intensity.

After the implementation of the first impact indicated above, an additional impact can be carried out for which it is necessary to bypass the patient and stand on the opposite side of the displacement of the lower articular process and the increased width of the joint space. With the pad of the middle or index finger of the supporting (left) hand, rest against the lateral part of the spinous process of the corrected vertebra and strike with the edge of the palm of the striking (right) hand, clenched into a fist, on the nail plate of the installed finger in the medial-lateral direction towards the open joint space, towards to the superior articular process below the underlying vertebra. As a result of such actions, the joint spaces of adjacent vertebrae are aligned and the lower articular process is reduced.

The above methods exclude the use of vertical impacts directly on: displaced lower process; swollen and swollen, inflamed joint under which the pinched nerve root is in direct contact.

It should be specially clarified that pain during joint displacement is experienced by the patient not only with nerve compression, but also with excessive friction in the joint (which can cause inflammation of the joint). That is why it is required to move apart, separate the articular surfaces in the place of their excessive convergence. Similarly, in this case, convergence can occur in the place of the "open" joint space, if the displacement was in the nature of an uneven misalignment between the right and left sides of the vertebra. Both excessive convergence and the occurrence of an open joint space are a departure from the norm and create pain.

Further clarifications of this general method are due to the fact that the shape and appearance of the joints of the spine of different departments are anatomically different. In this regard, the optimal method of influence is chosen.

In the lumbar spine, impacts to reduce the displaced inferior articular processes and correct the joint space are made only in the cranial, medial and lateral directions, depending on the side of the detected displacements (as described in the general case of applying the method above).

In the thoracic spine, blows to reposition the displaced inferior articular processes and correct the joint space are made only in the caudal and lateral direction, also depending on the side of the detected displacements.

When the two lower articular processes in the cervical region are displaced, the Glisson loop is used first, and then the lower articular processes of the displaced vertebrae are reduced in the indicated way.

In the cervical spine, impacts for reduction are preferably made only from the side of the displacement of the lower articular processes and only in the medial-ventral direction.

For additional diagnosis and detection of an increase in the width of the joint space, radiography, MRI, CT are used.

All strikes are made on the spinous process, not on the joint.

The attached images (figures) show:

Figure 1 - layout of the lumbar spine (side view);

Figure 2 - layout of the lumbar spine (top view);

Figure 3 - model of the cervical spine (top view).

The figure 1 shows the image of the lumbar spine. Previously, the blow was applied to the arrow 1 (figure 1). Arrow 2 (figure 1) indicates the nerve root under the joint. At the moment of impact, the strangulated spine experiences an additional negative impact. It takes time for him to calm down. After such a blow, the development of post-traumatic inflammation of the joint, its articular bag and ligaments is possible.

As mentioned above, first, the diagnosis and identification of articular displacement is carried out, including an increase in the width of the joint space. After that, the patient is placed on a hard flat surface (couch, massage table, etc.) in a horizontal position on the stomach. Rollers can be additionally placed under the patient, which slightly pushes the back up, allowing the spine to also appear somewhat stronger under the skin and improve palpation of the joint diagnostics and access to its correction.

The process of manual therapy consists in the fact that the pad of the middle finger of the supporting (for right-handers - left) hand is placed on the spinous process of the displaced vertebra, the index or ring finger of the same hand is placed paravertebral, while the nail phalanges of these three fingers are directed caudally, after which the blow with the edge the palm of the striking (for right-handed people) hand clenched into a fist is applied to the nail plate of the middle finger at an angle in the cranial-medial direction in order to push apart, separate the articular surfaces of excessively approached adjacent vertebrae within the boundaries of the joint.

If necessary, each of the blows can be replaced by several blows of the same or lesser intensity.

After the implementation of the first impact indicated above, an additional impact can be performed on the other side, for which it is necessary to bypass the patient and stand on the opposite side of the displacement of the lower articular process and the increased width of the joint space, with the pad of the middle or index finger of the supporting (left) hand rest against the side part of the spinous process (arrow 1 of figure 2 points to the spinous process) of the corrected vertebra and strike with the edge of the palm of the striking (right) hand, clenched into a fist, on the nail plate of the installed finger in the medial-lateral direction towards the open joint space. As a result of such actions, the joint spaces of the adjacent vertebrae are aligned and the lower articular process is reduced (Figure 2, arrow 2). The circle shows the location of the offset. In the lumbar spine, blows to reposition the displaced inferior articular processes and correct the joint space are made only in the cranial, medial and lateral directions, depending on the side of the detected displacements.

With this method, the correction of the joint and its joint space is performed less traumatically, since there is no additional compression and traumatic impacts in the area of the pinched nerve root, possible swelling and pain of the displaced joint.

In the thoracic spine, blows to reposition the displaced lower articular processes and correct the joint space are made only in the caudal and lateral directions, depending on the side of the detected displacements.

When the two lower articular processes in the cervical region are displaced, the Glisson loop is first used - the patient lies on his back, the Glisson loop is put on his head and a short-term extension is made with effort and a short jerk towards himself, and then the lower articular processes of the displaced vertebrae are reduced in this way.

In the cervical spine, impacts for reduction are preferably made only from the side of the displacement of the lower articular processes and only in the medial-ventral direction.

After the correction, mobility is restored, pain disappears during palpation of the movable motor segment. On ultrasound studies - straightening of the vertebral arteries, improvement of blood velocity parameters and restoration of their symmetry.

In this case, blows are applied only to the spinous process, and not to the joint, while any blow is applied not strictly vertically, but at an angle, or rather, at two angles, so that the blow vector is directed simultaneously sideways (left-right) and up and down. In this case, the direction of the blow along the up-down vector (cranial or vertebral) depends on the spine.

Example 1

Patient M., aged 40, complained of pain in the lumbar region and pulling pain along the back of the left thigh, aggravated by bending over. In the position of the patient lying on his stomach, a diagnosis was made according to "Michael and John Doherty". Soreness of the interspinous ligaments L3-4 and L4-5 was revealed. Deeper palpation revealed tenderness in the region of the L3 lower articular process on the left, as well as its protrusion in the dorsal direction, that is, subluxation. Examination of the articular spaces L4-5 revealed an increase in the width of the lumen of the interarticular space on the left, pain in the projection of the lower articular process on the left, and the presence of subluxation in the dorsal-caudal direction. When pressing on the back of the thigh of the left leg - severe pain. The Lasegue test is positive. X-ray of the lumbar spine showed intervertebral osteochondrosis and an increase in the interarticular gap on the left segments L3-4 and L4-5. Diagnosis of lumbar intervertebral osteochondrosis with severe pain radiating to the left leg. Treatment was carried out by exposure to manual therapy techniques in the amount of five sessions aimed at eliminating existing displacements (subluxations) of the lower articular processes of the affected vertebral motor segments (VMS) in the lumbar spine. In the position of the patient lying on his stomach, we get up from the side of pain (open joint spaces). We put the pad of the middle finger of the left hand on the spinous process of the third vertebra, the index finger of the left hand is paravertebral. The nail phalanges are facing caudally. With the edge of the palm of the right hand clenched into a fist, we strike the nail plate of the middle finger of the left hand in the cranial and medial direction in order to push apart, separate the articular surfaces of the adjacent vertebrae L 3 and L 4. Then we move to the opposite side (to the right of the patient), with a pad of the middle finger of the left hand, we rest against the lateral part of the spinous process and, by applying blows in the medial-lateral direction, we correct the joint space. In order to reduce its width. After the manipulation, with the help of palpation, we make sure that there is no pain. Then we move on to the next call. Manipulation is carried out in a similar way. At the end of the manipulation, the presence or absence of pain, bulging and swelling of the lower articular process is checked by palpation. With repeated pressure on the back of the left thigh, the pain decreased. An increase in range of motion was noted. After the fifth session, the pain was relieved. The physiological range of motion was restored. The Lasegue test is negative. With deep palpation of the area of the joint spaces, there is no pain. Palpation examination of the joint spaces L3-4 and L4-5 revealed the restoration of its contour and relief. The observation period is one year. There was no recurrence of spinal disease. The patient comes for examination once every six months.

Example 2. Patient A., 30 years old. He complained of dizziness and pain in the neck on the right. UZDG of the neck showed curvature of the vertebral arteries, asymmetry of blood flow in them. On the radiograph, osteochondrosis of the cervical spine. On examination - restriction of movement when turning the head to the right. On palpation: soreness and protrusion of the lower articular process C 5, both on the left and on the right. As well as pain and protrusion of the lower articular process on the left C4. Treatment was carried out using manual therapy techniques in the amount of three sessions. First, C4-5 joints were corrected. The patient is lying on his stomach, his head is bent in a position on his forehead. We are on the left side of the patient. We place the pad of the middle finger of the left hand on the lower Articular process C4. The ring finger of the same hand is placed paravertebral. The nail phalanges are directed cranially. With the edge of the palm of the right hand clenched into a fist, we strike the nail plate of the middle finger of the left hand in the medial and ventral direction, until the displacement of the articular process is eliminated. Next, we ask the patient to roll over on his back. We put on the Glisson loop, pull it with our hand and make a short jerk towards ourselves. Next, we invite the patient to roll over again on his stomach and put his head on his forehead. We carry out a repeated palpation examination of the C4-5 joints on the left. It does not hurt anymore. Let's move on to palpation of C5-6 joints. After extracting, we find that there is no pain on the left in the region of the articular processes. We approach the patient on the right, palpate the articular processes C5-6 on the right, the pain still remains. We put the pad of the middle finger of the left hand on the lower articular process of C5 on the right. The nail phalanx is directed cranially. With the edge of the palm of the right hand clenched into a fist, we strike the nail plate of the middle finger in the ventral and medial direction. For joint correction. After this action, the joint is palpated again. The pain has lessened. After the second session, there is no dizziness. After the third session, there was no pain on palpation of the joints, the range of motion was restored, and there were no dizziness. On ultrasound, straightening of the vertebral arteries and improvement of blood velocity parameters. There are no complaints. The observation period was one year, there were no recurrences of the disease, preventive examination and control is carried out every six months.

Example 3. Patient C 30 years old. Complaints of pain between the shoulder blades for a month. Received treatment at the clinic. diagnosed with osteochondrosis of the thoracic spine, exacerbation. Palpation of the fifth thoracic vertebra revealed pain on the left in the region of the lower articular process. Aggravated by pressure on the side of the spinous process (to the right). So there is a shift here. For correction, we approach the patient lying on his stomach on the right. We put the middle finger of the right hand on the lateral surface of the spinous vertebra, we rest against it with the pad of the finger. The ring finger of the same hand is placed paravertebral. The nail phalanges are directed cranially. With the other hand, clenched into a fist, we strike the nail plate of the installed middle finger. In this case, blows are performed in the caudal and lateral directions from the side of displacement, and from the opposite side. After the manipulation, we check, palpate the joint. No pain. After the correction, the patient was examined in a week. No pain. Palpation is painless. recommended by exercise therapy.

Example 4. Patient D., 43 years old. complaints of pain in the neck when turning the head to the right; pain between the shoulder blades when inhaling; lower back pain when bending over. She was seen by a neurologist at the clinic. Diagnosis: widespread osteochondrosis. On examination: limitation of head movement when turning to the right. Palpation of the 4th cervical vertebra on the right reveals pain in the joint, its compaction and an increase in the joint space. joint displacement. Repositioned. The patient is in the supine position. We approach from the right side, put the middle finger of the left hand over the enlarged joint space. The index finger of the same hand is placed paravertebral. The nail phalanges are directed cranially With the other hand, clenched into a fist, we strike the nail plate of the installed finger so that the joint space closes. The blow is applied in the medial-ventral direction. After we carry out repeated palpation of the joint of the 4th cervical vertebra. No pain. Traffic has been restored. Next, we palpate the thoracic region. We find pain and displacement on the left side of the 3rd thoracic vertebra. For correction, we approach the patient lying on his stomach on the right. We put the middle finger of the right hand on the lateral surface of the spinous vertebra, we rest against it with the pad of the finger. The ring finger of the same hand is placed paravertebral. The nail phalanges are directed cranially. With the other hand, clenched into a fist, we strike the nail plate of the installed finger. In this case, blows are performed in the caudal and lateral directions from the side of displacement, and from the opposite side. After the manipulation, we check, palpate the joint. No pain. On inhalation, the pain lessened. Let's move on to the lumbar region. We put a roller under the stomach and begin palpation diagnostics. We detect pain, lateral displacement in the joint and an increase in the joint space on the left of the 4th lumbar vertebra. We approach the patient on the right. We place the middle finger of the left hand on the spinous process and strike the nail plate of the installed finger at such an angle that the joint space closes. After the manipulation, we re-palpate the joint and fissure. the pain was greatly reduced. Conducted 3 similar sessions. There are no complaints. range of motion restored. palpation is painless.

Claims (3)

1. A method for treating diseases of the spine caused by injuries, overloads or degenerative-dystrophic processes, including the use of manual therapy techniques by placing fingers on the area of the affected vertebra, followed by striking, characterized in that the presence of subluxations in the facet joints of the affected spinal motion segments is previously detected and the direction of displacement of the lower articular processes, as well as the place of increasing the width of the joint space, while only the lower articular processes are corrected relative to the upper articular processes below the located vertebra, when performing strikes, the pad of the middle finger of the supporting hand is placed on the spinous process of the displaced vertebra, index or ring finger the same hand is placed paravertebral, while the nail phalanges of the indicated fingers are directed caudally, after which they strike with the edge of the palm clenched into a fist on the nail plate of the middle finger at an angle; at the same time, in the lumbar spine, blows are performed in the cranial, medial and lateral directions, not only from the side of their displacement, but also from the opposite side; in the thoracic spine, blows are performed in the caudal and lateral directions from the side of displacement and from the opposite side; in the cervical spine, blows are performed only from the side of the displacement of the lower articular processes and only in the medial-ventral direction. 2. The method according to claim 1, characterized in that, if necessary, additional exposure is carried out, for this they bypass the patient and stand on the opposite side of the displacement of the lower articular process and the increased width of the joint space, with the pad of the middle or index finger of the left hand rest against the lateral part of the spinous of the process of the corrected vertebra and strike with the edge of the palm of the right hand, clenched into a fist, on the nail plate of the installed finger, in the medial-lateral direction towards the joint space, which has an increased width. 3. The method according to claim 1, characterized in that when the two lower articular processes in the cervical region are displaced, the Glisson loop is used first, for this the patient lies on his back, the Glisson loop is put on his head and traction is performed with effort and a jerk towards himself, and then the lower articular processes of the displaced vertebrae are reduced.

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