RU2795732C1 - Method for the treatment of degenerative-dystrophic diseases of the spine - Google Patents

Abstract

FIELD: medicine; manual therapy.

SUBSTANCE: invention can be used to treat degenerative-dystrophic diseases of the spine (dorsopathies) with impaired posture and muscular-tonic vertebral and extravertebral syndromes. Manipulations are carried out with the patient's muscles in relation to their attachment points using mechanical action by the hands of a rehabilitation doctor, diagnostics of the muscle response and manipulations in the joints. Manipulations are performed by sequential imposition and movement of the palms and fingers on the spine from the sacrum to the base of the skull, while the patient is placed in the prone position. The mechanical impact is carried out on the spinous processes in the middle, then paravertebral near the spine on one side and on the other, then segment by segment at the level of each vertebral segment from the base of the skull to the sacrum with the first and second fingers. Further, the bases of the palms are set segmentally paravertebral, with one palm on the overlying segment, the other on the underlying one — crosswise with rotation along the axis and a subsequent push, sequentially starting from the upper thoracic and ending with the lumbosacral spine, while determining muscle relaxation, after which the patient is shifted to the position on the back, the fingers of the rehabilitation doctor are placed on the back of the neck on both sides segmentally paravertebral from 7 to 1 vertebra with traction along the axis of the spine until the patient’s muscles are relaxed, and manipulations in the joints are performed, if necessary, until a feeling of free relaxed rotation.

EFFECT: method provides relief of local muscle spasm, general muscle tension, restoration of correct posture and range of motion in the joints.

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Description

The invention relates to medicine, and more specifically to manual therapy, and can be used to treat degenerative-dystrophic diseases of the spine (dorsopathies) with impaired posture and muscular-tonic vertebral and extravertebral syndromes.

Degenerative-dystrophic diseases of the spine (DDSD) and related complaints and clinical manifestations are one of the most important problems of modern medicine, leading to disability in the working-age population (according to WHO statistics, up to 80% of the population aged 30 to 50 years). This is due to a consistently high number of patients of working age, often unsatisfactory results of conservative therapy and frequent recurrence of complaints after surgical treatment (Microdiscectomy in the treatment of herniated intervertebral discs of the lumbosacral spine. Polytrauma. 2019. The effectiveness of the system for predicting the results of surgical treatment of patients with herniated lumbar intervertebral discs Spine Surgery 2020 Minimally Invasive Spine Surgery: Stages of Development Issues of N.N. Burdenko Neurosurgery 2019 Minimally Invasive Endoscopic Foraminal Decompression in Adult Degenerative Scoliosis: Clinical Case and Literature Review Spine Surgery 2019 Modern Methods treatment of degenerative diseases of the intervertebral disc Literature review Issues of neurosurgery named after N. N. Burdenko 2016 Modern methods of treatment of degenerative diseases of the intervertebral disc Literature review Issues of neurosurgery named after N.N. N.N. Burdenko, 2016).

In the structure of the incidence of the adult population of our country, lumbar osteochondrosis is 48-52%. Temporary disability caused by non-compression syndromes of osteochondrosis accounts for 40% of neurological diseases. In the general structure of disability from diseases of the musculoskeletal system, degenerative diseases of the spine account for 20.4% and occupy the first place (41.1%) among the causes of primary disability. Patients with clinically significant manifestations of osteochondrosis of the spine are 51.2 per 1000 population. Compressive and non-compressive forms of osteochondrosis begin to be diagnosed from the age of 15-19 (2.6 cases per 1000 of the population of this age category), and by the age of 30, clinical manifestations of osteochondrosis are diagnosed in 1.1% of the population, by the age of 59 - in 82.5% population (Conservative treatment of patients with degenerative lumbar stenosis. Journal of Neurology and Psychiatry named after S.S. Korsakov 2019. Trunk imbalance in spinal deformities and instability of the hip joints. Pediatric surgery. 2020. Experience with denervation of the facet joints of the lumbar spine. Spinal surgery. Spine Deform 2019. A New Classification of CT/discography in Low-Back Disorders. Spine (Phila Pa 1976) 1987).

The most common reason for the development of osteochondrosis of the spine is the constant impact on it of forces of a mechanical nature, which dampen precisely the intervertebral discs (Chronic pain. Pathogenesis, clinic, treatment. Textbook. A guide for doctors. - M., 2007, - 83 p.). When the connective tissue is weak, static insufficiency of the spine occurs, which determines its vulnerability, and mechanical dysfunction, in turn, causes degeneration of the intervertebral discs, the main anatomical substrate of osteochondrosis of the spine (General principles of diagnostic testing as related to painful lumbar disorders: a critical appraisal of current diagnostic techniques / J. S. Saal - Spine - 2002. A New Classification of CT/discography in Low-Back Disorders. Spine (Phila Pa 1976) 1987. Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial. Spine J. 2018).

Thus, degeneration of the intervertebral disc that develops with osteochondrosis of the spine is more correctly considered as a multifactorial monoetiological disease: a combination of various conditions generates and maintains a specific cause of degeneration - biomechanical changes, first in the spinal motion segment (SDS), and subsequently, in the entire musculoskeletal segment. apparatus of the spine and the entire axial skeleton.

To date, there are various methods of treating ADHD. The most common method is surgical treatment (posterior decompression operations with or without stabilization, anterior decompression and stabilization operations, microdiscectomy, transpedicular fixation of the spinal motion segment, etc.). However, it should be noted that such treatment is associated with increased trauma, as well as a rather high risk of postoperative complications, recurrence of complaints and clinical manifestations of ADSD.

Currently, various types of manual medicine are used to treat DDSD (accompanied by pain syndromes, muscle spasms, postural disorders, scoliotic deformity of the spine, etc.). This type of treatment should include various types of massage, manual therapy and osteopathy.

One type of manual therapy is neuromuscular therapy, which is a specific pressure or movement of the doctor's fingers and palms on the patient's tissue. It refers to the so-called soft tissue or soft manual therapy techniques, the growing popularity and use of which is already a global trend (Manual medicine of musculoskeletal pain / / International Journal of Applied and Basic Research. - 2021. - No. 3. - P. 53- 58;). Recently, several randomized studies have been conducted that clearly demonstrate the high efficiency of the method, and further study of its delayed results is planned (19 Comparison of Three Manual Therapy Techniques as Trigger Point Therapy for Chronic Nonspecific Low Back Pain: A Randomized Controlled Pilot Trial Altern Complement Med. 2020; The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial Eur J Phys Rehabil; Bone Jt Surg. 2020; The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis J Back Musculoskelet Rehabil. 2021; General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques / J.S. Saal. - Spine, 2002; Muscle Energy Technique in the Rehabilitative Treatment for Acute and Chronic Non-Speciflc Neck Pain: A Systematic Review Healthcare (Basel) 2021).

For the prototype, a method for the treatment of postural disorders and scoliosis was chosen (RU 2648830 C1 from 2017). The invention relates to restorative medicine, manual therapy, osteopathy, massage, and can be used for the treatment and prevention of pain symptoms caused by impaired muscle tone, as well as in the complex of improving the human body. The prototype method is based on mechanical manipulations with muscles. First, the presence of a muscle response to a forceful action by the hands of a rehabilitator is diagnosed, which is carried out from the middle of the muscle towards one and then to another place of its attachment. As a result, it is determined to which of the attachment sites the muscle moves with less effort. In the direction of this place, a series of short actions is carried out in the form of pushes or muscle shifts until an equilibrium state of the muscle-ligamentous tone is established, in which the muscle shift becomes equally amplitude, equally uniform and carried out with the same effort to each place of its attachment. When changing the direction of smaller efforts to the opposite effect, they also change to the opposite direction until an equilibrium state is reached. In the absence of changes, the reception is repeated until an equilibrium state of the muscular-ligamentous tone is reached. Additionally, impacts are carried out in the form of a series of articulations of the joint to relieve it, around its axis, until a feeling of elastic resistance. The method ensures the achievement of sustainable rehabilitation of the musculoskeletal system.

The method has proven to be effective. However, in our opinion, it has a number of significant drawbacks. One of them is that the prototype involves a direct mechanical traction effect on spasmodic muscles, which leads to their additional traumatization, increases pain and muscle-tonic syndrome, can cause restriction of movements in the affected joint or spine, antalgic posture disorder. In addition, the prototype lacks techniques of manual mobilization and manipulation to eliminate functional blocks and restore the anatomically and physiologically correct position of the spine and joints.

Thus, it should be noted that all of the above methods are traumatic, which significantly reduces the effectiveness of the treatment of patients with degenerative-dystrophic lesions of the spine. All this prompted us to start developing a new method for the treatment of DDSD, which would allow the most sparing, without additional traumatization, to remove muscle hypertonicity, followed by manipulation to restore the anatomically and physiologically correct position of the joints and spine.

The technical result of the present invention is to create a less traumatic method for the treatment of patients with degenerative-dystrophic lesions of the spine.

This result is achieved by the fact that in the known method for the treatment of degenerative-dystrophic diseases of the spine, which includes manipulations with the patient's muscles in relation to their attachment points using mechanical action by the hands of a rehabilitation doctor, diagnosing the muscle response and performing manipulations in the joints, according to the invention, the manipulations are performed by sequential imposition and movement of the palms and fingers on the spine from the sacrum to the base of the skull, while the patient is placed in the prone position, the mechanical effect is carried out on the spinous processes in the middle, then paravertebral near the spine on one side and on the other, and then segment by segment at the level of each vertebral segment from the base of the skull to the sacrum with the first and second fingers, then the bases of the palms are set segmentally paravertebral, with one palm on the overlying segment, the other on the underlying one - crosswise with rotation along the axis and a subsequent push, sequentially starting from the upper thoracic and ending with the lumbar sacral spine, while determining muscle relaxation, after which the patient is transferred to the position on the back, the fingers of the rehabilitation doctor are placed on the back of the neck on both sides segmentally paravertebral from 7 to 1 vertebra with traction along the axis of the spine until the patient’s muscles relax, and manipulations in the joints are performed, if necessary, until a free relaxed rotation is felt.

Performing manipulations with the patient's muscles in relation to their attachment points by successively applying and moving the fingers and palms along the spinous processes from the sacrum to the base of the skull provides relaxation of the superficial trapezius and latissimus dorsi muscles. Manipulations in the process of successive imposition and movement of the fingers and palms of the hands paravertebral on one side and the other from the sacrum to the base of the skull provide relaxation of the extensor muscles of the back.

Segmental manipulations at the level of each vertebral segment from the base of the skull to the sacrum with the first and second fingers of the hands provide relaxation of the deep intervertebral muscles, and sequential segmental rotation with the bases of the palms, set crosswise paravertebral on the upper and lower segments, ensures the elimination of local muscle spasm, the subsequent push - blockade of the intervertebral joints throughout the spine.

When the fingers of the rehabilitation doctor are placed, carried out in the position of the patient on the back from 7 to 1 cervical vertebra, paravertebral from 2 sides, relaxation of the neck muscles in the reflexogenic zone occurs, which leads to general muscle relaxation, and subsequent traction along the axis of the spine complements the elimination of local muscle spasm.

In the presence of local muscle spasm in the girdle or limb segment homolateral to local vertebral muscle spasm with myopically in the joint, manipulations are performed by sequentially applying palms and fingers along the length of the limb segment, ensuring the elimination of local muscle spasm, followed by rotation of the limb in the joint in one direction and the other until sensation free rotation, ensuring the elimination of joint myopically.

The essence of the method is illustrated by examples.

Example 1

Patient V., born in 1951, applied on January 6, 2021 with complaints of pain in the lumbar spine radiating to the lower extremities. From the anamnesis it is known that such complaints have been noted for 5 years, over the past 3 months the intensity of pain has increased, he has undergone repeated courses of conservative drug therapy without effect. Objectively, at the time of examination, changes in posture were determined in the form of a difference in the iliac spines: the right one is 1 cm higher than the left one, and curvature of the lumbar spine, as well as pain in movements in the lumbar spine with an increase in the tone of the back extensor muscles. An x-ray of the lumbar spine was performed, which revealed a scoliotic deformity of the lumbar spine at the L3 level of 5 degrees, straightening of the lumbar lordosis, subchondral sclerosis of the endplates with a decrease in the height of the discs at the levels L1-2, L2-3, L3-4, L4- 5,L5-S1, marginal anterior osteophytes at the level of L5-S1. Diagnosis: Dorsopathy. Osteochondrosis, scoliotic deformity of the lumbar spine of the 1st degree, L5-S1 spondylosis, pain and muscular-tonic syndromes. The patient was recommended treatment according to the proposed method. The first session was performed on 01/08/2021: manipulations were performed by sequentially applying and moving the palms and fingers on the spine from the sacrum to the base of the skull and back, with the patient in the prone position. The mechanical impact was applied to the spinous processes in the middle, then paravertebral near the spine on one side and on the other, then segment by segment at the level of each vertebral segment from the base of the skull to the sacrum with the first and second fingers, until the underlying muscles were felt relaxed at each moment of manipulation, then the bases of the palms were placed segmentally paravertebral, with one palm on the overlying segment, the other on the underlying one - crosswise with rotation along the axis and a subsequent push, the need and strength of which was determined directly at the time of manipulation, based on the sensations of relaxation of the underlying muscles, until a sensation of the characteristic " clicks”, sequentially starting from the upper thoracic and ending with the lumbosacral spine, after which the patient was transferred to the position on the back, the fingers of the rehabilitation doctor were located on the back of the neck on both sides segmentally paravertebral from 7 to 1 vertebra with traction along the axis of the spine to sensations of muscle relaxation and general relaxation of the patient. A total of 5 sessions were held. The course ended on 01/12/2021. At the final session, the patient did not complain, noted an improvement during the treatment, objectively: posture disorders in the lumbar spine, pain in movements in it and increased tone of the back extensor muscles were not determined. The follow-up examination took place on February 7, 2022. During the examination, the patient did not complain, noted the absence of recurrence of pain after the treatment, objectively: posture disorders in the lumbar spine, pain in movements in it and an increase in the tone of the back extensor muscles were not determined. An x-ray of the lumbar spine was performed, which revealed straightening of the lumbar lordosis, subchondral sclerosis of the endplates with a decrease in disc height at levels L1-2, L2-3, L3-4, L4-5, L5-S1, marginal anterior osteophytes at the level of L5 -S1. The diagnosis was made: Dorsopathy. Osteochondrosis of the lumbar spine, L5-S1 spondylosis, without exacerbation. Exercise therapy recommended.

Example 2

Patient F., born in 1981, applied on June 15, 2021 with complaints of pain in the humeroscapular areas, dizziness. From the anamnesis it is known that such complaints have been noted for 18 years, the disease proceeds with seasonal exacerbations, over the past 2 weeks the intensity of complaints has increased, she has undergone repeated courses of conservative drug therapy with a temporary effect. Objectively, at the time of examination, changes in posture were determined in the form of a difference in the spacing of the spines of the scapulae: the right one is 1 cm higher than the left one, curvature of the thoracic spine, difficulty in moving in the shoulder joints with an increase in the tone of the muscles of the shoulder girdle, more on the right, Marinesco-Radovichi's symptom on the left, overshooting with a finger nasal test on the left. An X-ray of the cervical and thoracic spine was performed, which revealed a scoliotic deformity of the thoracic spine at the level of Th 7 of 5 degrees, subchondral sclerosis of the endplates with a decrease in disc height at levels of Th 6-8, marginal anterior osteophytes at this level, signs of C5 instability -6. Doppler ultrasound of the vessels of the neck and brain was performed, which revealed irregularity in the course of the vertebral arteries in the 2nd segment with their extravasal compression during rotational samples by 20%. Diagnosis: Dorsopathy. Widespread osteochondrosis, scoliotic deformity of the thoracic spine of the 1st degree, C5-6 instability, pain and muscular-tonic syndromes, vertebrobasilar insufficiency. The patient was recommended treatment according to the proposed method. Manipulations were performed by sequential imposition and movement of the palms and fingers on the spine from the sacrum to the base of the skull and back, with the patient in the prone position. The mechanical impact was applied to the spinous processes in the middle, then paravertebral near the spine on one side and on the other, then segment by segment at the level of each vertebral segment from the base of the skull to the sacrum with the first and second fingers, until the underlying muscles were felt relaxed at each moment of manipulation, then the bases of the palms were placed segmentally paravertebral, with one palm on the overlying segment, the other - on the underlying one - across with rotation along the axis and a subsequent push, the need and strength of which was determined directly at the time of manipulation, based on the sensations of relaxation of the underlying muscles, until a sensation of the characteristic " clicks”, sequentially starting from the upper thoracic and ending with the lumbosacral spine, after which the patient was transferred to the position on the back, the fingers of the rehabilitation doctor were located on the back of the neck on both sides segmentally paravertebral from 7 to 1 vertebra with traction along the axis of the spine to sensations of muscle relaxation and general relaxation of the patient. 5 sessions of manual therapy were carried out. The course was completed on 06/25/2021. At the final session, the patient did not complain, she noted an improvement during the treatment, objectively: posture disorders in the thoracic spine, difficulty in moving in the shoulder joints, increased tone of the muscles of the shoulder girdle, Marinesco-Radovici symptoms were not determined, The patient performed the coordination tests correctly. The control examination took place on March 19, 2022. During the examination, the patient did not complain, she noted the absence of recurrence of complaints after the treatment, objectively: posture disorders in the thoracic spine, difficulty in moving in the shoulder joints, increased muscle tone of the shoulder girdle, Marinesco-Radovici symptoms were not determined , the patient performed the coordination tests correctly. An X-ray of the cervical and thoracic spine was performed, which revealed: subchondral sclerosis of the endplates with a decrease in disc height at levels Th 6-8, marginal anterior osteophytes at this level, signs of C5-6 instability. The diagnosis was made: Dorsopathy. Widespread osteochondrosis, C5-6 instability, without exacerbation. Exercise therapy recommended.

Thus, the proposed method allows you to eliminate local muscle spasm, general muscle tension, restore correct posture and range of motion in the joints by low-traumatic effects, which increases the effectiveness of the method and expands the indications for its use.

The inventive method can be used both in departments of medical institutions and in private practice. The method is easily reproducible, no special technique is required, since everything is based on well-known massage techniques.

The method was developed at the Department of Physical Methods of Treatment and Sports Medicine of the Faculty of Postgraduate Education of the First St. Petersburg State Medical University named after Academician I.P. Pavlov" of the Ministry of Health of the Russian Federation and was clinically tested in 30 patients with a positive result.

Claims (1)

A method for the treatment of degenerative-dystrophic diseases of the spine, which includes manipulations with the patient's muscles in relation to their attachment points using mechanical action by the hands of a rehabilitation doctor, diagnostics of muscle response and manipulations in the joints, characterized in that the manipulations are performed by sequentially applying and moving the palms and fingers on the spine from the sacrum to the base of the skull, while the patient is placed in the position on the stomach, the mechanical effect is carried out on the spinous processes in the middle, then paravertebral near the spine on one side and the other, then segment by segment at the level of each vertebral segment from the base of the skull to the sacrum first and the second fingers, then the bases of the palms are set segmentally paravertebral, with one palm on the overlying segment, the other on the underlying one - crosswise with rotation along the axis and a subsequent push, sequentially starting from the upper thoracic and ending with the lumbosacral spine, while determining relaxation of the muscles, after which the patient is shifted to the position on the back, the fingers of the rehabilitation doctor are placed on the back of the neck on both sides segmentally paravertebral from 7 to 1 vertebra with traction along the axis of the spine until the patient feels relaxation of the muscles, and manipulations in the joints are performed, if necessary , until you feel a free relaxed rotation.