RU2808350C1 - Method of correcting idiopathic scoliosis of lumbar spine in girls of 11-15 years of age - Google Patents

Abstract

FIELD: medicine; pediatrics and orthopedics; rehabilitation and kinesiology.

SUBSTANCE: invention can be used both in medical institutions of the appropriate profile, and at home by performing exercises by children under the supervision and with the help of adults. A method of correcting combined idiopathic scoliosis of the lumbar spine in girls aged 11–15 years includes performing 15 gymnastic exercises in a certain sequence, including such exercises as wall hangings, hips muscle stretching, strength and strengthening exercises, balancing, gait correction, abdominal work, squats, in accordance with the claims. A number of exercises are performed using conscious breathing. Exhalation is performed with resistance — through half-closed lips, lasting 8 seconds, and inhalation — consciously controlled, directed, is a breath with the patient's voluntary attention being focused on the work of the intercostal muscles in a given respiratory zone of the lungs — on the side of the chest opposite the lumbar curvature, in the lower parts of the lungs.

EFFECT: this complex optimizes the load for 11–15 year old girls suffering from scoliosis, without loss of efficiency, with the prevention of further progression of scoliosis, by increasing the proportion of breathing exercises in the complex, excluding difficult-to-perform exercises from the complex and reducing the number of approaches when performing individual exercises of the complex, according to compared with the prototype, taking into account gender differentiation in this age period, in which girls have less development of strength abilities, muscle strength than boys, and there is also a differentiation of the type of breathing - in boys on the abdominal, in girls — on the chest type of breathing, weakness of the indicators of the function of the respiratory system, which therefore requires a more targeted developmental load on this system.

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Description

The invention relates to medicine, pediatrics and orthopedics, rehabilitation and kinesiology and can be used both in medical institutions of the appropriate profile and at home by performing exercises for children under the supervision and with the help of adults.

Idiopathic scoliosis (IS) is a disease whose etiology is still unknown. In general, experts say that its cause is the body’s protective compensatory reaction to excessive growth of the bones of the spinal column in relation to the growth of the spinal cord (M.G. Dudin, D.Yu. Pinchuk. Idiopathic scoliosis: diagnosis, pathogenesis. 2009) . Deviations occur in the functional state of the body's control systems - nervous and endocrine, while excess bone growth of the spine is eliminated by rotating and moving the vertebrae to the side. There are also arguments about the role of genetic factors in the development of IS.

Several classifications of scoliosis have been proposed. In particular, the classification according to the localization of the arc of curvature identifies a number of its main types.

1. Thoracic scoliosis with maximum deviation of Th7-Th9 vertebrae; in most cases - right-sided with one arc of curvature, which is the subject of this application for invention.

2. S-shaped combined scoliosis with 2 arches, the thoracic curve has a maximum deviation of Th7-Th9, the lumbar curve with the apex of deviation L1-L3. The thoracic curve is more often right-sided, and the lumbar curve is more often left-sided.

In this case, S-shaped combined scoliosis with 2 arcs of curvature can be divided into 3 types:

a) the arcs are approximately the same (within 5-7 degrees),

b) the thoracic curve is significantly larger than the lumbar curve,

c) the lumbar curve is significantly larger than the thoracic curve.

3. Lumbar scoliosis with apex in L2-L3, which is divided into 2 types:

a) lumbar scoliosis itself, in most cases left-sided;

b) in combination with thoracic hyperkyphosis.

4. Upper thoracic scoliosis with apex Th2-Th4 (quite rare), variants of which are:

a) actual upper thoracic scoliosis with one arc of curvature;

b) the third upper thoracic arch, often on the left, with two already existing - thoracic on the right and lumbar on the left;

c) a second upper thoracic arch with an existing thoracic arch.

5. C-shaped thoracolumbar scoliosis: one extended arc of curvature, including the vertebrae of the thoracic and lumbar spine.

In general, IS most often occurs in adolescents - from the age of 10 years until the end of active skeletal growth (up to 16-18 years). At the same time, regular examinations 2-3 times a year are necessary so as not to miss the beginning of progression. In turn, in the group of adolescents, IS is most often observed in girls.

As noted by a number of authors (RU 2329014 C2, 07/20/2008, Yu.V. Kholostov et al.), at the age of 6 to 11 years, there are no significant gender differences in the musculoskeletal system. During puberty (11-15 years), there is a significant increase in mobility of the lumbar spine in girls and the cervical spine in boys. Due to the enlargement of the pelvis, there is a more frequent formation of scoliotic posture in girls, which also explains the increased mobility of their iliac pelvic bones. From 15 to 20 years of age, the difference increases slightly due to an increase in the width of the shoulder girdle in young men, the mobility of the thoracolumbar region is higher in them, and the rotational capabilities of the cervical spine in young men are also increased. The mobility of the lumbar region and pelvic bones increases in girls compared to the previous age group.

In the process of our many years of research in the development of complexes of gymnastic exercises for scoliosis (Levkov V.Yu., Polyaev B.A. “Conscious correction of scoliosis and posture disorders” (based on the German method of Katharina Schroth), scientific and practical guide. M. 2020. 144 p.) we also established a number of features of the musculoskeletal system in girls aged 11-15 years with IS scoliosis. Based on the results of further practical studies, conclusions were drawn about the need for a more differentiated approach to the selection of therapeutic exercises depending on the gender and age of patients, which subsequently led to the development of the proposed method.

Various complexes of therapeutic exercises are known, including original ones, using specially designed devices for various types of scoliosis (Complex treatment of scoliosis in children. Proceedings of a scientific and practical conference with an international study. St. Petersburg, September 19, 2018. Electronic text edition. St. Petersburg. Science-intensive technologies. 2018. 133 pp.; RU 2329014 C2, 07/20/2008, Kholostov Yu.V. et al.; RU 2166922 C2, 05/20/2001, Nizhny Novgorod State Research Institute of Traumatology and Orthopedics), sometimes used in combination with other treatment methods - massage, physiotherapy, breathing techniques, manual therapy (SU 1806698 A1, 04/07/1993, Traditional Medicine Clinic of Dr. A.I. Sukhanov; RU 2597407 C1, S.M. Bubnovsky, 09/10/2016).

The gymnastics of Katharina Schroth (Schroth therapy) is known - the main method of conservative treatment of scoliosis in Germany and in Europe as a whole since the beginning of the 20th century (Timinko A.V. Gymnastics of Katharina Schroth for scoliosis: the basic principle of action and exercises. 10.15.2018 Electronic resource: https://spinatitana.com/pozvonochnik/grudnoj-otdel/skolioz/gimnastika-katariny-shrot-pri-skolioze-osnovnoj-printsip-dejstviya-i-vypolneniya-uprazhnenij.html).

Schrot therapy allows you to stop the progression of scoliosis, reduce the angle of curvature of the spine, even out muscle tone, and improve posture. This is a set of special isometric exercises, the basis of which is controlled asymmetric breathing. These exercises made it possible to correct pathological curves of the spinal column in 3 planes: frontal, horizontal, sagittal. Schroth developed her own classification of scoliosis, a number of effective exercises and called it “Three-dimensional correction of scoliosis.” This gymnastics is called respiratory orthopedics according to the K. Schroth method.

The principle of its operation is as follows. With scoliosis, asymmetric pathological breathing is observed - most of the air enters the convex half of the chest, due to which the curvature of the spine increases, and a rib hump is formed. According to K. Schroth, the body of a patient with scoliosis resembles a ball with a dent. If you fill the ball with air, the dent will straighten out. In the same way, a concave part of the human body can straighten out under air pressure.

Thus, if you consciously breathe through the concave side of the chest, you can prevent further curvature of the spine and achieve a significant reduction in the angle of displacement in scoliosis.

The intercostal muscles obey the commands of consciousness in the same way as the muscles of the limbs. In other words, conscious regulation of breathing is possible in both adults and children.

The correction should be gradual: from the third stage of scoliosis to the second, from the second stage to the first, from the first stage to complete recovery. Scoliosis of the 4th degree cannot always be corrected, much less cured. However, to achieve a lasting positive result, it is necessary to repeat the courses: for children - once a year, for adults - once every 2-3 years.

Gymnastics by Katharina Schroth allows you to achieve the following results:

- improving posture, getting rid of cosmetic defects;

- increased self-esteem, improved psychological state;

- reduction or elimination of pain;

- stopping the progression of scoliosis, consolidating the results;

- normalization of breathing;

- stabilization of the correct and healthy position of the back in different planes;

- no need for surgery.

Before gymnastics, the doctor sets the patient to a corrective position: on the floor, lying on his side or back, standing or sitting, using aids (gymnastic wall, poles, ball, roller). The patient performs the exercise, trying to make the maximum stretching force while inhaling - this helps to increase the distance between the ribs and bring them to the correct position.

The patient exhales through half-clenched lips and performs an exercise whose task is to reduce the distance between the ribs on the convex side. As you exhale, perform an exercise that reduces the distance between the ribs on the side of the convexity.

Since the exercises are repeated individually many times, after some time of training, the patient consciously accepts the position corrected by the doctor, and without the presence of a doctor or mirrors.

Gymnastics classes are conducted individually. The patient lies on his stomach, and the doctor-instructor lightly massages the sinking area so that the patient focuses his attention on it and remembers its location.

Then the doctor asks the patient to inhale with the sinking part of the body. To do this, first the doctor places his hand on the patient’s body, then holds it suspended; in the first case, the patient must raise the doctor’s palm, then touch it with his back.

The patient exhales through semi-compressed lips. The exhalation should be lengthened, which helps to increase the resistance to exhalation and train the intercostal muscles. When exhaling, the doctor can press on the convex areas, stimulating the muscles of these areas, tightening the muscles, reducing the intercostal distance on the convex side. With this type of breathing, the patient understands which parts of the body need to be used when exhaling and which areas when inhaling. The effectiveness of training increases significantly if:

- the patient follows the body position specified by the doctor, because this helps to better work the muscles and correct the arc of scoliosis;

- each exercise is performed at least 24-30 times a day, while the patient must monitor the progress of the workout using mirrors;

- during gymnastics, the patient drinks at least one liter of water.

Regular performance of Schroth gymnastics (at least 3 times a week for 2 hours a day) during periods of wearing a corset and after its removal helps to achieve optimal correction of deformity in the corset, the development of a stereotype to consciously accept the correct position, even in the absence of orthopedic devices, and strengthening effect of therapy.

As the closest analogue (prototype), let's consider the method described in our earlier publication: Levkov V.Yu., Polyaev B.A. Conscious correction of scoliosis and posture disorders (based on the German method of Katharina Schroth), scientific and practical. management, M., 2020, 144 pp., see p. 91-101.

According to the prototype, the author’s program for conscious correction of scoliosis (ACS) combines a number of techniques for IS rehabilitation:

- local controlled breathing and individualized selection of derotational exercises, based on K. Schroth’s technique, which the patient can perform independently after training;

- elements of corrective Vojta therapy to activate the deep back muscles and teach the patient new, adaptive movement patterns;

- the author’s set of exercises “Balance-Coordination”;

- analysis and correction of the patient’s daily motor skills;

- in the OKS complex, each exercise and movement is selected for the scoliotic deformity of a particular patient so that he can understand what he is doing and why, which increases motivation for exercise and improves rehabilitation results.

The prototype method is devoted mainly to the correction of scoliosis in the most common patients - children of pre-adolescence and early puberty - from 10 years old, when a progressive course of scoliosis is observed due to a general increase in the growth rate of organs and body systems. In our new, modified method for correcting thoracic scoliosis with a right-sided arch, we are talking about solving the problem of preventing the progression of scoliosis, taking into account differentiation by gender and age, namely, we propose a modification of our well-known method in relation to girls 11-15 years old suffering from thoracic IS . During this period, the most active differentiation of sexual characteristics and hormonal changes occur, which affect the rapid progression of scoliosis. In girls, it is also associated with the menstrual cycle; in particular, the period of 1.5 years before and after menarche deserves special attention.

Thus, during puberty, in boys up to 17 years of age, the volume of the lungs and chest increases, and the strength of the respiratory muscles increases, but in girls - only from 13-14 years of age. At the age of 10-14 years, gender differences in indicators of total and vital lung capacity (TLC and VC) appear. Girls and women have lower vital vitality than boys and men. In girls from 11-12 years of age, the increase in maximum pulmonary ventilation (MVV) also lags behind its increase in boys.

Breathing and circulation in teenage girls are less efficient at providing oxygen to tissues. This is evidenced by the worse relationships between the rate of oxygen supply to the lungs, alveoli, oxygen transport by arterial blood and oxygen consumption (Shakhlina L. Ya.-G., Futorny S.M. Puberty of girls, its role in the practice of sports training. // News of Tula State University, Physical Culture, Sports, 2014, pp. 181-189).

Final ossification of the skeleton is completed in women at 17-21 years of age, and in men at 19-25 years of age, which requires appropriate timely therapeutic interventions during certain periods of development in order to obtain sufficient effectiveness.

An increase in the growth rate of the spine in children is observed already at 7-9 years of age. By the beginning of puberty, the growth of the spinal column initially slows down, but a new acceleration of its growth is observed in girls by the age of 12-13, and in boys later, by the age of 13-14 (S.A. Esakov. Age-related anatomy and physiology (course of lectures) Izhevsk, 2010, 196 pp., chapter 3).

At the same time, already at the age of 8-10 years, gender differences in the pelvis begin to appear. The pelvis in girls and women is larger than in men, wider and located lower, which is associated with the functions of gestation and subsequent childbirth. As for the tubular bones, the fusion of the epiphyses with the diaphysis, as a rule, occurs at 13-15 years, and in girls again 1-2 years earlier than in boys (S.A. Esakov. Age-related anatomy and physiology (course of lectures) Izhevsk, 2010, 196 pp., chapter 3).

Thus, in girls of puberty, the functions of the respiratory system are less developed, which can make it difficult to perform a number of complex therapeutic exercises with high load. But at the same time, elements of the musculoskeletal system, in particular the spine and pelvic bones, develop more rapidly. The mobility of the lumbar spine and pelvic bones increases, as noted above, which necessitates differentiation of the intensity and direction of loads on various body systems to prevent the progression of scoliosis.

In connection with the above, from both a medical and social point of view, the task of overcoming this contradiction through differentiated correction of scoliotic deformities in girls aged 11-15 years, each of whom may become a mother in the future, is very relevant.

In this case, the prototype method is intended for the correction of scoliosis in children of different sexes and ages. He reveals techniques for teaching local breathing - conscious, controlled, directed breathing into certain areas of the chest. It is necessary to first train the patient to visualize a deep breath, i.e. the process of air entering sequentially into all parts of the respiratory system from the nose to the final parts of the alveoli of the lungs (p. 45 of the prototype).

To do this, first the process is visualized symmetrically, then - depending on the specific spinal deformity - with an emphasis on a certain respiratory area (zone), assisted by pressing the assistant/doctor's hand on the interested area of the chest for the patient to voluntarily activate the intercostal muscles of this area.

There are 3 respiratory zones, directed breathing into which helps to correct a certain type of IS. Directed breathing begins, as a rule, in one main zone, then adding breathing to the remaining zones (p. 45-48 of the prototype).

The main respiratory zone (zone 1) for thoracic IS with a right-sided curve is the back side of the chest, opposite the thoracic curvature (i.e., on the left). According to the prototype (pp. 48, 91), directed breathing exercises begin with this. In general, a conscious, directed inhalation into a given respiratory zone of the lungs is performed in the starting position, and the main elements of the exercise are performed while exhaling with resistance.

When mastering directed breathing within the framework of the prototype method, they move on to performing preparatory stretching exercises, which are not differentiated by gender and age, which in this case can be attributed to the disadvantages of the prototype. The prototype method (p. 91-101) also contains a number of exercises that are physically difficult for girls 11-15 years old to perform due to age-related characteristics. In this regard, we modified this well-known method, in particular, eliminating a number of physically difficult exercises, adding conscious breathing (CB) to a number of exercises, and changing the number of approaches in the exercises. General aspects and differences between the prototype and the modified method are shown below in Table 1.

The well-known complex of conscious correction of scoliosis (ACS), disclosed in the publication of the closest analogue of the proposed method, has shown its effectiveness in pre-teen and teenage children with right-sided thoracic scoliosis.

However, as noted above, modification of this complex seems important, in the form of its simplification in terms of performing physical exercises, while simultaneously increasing the proportion of breathing exercises (conscious breathing, OD) when performing the complex, taking into account the gender and age characteristics of the respiratory system and musculoskeletal system for girls 11-15 years old.

Thus, the technical result of the proposed method for correcting right-sided thoracic IS is the optimization of exercises for this group of patients - girls 11-15 years old, physical facilitation of their exercises, compared with the prototype method, but without loss of effectiveness, with the prevention of further progression of scoliosis, for by increasing the proportion of breathing exercises in the complex (consciously directed inhalation and exhalation with resistance are added to a number of gymnastic exercises for which they are not shown in the prototype), excluding physically difficult exercises from the complex, reducing the number of approaches when performing individual exercises of the complex, but with redistributing the number of respiratory cycles in them for more effective development of respiratory function, as well as adding some new exercises (Table 1).

The need for these modifications is associated with the beginning of rapid sexual differentiation in this age period, in which girls have less development of strength abilities and muscle strength than boys, and differentiation of the type of breathing also occurs - in boys to abdominal breathing, in girls - to thoracic breathing , weakness of a number of indicators of the function of the respiratory system, requiring a more targeted developmental load on this particular system. All this determined the modifications we made to the proposed method of correcting IS for girls of this particular age group.

In the prototype, for children of both sexes, the number of approaches is 5-6 with 6-8 breathing cycles, which can be physically too taxing for girls of puberty, so we adjusted (reduced) the number of approaches for them and redistributed the number of respiratory cycles performed in each approach to different exercises - to solve the problem of maintaining a sufficient load on the respiratory and musculoskeletal system, but while ensuring that subsequent exercises of the complex are more subjectively comfortable for girls.

Thus, to achieve a technical result, we propose a method for correcting thoracic idiopathic scoliosis in girls aged 11-15 years, including performing gymnastic exercises using conscious breathing.

This method is used to correct thoracic scoliosis with a right-sided thoracic curve. In this case, gymnastic exercises are the following set of sequential exercises performed by the patient daily.

1) “Half hang on the wall bars”, which is an exercise that is performed from the starting position (IP): standing close to the wall bars, toes placed under the lower bar, arms extended upward, palms lying on the bar, which is one lower than that , which the patient is able to reach.

In this case, the patient’s hands are positioned wider than the shoulders, and the feet and knees are positioned at the width of the patient’s pelvis.

Holding the bar with his hands, the patient hangs, pressing his knees to the lower bars and relaxing as much as possible.

Next - return to IP and repeat the exercise while hanging one bar lower than the previous one, with knees bent, then - again to IP and another repetition one bar lower than the previous repetition.

The duration of the hang is 10-20 seconds while the patient maintains physiological lumbar lordosis.

Perform 3 approaches of 3 planks from top to bottom in each approach, a rest pause between approaches is 30 seconds, the patient’s breathing is free while performing this exercise.

2) “Stretching the inner thigh,” which is an exercise that is performed from the IP: sitting on the buttocks on a mat, legs bent at the knees and hip joints, knees spread apart, feet with plantar surfaces touching each other in front of the patient, palms straightened lie on the floor behind the buttocks.

While performing the exercise, the patient pulls the connected, pressed plantar surfaces of the feet towards each other as much as possible, trying to lower his knees down, while at the same time straightening his back as much as possible, pushing off the floor with his hands, lowering his shoulders, pulling the top of his head up, while inhaling and exhaling in form of conscious breathing as follows.

In PI, a consciously controlled - directed inhalation (ONI) is carried out, which is an inhalation with the patient’s voluntary attention focused on the work of the intercostal muscles in a given respiratory zone of the lungs: on the side of the chest opposite the thoracic curvature arch.

In this case, the doctor focuses the child’s attention on this given respiratory zone of the lungs in the area of its projection on the back surface of the chest, pressing on it with his hand.

When performing the exercise, exhale with resistance - through semi-compressed lips, for 8 seconds.

Do 4 sets of five inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds

3) “Standing with supports”, which is an exercise that is performed from the IP: standing facing the wall bars, each hand wraps a hand around the vertical supports of the wall bars, which are located wider than the patient’s shoulders.

In this case, the patient’s feet stand on the floor on the inside of the wall bars parallel to each other, the heels are under the hip joints, the legs are bent at the knee joints, the pelvis is turned posteriorly while maintaining the physiological lordosis of the lumbar spine, the position of the legs and pelvis is symmetrical.

With the right raised hand, grasp the vertical support of the wall bars at the top so that the right elbow and shoulder are at the same horizontal level, the right elbow is pressed against the vertical support of the wall bars.

With your left hand, hold the vertical support of the wall bars higher so that your left elbow is at ear level.

The patient tries to maintain a symmetrical position of the body and head between the vertical supports of the wall bars.

In the PI, the ENV is carried out into a given respiratory zone of the lungs, and during exhalation with resistance, the following actions are simultaneously carried out:

- press down with hands and elbows on the vertical supports of the wall bars,

- shoulders do not lift,

- the top of the head is pulled as high as possible,

- stand stable

- the stomach and ribs are pulled in.

Perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds.

4) “Lying on the side with a chair”, which is an exercise that is performed from the IP: lying on the left side on the mat, the patient’s head is under the chair, the neck is between the legs of the chair, the right arm is bent at the shoulder and elbow joints, with the palm resting on top of the chair seat, resting against it, the left arm is extended along the longitudinal axis of the body under the chair between its legs.

The patient's left leg is bent, the right leg is straight, extended along the axis of the body, with the foot and ankle resting on a solid object placed under it with a height that ensures that the longitudinal axis of the right leg is parallel to the vertical axis of the patient's torso. The patient's head lies on the left outstretched arm.

Conscious breathing is carried out, for which purpose, in the PI, an ER is carried out into a given respiratory zone of the lungs, and during exhalation with resistance, simultaneously:

- the top of the head is pulled as high as possible,

- the stomach and ribs are pulled in;

- resting your right palm on the chair, pull your right elbow up and forward,

- move the right shoulder away from the ear - laterally,

- in this case, the torso, pelvis, right thigh and foot are kept in one line.

By the beginning of the next ONV, the right arm and shoulder are relaxed, returning to the IP.

Perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds.

5) “Sitting on a ball in front of a wall bar,” which is an exercise that corrects the thoracic spine through asymmetrical muscle work.

This exercise is performed from the following corrective IP: sitting on a gymnastic ball-fitball facing the wall bars, the size of the ball is such that when sitting on it the patient’s pelvis is located above the level of his knees, the patient’s feet with the entire plantar surface are under the lower crossbar of the wall bars, the knees touch bars of the Swedish wall located above the knees; the right hand is located on the crossbar at shoulder level, the left hand is on the crossbar, which is located at the level of the crown, elbows are straightened to the sides, shoulders are lowered, the patient turns the pelvis posteriorly, maintaining physiological lordosis and kyphosis of the spine.

They carry out conscious breathing, for which purpose, in a corrective PI, they perform an ER into a given respiratory zone of the lungs, and while exhaling with resistance, perform the following simultaneous actions:

- with the right hand the patient pulls the bar towards himself,

- with the left hand the patient pulls the bar towards himself and down,

- tries to bring himself closer to the wall bars with his chest,

- pulls the top of the head up as much as possible, while the chin line corresponds to the horizon line,

- the patient springs on the ball with the maximum amplitude possible for him,

- elbows straightened to the sides,

- the patient pulls in the abdomen and ribs - more on the left than on the right.

Perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds, during pauses the corrective IP is maintained.

6) “Lying on the side of the thoracic arch”, which is an exercise that is performed from the IP: the patient lies on the right side - on the side of the thoracic arch of curvature, a massage roller with a diameter is placed under the top of the arch, providing passive correction of the patient’s thoracic arch in the frontal plane, arms The patient is stretched upward, the head is between the arms, lies on the shoulder of the right hand, the right leg is bent at the knee and hip joint at 90 degrees, the right heel is in front of the knee of the left leg, the left leg is straight.

In this case, in the PI, the ENV is carried out into a given respiratory zone of the lungs, and during exhalation with resistance, the patient, grabbing the wrist of the left hand with his right hand, by pulling it up, along the longitudinal axis of the body, stretches the left side of the chest, drawing in the ribs on the left as much as possible and stomach, to the beginning of inhalation - return to IP.

Perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds.

7) “Balance”, which is a stabilization exercise that is performed using a balancing board, the length and width of which is 2 cm greater than the corresponding dimensions of the patient’s foot, and which has on its lower surface a half-cylinder with a diameter of 2 cm rigidly fixed along the longitudinal axis of the board, that when the patient stands on the plank with one leg, it creates a balancing effect, while the second leg is pulled back by bending the knee joint 90 degrees.

At the same time, they pull the top of the head up as much as possible, lower the shoulders, move the shoulder blades medially, pull in the stomach and ribs - on the left more than on the right, hold the balancing position for as long as possible for the patient, then change the leg.

During the exercise, 3 approaches are performed for each leg, the patient breathes freely, the rest pause between approaches is 10 seconds.

8) “Riding on a chair”, which is an exercise in which a chair with a flat back is used, IP - sitting “astride” on a chair, facing its back, the patient rests his forearms on the back of the chair, legs apart, placed in front of him.

They carry out conscious breathing, for which, in the PI, the patient performs an ERV into the given respiratory zone of the lungs, and during exhalation with resistance, the patient simultaneously performs the following actions:

- drops shoulders

- presses his forearms on the back of the chair, - pulls the top of his head up as much as possible,

- strains the abdominal press, draws in the stomach and ribs - more on the left than on the right.

Perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds.

9) “Corrective gait”, which is an exercise that is performed from the IP: standing, legs together, the patient pulls the top of the head up, the chin line is along the horizon, the shoulders are lowered and turned back, the thumb of the lowered right hand is turned outward as much as possible, the palm is In this case, they are turned forward as much as possible, the stomach is tucked in, and they consciously try to maintain a straight posture.

The movement begins with either leg, take a step forward and place the foot forward on the heel at a distance of 10 cm from the toes of the other leg - counting once.

Then move the stepped leg back, placing it on the toes at a distance of 10 cm from the heel of the second leg - on the count of two.

Next, they repeat the movement forward with the first foot on the heel - for a count of three, again repeat the movement with the same leg back on the toes - for a count of four, then again put the first leg forward and transfer the body weight to it, taking a full step - for a count of five, then similarly repeat the above movements with the second leg.

At the same time, conscious breathing is carried out, for which purpose, in the PI, an ER is performed in a given respiratory zone of the lungs, and when performing a step, exhale with resistance, perform 30 times, 5 counts for each leg.

10) “90 degree body lift press”, which is an exercise that is performed from the IP: lying on your back, legs raised and bent at the hip and knee joints 90 degrees, straight arms raised vertically above your head.

The patient raises his head, shoulders and shoulder blades, pulls his arms up as he exhales; lowers his hands, returning to IP, breathing freely.

In this case, first perform 3 approaches of 15 repetitions of the inhalation-exhalation cycle in each approach, rest pauses between approaches are 30 seconds, every day add 1 inhalation-exhalation cycle in each approach, increase to 30 inhalation-exhalation cycles in one approach and then continue in this mode.

11) “Press on the oblique abdominal muscles”, which is an exercise that is performed from the IP: lying on your back, legs, bent at the knees, raised so that the feet are 20 cm higher from the floor, arms bent at the elbows in front of you, hands - to the ears, the head and shoulders are raised 20 cm from the floor, the patient, holding himself in this position, then touches the left knee with his right elbow, while straightening the right leg at the knee, maintaining a flexion angle of 45 degrees in the right hip joint.

Then the left elbow touches the right knee, changing the position mirror the previous one, breathing freely.

First, perform 3 approaches of 20 inhalation-exhalation cycles in each approach, rest pauses between approaches - 30 seconds, every day add 1 inhalation-exhalation cycle in each approach, bring the total number of inhalation-exhalation cycles to 30 per approach and then continue in this mode.

12) “Correct squats”, which is an exercise that is performed from IP: standing in front of a mirror, legs wider than shoulders, with a gymnastic stick, fix the thoracic spine as symmetrically as possible - placing the stick horizontally on the shoulders, holding it with a back grip of both hands located wider than the shoulders .

From the IP, do a squat until the pelvis drops to the level of the knees, so that the thigh is parallel to the floor, support is on the entire foot, without lifting the heels from the floor, while maintaining the physiological curves of the spine, during the squat they take a normal breath, while lifting - normal exhalation.

Start with 3 approaches of 15 inhalation-exhalation cycles in each approach, daily increasing the inhalation-exhalation cycle by 1 cycle in each approach, bringing the total number of inhalation-exhalation cycles to 30 in each approach and then continue in this mode, rest pause between approaches - 30 sec.

13) “Classic plank”, which is an exercise that is performed from IP supports on the toes and elbows, which are placed strictly under the patient’s shoulder joints, and forearms, which are extended forward along the horizontal surface of the support, the patient holds the torso in this position:

- maintains natural lumbar lordosis,

- keeps the pelvis level, without lowering the right side,

- the top of the head is pulled as much as possible along the longitudinal axis of the body, the head is not thrown back or lowered, maintaining its middle position.

They start with one approach, while the duration of the approach is until the patient can hold the plank position as much as possible, then add 1 approach daily, bringing up to 4 approaches and then continue in this mode, the rest pause between approaches is 30 seconds, breathing is free.

14) “Balance on the knees on a ball”, which is an exercise during which the patient maintains balance on a gymnastic ball-fitball; the exercise consists of three stages:

- first, the patient holds the wall bars with his hands and kneels on the ball, which he is trying to hold on to,

- then tries to stay on the ball, releasing his hands from the wall bars,

- without the help of a wall bars, climbs onto the ball with his knees and stays on it.

Perform 3 approaches with the sequential implementation of three stages of the exercise against the background of conscious breathing - ONB and exhalation with resistance - at a pace that is comfortable for the patient, a rest pause between approaches is 30 seconds.

15) “Final wall bars” - the exercise is performed as a repetition of the first exercise of the complex.

It should be noted that we offer this complex for patients with a right-sided thoracic curve of spinal curvature, which is most common in this type of scoliosis. However, if a girl has a more rare left-sided thoracic curve of curvature, then the exercises of this complex can be done in a similar way for this type of thoracic scoliosis.

Patients must perform this complex for life, every day. In this case, the initial course can be educational for mastering the technique of conscious breathing, and usually lasts 10 lessons. The given respiratory zones are, in fact, areas of the lungs, the first of which (used in the proposed method) is located in the concavity zone of the thoracic arch of the spine and, when inflated with air (with consciously directed inhalation - NV), accordingly, contributes to the straightening of this arch. The second respiratory zone for performing conscious breathing is located in the lower parts of the lung from the side of the concavity of the lumbar arch of the spine, and when filled with air during NVH, it will also contribute to its straightening, which is used in the correction of lumbar types of scoliosis.

When performing a number of exercises, it is important for the patient to control his position and movements in the mirror. For example, when performing “Corrective gait”, as well as during exercises for which the Swedish wall is used. Therefore, it is suggested to have such a mirror in the room where it is installed.

To demonstrate the achievement of the specified technical result, we provide clinical examples of the implementation of the claimed method.

Example No. 1.

Patient D., 11 years old, girl, height 165 cm, weight 38 kg, underweight with very tall height. Two years ago, a diagnosis of right-sided thoracic idiopathic scoliosis of the 1st degree was made.

Menarche is absent. Complaints: occasional physical fatigue, rarely discomfort in the back and abdomen during physical activity and prolonged sitting. The gait is not affected.

Upon examination, slight asymmetry of the shoulder blades and waist triangles was revealed. When the torso is tilted forward in a standing position, the fingers reach the floor; palpation of the vertebrae is painless. Lower limbs of equal length.

Radiographs show an arc of curvature to the right in the thoracic region (8 degrees) with an apex at T8. Respiratory function indicators: VC, ELC and MVL are below the age norm. Indicators of endurance, strength of the abdominal and back muscles are also reduced.

For 10 days, we carried out the proposed training course from the OKS gymnastics complex in our proposed modified version for girls of this age - in the form of a training course for the patient on how to conduct exercises, with the aim of further implementing them independently at home. The exercises were well tolerated, the exercises were comfortable, and no pain was observed.

Having learned the complex, the girl herself, with the help of adults, subsequently performed the proposed modified complex every day, observation - throughout the year.

During the follow-up examination and examination, no progression of scoliosis was observed. On radiographs, the curvature has decreased: the arch to the right in the thoracic region is 6 degrees, with the apex at T8. Indicators of respiratory function: VC, ELC and MVL - age norm. Indicators of endurance, strength of abdominal and back muscles are the age norm. Gait is not impaired. The asymmetry of the shoulder blades and waist triangles is minimal.

Thus, the proposed course allowed this patient to prevent the progression of scoliosis. The girl continues to use the complex.

Example No. 2.

Patient I., 12 years 7 months, girl, height 170 cm (tall), weight 52 kg (average). The diagnosis of right-sided thoracic idiopathic scoliosis of the 1st degree was established at the age of 10 years. By the age of 12, scoliosis progressed to degree 2. Menarche begins at 12.5 years.

Complaints: rapid physical fatigue, periodic headaches, pain in the thoracic spine and lower ribs during prolonged sitting and standing (more than 2 hours). The gait is asymmetrical.

Upon examination, there is a noticeable asymmetry of the shoulder blades and waist triangles. When the torso is tilted forward in a standing position, the fingers reach the lower third of the legs, asymmetrically, palpation of the vertebrae is painful in the middle thoracic spine. Lower limbs of equal length.

Radiographs show an arc of curvature to the right in the thoracic region (14 degrees) with an apex at T9. Respiratory function indicators: VC, ELC and MVL are below the age norm. Indicators of endurance, strength of the abdominal and back muscles are below the age norm.

For 10 days, the patient was taught the proposed course from the OKS gymnastics complex in a modified version for girls of this age. The tolerability of the exercises was satisfactory, although in the first two days there was a slight pain syndrome in the thoracic spine when performing half-hangs on the wall bars.

Having learned the complex, the girl then performed the proposed modified complex herself every day for a year. Pain in the spine did not bother me.

During the follow-up examination and examination after a year, no progression of scoliosis was observed. The asymmetry of the shoulder blades and waist triangles is almost smoothed out. On radiographs, the angles of curvature decreased to values characteristic of the 1st degree of scoliosis: the arc to the right in the thoracic region is 10 degrees, with the apex at T9. Respiratory function indicators: VC, ELC and MVL correspond to the age norm. Indicators of endurance, strength of the abdominal and back muscles also correspond to the age norm. Headaches are rare; pain in the thoracic spine does not bother me.

Thus, in this patient, the modified complex helped stop the progression of scoliosis and return it to one degree lower than the one with which the patient came to us. The girl continues to use the complex.

Example No. 3.

Patient Ya., 14 years 10 months, height 175 cm (above average), weight 51 kg (underweight). The diagnosis of right-sided thoracic idiopathic scoliosis of the 1st degree was established at the age of 8 years. When contacted, a diagnosis of progressive thoracic scoliosis up to the 3rd degree was established, despite annual courses of treatment. Menarche from the age of 12, painful, irregular, accompanied by migraine-type headaches. Meals are irregular.

Complaints: periodic headaches and pain in the thoracic spine during physical activity, standing, sitting and normal walking, with rapid fatigue. Gait with pronounced asymmetry.

On examination, there is a pronounced asymmetry of the shoulder blades and waist triangles. When the torso is tilted forward in a standing position, the fingers reach the level of the lower third of the lower leg, asymmetrically, palpation of the vertebrae is moderately painful in the thoracic spine. Lower limbs of equal length.

Radiographs show an arc of curvature to the right in the thoracic region (28 degrees) with an apex at T9. Respiratory function indicators: VC, ELC and MVL are below the age norm. Indicators of endurance, strength of the abdominal and back muscles are significantly reduced.

For 10 days, the patient was taught the proposed course from the OKS gymnastics complex in a modified version for girls of this age group. The tolerability of the exercises in general can be considered satisfactory, however, in the first days, pain was observed in the thoracic spine during half-hangs and balance exercises.

Having learned the complex, the girl then performed the proposed modified complex herself every day for a year. Pain in the spine did not bother me.

In addition, based on the clinical recommendations of SOSORT (Society on Scoliosis Orthopedic and Rehabilitation Treatment), the patient was prescribed to wear a functional corrective corset according to the Chenault type for 20 hours a day.

During the follow-up examination and examination after a year, no progression of scoliosis was observed. The asymmetry of the shoulder blades and waist triangles has been smoothed out. On radiographs, the angle of curvature decreased to the second degree - 20 degrees, with the apex at T9. Respiratory function indicators: VC, ELC and MVL correspond to the age norm. Indicators of endurance, strength of the abdominal and back muscles correspond to the age norm. Pain in the spine, headaches are rare.

Thus, in this patient, a modified set of exercises together with the Chenot corset also helped stop the progression of scoliosis, with which the patient came to us. The girl continues to use the complex at home.

Claims (86)

A method for correcting idiopathic scoliosis of the thoracic spine in girls aged 11-15 years, including performing gymnastic exercises using conscious breathing, characterized in that the method is carried out for the correction of thoracic scoliosis with a right-sided thoracic arch, In this case, gymnastic exercises represent the following set of sequential exercises performed by the patient daily: 1) “Half hang on the wall bars”, which is an exercise that is performed from the starting position (IP): standing close to the wall bars, toes placed under the lower bar, arms extended upward, palms lying on the bar, which is one lower than that , which the patient is able to reach; in this case, the patient’s hands are positioned wider than the shoulders, and the feet and knees are positioned at the width of the patient’s pelvis, holding the bar with his hands, the patient hangs, pressing his knees to the lower bars and relaxing as much as possible, then - return to IP and repeat the exercise while hanging one bar lower than the previous one, with knees bent, then - again to IP and another repetition one bar lower than the previous repetition, the duration of the hang is 10-20 seconds while the patient maintains physiological lumbar lordosis, perform 3 approaches of 3 planks from top to bottom in each approach, rest pause between approaches - 30 seconds, the patient’s breathing is free while performing this exercise; 2) “Stretching the inner thigh,” which is an exercise that is performed from the IP: sitting on the buttocks on a mat, legs bent at the knees and hip joints, knees spread apart, feet with plantar surfaces touching each other in front of the patient, palms straightened lie on the floor behind the buttocks, When performing the exercise, the patient pulls the connected, pressed plantar surfaces of the feet towards each other as much as possible, trying to lower the knees down, while at the same time straightening the back as much as possible, pushing off the floor with the hands, lowering the shoulders, pulling the top of the head up, while inhaling and exhaling in form of conscious breathing as follows: in the PI, a consciously controlled - directed inhalation (ONI) is carried out, which is an inhalation with the patient’s voluntary attention focused on the work of the intercostal muscles in a given respiratory zone of the lungs: on the side of the chest opposite the thoracic curvature arch, in this case, the doctor focuses the child’s attention on this given respiratory zone of the lungs in the area of its projection on the back surface of the chest, pressing on it with his hand; and when performing the exercise, exhale with resistance - through half-clenched lips, lasting 8 seconds, do 4 approaches of five inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds; 3) “Standing with supports”, which is an exercise that is performed from the IP: standing facing the wall bars, each hand wraps a hand around the vertical supports of the wall bars, which are located wider than the patient’s shoulders; in this case, the patient’s feet stand on the floor on the inside of the wall bars parallel to each other, the heels are under the hip joints, the legs are bent at the knee joints, the pelvis is turned posteriorly while maintaining the physiological lordosis of the lumbar spine, the position of the legs and pelvis is symmetrical; with the right hand raised, cover the vertical support of the wall bars at the top so that the right elbow and shoulder are at the same horizontal level, the right elbow is pressed against the vertical support of the wall bars; with the left hand, hold the vertical support of the wall bars higher so that the left elbow is at ear level, the patient tries to maintain a symmetrical position of the body and head between the vertical supports of the wall bars, in the PI, the ENV is carried out into a given respiratory zone of the lungs, and during exhalation with resistance, the following actions are simultaneously carried out: - press down with hands and elbows on the vertical supports of the wall bars, - shoulders do not lift, - the top of the head is pulled as high as possible, - stand stable - the stomach and ribs are pulled in; perform 4 approaches of 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds; 4) “Lying on the side with a chair”, which is an exercise that is performed from the IP: lying on the left side on the mat, the patient’s head is under the chair, the neck is between the legs of the chair, the right arm is bent at the shoulder and elbow joints, with the palm resting on top of the chair seat, resting against it, the left arm is extended along the longitudinal axis of the body under the chair between its legs, the patient’s left leg is bent, the right leg is straight, extended along the axis of the body, with the foot and ankle resting on a solid object placed under it with a height that ensures that the longitudinal axis of the right leg is parallel to the vertical axis of the patient’s torso, the patient's head lies on the left outstretched arm, carry out conscious breathing, for which purpose, in the PI, they carry out the NVB into the given respiratory zone of the lungs, and during exhalation with resistance, simultaneously: - the top of the head is pulled as high as possible, - the stomach and ribs are pulled in; - resting your right palm on the chair, pull your right elbow up and forward, - in this case, the torso, pelvis, right thigh and foot are kept in one line, and by the beginning of the next ONV, relax the right arm and shoulder, return to IP; perform 4 approaches of 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds; 5) “Sitting on the ball in front of the Swedish wall”, which is an exercise that corrects the thoracic spine through asymmetrical muscle work, this exercise is performed from the following corrective IP: sitting on a gymnastic ball-fitball facing the wall bars, the size of the ball is such that when sitting on it the patient’s pelvis is located above the level of his knees, the patient’s feet with the entire plantar surface are under the bottom crossbar of the wall bars, the knees touch bars of the Swedish wall located above the knees; the right hand is located on the crossbar at shoulder level, the left hand is on the crossbar, which is located at the level of the crown, elbows are straightened to the sides, shoulders are lowered, the patient turns the pelvis posteriorly, maintaining physiological lordosis and kyphosis of the spine; carry out conscious breathing, for which purpose, in a corrective PI, they perform an ER into a given respiratory zone of the lungs, and while exhaling with resistance, perform the following simultaneous actions: - with the right hand the patient pulls the bar towards himself, - with the left hand the patient pulls the bar towards himself and down, - tries to bring himself closer to the wall bars with his chest, - pulls the top of the head up as much as possible, while the chin line corresponds to the horizon line, - the patient springs on the ball with the maximum amplitude possible for him, his elbows are straightened to the sides, - the patient draws in the abdomen and ribs, perform 4 approaches of 8 inhalation-exhalation cycles in each approach, a rest pause between approaches is 30 seconds, during pauses the corrective IP is maintained; 6) “Lying on the side of the thoracic arch”, which is an exercise that is performed from the IP: the patient lies on the right side - on the side of the thoracic arch of curvature, a massage roller with a diameter is placed under the top of the arch, providing passive correction of the patient’s thoracic arch in the frontal plane, arms the patient is stretched upward, the head is between the arms, lies on the shoulder of the right hand, the right leg is bent at the knee and hip joint at 90 degrees, the right heel is in front of the knee of the left leg, the left leg is straight; at the same time, in the PI, an ENV is carried out into a given respiratory zone of the lungs, and during exhalation with resistance, the patient, grabbing the wrist of the left hand with his right hand, by pulling it up, along the longitudinal axis of the body, stretches the left side of the chest, drawing in the ribs and abdomen as much as possible , to the beginning of inhalation - return to IP; perform 4 approaches of 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds; 7) “Balance”, which is a stabilization exercise that is performed using a balancing board, the length and width of which is 2 cm greater than the corresponding dimensions of the patient’s foot, and which has on its lower surface a half-cylinder with a diameter of 2 cm rigidly fixed along the longitudinal axis of the board, that when the patient stands on the plank with one leg, it creates a balancing effect, while the second leg is pulled back by bending the knee joint 90 degrees; at the same time, they pull the top of the head up as much as possible, lower the shoulders, move the shoulder blades medially, pull in the stomach and ribs, hold the balancing position for as long as possible for the patient, then change the leg; during the exercise, perform 3 approaches for each leg, the patient breathes freely, rest pause between approaches is 10 seconds; 8) “Riding on a chair”, which is an exercise in which a chair with a flat back is used, IP - sitting “astride” on a chair, facing its back, the patient rests his forearms on the back of the chair, legs apart, placed in front of him, carry out conscious breathing, for which, in the PI, the patient performs an ERV into the given respiratory zone of the lungs, and during exhalation with resistance, the patient simultaneously performs the following actions: - drops shoulders - presses his forearms on the back of the chair, - pulls the top of the head up as much as possible, - strains the abdominal press, draws in the stomach and ribs, perform 4 approaches of 8 inhalation-exhalation cycles in each approach, rest pause between approaches - 30 seconds; 9) “Corrective gait”, which is an exercise that is performed from the IP: standing, legs together, the patient pulls the top of the head up, the chin line is along the horizon, the shoulders are lowered and turned back, the thumb of the lowered right hand is turned outward as much as possible, the palm is in this case, they are turned forward as much as possible, the stomach is tucked, they consciously try to maintain a straight posture, the movement begins with either leg, take a step forward and place the foot forward on the heel at a distance of 10 cm from the toes of the other leg - on the count of times, then move the stepped leg back, placing it on the toes at a distance of 10 cm from the heel of the second leg - on the count of two, then repeat the forward movement with the first foot on the heel - for a count of three, again repeat the movement of the same leg back onto the toes - for a count of four, then they put the first leg forward again and transfer their body weight to it, taking a full step - to the count of five, then similarly repeat the listed movements with the second leg, at the same time, conscious breathing is carried out, for which purpose, in the PI, an ER is performed into a given respiratory zone of the lungs, and when performing a step, exhale with resistance, perform 30 times, 5 counts for each leg; 10) “90 degree body lift press”, which is an exercise that is performed from the IP: lying on your back, legs raised and bent at the hip and knee joints 90 degrees, straight arms raised vertically above your head, the patient raises his head, shoulders and shoulder blades, pulls his arms up as he exhales; lowers his hands, returning to IP, breathing freely, in this case, first perform 3 approaches of 15 repetitions of the inhalation-exhalation cycle in each approach, rest pauses between approaches are 30 seconds, every day add 1 inhalation-exhalation cycle in each approach, increase to 30 inhalation-exhalation cycles in one approach and then continue in this mode; 11) “Press on the oblique abdominal muscles”, which is an exercise that is performed from the IP: lying on your back, legs, bent at the knees, raised so that the feet are 20 cm higher from the floor, arms bent at the elbows in front of you, hands - to the ears, the head and shoulders are raised 20 cm from the floor, the patient, holding himself in this position, then touches the left knee with his right elbow, while straightening his right leg at the knee, maintaining a flexion angle of 45 degrees in the right hip joint, then touches with his left elbow right knee, changing the position mirror the previous one, breathing freely, first perform 3 sets of 20 inhalation-exhalation cycles in each approach, rest pauses between approaches - 30 seconds, every day add 1 inhalation-exhalation cycle in each approach, increasing the total number of cycles inhale-exhale up to 30 in one approach and then continue in this mode; 12) “Correct squats”, which is an exercise that is performed from IP: standing in front of a mirror, legs wider than shoulders, with a gymnastic stick, fix the thoracic spine as symmetrically as possible - placing the stick horizontally on the shoulders, holding it with a back grip of both hands located wider than the shoulders , from the IP, do a squat until the pelvis drops to the level of the knees, so that the thigh is parallel to the floor, support is on the entire foot, without lifting the heels from the floor, while maintaining the physiological curves of the spine, during the squat they take a normal breath, while lifting - normal exhalation start with 3 approaches of 15 inhalation-exhalation cycles in each approach, daily increasing the inhalation-exhalation cycle by 1 cycle in each approach, bringing the total number of inhalation-exhalation cycles to 30 in each approach and then continue in this mode, rest pause between approaches - 30 sec; 13) “Classic plank”, which is an exercise that is performed from IP supports on the toes and elbows, which are placed under the patient’s shoulder joints, and forearms, which are extended forward along the horizontal surface of the support, the patient holds the torso in this position: - maintains natural lumbar lordosis, - keeps the pelvis level, without lowering the right side, - pulls the top of the head as far as possible along the longitudinal axis of the body, does not throw back or lower the head, maintaining its middle position, start with one approach, while the duration of the approach is until the patient can hold the plank position as much as possible, then add 1 approach daily, bringing up to 4 approaches and then continue in this mode, rest pause between approaches - 30 seconds, breathing freely; 14) “Balance on the knees on a ball”, which is an exercise during which the patient maintains balance on a gymnastic ball-fitball; the exercise consists of three stages: - first, the patient holds the wall bars with his hands and kneels on the ball, which he is trying to hold on to, - then tries to stay on the ball, releasing his hands from the wall bars, - without the help of a wall bars, climbs onto the ball with his knees and stays on it, perform 3 approaches with the sequential implementation of three stages of the exercise against the background of conscious breathing - ONB and exhalation with resistance - at a pace comfortable for the patient, a rest pause between approaches - 30 seconds; 15) “Final wall bars” - the exercise is performed as a repetition of the first exercise of the complex.