RU2815143C1 - Method for increasing hip joint mobility in coxarthrosis in elderly patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to means of physiotherapy exercises, the integrated use of which will make it possible to slow down the progress of the disease, thereby avoiding or delaying hip replacement in deforming arthrosis in elderly patients. Invention can be used in medical institutions, in health resorts, as well as at home for restoring mobility of hip joints. Performing physical exercises in the form of exercises conducted independently for 16 weeks, including: sessions 3 times a week on week days, in which each session includes three consecutive complexes, performed in different initial positions, wherein the first is a set of exercises for stretching deep muscles of the spine, second is a set of exercises for increasing mobility and range of motion of hip joints, the third is a set of pelvic and gait correction exercises, exercises conducted daily 1 hour before bedtime in the form of only one set of exercises for stretching the deep muscles of the spine, as well as exercises conducted on days when three consecutive complexes are not performed, after morning awakening in the form of walking on all fours for 10 minutes.

EFFECT: method provides increased mobility and range of mobility of hip joint, as well as statodynamic function of the extremity as a whole, which will help to slow down the development of the disease and avoid or delay the surgical intervention.

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Description

The invention relates to medicine, in particular, to means of therapeutic physical education (PT), the integrated use of which will slow down the progression of the disease, thereby avoiding or delaying hip arthroplasty (HJ) for deforming arthrosis in the elderly. Can be used in medical institutions, sanatoriums and resorts, as well as at home to restore mobility of the hip joints.

Deforming arthrosis of the hip joint (coxarthrosis) is a chronic pathology accompanied by gradual destruction of the cartilage tissue of the affected area, starting gradually with microscopic changes in the structure of the cartilage. Increased load, inflammatory diseases, and impaired blood supply lead to depletion of cartilage tissue, which, in turn, deforms the contours of the articular site. As a result, the distribution of load on the contacting surfaces of the tissues changes, and areas with maximum pressure begin to wear out faster. Regardless of the cause of development, the extreme degree of manifestation of deforming arthrosis of the hip joint is aseptic necrosis, followed by osteoporosis of the femoral neck and the risk of its fracture when falling from one’s own height and, as a consequence, ETS.

People aged 45-55 years are most at risk of developing coxarthrosis, while the incidence increases significantly with age, which is statistically confirmed. If the age group of 46-55 years old accounts for 25% of patients with coxarthrosis, then 70-76 year olds account for 75% of those observed in clinics and surgical hospitals according to the average annual regional indicators of the Russian Federation (Epidemiological assessment of the prevalence of coxarthrosis according to reports from medical organizations. Koryak V. A., Botvinkin A.D., Sorokovikov V.A. ACTA Biomedica SCIENTIFICA, 2022, Vol. 7, No. 2)

Consequently, in the elderly age group (60-74 years), the prevalence of the disease is not only quite high, but also has more severe forms. And given the low birth rate and increasing life expectancy, the number of people of working age will steadily decrease, and the proportion of elderly people will increase. According to UN estimates, between 2000 and 2050 the absolute number of people aged 60 years and over will increase from 605 million to 2 billion (https://www.un.org/en/global-issues/ageing). As a result of the global aging of the population, an increase in the number of diseases and ETS surgical interventions is expected, which, in turn, will lead to increased public health costs for treatment, high-tech hip replacement surgeries, and care for the sick.

This is one of the main arguments in favor of developing and implementing a method for increasing the mobility and range of motion of the hip joint in coxarthrosis in elderly people, which allows slowing down the progression of the disease, avoiding or delaying ETS.

On average, about 124,000 joint replacement operations are performed in adult patients per year in the Russian Federation, including about 70,000 ETS operations. Of these, 73.4% of joint replacement operations are performed on persons over working age, for whom the percentage of ETS operations is 52.7% (Federal State Statistics Service/Official Statistics/Population. Official website http:rosstat.gov.ru/search) .

Despite the increasing number of ETS operations every year, which make it possible to relieve pain, correct limb length, and increase range of motion, the postoperative period does not always pass without complications in the elderly, which is associated with a combination of damage to other organs and systems that complicate the treatment of this group. All this is aggravated by a decrease in motor activity and a deliberate limitation of loads on the diseased joint/joints, as a result of which even surgical intervention does not solve the problems of the diseased joint, since patients in the postoperative period will not be able to perform the required amount of physical activity to ensure complete restoration of the motor functions of the operated joint due to for lack of physical fitness and motor skills. For these reasons, 70% of patients after ETS need repeat surgery in the first year (The Truth about the Hip Joint. Life without Pain. Eksmo, Moscow, 2011, p. 187).

Moreover, the number of working pensioners as of October 1, 2022 in Russia amounted to 8.1 million people, which means that a fairly large number of elderly people are ready and able to continue their working activities, and therefore they urgently need recommendations to maintain your health in shape, despite the fact that coxarthrosis ranks first in terms of temporary and permanent disability and accounts for more than 50% of the total number of endoprosthetics in Russia in the elderly.

Thus, the proposed method can also be used as preoperative preparation if surgery is unavoidable.

There are known methods for the rehabilitation of patients with coxarthrosis, which are based on inertial movements [patent RU 2186556, A61N 1/00, publ. 08/10/2002. Bull. 34; patent RU 2708451, A61N 1/00, publ. 06.12.2022. Bull. 34; patent RU 2725088, A61N 1/00, publ. 06/29/2020. Bulletin 19]. Having different physical exercises in their arsenal, they are similar in the way they are performed. The first method uses moderately sharp, high-quality jerking movements of the torso and hips to the possible limits of mobility of the hip joints until moderate pain is felt in them. The second method uses movements based on articulatory techniques in osteopathy and manual therapy, allowing the joint to be brought to the barrier of its movement without the need to perform amplitude movements in the position of the joint where there are no restrictions. The third method used multi-vector movements in the frontal plane for the purpose of vertical decompression of the links in the kinematic chains of the musculoskeletal system, helping to maintain the body in an anatomical position and increase the range of motion in the hip and shoulder joints due to elastic bands of varying degrees of elasticity.

The disadvantages of these methods are jerking movements up to the anatomical barrier, which is contraindicated for elderly people, taking into account age-related osteoporosis. Also, when selecting exercises, the need to use all anatomically possible movements characteristic of the hip joint (flexion-extension, abduction-adduction, outward-inward rotation, circular movements) is not taken into account. The methods are intended for a younger age category with early signs of coxarthrosis.

There are known methods for differentiated administration of therapeutic exercises to the hip joint area, taking into account the patient’s pain [RU 2234301, A61N 1/00, publ. 08/20/2004. Bull. No. 23; patent RU 2286124, A61N 1/00, publ. 10/27/2006. Bull. No. 30; patent RU 2358676, A61N 1/00, publ. 06/20/2009. Bull. No. 17]. The methods are intended more to relieve pain rather than to restore the motor function of the joint, since the list of exercises does not include all anatomically possible movements of the hip joint, and attention is paid only to the limb being rehabilitated.

A known method [patent UA 90674, A61H, publ. 06/10/2014. Bull. No. 11], which is based on the restoration of the functions of the musculoskeletal system, including the hip joint, using basic and multifunctional exercise equipment, kinesiotherapy massage, contrast of heat and cold, and protein nutrition.

There is a known method for complex treatment of joints of the lower extremities [patent RU 2547608, A61N 1/00, publ. 04/10/2015. Bull. 10], aimed at the treatment of deforming arthrosis through kinesiotherapy using simulators that have a plane with a sciatic support, allowing the pelvis to be fixed on it at the level of the gluteal fold with a belt with the inclusion of hinges with the possibility of combining the axes of rotation with the axes of rotation of the joint, that is, with all anatomical possibilities joints of the lower extremities.

Most clinics do not have such an arsenal of simulators, which require specially trained personnel to operate them.

Therefore, despite the high efficiency of these methods, their use is extremely limited.

There is a known method for complex treatment of joints of the lower extremities [RU 2281746, A61N 1/00, publ. 08/20/2006. Bull. No. 23], which consists of kinesiotherapy with weights: walking in weighted shoes and a weighted belt or vest, the weight of which is from 10 to 20 kg, after pain relief.

The disadvantages of this method are the limited number of patients. Those with spinal problems, as well as signs of osteoporosis, which is typical for older people, are contraindicated in walking with such weights, and additional equipment is also required. The proposed method will undoubtedly strengthen the muscles of the lower extremities, but will not provide the necessary load to the ligaments and the joint separately, and will not be able to increase the range of motion specifically in the hip joint, limiting itself to stretching in the joint due to additional weight.

And a common drawback of the above patents is the lack of corrective measures associated with pelvic distortion and shortening of the lower limb, characteristic of coxarthrosis, which will not restore or improve the biomechanics of walking.

There is a known method for rehabilitation of the functions of the musculoskeletal system in the treatment of diseases of the spine and joints of the lower extremities [WO 2019054976, A61H 1/00, publ. 03/21/2019], which is based on the restoration of the biomechanics of walking due to the correct placement of the foot using a device for stretching the muscles and tendons of the posterior surface of the lower extremities, feet and ankle joint, which improve the mobility of the hip joint by stretching the muscles of the posterior surface and hamstring.

Just as in the previous method, it is possible to strengthen the muscles of the lower extremities and improve the mobility of the hip joint (flexion-extension), but not in all anatomically possible movements in the said joint. The method requires additional equipment, which is not always available, as well as a specialist working with the device to restore the biomechanics of walking.

All of the above inventions, patented as methods of physical rehabilitation, are intended mainly for post-traumatic rehabilitation of the hip joint, prevention and treatment of the musculoskeletal system, including coxarthrosis in the early stages of the development of the disease. Elderly people are characterized by a higher degree of development of coxarthrosis, often affecting both joints.

It should be noted that, despite the difference in the means used, all the methods considered determine the need to include general developmental exercises on the muscles and ligaments of the spine as a warm-up in the process of restoring joint mobility. This is not entirely legal. Coxarthrosis is always accompanied by osteochondrosis of the lumbar spine, problems with which begin much earlier than with the hip joint. It is in the muscles of the lumbar region, where the nerve pathways innervated from the L3 segment leading to the hip joints pass, that spasms occur, disrupting the innervation and reducing blood supply, and, consequently, nutrition of the joint. Therefore, as a warm-up before doing therapeutic exercises, it is more advisable to use not general developmental exercises, but exercises to stretch the muscles and ligaments of the spine, including the lumbar region, which allows you to relieve muscle spasms, which increases significantly with age in inactive people.

There are two muscle groups in the human body. The first group, the tonic muscles (deep) are constantly in tension. Even when a person is sleeping, they are closely connected with the midline structures of the brain and the old cortex, which are responsible for the autonomic neuroendocrine and emotional functions of the human body. In modern man, the deep muscles are constantly in a state of pathologically increased tonic tension.

The second group, phasic muscles, are responsible for the instantaneous application of force. In modern humans, they are pathologically weakened, as a result of which they reduce the force of their contraction, acquire dystrophic signs - the nutrition of the vertebrae and intervertebral discs, carried out by the deep intervertebral discs, inside which blood vessels pass, is disrupted. Causes may include muscle injuries, weakening (hypotrophy) of muscles, or sitting for long periods of time (postural stress). And in elderly people, who are generally hypodynamic, “protecting” sore joints and not loading them, the hypotrophy of this muscle group is especially pronounced. Accordingly, these muscles need to be strengthened, but without relaxing the first muscle group, the work of the second muscle group will not be effective.

In addition, an increase in tonic tension may occur, accompanied by a high density of muscle fibers, straightening the curves of the spine.

As the disease progresses (grade 2, 3), joint mobility changes. In addition to the limitations of internal rotation (circular rotation) and abduction, dysfunctions of extension-flexion and external rotation of the hip are added. Simultaneously with the limitation of joint function, contracture of the adductor muscles develops (limitation of passive movements), rotating the thigh outward and flexing the thigh inward, and the abductor and extension muscles of the thigh become hypotrophied. That is why it is necessary to carry out rehabilitation in a gentle manner, but in all anatomically possible movements in the hip joint, taking into account the volume of the affected joints (unilateral or bilateral coxarthrosis).

As a result of an uneven load on the muscles, a tilt of the pelvis occurs and an increase in lumbar lordosis, which, in turn, leads to overstretching and hypotrophy of the abdominal muscles, which also must be taken into account when drawing up sets of exercises. In this case, in a standing position, the leg on the side of the diseased joint is shortened (with unilateral coxarthrosis) and when leaning on the foot, there is a tilt to the diseased side with a shift of the pelvis, walking is carried out with a limp on the “sick” side. When two joints are affected, the bend in a standing position is towards the joint with the greatest damage, and walking resembles a “duck walk”, in which the patient shifts from one foot to another. And if with 2, 2-3 degrees of coxarthrosis, muscular compensation is possible due to a healthy joint, then with 3 degrees, as a rule, a violation of the biomechanics of correct gait leads not only to increased pain, but also to the aesthetic problem of the patient’s perception by others.

All of the above necessitates correction of both the pelvis and gait after performing the main load on the hip joints.

The given justifications for the use of complexes, taking into account age-related changes and progression of the disease, make the proposed invention original.

Thus, the claimed invention has no analogues and represents a unified program for physical rehabilitation of elderly people with coxarthrosis, consisting of sets of exercises aimed at relieving tension from the deep muscles of the spine, increasing the mobility of the hip joints, taking into account their anatomically possible movements, correction of the pelvis and gait .

The task to which the claimed invention is aimed is to create an optimal program that includes exercises that increase the mobility and range of motion of the hip joints in elderly people, depending on the degree of development of the disease.

The technical result of the invention is to increase the mobility and range of motion of the hip joint, as well as the static-dynamic function of the limb as a whole, which will help slow the progression of the disease and delay surgical intervention. At the same time, increasing independence in everyday life, reduction or absence of pain syndrome will allow for social, everyday and professional recovery, and therefore quality of life. Changing the retirement age upward makes solving these problems for older people especially relevant.

The technical result is achieved due to the fact that in the method of increasing the mobility of the hip joint with coxarthrosis in elderly people, physical exercises are performed in the form of classes carried out independently for 16 weeks, including:

classes 3 times a week on weekdays every other day, in which each lesson includes three consecutive complexes performed in different starting positions, while the first is a set of exercises for stretching the deep muscles of the spine (complex No. 1), the second is a complex exercises to increase mobility and range of motion of the hip joints (complex No. 2), the third is a set of exercises to correct the pelvis and gait (complex No. 3);

exercises performed daily 1 hour before bedtime in the form of only one set of exercises to stretch the deep muscles of the spine, as well as;

classes carried out on days when three consecutive complexes are not performed, after waking up in the morning in the form of walking on all fours for 10 minutes.

To ensure the effectiveness of rehabilitation measures, classes were conducted four times per course in small groups (3-5 people) under the guidance of a physical therapy instructor.

The first lesson was held before the start of the course and included analysis and explanation of the technique of performing exercises offered to patients for independent practice, as well as the issuance of methodological recommendations with photographs for each set of exercises.

The second, third, and fourth sessions were conducted after the 12th, 24th and 36th sessions, completed independently by the patients, in order to monitor the correct implementation of the proposed program.

The method is performed as follows.

A method of increasing the mobility of the hip joint with coxarthrosis in the elderly is implemented over 16 weeks by patients independently at home: in the form of classes conducted every other day on weekdays, and including three sequential sets of exercises: a set of exercises for stretching the deep muscles of the spine, a set of exercises to increase the mobility of the hip joints and a set of exercises to correct the pelvis and gait; daily exercises performed one hour before bedtime in the form of a set of exercises to stretch the deep muscles of the spine; and classes carried out on days when there are no classes, including three consecutive sets of exercises, and performed in the morning in the form of walking on all fours for 10 minutes.

Previously, all patients in small groups (3-5 people) before the start of the rehabilitation period, under the guidance of an exercise therapy instructor, received the necessary recommendations on the technique of performing exercises, both practical and theoretical (patients were given methodological recommendations for all used complexes with photographs of exercises) .

The first set of exercises for stretching the deep muscles of the spine, which allows you to relieve muscle tension, consists of ten consecutive exercises (exercises 1-5 - starting position “standing on all fours”, exercises 6-10 - starting position “lying on your back”), repeated 10 once each, without rest breaks between exercises. As part of a complex lesson, every other day it is performed in a dynamic mode, at a slow pace (one movement for 4 counts) [Rubtsov A.T. Health groups, FIS, Moscow, p. 32], while exhalation is performed when performing the movement, and inhalation is performed when returning to the starting position.

As a separate complex, every day, 1 hour before bedtime, each exercise is performed in a static mode for 30 seconds with voluntary breathing without pauses for rest between exercises, but when returning to the starting position, relaxation is necessary. Alternating muscle tension and relaxation, as well as slow static stretching, removes muscle spasms, increases the height of the intervertebral discs, eliminating or reducing pressure on the roots of the intervertebral discs, increases blood circulation, which allows you to relieve muscle tension in the spine that has accumulated during the day, and reduce or remove pain. , which is extremely necessary to maintain positive emotions from exercise in patients.

Throughout the entire rehabilitation course, the first set of exercises to stretch the deep muscles of the spine is performed twice, both in each lesson held three times a week every other day on weekdays, and daily one hour before bedtime, and includes performing 10 (ten) exercises , in which:

- in the first exercise, standing on all fours, stretch their hand forward, sliding their palm along the support, while simultaneously pulling their opposite leg back, sliding their toes along the support, then return to the starting position and repeat the exercise, changing the position of the arm and leg, then return to the starting position;

- in the second exercise, standing on all fours, lower the pelvis onto the heels, stretching the arms forward, sliding along the support and tilting the head to the elbows, then return to the starting position;

- in the third exercise, standing on all fours, bend your arms at the elbows, touching the support with your chest and stretching your chin forward, then return to the starting position;

- in the fourth exercise, standing on all fours, pull the leg bent at the knee towards the chest of the same name, lifting the foot off the floor and tilting the head, touching the cervical fossa with the chin, then return to the starting position and repeat with the other leg, then return to the starting position;

- in the fifth exercise, standing on all fours, bend the lower back, lifting the chin up, then return to the starting position, then, slouching, tilt the head down, touching the cervical fossa with the chin, then return to the starting position;

- in the sixth exercise, they turn over onto their back, bending their knees with their support on the floor, arms along the body with palms down, then pull the bent knee to the chest while simultaneously stretching the arm of the same name forward in weight, parallel to the floor, and tilting the chin to the cervical fossa , then return to the starting position, then repeat the exercise by changing the position of the legs and arms, then return to the starting position;

- in the seventh exercise, lying on your back, bend your knees with your hands on the floor and your hands at your shoulders, stretch your arms forward to your knees, raising your shoulders off the floor and tilting your chin to the cervical fossa, then return to the starting position;

- in the eighth exercise, lying on your back, bending your knees with support on the floor, hands in the “lock” on the back of your head, at the same time lift your shoulder blades off the floor and pull your leg bent at the knee to your chest, then return to the starting position, then repeat exercise with the other leg, then return to the starting position;

- in the ninth exercise, lying on your back, bending your knees and resting on the floor, arms along your body, palms down, lift your pelvis as high as possible, squeezing your buttocks, then return to the starting position;

- in the tenth exercise, lying on your back, bend your knees with support on the floor, arms along the body with palms down, raise the pelvis while raising the leg bent at the knee to the chest, then return to the starting position, then repeat the exercise with the other leg, then return to their original position.

Changing the starting positions in a complex to relax the deep muscles of the spine is due to the following reasons:

- opposite and identical stretches in the initial position “standing on all fours”, the muscles of the upper and lower extremities are activated, they direct blood flow from the lower back, where painful stagnation occurs, to the muscles of the arms and legs, which perform a drainage function, relieving internal swelling (inflammation) of the deep muscles , thereby reducing pain;

- longitudinal stretching in the initial position “lying on your back” with different positions of the arms and legs on the same side or both sides at the same time allows you not only to “gently” stretch the muscles of the entire spine, but also to use the abdominal muscles in a gentle manner;

- stretching in the initial position “lying on your back” with lifting of the pelvis allows you to engage the muscles of the lumbosacral spine, as well as the gluteal muscles, improving drainage function, which helps to effectively work with pain in the lower back, and in combination with exercises without lifting the pelvis, it ensures the work of antagonist muscles (that is, the muscles of the opposite side), allowing you to perform a large number of movements and the therapeutic effect is achieved faster.

The almost horizontal position of the spine allows for a gentle load, as it eliminates axial pressure on the vertebrae, ensuring relaxation of deep muscles and relieving tension, and therefore removing or reducing pain.

The second set of exercises to increase mobility and range of motion of the hip joints is performed for patients with unilateral and bilateral coxarthrosis in the subacute period and the period of remission. It helps to increase the mobility of the hip joints, and just like the first complex, it is performed on weekdays every other day, and includes 20 sequential exercises, in which:

for unilateral coxarthrosis, exercises from the first to the sixth are performed in the starting positions: “standing with support”, while:

- during the first exercise, standing with your side to the support, the healthy leg on a hill, the patient hanging down, swing the straight leg forward, toe “away from you”, back - toe “towards you”, then return to the starting position;

- in the second exercise, stand sideways to the support, the healthy leg is on a hill, the sick leg hangs down, perform swings with a straight leg to the side-up, outward, toe “away”, cross in front of the healthy leg, side-up, outward, cross behind the healthy leg, then return to the starting position;

- during the third exercise, stand sideways to the support, the healthy leg is on a hill, the sick leg hangs down, shake the leg, relax, one-time, 30 seconds;

- in the fourth exercise, stand sideways to the support, the healthy leg is on a hill, the patient is hanging down, raise the leg bent at the knee above the hip joint, toe “away”, the torso is not tilted, then return to the starting position;

- in the fifth exercise, stand sideways to the support, the healthy leg is on a hill, the patient hangs down, raise the leg bent at the knee to the level of the hip joint, then take it to the side and bring it to the front position, inhale, then return to the starting position ;

- in the sixth exercise, standing sideways to the support, healthy leg on a hill, the sick leg hanging down, shake the leg, relax, one-time, 30 seconds;

for bilateral coxarthrosis, from the first to the sixth exercises, instead of the initial position “standing in support”, use the initial position “kneeling with support on a chair”, implemented as follows:

- stand facing the seat of the chair;

- lean your elbows with your palms on the seat of the chair, fingers forward;

- lean alternately on your forearms;

- kneel down, bending them one by one;

- standing at shoulder width;

- tilt your torso 45 degrees to the seat, you can lean your head on the back of the chair, thereby relieving your knees, while:

- in the first exercise, from the starting position, swing the leg bent at the knee, back and forth, with the foot suspended, then return to the starting position, and repeat the exercise with the other leg, then return to the starting position;

- in the second exercise, from the starting position, perform a swing with the leg bent at the knee outward and inward, the foot in weight, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the third exercise, from the starting position, perform a swing with the leg bent at the knee back, the heel close to the buttock, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the fourth exercise, from the starting position, straighten the leg at the knee joint and move it back onto the toe, then return to the starting position, and after that repeat the exercise with the other leg, then return to the starting position;

- in the fifth exercise, from the starting position, the leg bent at the knee is taken to the side, trying to place the heel at the level of the hip joint, while the shin is turned to the thigh by 90 degrees, then they return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the sixth exercise, from the starting position, perform circular rotations with the leg bent at the knee to the outside, the foot in weight, while the lower leg is turned to the thigh at 90 degrees, then return to the starting position, then repeat the exercise with the other leg, then return to initial position.

Next, exercises seven through eleven are performed in the starting position “lying on the stomach,” both for unilateral coxarthrosis, in which each exercise is started from the healthy leg, and for bilateral coxarthrosis, in which each exercise is started from the side of the least damaged joint, with voluntary breathing, wherein:

- in the seventh exercise, lying on your stomach, legs together, chin on the back of your hands, arms bent at the elbows, bend your leg at the knee 90°, lift it up without straightening the knee, then return to the starting position, then repeat with the other leg, perform the exercise the same number of times on each leg;

- in the eighth exercise, lying on your stomach, legs bent at the knees at 90°, chin on the back of the palms, arms bent at the elbows, alternately lifting the hips up without straightening the knees, after which they return to the starting position;

- in the ninth exercise, lying on your stomach, legs together, chin on the back of your hands, arms bent at the elbows, move your leg to the side, then return to the starting position, then repeat the exercise with the other leg, perform the exercise the same number of times on each leg;

- in the tenth exercise, lying on the stomach, the healthy leg is bent at the knee at 90°, the chin is on the back of the palms, the arms are bent at the elbows, the healthy leg is taken to the side without straightening the knee, sliding along the surface, inhale, return to starting position, then repeat the exercise with the other leg, the exercise is performed the same number of times on each leg;

- in the eleventh exercise, lying on the stomach, legs together, chin on the back of the palms, arms bent at the elbows, bend the leg at the knee joint, sliding along the surface and lifting it above the hip joint (crawling “on the hips”), trying to do the iliac spine bring it closer to the surface, then return to the starting position, then repeat the exercise with the other leg, the exercise is performed the same number of times on each leg.

Next, perform exercises from the twelfth to the twentieth exercise - “lying on your back”, with voluntary breathing, while:

- in the twelfth exercise, lying on your back, legs together, arms along the body, imitate the movements of a cyclist, stopping with your legs after each circle, then returning to the starting position;

- in the thirteenth exercise, lying on your back, legs together, arms along the body, move with the help of your hands to a sitting position, leaning on the surface, then return to the starting position with the help of your hands, leaning on the surface, then return to the starting position;

- in the fourteenth exercise, lying on your back, with unilateral coxarthrosis, the healthy leg is bent at the knee, the foot is supported, the heel of the sore leg lies on the knee of the leg, abduct the thigh by pressing on the knee with the same hand, then return to the starting position, with bilateral coxarthrosis, begin the exercise on the side of the most damaged joint, support on the less damaged limb;

- in the fifteenth exercise, lying on your back, legs together, arms to the sides, palms up, swinging your arms forward, transfer your torso to a sitting position, then return to the starting position, while trying to carefully place your torso on the surface;

- in the sixteenth exercise, lying on your back, legs together, arms along the body, perform alternating circular rotations with a straight leg in the hip joint, toe “away”, in one direction 4 times and in the other direction 4 times, after which they return to the starting position;

- in the seventeenth exercise, lying on your side on the side of the healthy leg with unilateral coxarthrosis, or the least affected leg with bilateral coxarthrosis, one arm bent at the elbow under the head, the other supported in front of the chest, with the back, pelvis, and legs forming a straight line , raise the leg up with a static delay in the extreme position, 5 seconds, then return to the starting position, and if it is impossible to perform the exercise in the starting position on the side on the side of the more affected joint, place a soft pillow or perform the exercise on only one side;

- in the eighteenth exercise, lying on your side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, while the back, pelvis, legs form a straight line, perform a springy lift of the leg up with an average amplitude, then return to the starting position, and if it is impossible to perform the exercise in the original position on the side on the side of the more affected joint, place a soft pillow or perform the exercise only on one side;

- in the nineteenth exercise, lying on your side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, while the back, pelvis, legs form a straight line, move the leg forward, the toe “towards you” weight, then return to the starting position, move the leg back, toe “towards you” on the weight, then return to the starting position, and if it is impossible to perform the exercise in the starting position on the side of the more affected joint, place a soft pillow or perform it only on one side;

- in the twentieth exercise, lying on the side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, perform springy swings of the leg back and forth with an amplitude possible for each, toe “pull away”, then return to the starting position, and if it is impossible to perform the exercise in the starting position on the side on the side of the more affected joint, place a soft pillow or perform the exercise on only one side.

Having finished performing the complex, take the starting position “lying on your back” and perform 2-3 voluntary exercises to restore breathing 4 times.

The repetition and mode of performing each of the exercises of the second complex changes as follows:

on the 1st week - perform 10 repetitions with pauses for rest between exercises;

in the 2nd week - perform 10 repetitions without pauses for rest between exercises.

Next, the first lesson of each week, starting from the 3rd week, the number of repetitions of each exercise is increased by 2, reaching 30 repetitions by the end of the course. Since the essence of training exercises for restoring joint mobility is reusable, regularly repeated and gradually increasing physical activity that improves motor activity and promotes the return of performance [Kochetkov A.V., Kochuneva O.Ya. Kinesitherapy of patients after hip replacement. Toolkit. FMBA of Russia. Federal State Budgetary Institution TsKBVL FMBA of Russia, Moscow, 2013; S. Bubnovsky. You can't stop living for a long time. Moscow, Eksmo, 2023, p. 28].

As a support for the arm in case of unilateral coxarthrosis in the initial “standing” position, you can use: a gymnastic wall, the back of a chair, or a staircase railing.

The healthy leg should be on a height of 10-15 cm (stair step, step platform, stack of A4 books, etc.).

With a violation of the functional mobility of the hip joint, as deforming arthrosis develops, shortening of the lower limb occurs on the side of the diseased joint. Therefore, when performing swing movements necessary for joint warm-up, a height of up to 15 cm is used under the healthy leg without support on the patient.

In patients with bilateral coxarthrosis, this is not possible, therefore, in a lightweight initial position of “kneeling with the support of your hands in the seat of a chair,” “swings” are used, the nature of the movements reminiscent of “swings” with a small amplitude.

In addition, you need to remember the “healthy leg rule” when performing exercises of both the first and second complexes. This will allow muscle memory to quickly restore the correct pattern of movement of the diseased joint using the example of a healthy one. If both joints are affected, the exercise should begin on the side with the least severity of the disease. The same degree of damage to the joints practically does not occur, since diseases of the second joint begin much later and are caused by excessive stress due to the preservation of the diseased joint, while the limb with the greatest degree of disease is always shorter.

The third set of exercises for correcting the pelvis and gait is carried out in the same way as the first and second sets of exercises on weekdays every other day, and includes 14 sequential exercises, the first 10 exercises of which are performed in a dynamic mode at a slow pace with a gradual increase in the number of repetitions in the original position “lying on your stomach”, “lying on your back”, the following 4 exercises are performed in the form of walking, while:

- during the first exercise, lying on your stomach, palms bent at the elbows under the chin, feet to relax the legs on a soft pillow, straighten the knee, stretching the toe forward along the floor, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the second exercise, lying on the stomach, palms of the arms bent at the elbows under the chin, feet to relax the legs on a soft pillow, bend the leg at the knee and slide it along the floor, lift it above the level of the hip joint, without moving the elbows, then return to the starting position, after this, repeat the exercise with the other leg, then return to the starting position;

- in the third exercise, lying on the stomach, the palms of the arms bent at the elbows under the chin, the feet to relax the legs on a soft pillow, bend one leg at the knee joint, the shin is turned to the thigh at 90 degrees, raise the knee and place it on the outside of the knee of the other leg, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the fourth exercise, lying on the stomach, the palms of the arms bent at the elbows under the chin, the feet to relax the legs on a soft pillow, lift the leg and bring it behind the other, touching the heel to the floor, lifting the pelvis from the same side outward, while the elbows do not shift, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the fifth exercise, lying on the stomach, the palms of the arms bent at the elbows under the chin, the feet to relax the legs on a soft pillow, roll on the stomach in one direction or the other, while swaying the hips, but without lifting them off the floor, then return to the starting position, when This exercise is performed alternately in each direction with the same number of times;

- in the sixth exercise, turn over onto your back, arms along the body, legs together, a soft pillow under the knees to relax the legs, bend one leg at the knee, placing the foot on the floor so that the toes are at the level of the knee of the other leg, swing the leg up without force - down, without changing the position of the pelvis, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position;

- in the seventh exercise, lying on your back, arms along the body, legs together, to relax the legs, a soft pillow under the knees, bend one leg at the knee with support on the floor, place the other with the foot on it, while resting the base of the palm of the same raised leg on the knee of the same legs, pressing on the knee, straightening the elbow, then return to the starting position, after which they repeat the exercise with the other leg, in addition, in the third week the exercise is complicated, and instead of resting the base of the palm on the knee, they clasp the thigh of the supporting leg in a “lock” and pull it towards chest, then return to the starting position, then repeat the exercise with changing the position of the arms and legs, then return to the starting position;

- in the eighth exercise, lie on your back, arms along the body, legs together, to relax the legs, a soft pillow under the knees, bend one leg at the knee with support on the floor, place the other with the foot on it, raise the pelvis, trying to pull the knee of the raised leg down to the floor , return to the starting position, then repeat the exercise in the other direction, then return to the starting position;

- in the ninth exercise, lying on your back, arms along the body, legs together, a small pillow under the knees to relax the legs, stretch the heel of one leg along the floor without lifting it, then return to the starting position, perform the exercise asymmetrically 10 times, without changing body position, in which case the exercise is performed only with the sore leg or the one with a greater degree of joint damage;

- in the tenth exercise, lying on your back, arms along your body, legs together, a soft pillow under your feet to relax your legs, stretch with the sore leg, the toe “away from you”, and the healthy sock “towards you”, then return to the starting position, the exercise is performed asymmetrically 10 times, without changing the position of the body, the exercise is repeated without changing the position of the feet according to the principle of the previous position, and with bilateral coxarthrosis, the toe is done towards oneself with the foot with the least damage to the joint.

- in the eleventh exercise, they perform walking in the form of a “herringbone” exercise, in which they walk along a drawn line, in the direction of movement, where the feet are placed at 45 degrees, one after another (the line between the feet) while maintaining the direction of the feet, perform the exercise in 20 steps with returning to the starting point by regular walking three times, the pace and breathing are arbitrary;

- on the twelfth exercise, they perform walking in the form of a “clown step” exercise, in which they walk from the position of the heels together, toes far to the sides, maintaining the direction of the feet (the line between the feet), perform the exercise in 20 steps, returning to the starting point with regular walking three times , the pace and breathing are arbitrary;

- in the thirteenth exercise, they walk along drawn marks (transverse to the course of movement), equal to the step length plus 5 cm, with the foot placed in the middle on the mark, pulling the toe of the foot from the side of the affected or most affected joint “away from you” (step length https:/ /wpcal.com); for men Height (cm) * 0.413; for women Height (cm) * 0.415), perform an exercise of 20 steps with a return to the starting point with normal walking three times, the pace and breathing are arbitrary;

- in the fourteenth exercise, they walk between two drawn lines of 35 cm, trying not to go beyond their boundaries, perform the exercise in 20 steps, returning to the starting point with regular walking three times, the pace and breathing are arbitrary.

When performing the third set of exercises, which is aimed at correcting the lower extremities, pelvis, gait, exhalation is performed when performing the movement, and inhalation is performed when returning to the starting position; in addition, exercises are performed as in dynamic mode at a slow pace with a gradual increase in the number of repetitions in the next order:

in the 1st week - 10 repetitions, with pauses for rest between exercises, which must be started with the “healthy” leg, with 4 repetitions on the “healthy” leg, and in exercises from the first to the eighth - 6 repetitions on the sore leg;

in the 2nd week - 10 repetitions without pauses for rest between exercises, 4 repetitions on the healthy leg, and 6 repetitions on the sore leg, and in case of bilateral coxarthrosis, exercises from the first to the eighth (except the fifth) are performed on the leg with the least damage joint, with a large one - 6 repetitions.

Then the first lesson of every second week, starting from the third week, the number of repetitions of the exercise increases for each limb one repetition, reaching a total of 20 repetitions for both legs by the end of the course.

On the ninth and tenth exercises in the 1st week, the number of repetitions is 10, and then each week they add 2 repetitions, bringing it to 20, since the exercise is asymmetrical. Perform with one leg - either the “sick” leg or the leg with the greatest degree of damage.

A correction complex is a combination of exercises to stretch one muscle group and relax another with the goal of balance. But stretching to a certain level becomes addictive, so in order to effectively solve the assigned tasks, it is necessary to regularly change the number of repetitions of the exercise and the mode of their implementation.

The walking of patients with coxarthrosis is characterized not only by possible lameness, but also by asymmetrical foot placement without maintaining direction, and different stride lengths of the limbs.

To maintain balance in exercises eleven to fourteen, it is allowed to place your hands on your belt, thumbs towards the lower back or arms to the sides at shoulder level, palms down.

When performing sets of exercises, patients should not strive from the first days to perform a range of motion in the hip joint that is close to the anatomical barrier of the joint. It is necessary to take into account your capabilities, which, as a rule, increase in the process of regular training. Mild pain will indicate the end of the movement.

You should also pay attention to walking, which is not corrective.

On days that do not include a complex exercise, as a warm-up to activate the body, perform an exercise in the form of walking on all fours for 10 minutes. Movement is carried out according to the principle: right leg - left arm. In this case, the step should be stretching at a slow pace with voluntary breathing.

Since there is no axial load in the exercise, only the arms and legs are involved, it is quite gentle, but increases blood circulation and can be performed immediately after waking up. When performing the exercise, you can use gloves and knee pads (or wrap an elastic bandage around your knees). The nature of the exercise remains unchanged throughout the entire rehabilitation course.

It is also recommended to do a complex lesson in the first half of the day. Whatever the direction of physical education, the cardiovascular system is one of the first to respond to physical activity, the flow of blood and oxygen increases not only to the skeletal muscles, but also to the heart, and metabolism in tissues increases. Consequently, for the day the patient will be provided with increased performance, improved coordination of movements and mood.

An important advantage of the proposed invention is the availability of the proposed means of physical education. And due to the lack of rehabilitation centers willing to cooperate with older patients suffering from deforming arthrosis of the hip joint, free of charge on a regular basis, the generally accepted practice of short-term exercise therapy courses (10-12 sessions) under the compulsory medical insurance policy in clinics at the place of residence, this invention will be in demand as for independent practice by patients of the elderly age group, and for use in widespread clinical practice in medical institutions of any type, both fragmentarily and completely, both for treatment and for preparation for hip replacement.

The invention makes it possible to improve the quality of life of elderly people by slowing the progression of the disease and postponing surgical intervention, and therefore will reduce public health costs for treatment and endoprosthetics of this category of patients.

Examples of implementation of the invention

The study on the use of a method for restoring mobility of the hip joint during coxarthrosis in elderly people according to the claimed invention included 20 patients aged 60 to 74 years with unilateral and bilateral coxarthrosis. In each case there are 10 people and an equal number of men and women.

All patients included in this study had previously undergone medical examination at the Federal State Budgetary Institution “National Medical Research Center for TPM” of the Ministry of Health of the Russian Federation, based on the results of which the sample was formed.

Patient inclusion criteria:

- X-ray confirmed diagnosis (2, 2-3, 3 degree of coxarthrosis);

- lack of technical means for movement in everyday life (canes, crutches, Nordic walking poles);

- absence of diseases of other joints of the lower extremities;

- stage of remission of chronic diseases, if any;

- the patient’s ability to participate in the study for 4 months.

During the study, the following methods were used to assess the effectiveness of patients’ self-study: questionnaires, control tests, diagnostics.

The survey was carried out using a questionnaire of physical activity (ODA23+), containing 23 questions, allowing to assess the level of physical activity in dynamics, taking into account the characteristics of lifestyle [patent for invention RU 2485895, IPC A61 B 10/00, publ. 06/27/2013 Bulletin. No. 18]. According to the questionnaire, there are 5 levels of physical activity: very low, low, average (moderate), high and very high.

Body mass index (BMI) was assessed using the formula I=m/ h ² , where:

m is body weight in kilograms;

h - height in meters;

and was measured in kg/ ^m2 and made it possible to assess the correspondence between a person’s mass and his height and, thereby, indirectly judge whether the mass is normal or excessive.

Questionnaires on ODA23+ and BMI assessment were carried out monthly, but Table 1 presents for comparison the results “before” and “after” the end of the rehabilitation course, since changes for the better were cumulative in nature, the comparison for individuals was not as significant as in total measurement.

Assessment of physical performance was carried out twice: before the start of independent exercises of patients and after their completion using the 6-minute walk test (TST).

The final assessment of a 6-minute walk includes 4 levels of assessment of physical performance by the number of meters walked: IV functional class (FC) - <300 m, III FC - 300-374 m, II FC - 375-450 m, I FC - >450 m .

As a specialized assessment of changes in hip joint mobility, angularometry (angle of flexion, extension, abduction) was used “before” and “after” the rehabilitation course (Table 2).

Coxarthrosis, depending on the degree of the disease, manifests itself not only in a discomfort caused by stiffness of the hip joint, but also in pain that interferes with motor activity.

Therefore, throughout the entire rehabilitation course, daily before bedtime, after completing the evening complex, a visual analog scale (VAS) was used to assess pain intensity.

The visual analog scale of pain is a straight line segment 10 cm long. Its beginning corresponds to the absence of pain - “no pain”, and the end point reflects excruciating unbearable pain - “unbearable pain”. The line can be either horizontal or vertical. The patient is asked to make a mark on it that corresponds to the intensity of the pain he is currently experiencing. The distance between the beginning of the segment (“no pain”) and the mark made is measured in centimeters and rounded to the nearest whole. Each centimeter along the line corresponds to 1 point. At a mark of up to 2 cm, pain is classified as mild, from 2 cm to 4 cm - moderate, from 4 cm to 6 cm - severe, from 6 cm to 8 cm - severe, and 10 cm - unbearable.

As a rule, all patients easily understand the VAS.

Table 3 presents for comparison the results “before” and “after” the end of the patients’ self-study, since in the total measure they are more significant than in the daily measure. Information about daily measurements was transmitted to the instructor or physical therapy doctor via email or WhatsApp.

Individuals with coxarthrosis, as a rule, are characterized by a step length that does not correspond to the generally accepted formula:

for men Height (cm)*0.413; for women Height (cm)*0.415.

For fear of aggravating pain and stiffness of the joint, the step is shortened, and with unilateral coxarthrosis only on the side of the diseased joint, with bilateral coxarthrosis - on both sides, but where the degree of the disease is higher, the step is shortened more.

The following method was chosen to assess gait correction and, therefore, step length.

Using the previously presented formulas, the individual step length was calculated for each patient, as well as the number of steps on a segment of 20 meters. After this, a real measurement of the steps taken by the patients was carried out on a segment of 20 meters “before” and “after” the rehabilitation course (Table 4).

The results obtained showed the effectiveness of the proposed method, which allowed us to draw the following conclusions regarding this invention:

Analysis of the data obtained indicates that in all patients, regardless of age and gender (maximum - 73 years, minimum - 61 years), there are changes in indicators for the better, thanks to regular exercises, their volume of physical activity has increased, while none of the students stopped independent training for any reason, having fully mastered the planned four-month course of rehabilitation measures.

According to the results of ODA23+, 16 patients moved to the next higher level, and four patients (Nos. 13, 15, 16, 17) were able to force themselves to step over one - from “very low” to “medium”, which is especially important for elderly people. That is, patients (25% of those involved) who had virtually no physical activity were able to compose themselves, which is very problematic at this age due to the fear of worsening well-being, and begin to exercise regularly.

Regular exercise could not help but affect BMI. If before the start of the study BMI = N in only one person No. 10, then after the study in six people (patients No. 1, 2, 5, 6, 9, 10), and the 10th patient was able to reduce BMI by 15%, which applies to overweight patients.

Patients No. 3, 8, 12, 18 from the category of “obesity of the 1st degree” moved to the category of “overweight”; and patients No. 14, 15, 16, 17, 19, 20 - from “2nd degree obesity” to “1st degree obesity”, the 13th patient was able to step into the “overweight” category, which is expected, since physical activity is significantly increased from “very low” to “medium”.

It is worth noting the differences between patients with unilateral and bilateral coxarthrosis.

The former are characterized by a lower BMI (28>N - overweight; 35.3>N - 2 degrees of obesity at the beginning; 24.85=N; 30.2>N - 1 stage of obesity at the end) and a higher level motor activity (6 out of 10 had a high level of activity at the end).

The latter are characterized by a lower level, which is understandable from the point of view of obesity and difficulty of movement (9 out of 10 patients at the end had an average level of activity, with the exception of the 11th patient with a lower initial BMI, who moved to a high level).

As for physical performance indicators (PPC), all patients, without exception, improved their performance in terms of the number of meters walked.

At the same time, all patients in the group with unilateral coxarthrosis changed their FC from 1 to 2, and patients with bilateral coxarthrosis - from 3 to 2. TSH is a reflection of aerobic endurance, a sufficient level of which ensures a comfortable state in everyday life and the training of which is the most common recommendation in guidelines for the elderly.

The results are presented in Table 1.

The results of assessing the increase in hip mobility and decrease in pain intensity are presented in Table 3.

The results of changes in step length due to corrective exercises are presented in Table 4. In patients with unilateral coxarthrosis, the step length increased, and became longer than normal, and in patients with bilateral coxarthrosis, with a general positive effect, it only approached the norm, but did not quite reach it.

The results obtained showed that the proposed method of restorative gymnastics has a pronounced positive effect not only in improving joint mobility and reducing pain intensity, but also in improving the quality of life of elderly patients by reducing BMI and increasing physical performance.

The set of proposed sets of exercises for self-study on a regular basis made it possible to solve not only specialized problems in relation to the hip joint, but also general ones that determine the quality of life of a modern person: BMI, increase motor activity and improve physical performance.

An increase in joint mobility and a decrease in the assessment of pain intensity became possible thanks to an integrated approach in the selection of exercises: the use of exercises taking into account the anatomically possible movements of the hip joint, correction of the pelvis and gait by normalizing step length. At the same time, as preparatory, i.e. Warm-up exercises use exercises to stretch the deep muscles of the spine to relieve tension and spasms. And as a morning exercise, walking on all fours is used, which increases blood circulation and allows you to simultaneously use your arms, torso, and legs.

Thus, this comprehensive rehabilitation program can be used for the treatment of coxarthrosis in the subacute period and the period of remission, as well as preparatory preoperative preparation, if ETS is inevitable, it allows not only to strengthen the necessary muscles, but also increases physical performance, so necessary for recovery in the postoperative period.

Claims (70)

A method of increasing the mobility of the hip joint with coxarthrosis in elderly people, characterized by physical exercises carried out independently for 16 weeks, including: classes 3 times a week on weekdays, every other day, in which each lesson is carried out in the form of three consecutive complexes performed in different starting positions; exercises carried out daily 1 hour before bedtime in the form of only one first set of exercises; as well as classes carried out on days when three consecutive complexes are not performed, after waking up in the morning in the form of walking on all fours for 10 minutes; in this case, the first set of exercises, performed both 3 times a week every other day on weekdays and daily one hour before bedtime, includes ten consecutive exercises performed in different starting positions, where the first to fifth exercises are performed in the starting position position “standing on all fours”, and from the fourth to the tenth exercise in the starting position “lying on your back”, repeated 10 times each, without pauses for rest between exercises, exhale when performing the movement, and inhale when returning to the starting position, when this: - in the first exercise, standing on all fours, stretch their hand forward, sliding their palm along the support, while simultaneously pulling their opposite leg back, sliding their toes along the support, then return to the starting position and repeat the exercise, changing the position of the arm and leg, then return to the starting position position; - in the second exercise, standing on all fours, lower the pelvis onto the heels, stretching your arms forward, sliding along the support and tilting your head to the elbows, then return to the starting position; - in the third exercise, standing on all fours, bend your arms at the elbows, touching the support with your chest and stretching your chin forward, then return to the starting position; - in the fourth exercise, standing on all fours, stretch the leg bent at the knee towards the chest of the same name, lifting the foot off the floor and tilting the head, touching the cervical fossa with the chin, then return to the starting position and repeat with the other leg, then return to the starting position; - in the fifth exercise, standing on all fours, bend the lower back, lifting the chin up, then return to the starting position, then, slouching, tilt the head down, touching the cervical fossa with the chin, then return to the starting position; - in the sixth exercise, they turn over onto their back, bending their knees with their support on the floor, arms along the body with palms down, then pull the bent knee to the chest while simultaneously stretching the arm of the same name forward in weight, parallel to the floor, and tilting the chin to the cervical fossa , then return to the starting position, after which they repeat the exercise by changing the position of the legs and arms; - in the seventh exercise, lying on your back, bend your knees with your hands on the floor and your hands at your shoulders, stretch your arms forward to your knees, raising your shoulders off the floor and tilting your chin to the cervical fossa, then return to the starting position; - in the eighth exercise, lying on your back, bending your knees with support on the floor, hands in the “lock” on the back of your head, at the same time lift your shoulder blades off the floor and pull your leg bent at the knee to your chest, then return to the starting position, then repeat exercise with the other leg; - in the ninth exercise, lying on your back, bending your knees with support on the floor, arms along the body, palms down, raise the pelvis as high as possible, squeezing the buttocks, then return to the starting position; - in the tenth exercise, lying on your back, bend your knees with support on the floor, arms along the body with palms down, raise the pelvis while raising the leg bent at the knee to the chest, then return to the starting position, after which repeat the exercise with the other leg , and return to their original position, the second set of exercises is carried out after the first set only on weekdays every other day, and it includes 20 consecutive exercises, in which: for unilateral coxarthrosis, from the first to the sixth exercises, perform the initial positions “standing with support”, while: - in the first exercise, standing sideways to the support, the healthy leg on a hill, the sick leg hanging down, swing the straight leg forward, toe “away from you”, back - toe “towards you”, then return to the starting position; - in the second exercise, stand sideways to the support, the healthy leg is on a hill, the patient hangs down, perform swings with a straight leg to the side-up, outward, toe “away”, cross in front of the healthy leg, side-up, outward, cross behind with a healthy leg, then return to the starting position; - during the third exercise, stand sideways to the support, the healthy leg is on a hill, the sick leg hangs down, shake the leg, relax, one-time, 30 seconds; - in the fourth exercise, stand sideways to the support, the healthy leg is on a hill, the patient is hanging down, raise the leg bent at the knee above the hip joint, toe “away”, the torso is not tilted, then return to the starting position; - in the fifth exercise, stand sideways to the support, the healthy leg is on a hill, the patient hangs down, raise the leg bent at the knee to the level of the hip joint, then take it to the side and bring it to the front position, inhale, then return to the starting position; - in the sixth exercise, standing sideways to the support, healthy leg on a hill, the sick leg hangs down, shake the leg, relax, one-time, 30 seconds, for bilateral coxarthrosis, from the first to the sixth exercises, instead of the initial position “standing in support”, use the initial position “kneeling with support on a chair”, in this case: - in the first exercise, from the starting position, swing the leg bent at the knee, back and forth, with the foot suspended, then return to the starting position, and repeat the exercise with the other leg, then return to the starting position; - in the second exercise, from the starting position, perform a swing with the leg bent at the knee outward and inward, the foot in weight, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the third exercise, from the starting position, perform a swing with the leg bent at the knee back, the heel close to the buttock, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the fourth exercise, from the starting position, straighten the leg at the knee joint and move it back onto the toe, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the fifth exercise, from the starting position, the leg bent at the knee is taken to the side, trying to place the heel at the level of the hip joint, while the shin is turned to the thigh by 90 degrees, then they return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the sixth exercise, from the starting position, perform circular rotations with the leg bent at the knee to the outside, the foot in weight, while the lower leg is turned to the thigh at 90 degrees, then return to the starting position, then repeat the exercise with the other leg, then return to initial position, then perform exercises seven to eleven in the starting position “lying on the stomach”, both for unilateral coxarthrosis, in which each exercise is started from the healthy leg, and for bilateral coxarthrosis, in which each exercise is started from the side of the least damaged joint, with spontaneous breathing , wherein: - in the seventh exercise, lying on the stomach, legs together, chin on the back of the palms of the arms bent at the elbows, bend the leg at the knee 90°, lift it up without straightening the knee, then return to the starting position, then repeat the exercise with the other leg, exercise perform the same number of times on each leg; - in the eighth exercise, lying on your stomach, legs bent at the knees at 90°, chin on the back of the palms of the arms bent at the elbows, alternately lifting the hips up without straightening the knees, after which they return to the starting position; - in the ninth exercise, lying on your stomach, legs together, chin on the back of your palms with your arms bent at the elbows, move your leg to the side, then return to the starting position, then repeat the exercise with the other leg, the exercise is performed the same number of times on each leg; - in the tenth exercise, lying on the stomach, the healthy leg is bent at the knee at 90°, the chin is on the back of the palms of the arms bent at the elbows, the healthy leg is moved to the side without straightening the knee, sliding along the surface, inhale, return to starting position, then repeat the exercise with the other leg, the exercise is performed the same number of times on each leg; - in the eleventh exercise, lying on the stomach, legs together, chin on the back of the palms of the arms bent at the elbows, bend the leg at the knee joint, sliding along the surface and lifting it above the hip joint, trying to bring the iliac spine closer to the surface, then return to the starting position position, then repeat the exercise with the other leg, the exercise is performed the same number of times on each leg, then perform exercises from the twelfth to the twentieth exercise - “lying on your back”, with voluntary breathing, while: - in the twelfth exercise, lying on your back, legs together, arms along the body, imitate the movements of a cyclist, stopping with their legs after each circle, then returning to the starting position; - in the thirteenth exercise, lying on your back, legs together, arms along the body, move with the help of your hands to a sitting position, leaning on the surface, then return to the starting position with the help of your hands, leaning on the surface, then return to the starting position ; - in the fourteenth exercise, lying on your back, with unilateral coxarthrosis, the healthy leg is bent at the knee, the foot is supported, the heel of the sore leg lies on the knee of the leg, abduct the thigh by pressing on the knee with the same hand, then return to the starting position, with bilateral coxarthrosis they begin exercise on the side of the most damaged joint, relying on the less damaged limb; - in the fifteenth exercise, lying on your back, legs together, arms to the sides, palms up, swinging your arms forward, move your torso to a sitting position, then return to the starting position, while trying to carefully place your torso on the surface; - in the sixteenth exercise, lying on your back, legs together, arms along the body, perform alternating circular rotations with a straight leg in the hip joint, toe “away”, in one direction 4 times and in the other direction 4 times, after which they return to the starting position ; - in the seventeenth exercise, lying on the side on the side of the healthy leg with unilateral coxarthrosis or the least affected leg with bilateral coxarthrosis, one arm bent at the elbow under the head, the other supported in front of the chest, with the back, pelvis, and legs forming a straight line , raise the leg up with a static delay in the extreme position, 5 seconds, then return to the starting position, and if it is impossible to perform the exercise in the starting position on the side on the side of the more affected joint, place a soft pillow or perform the exercise only on one side; - in the eighteenth exercise, lying on the side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, while the back, pelvis, legs form a straight line, perform a springy lift of the leg up, then return to starting position, and if it is impossible to perform the exercise in the starting position on the side on the side of the more affected joint, place a soft pillow or perform the exercise only on one side; - in the nineteenth exercise, lying on the side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, while the back, pelvis, legs form a straight line, move the leg forward, the toe “towards you” in weight, then return to the starting position, move the leg back, toe “towards you” in weight, then return to the starting position, and if it is impossible to perform the exercise in the starting position, place a soft pillow on the side of the more affected joint or perform it only on one side; - in the twentieth exercise, lying on the side on the side of the healthy leg, one arm bent at the elbow, under the head, the other in support in front of the chest, perform springy swings of the leg back and forth with an amplitude possible for each, toe “pull away”, then return to the starting position, and if it is impossible to perform the exercise in the starting position on the side on the side of the more affected joint, place a soft pillow or perform the exercise only on one side, then take the starting position “lying on your back” and perform 2-3 voluntary exercises to restore breathing 4 times, while the repetition and mode of performing each of the exercises of the second complex changes as follows: on the 1st week - perform 10 repetitions with pauses for rest between exercises; in the 2nd week - perform 10 repetitions without pauses for rest between exercises, then the first lesson of each week, starting from the 3rd week, the number of repetitions of each exercise is increased by 2, reaching 30 repetitions by the end of the course, after completing the second complex, they begin to perform the third set of exercises, which is carried out in the same way as the first and second sets of exercises on weekdays every other day, and includes 14 consecutive exercises, the first 10 exercises of which are performed in a dynamic mode at a slow pace with a gradual increasing the number of repetitions in the initial position “lying on your stomach”, “lying on your back”, the following 4 exercises are performed in the form of walking, while: - in the first exercise, lying on your stomach, palms bent at the elbows under the chin, feet to relax the legs on a soft pillow, straighten the knee, while stretching the toe forward along the floor, then return to the starting position, after that repeat the exercise with the other leg, then return to their original position; - in the second exercise, lying on your stomach, palms bent at the elbows under the chin, feet to relax the legs on a soft pillow, bend the leg at the knee and, sliding it along the floor, lift it above the level of the hip joint, without moving the elbows, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the third exercise, lying on your stomach, palms bent at the elbows under the chin, feet to relax the legs on a soft pillow, bend one leg at the knee joint, shin is turned to the thigh at 90 degrees, raise the knee and place it on the outside of the other knee legs, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the fourth exercise, lying on your stomach, palms of your arms bent at the elbows under the chin, feet to relax your legs on a soft pillow, lift your leg and bring it behind the other, touching the heel to the floor, lifting the pelvis outward on the same side, while doing so with your elbows do not move, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the fifth exercise, lying on your stomach, palms of your arms bent at the elbows under the chin, feet to relax your legs on a soft pillow, roll on your stomach in one direction or the other, while swaying your hips, but without lifting off the floor, then return to the starting position , in this case the exercise is performed alternately in each direction with the same number of times; - in the sixth exercise, turn over onto your back, arms along the body, legs together, a soft pillow under the knees to relax the legs, bend one leg at the knee, placing the foot on the floor so that the toes are at the level of the knee of the other leg, swing the leg up without force - down, without changing the position of the pelvis, then return to the starting position, then repeat the exercise with the other leg, then return to the starting position; - in the seventh exercise, lying on your back, arms along the body, legs together, to relax the legs, a soft pillow under the knees, bend one leg at the knee with support on the floor, place the other with the foot on it, while resting the base of the palm of the same raised leg on the knee of the same leg, pressing on the knee, straightening the elbow, then return to the starting position, after which they repeat the exercise with the other leg, in addition, in the third week the exercise is complicated and instead of resting the base of the palm on the knee, they clasp the thigh of the supporting leg in a “lock” and pull it towards chest, then return to the starting position, then repeat the exercise with changing the position of the arms and legs, then return to the starting position; - in the eighth exercise, lying on your back, arms along your body, legs together, a soft pillow under your knees to relax your legs, bend one leg at the knee with support on the floor, place the other with your foot on it, raise your pelvis, trying to pull the knee of the raised leg down towards floor, return to the starting position, then repeat the exercise in the other direction, then return to the starting position; - in the ninth exercise, lying on your back, arms along the body, legs together, a small pillow under the knees to relax the legs, stretch the heel of one leg along the floor without lifting it, then return to the starting position, perform the exercise asymmetrically 10 times, without changing this is the position of the body, and the exercise is performed only with the sore leg or the one with a greater degree of joint damage; - in the tenth exercise, lying on your back, arms along your body, legs together, a soft pillow under your feet to relax your legs, stretch with the sore leg, toe “away from you”, and the healthy sock “towards you”, then return to the starting position, perform the exercise asymmetrically 10 times, without changing the position of the body, while the exercise is repeated without changing the position of the feet according to the principle of the previous position, and in case of bilateral coxarthrosis, the toe is made towards oneself with the foot with the least damage to the joint; - in the eleventh exercise, they perform walking in the form of a “herringbone” exercise, in which they walk along a drawn line, in the direction of movement, where the feet are placed at 45 degrees, one after another, the line between the feet, while maintaining the direction of the feet, perform the exercise along 20 steps with a return to the starting point by regular walking three times, the pace and breathing are arbitrary; - on the twelfth exercise, they perform walking in the form of a “clown step” exercise, in which they walk from the position of the heels together, toes far to the sides, maintaining the direction of the feet, with a line between the feet, perform the exercise in 20 steps, returning to the starting point with normal walking three times, the pace and breathing are arbitrary; - in the thirteenth exercise, they walk along the drawn marks - across the course of movement, equal to the step length plus 5 cm, while the foot is placed in the middle on the mark, pulling the toe of the foot from the side of the affected or most affected joint "away from you", perform the exercise in 20 steps with returning to the starting point by normal walking three times, the pace and breathing are arbitrary; - in the fourteenth exercise, they walk between two drawn lines of 35 cm, trying not to go beyond their boundaries, perform the exercise in 20 steps, returning to the starting point with regular walking three times, the pace and breathing are arbitrary, in this case, when performing the third set of exercises, exhale when performing the movement, and inhale when returning to the starting position; in addition, the exercises are performed both in a dynamic mode and at a slow pace with a gradual increase in the number of repetitions in the following order: in the 1st week - 10 repetitions with pauses for rest between exercises, which must be started with the “healthy” leg, with 4 repetitions on the “healthy” leg and in exercises from the first to the eighth - 6 repetitions on the sore leg; in the 2nd week - 10 repetitions without pauses for rest between exercises, 4 repetitions on the healthy leg and 6 repetitions on the sore leg, and in case of bilateral coxarthrosis, exercises from the first to the eighth, except the fifth, are performed on the leg with the least damage to the joint , with large – 6 repetitions, then the first lesson of every second week, starting from the third week the number of repetitions of the exercise increases for each limb one repetition, reaching a total of 20 repetitions for both legs by the end of the course, on the ninth, tenth exercises in the 1st week the number of repetitions is 10, and then 2 repetitions are added each week, bringing it to 20, In addition, classes conducted on days when three consecutive complexes are not performed, after waking up in the morning in the form of walking on all fours, movement is carried out according to the principle: right leg - left hand, while the step is performed stretching, at a slow pace with voluntary breathing.