Restorative gymnastics after spinal injury. Injury of the cervical spine: exercise therapy as a method of rehabilitation

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Exercise therapy for spinal injuries Prepared by the teacher of physical culture Maraeva Marina Vasilievna

Spinal injuries are the most severe injuries of the musculoskeletal system. Physiotherapy exercises for spinal injuries are prescribed taking into account the duration and degree of damage, as well as the nature of the damage and neurological disorders. The acute period of treatment includes therapeutic measures, the main task of which is to eliminate the displacement of the vertebrae, compression of the membranes of the spinal cord and its roots.

After the most favorable conditions for restoring anatomical relationships, as well as preventing relapses and secondary injuries of nerve elements, are created with the help of exercise therapy (physiotherapy exercises) and LG (therapeutic gymnastics) for spinal injuries, it is necessary to proceed to the next stage - the use of a set of physical exercises for injuries of the spine, which will be aimed at increasing the strength and endurance of the muscles of the trunk and neck, and then at increasing the mobility of the spine.

Clinical and physiological substantiation of physical exercises. Therapeutic physical training is a set of methods of treatment, prevention and medical rehabilitation, which are based on the use of physical exercises, methodically developed and specially selected. When prescribing them, the doctor takes into account the nature of the disease, its features, stage and degree of the disease process in organs and systems. The therapeutic effect of physical exercises is based on strictly defined loads in relation to the weakened and sick. Allocate general workout to improve and strengthen the body and special training aimed at eliminating impaired functions in certain organs and systems. The complexes of exercises with physiotherapy exercises are aimed at increasing the mobility of the joints, stretching the muscles. They allow to improve metabolic processes in pathologically altered tissues, to raise the level of compensation. Application physiotherapy exercises prevents further progression of the disease, accelerates the recovery time and increases the effectiveness of complex therapy of patients.

Physical rehabilitation is the use of physical exercises and natural factors for therapeutic and prophylactic purposes in a complex process of restoring health, physical condition and working capacity of sick and disabled people. It is an integral part of medical rehabilitation and is used in all its periods and stages.

The purpose of rehabilitation is the rapid regeneration of muscles during their atrophies associated with prolonged physical inactivity, in order to restore the strength and tone of the limb, restore the full range of motion in the joints after immobilization (after fractures), accelerate the regeneration of cartilage tissue, improve the trophism of organ and bone tissues, increase mobility with adhesions in the abdominal cavity after abdominal operations, increasing the general tone of the patient and improving the psycho-emotional state, relieving pain and swelling after joint injuries, restoring physical activity after strokes, paresis and paralysis, as well as in the postoperative period in patients after operations associated with diseases and injuries musculoskeletal system (after injuries, fractures, bruises and sprains). The rehabilitation process is based on the stimulation of the patient's own capabilities under external influence. Physical exercises, modern equipment help stimulate local and general immunity, improve tissue repair processes, restore blood and lymph circulation.

Tasks and methodology of exercise therapy for injuries: 1) Cervical 2) Thoracic 3) Lumbar

The sequence of therapeutic measures in exercise therapy in case of damage cervical of the spine depends on the prescription, degree, nature of the damage and neurological disorders. In acute cases, treatment is based on eliminating the displacement of the vertebrae, compression of the membranes of the spinal cord and its roots, creating the most favorable conditions for restoring anatomical relationships. After that, the main efforts are directed to restoring the strength of the muscles surrounding the cervical spine, and then to restoring its mobility.

The tasks of exercise therapy in case of damage to the cervical spine in the first period (the period of skeletal traction) are to improve pulmonary ventilation and prevent congestion in the lungs, and combat physical inactivity. During the period of immobilization, the volume of classes and the duration of the exercises increase, the patient's motor mode increases. It is allowed to sit with legs down, move first within the ward, and then around the department. During this period, forward bending of the torso is contraindicated. In the post-immobilization period, therapeutic exercises are aimed at strengthening the muscles of the neck and shoulder girdle, restoration of movements in the cervical spine, rehabilitation of patients. To eliminate the additional load on the spine, physical exercises are performed in and. n. lying down. Conduct exercises for the upper and lower extremities, trunk muscles, isometric exercises for the muscles of the neck, turning the head. The duration of the procedure is 25–30 min.

Thoracic and lumbar injuries Compression fractures of the vertebral body are the most common. In this case, conservative treatment is required. If there is a slight compression (no more than 16 of the height of the vertebral body), then you need to use the functional method of treatment, which was developed by V.V. Gorinevskaya and E.F. Drewing (1954). With this method of treatment, the patient must be laid on a hard bed, in which the head end is raised by 40-60 cm. To provide the patient with maximum unloading of the spine, cotton-gauze rollers are placed under the area of ​​physiological lordosis. Longitudinal traction for the armpits is also used, this is necessary for axial unloading of the spine.

Physical therapy exercises for this spinal injury are divided into 3 periods. First period. Usually lasts the first 7-10 days. At this time, physiotherapy exercises and therapeutic exercises are required to perform the following tasks: increasing the vitality of the patient, improving the activity of the cardiovascular and respiratory systems, as well as the organs of the gastrointestinal tract. Therapeutic exercises included in exercise therapy complex, include breathing exercises (static and dynamic), as well as general developmental exercises for small and medium muscle groups and joints. At the same time, active movements of the legs are performed only in light conditions (sliding the foot along the plane of the bed.

Second period. Continues until the 30th day after the injury. During this period, the tasks of physiotherapy exercises and therapeutic exercises include the normalization of activity internal organs, improving blood circulation in the area of ​​damage, as well as strengthening the muscles of the trunk, shoulder and pelvic girdle. Thanks to regular classes Exercise therapy in this period, the patient develops a "muscle corset", and the body prepares for a further expansion of the motor regime. Moreover, the total load during exercise should gradually increase. This is due to an increase in the number of repetitions of movements and the duration of the lesson (up to 20 minutes). Third period. Continues until 45-60 days after injury. Exercise therapy and therapeutic exercises in this period are aimed at strengthening the muscles of the trunk, limbs, muscles of the pelvic floor. Also, the systematic implementation of therapeutic exercises improves the coordination of movements and mobility of the spine. This period is characterized by the fact that due to the increase in the duration and density of classes, as well as the inclusion of a set of physical exercises for spinal injuries with resistance and weights, the overall exercise stress. In order for the spine to gradually move to axial load, exercises start from the starting position standing on all fours and kneeling. It is in the standing position on all fours that the spine is unloaded, and lordosis in the cervical and lumbar spine also increases.

Exercise therapy for compression fractures of the vertebrae (thoracic and lumbar) in the first period of treatment: an approximate set of exercises Starting position - lying on your back, arms along the body. Diaphragmatic breathing. A bag of sand (or a plastic bottle) weighing 1 - 1.5 kg on the stomach (sometimes in the upper, sometimes in the lower abdomen). On exhalation, raise the load as high as possible, hold your breath for 5 to 10 seconds, lower it while inhaling. It is performed 4-6 times. Squeezing and unclenching the fingers of the hand. Dorsal and plantar flexion of the feet. Flexion and extension of the arms in the elbow joints. Circular movements of the feet. Flexion and extension of the hands in the wrist joints. Circular movements in the wrist joints. Diaphragmatic breathing. Straight arms are spread apart at shoulder level and slightly laid back. Small circular movements of the hands with some tension in the muscles of the back and shoulder blades. Alternate abduction and adduction of the legs, without taking them off the plane of the bed. Alternate bending of the legs in the knee joints, sliding the foot along the plane of the bed. The legs are bent at the knees, the feet rest on the bed. Raise the pelvis with support on the shoulder blades and feet. Diaphragmatic breathing. Isometric tension of the muscles of the hand. Slowly squeeze your fingers with tension for 2-10 seconds. Isometric tension of the calf muscles. Slowly with tension to produce a dorsiflexion of the foot, hold for 2-10 seconds, then plantar flexion of the foot, hold for 2-10 seconds. Isometric tension of the muscles of the shoulder girdle. Slow tension of the muscles of the shoulder girdle for 2-10 seconds. Isometric tension of the thigh muscles. Slow tension of the thigh muscles for 2-10 seconds. Isometric tension of the gluteal muscles. Slow tension of the buttocks for 2-10 seconds. Isometric tension of the back muscles. Slow tension of the back muscles for 2-10 seconds. Diaphragmatic breathing. Note. Exercises are performed at a calm pace with pauses for rest. Each movement is repeated no more than 4-6 times. Classes are held 2-3 times during the day.

Approximate exercise therapy complex during the stretching period: 1. Lie on your back, stretch your arms along the body. Then proceed to the exercises: 2. Breathing with the diaphragm (4-5 times) 3. Flexion of the feet (plantar and back) 4. Squeezing and unclenching the fingers of the hand 5. Circular movements of the feet 6. Flexion and extension of the arms in the elbow joints 7. Flexion of the legs in the knee joints (alternate), while the foot slides along the plane of the bed 8. Diaphragmatic breathing 9. Flexion and extension of the hands in the wrist joints 10. Abduction and adduction of the legs (alternate), while not tearing them off the plane of the bed 11. Circular movements hands in wrist joints 12. Diaphragm breathing. These exercises are performed at a calm pace, pauses for rest are used. Moreover, each movement should be repeated no more than 4-6 times. As a rule, classes are held 2-3 times during the day. Also, in physical therapy for spinal injuries, various labor operations are widely used, such as rolling and rolling bandages and gauze napkins, knitting, modeling from plasticine, etc.

Thus, in the treatment of spinal injuries, it is very necessary to use complexes of various exercises. Systematic therapeutic gymnastics and physiotherapy exercises for spinal injuries play an important role in restoring body functions and contribute to its further strengthening.

Its goal is to help reduce congestion in the lungs by freeing the bronchi from the accumulated secret and increasing pulmonary ventilation. Congestive lungs often complicate the course of traumatic spinal cord disease. Hypodynamia, a decrease in lung excursion due to weakness of the intercostal muscles, a decrease in the mobility of the diaphragm create conditions for obstruction of the bronchial tree with mucus, the breathing rhythm is upset, and hypoxia occurs. Respiratory disorders are especially common in patients with injuries of the cervical spine and spinal cord. Therefore, respiratory gymnastics should be included in medical complexes in all patients with high localization of damage.

Based on the task, as well as methodological techniques, in people who have had a spinal injury, the combination of elementary gymnastic exercises(dynamic exercises) with special starting positions (static exercises). These exercises can be strengthened by the methodist's hand - tapping, vibration, compression. Providing a local impact on the upper or lower part of the chest alternately, the methodologist can include one or another segment of the lung in vigorous activity. Additional techniques are breathing through a tube, inflating rubber bladders, breathing through a closed mouth, etc. This increases the depth of breathing and stimulates respiratory muscles and extra resistance. In the course of the lesson, frequent changes in drainage positions should be practiced. Breathing exercises are held 3-4 times a day for 15-20 minutes, before that it is advisable to perform several general strengthening exercises.

Sports after spinal injury

The use of elements of sports in physiotherapy exercises has been promoted for a long time and widely. On sport games How important factor in the rehabilitation of the disabled indicates R. F. Jones (1982). Usefulness of gaming sports activities practitioners also recognize that sports movements are a necessary element of a rehabilitation program for patients with injuries of the spine and spinal cord. W. Arnold, N. Richter and J. Schauer (1982) as a result of special physiological studies found that in patients with transverse spinal cord injury under the influence sports training the general working capacity increases, the maximum oxygen consumption increases, hemodynamic parameters, biochemical and vegetative reactions improve. V. N. Moshkov (1972) points out that sports-applied exercises in physical therapy should be used without sports tasks, their significance is reduced to a positive effect on the psycho-emotional and psycho-physiological sphere, that is, to moderate training, hardening, filling leisure, increasing overall tone .

Meanwhile, sports games are always competitive in nature. L. Guttmann was the inspirer and direct organizer of the first World Olympic Games paraplegics, which have since been held every 4 years. Since 1980, in our country (Omsk), for the first time, sports competitions for patients with spinal injuries began to be held on the basis of the rehabilitation department. First sport competitions were held in 11 sports: medley relay, basketball, shot put, javelin or discus throw, air gun shooting, ring and ball throwing, table tennis, checkers, chess. G. I. Zuev believes that this list can be expanded to include wheelchair slalom, horseback riding, figure driving, and fencing. Every year in the Saki specialized sanatorium. N. N. Burdenko also organizes summer sports games for patients who have suffered a spinal injury; in 1989, the first All-Union Sports Contest for the Disabled was held.

Nevertheless, it should be recognized that the place of sports events in the system of rehabilitation treatment of patients with traumatic spinal cord disease is insignificant. And the point is not the scale of these events. We fully share the opinion of V. L. Naidin (1972) that currently "they use sport exercises, which play a mostly non-specific, general strengthening role. The biomechanical features of the technique of sports movements are not fully used, there is not enough targeted use of specific exercises of a particular sport to restore or compensate for motor disorders. "Sports movements should become the next, more complex and highest stage of therapeutic functional gymnastics. It is necessary to select sports taking into account the characteristics of the clinic, functional loss, degree of recovery and level of compensation, and such sports exercises that would be adequate to the motor defect in terms of biomechanical parameters, that is sports events should, as it were, continue therapeutic exercises, but an order of magnitude higher, and become for the patient a kind of test of the achieved motor activity. In our opinion, it is this approach to business that can fully contribute to functional recovery.

The following sports are suitable for patients with traumatic spinal cord disease: throwing the ball into the basket, table tennis, swimming, rowing, skiing, water biking, archery, throwing rings, shot put, javelin throwing, throwing the ball at the target. We do not see any benefit and expediency from such competitions as wheelchair racing and figured driving, and we consider them meaningless. Sports movements in the recommended sports are most consistent with biomechanical indicators, the structure and pattern of movements, the goals of functional recovery of patients. The period of preparation for competitions and training should be recognized as especially positive.

Therapeutic massage after spinal injury

The importance of massage in the treatment of spinal injuries cannot be overestimated. The constituent elements of the mechanism of its action perfectly meet the goals and objectives of restorative treatment. Theoretical justification, technical and methodological issues of using massage in treatment are fully and in detail reflected in the literature. Therefore, there is no need to dwell on these issues. We set ourselves the task of highlighting only some of the issues related to the use of massage in people who have suffered trauma to the spine and spinal cord.

Massage has a variety of effects on the body.

1. reflex action. The mechanical energy of massage movements is converted into the energy of nervous excitation, which triggers complex reflex reactions, the result of which is the normalization of tonic ratios and muscle elasticity. So, during the massage of agonists, inhibition of the antagonist muscles reflexively develops, which improves the reciprocity of the muscles.
2. humoral factor. Under the influence of massage, biologically active substances - acetylcholine and histamine - are formed in the skin and enter the bloodstream, and tissue bioenergy increases. An increase in acetylcholine quanta contributes to replenishing the mediator deficiency under denervation conditions and thus enhances impulse conduction, while increasing excitability, lability and contractility of the neuromuscular apparatus. Histamine has a vasoactive effect.
3. mechanical factor. The flow of nerve impulses that occurs when the muscle proprioceptors are stimulated rushes to the cerebral cortex, enhances the excitation processes there and, therefore, tones the entire body. During the massage, angioreceptors are also subjected to direct mechanical action, which, combined with an increase in the level of histamine, leads to an intensification of blood and lymph circulation, as a result of which cellular nutrition improves, the release of tissues from accumulated metabolites accelerates, redox processes improve, that is, tissue trophism normalizes. .

Therapeutic massage used in patients with traumatic spinal cord disease can be divided into 4 main groups: classic manual massage, segmental massage, acupressure, hardware massage (mechanical, vibrational, air, or pneumo-massage, water, or hydromassage).

Manual classic massage combines 4 groups of techniques that differ in the nature of the action: stroking, rubbing, kneading, vibration.

Stroking is flat and embracing, it can be carried out with one hand and two hands, intermittently and continuously. Distinguish between superficial and deep stroking, and in the direction of movement - spiral and concentric.

Rubbing is one of the most common techniques in the spinal clinic. The most energetic action is kneading. Reception can be carried out unidirectionally and multidirectionally, it can be performed with the laying of one hand on the other, that is, with amplification. An effective remedy are massage techniques with vibration. Classical massage can be performed not only manually, but also with the help of auxiliary devices and tools - massage brushes, rollers, massage hammer.

With segmental massage through irritation of certain reflexogenic zones, a selective effect is achieved on individual internal organs and systems of the body, purposefully changing their functions. In this case, the basic techniques of classical massage are used, as well as some special techniques, in particular drilling, moving, stretching, squeezing, etc. Acupressure, in essence, is a kind of segmental-reflex massage, but with a peculiar technique. In this case, local areas of biologically active points are exposed, which since ancient times have been used in folk medicine of the East for pressure, cauterization and acupuncture in order to obtain reflex responses to these irritations in the form of a reactive change in one or another function. The technique of acupressure consists in finger action at given points. With acupressure, pressure, rubbing, vibration, puncture, rotation are used. The set of points is determined by their functional purpose and the specific therapeutic task in this case. Massage is carried out in two versions - inhibitory and exciting. In the first case, the procedure is carried out with an increase in the intensity of irritation and an increase in time parameters - from 1-1.5 to 2.5-4 minutes; in the second - strong, short and fast irritations, successively applied to specific points.

IN last years increased interest in hardware types of massage.

Vibration - rhythmic vibrations of an elastic medium - has a wide therapeutic range. For vibration and vibration-impact massage, low-frequency vibration from 30-50 to 150-170 Hz is mainly used.

Water massage (hydromassage) is carried out in manual and hardware versions. Manual underwater massage is a classic massage performed under special conditions. There are several types of hydromassage with the help of devices:

1. Water jet massage. The procedures are carried out with a jet of water (or several jets at the same time) in the air. An example is the Charcot shower, circular shower. For the treatment of patients with traumatic disease of the spinal cord, you can use a hinged douche-massage (by the type of circular).
2. Water jet massage under water. Procedures are released in special baths using the apparatus. A jet of water is ejected through a flexible hose at a pressure of 2-3 atm. To change the power of the jet, various nozzles can be put on the hose. The mechanical force of the jet can also be adjusted by changing the distance to the body area and the angle of impact. In patients with spinal injury, pressure from 0.5 ati to 1-2 ati is applied for 15-20 minutes. Stroking is carried out with a gap of 25-40 cm. For circular rubbing, a gap of 10 cm is set, vibration is carried out at a gap of 30 cm.
3. Underwater pneumomassage is carried out with a jet of compressed air under water. The method is extremely simple and can be applied in any hospital.

Exercise therapy at the home stage of rehabilitation after a spinal injury

As a rule, patients are transferred to home treatment after reaching a certain level of motor activity at a particular stage of rehabilitation. Discharge home should not mean stopping active therapy, as is often the case, including not stopping and training sessions exercise therapy. When the patient is discharged, it is necessary to provide a detailed program and lesson plan. Exercise therapy at home is aimed at consolidating the range of motion achieved by the patient and adapting it to the existing defect. The patient must be discharged from the hospital (clinic, specialized rehabilitation department) trained in self-service and mastered household skills. Further improvement self-service contributes to an increase in existing movements and, on this basis, in some cases contributes to the development of new motor acts. At home, the patient can pay more attention to these issues. Great importance at the same time, they have some special devices, simple and uncomplicated designs, which greatly facilitate the living conditions of patients. So, the toilet should be equipped with special chairs and frames-holders, in the bathroom, brackets along the bathtub or hanging trapezes are needed, holding on to which the patient could pull himself up and move to the bathtub and back on his own. Washbasins must also be equipped with a knee support and a fixing device (belt or rigid construction). The kitchen should also be properly equipped (brackets, knee pads, drawers, additional locking handles for pots, various holders, etc.). Based on the occupation, hobbies and inclinations of the patient, it is necessary to carefully consider and appropriately equip workplace in the apartment. In the room where the patient is located, from the bed along the walls at a distance of 10 cm from the wall, a beam should be drawn or a pipe such as a water pipe should be stretched, holding on to which the patient can move freely.

It is advisable to allocate a place in the apartment for the installation of gymnastic equipment and simulators. Some of our patients show amazing ingenuity both in constructing such devices and in placing them in the apartment. Household skills are practiced when doing household chores - making the bed, cooking, setting the table, washing dishes, cleaning the apartment, doing laundry, etc. The patient must take on these household chores, freeing up the time of his loved ones to help him in other areas of life and to help with exercise therapy. Home therapeutic exercises are carried out by the same methodological techniques that have been developed above. Preference should be given to active exercise. Therapeutic exercises should be carried out 2-3 times a day for 45-90 minutes. Start with general strengthening exercises. Such classes are held in the form of morning hygienic gymnastics, and during the day they are carried out in alternation with the main exercises of therapeutic exercises. The movements that the patient has mastered sufficiently during his stay in the hospital are now performed with fewer repetitions. Attention should be paid to clarity, accuracy and coordination of movements. Most of the time should be devoted to the next most difficult section of gymnastics, in which the patient has not yet achieved success. Particular attention should be paid to training the functional mobility of the arms, especially the hands, standing and walking. As practice shows, only 12.4% of patients regularly train at home on their feet, 17.6% periodically engage in training in movement. Classes in standing and walking at home should be carried out at least twice for 45-60 minutes. Standing is useful to combine with gymnastic exercises. It is advisable to supplement exercise therapy at home with sports elements (for example, working with a ball) and mechanotherapeutic exercises (exercise bike, "Health" wall). For exercise therapy at home, auxiliary tools are used (knee stops, bars, rollers, rolling, loops, blocks, etc.).

After discharge from the hospital (1-2 months), classes at home should be conducted by exercise therapy instructors specially allocated from the rehabilitation departments (offices) of polyclinics at the patient's place of residence (scheme). The forces of these units regularly conduct massages at home. Assistance in organizing classes and methodological guidance is provided by a physical therapy methodologist who works in close contact with the patient's attending physician. Subsequently, the patient is engaged independently under the supervision of an instructor. Where possible, the methodologist teaches the patient's family members the elementary methods of helping to conduct classes. The doctor and methodologist of exercise therapy also takes part in the organization of occupational therapy at home, setting certain tasks for the patient and specifying tasks. When a certain level of compensation is reached, the question of transferring the patient to industrial rehabilitation (home-based work) may be raised. These issues are resolved by the exercise therapy methodologist together with the patient's attending physician through the rehabilitation commission (where it does not exist, through the VKK) and social security authorities.

Exercise therapy program for the rehabilitation of patients with traumatic spinal cord disease

Each stage of treatment of patients who have undergone spinal injury has its own set of exercise therapy, which should be based on the features of the development and course of traumatic disease, the general condition of the patient, the functional characteristics of the level motor reactions and the ability of the patient.

The question of the time of inclusion of patients in motor activity is controversial. Some authors consider exercise therapy contraindicated in the acute stage of the early period of traumatic spinal cord disease. We have already pointed out the fallacy of this position. The recommendation of exercises for bending the spine, bending and turning 1-1.5 months after injury and surgery is questionable. It is hardly advisable to put the patient on his feet 1-2 months after the injury, and by the 3rd month to start planting him. Such tactics lead to sad, sometimes irreparable, consequences. In this case, spondylolisthesis often occurs, secondary compression of the spinal cord, grafts are rejected, fixators diverge, S-shaped kyphoscoliosis develops, pelvic curvature, Kümmel-Verneuil syndrome. All this aggravates the clinical picture, necessitates repeated operations, and complicates the prognosis. The practice of teaching patients to crawl has taken root. The implementation of such recommendations leads to heterotopic changes and bone remodeling. knee joint, deformities, development of the Pellegrini-Stied syndrome. In patients with spinal injury, metabolism is impaired, including mineral metabolism. In addition, there is a constant loss of calcium in the feces as a result of impaired absorption of fatty acids and disorders of phosphorus-calcium metabolism in bone tissue. All this leads to a change in the bone structure with increased leaching of calcium phosphate from the bones. The architectonics of the bones changes, the cortical layer becomes thinner, in some cases the structural pattern of the bone becomes stronger, the spongy substance turns into a compact structure, the bone becomes homogeneous, and osteosclerosis develops. Both osteoporosis and osteosclerosis change the mechanical properties of bones, which causes them to break (pathological fractures). Under such conditions, during exercise therapy you have to be extremely careful. Walking training should be carried out strictly in stages, without neglecting fixing devices and orthopedic devices. In some works on exercise therapy in patients with traumatic spinal cord disease, recommendations are given on how to fall correctly. In our opinion, it is more reasonable not to allow the patient to fall.

Continuity and stages are the fundamental principle of rehabilitation, which allows rational use of the possibilities of exercise therapy. The stationary stage of rehabilitation covers two time periods: the period of stay in the clinic (or the neurosurgical department of the hospital) and the period of stay in a general rehabilitation center. The duration of the first is 4-6 months, the second - from 8 months to 1 year. That is, the stationary stage of rehabilitation falls on the acute and most of the subacute stage of the early period of traumatic spinal cord disease.

The early inclusion of gymnastics in the medical complex is of a preventive nature, the exercises have a pronounced general strengthening effect and create the basis for functional recovery. However, caution must be exercised in doing so. For example, in pain and extension therapy, movements in the shoulder joints are made slowly and extremely carefully. In cases where a patient with a trauma of the cervical spine underwent decompressive laminectomy, movements in the shoulder joints are excluded for the first 10-12 days; during interbody corporodesis and alloplasty, they can be performed in the sagittal plane up to 50-60° from the 3rd week (exercises in isometric mode, you can turn it on immediately).

The sanatorium-resort stage of rehabilitation falls at the end of the early period of traumatic spinal cord disease. At home, rehabilitation is carried out already in the chronic stage of the late period. In the chronic and residual stages, repeated courses of treatment are prescribed in rehabilitation centers. The plan and program of classes for repeated courses are determined on the basis of an analysis of the results achieved by the patient. As a rule, repeated courses complicate both in terms of workload and functional orientation.

At each stage of rehabilitation, it is necessary to set a goal and a specific task, based on the characteristics of the course of a traumatic disease in a given patient, the level of decay of functions and the degree of functional disorders. It is impossible to foresee all situations of pathological attitudes, their combinations and combinations, to which hypertonicity, stiffness, deformities, contractures, muscle atony can lead. The therapeutic complex of exercises in each case is the creativity of the doctor. However, the provisions outlined above, in our opinion, can become the basis for it. The doctor's art, probably, will consist in a differentiated selection of exercises, their complex combination and rational sequence based on a deep and detailed analysis of a motor defect and its clinical manifestations.

As experience shows, the motor activity of patients with spinal injury is adapted by the following terms: turning in bed with outside help - 7-10 days after the injury; independent turning in bed - 1.5-2 months; lateral torso flexion - after 2 months; training on the orthostand up to 75° - 2-3 months; transfer to a vertical position on an orthostand - 3-4 months (in severe cases - 5 months); staging in apparatus behind bars - 4-5 months; landing with support - 5 months; development of diverse leg movements in a vertical position - 5-6 months; development of step elements - 6-8 months; free fit - 7-8 months; walking training in apparatus behind bars - 8-10 months; setting behind the knee support - 10-12 months; non-apparatus walking - after 12 months. These terms are acceptable for patients treated immediately after injury at the modern level (elimination of spinal cord compression, reliable stabilization of the spine, rationally selected medications and adequate physiotherapy). The main criterion for the effectiveness of rehabilitation can only be functional recovery. Persistent neurological deficit, the absence of positive dynamics in the motor sphere for two years are the basis for a thorough neurological and neurosurgical examination of the patient and repeated surgery (according to indications), which includes revision of the spinal cord, elimination of compression, excision of scars and adhesions, meningoradiculolysis, removal of cysts, reconstruction spinal canal. Only such an active tactic can ensure the success of the rehabilitation of patients with traumatic spinal cord disease. In a number of cases, when functional recovery does not occur, there is a direct indication for revision and decompression of the spinal cord, patients refuse to undergo a second operation. In such situations, physical therapy exercises are carried out, aimed at compensating and vicarious replacement of the missing functions.

Restorative therapeutic exercises after spinal injury

The main purpose of this type of exercise is a general stimulating effect. Such exercises are included in all gymnastic complexes in alternation with targeted activities. General strengthening gymnastics in the form of non-specific elementary gymnastic exercises of a general nature is aimed at activating the cardiovascular system, respiration, improving metabolic-endocrine and autonomic functions. Gradually, in the course of classes, general strengthening exercises are replaced by special ones. However, such a replacement in medical complexes should not be complete: subsequently, the exercises alternate with more or less frequency. Techniques for performing general strengthening exercises are described above, when considering exercises of mobilizing gymnastics. It should be noted that targeted gymnastic activities on motor-visceral reflexes stimulate the activity of internal organs. And yet, in some cases, there is a need for special organ-functional stimulations, which can be facilitated by specially selected exercises.

Movement disorders in back and spine injuries

Each of the syndromes of traumatic spinal cord disease is a severe form of pathology. And yet, among them, movement disorders are leading, since this disrupts the most important means of communication and interaction between a person and the environment, his social activity and labor activity. In addition, both trophic and pelvic disorders, as well as other manifestations of a spinal injury, are determined by a motor defect in the process of developing a traumatic disease.

Damage to the cortical-muscular connections is manifested by paralysis and paresis. Their nature depends on the level of injury: damage to the rostral parts of the spinal cord is accompanied by loss of voluntary motor activity, exaltation of reflexes and spastic muscle tone; caudal part - flaccid paralysis (paresis), atony, areflexia and atrophy. With injuries of the cervical localization, motor disorders extend to the upper and lower extremities. Injuries to the chest and lumbar spinal cord lead to paralysis or paresis of the legs. Movements in the distal extremities are more severely affected. Paralysis develop less often than paresis. Usually the process is two-way. With half damage to the spinal cord, Brown-Séquard syndrome develops.

Motor cells lying caudal to the level of the injury site are deprived of descending impulses. In the nerve centers, ribonucleic and protein metabolism is disturbed, the ion gradient and cholinesterase activity change. At the same time, the muscular apparatus is morphologically preserved, it suffers only from inactivity, deterioration in the conditions of blood supply, and a decrease in nervous trophic influences, which leads to functional malnutrition. However, over time, denervation leads to a restructuring of the neuromuscular synapse, a change in the excitable properties of the membrane, the rate of processes that determine the act of reducing the tonic properties of muscles, the mechanism of accelerating and slowing down reactions, and a restructuring of intracellular metabolism.

Violation of signal transmission from receptors leads to a rupture of the afferent connection between intercalary neurons and motoneurons of its own level. Sensitive fallout exacerbates the functional defect of the muscles, the innervation of which turned out to be impaired. As a result, the muscles lose their gravitational properties, the ability to close joints, coordination and the ability to move the body in space are impaired. A lack of excitation leads to the formation of a synaptic block, atony. At the same time, the peripheral neuromuscular apparatus loses excitability, conduction becomes impossible, the production of acetylcholine in the synaptic endings decreases, and the functional significance of the muscles is reduced to zero. The reaction of muscle degeneration and their atrophy develops.

The focus of spinal cord injury is characterized not only by the death of nerve cells, but also by the steady loss of a certain number of functioning cells of the motoneurons of the anterior horns located perifocal to the injury zone. Over time, the prolapse area narrows due to a spontaneous partial decrease in alteration and revitalization of atonized cells under the influence of an increased influx of irradiating impulses. But during the course of the disease, not only the reverse development of alteration occurs: some of the initially intact axons can turn into a functional blockade due to developing metabolic disorders, disorders of the cerebrospinal fluid and blood circulation, and the appearance of connective tissue and glial formations. muscle strength in the muscles innervated by the caudal segment of the spinal cord, it is significantly reduced, often to 0 points. The electrical activity of denervated muscles "at rest" is increased. Moreover, this increase is greater in mixed paralysis and in muscles inervated by segments adjacent to the focus of injury. According to E. V. Tkach (1971), this indicates that the deactivation of descending inhibitory influences on the motor neuron plays a certain role in the generation of this activity. With voluntary activity, a decrease in the bioelectrical activity of the muscles was found due to a decrease in the amplitude of oscillations in the case of spastic paresis and a decrease in the frequency and amplitude in flaccid paresis. An increase in activity with synergies and activity of antagonist muscles was established. O. G. Kogan (1975) pointed out the presence of a perversion of lengthening-shortening reactions in spastic paresis. It is expressed in the fact that during passive shortening of the muscle, an electrical activity arises that exceeds the activity during its lengthening. Also, hypersynchronization of oscillations (most pronounced in flaccid paresis), a change in the lability of neuromuscular synapses, and a decrease in the rate of conduction of excitation along the peripheral nerve were also established.

In denervated muscle tissue, lipid and carbohydrate metabolism, ATP content are disturbed, which affects the basic properties of muscle fiber - extensibility and contractility, reduces muscle contractility and contributes to their rigidity. Tonic disorders in the form of atony and spasticity form vicious limb settings - drooping foot, loose joints, muscle and articular contractures. Changes in the nature of the forces applied by the muscles to the bone lead to adaptive restructuring in the zone of muscle attachment, changes in the architectonics of the bones, atrophy or hypertrophy of the bone elements. More often than not, the process is mixed. This is facilitated by trophic, vascular and metabolic disorders, characterized by calcification of the interstitial tissue. Zones of disorganization of the bone substance usually develop in the region of the epiphyses. Heterotopic restructuring of bone tissue, accompanied by paraossal and paraarticular ossifications, ossifying myositis, changes the configuration of bones and joints, sometimes leading to pronounced deformities of the limbs. In some cases, bone restructuring occurs under the influence of inadequate treatment, increased or perverted functional load.

With injuries of high localization, dislocations of the muscles of the shoulder girdle are noted - the shoulders are lowered, adducted and rotated inward. Due to the weakness of the deltoid, scalene and triceps muscles, reciprocal relationships are violated. As a rule, muscle displacements are asymmetrical. Weakness of the back muscles back muscles scapula, subscapularis muscles causes the displacement of the scapula. The support on the shoulder blade is reduced, as a result of which the extension of the arm is difficult. Despite the weakness of the main flexors of the forearm - the brachioradialis and biceps muscles - the function does not completely drop out, since the round pronator is a synergist of the flexor muscles and partially compensates for the execution of this movement. And since both the two-headed and brachioradialis muscle, in addition to flexion of the forearm, are involved in its supination, then this function suffers, being provided only with long and short arch supports of the forearm. With spastic paresis, supination of the forearm is often limited. Flexion of the shoulder joint is difficult, and in most patients it is 20-45°, less often - 70-90°. Extension is possible by 25-30°, since the extensor muscles (deltoid, scalene, partially triceps) are very weak. In the elbow joint with flaccid paresis, overextension is often noted, with spastic paresis, extension may be limited (from 170 to 120 °).

The distal muscle groups are especially affected. Even with spastic paresis, the so-called "atrophy of inactivity" develops here. The interdigital spaces recede, the tenar and hypothenar are smoothed. Manipulative possibilities in fingers are oppressed. With flaccid paresis, the hands are board-like flattened, with spastic and flaccid-spastic paresis, flexion of the fingers of varying degrees and flexion of the hand are noted. Flexor installations usually capture II-V fingers, spreading with mixed paresis to two phalanges, and with spastic paresis - to three. With a sluggish tone, looseness in wrist joint. With spastic paresis, extension in the wrist joint is difficult, "viscous" and possibly up to 25-40°, less often up to 10-20°. In some cases adductor contracture of the hand at an angle of 20-30-40° is noted. Over time, a motor defect in the proximal sections upper limbs compensated to a greater or lesser extent, in the distal sections, especially in the fingers, functional losses are persistent, manipulative capabilities are sharply suppressed, keyboard movements of the fingers are difficult, breeding, opposition, flexion and extension are disturbed. At the same time, with higher levels of spinal cord injuries, motor activity in the fingers is more pronounced, and the lower the level of injury, the more this activity decreases.

With injuries of the cervical and upper thoracic spine, the muscles of the chest (pectoralis major, pectoralis minor) and abdomen (straight, oblique) are atrophic. Often the intercostal muscles are also weak, while the intercostal spaces increase, rib cage deformed. Weakened abdominal muscles are stretched and unable to perform a corset function.

With lower paresis, the range of active movements in the joints of the legs is more or less limited. Abduction and rotation of the thigh are reduced, extension of the lower leg and dorsiflexion of the foot are depressed. Hypotrophy extends to the gluteal muscles, muscles of the thigh and lower legs. Because the big gluteal muscle is one of the most powerful extensors of the body, then its weakening contributes to the formation of lordosis. Weakness of the muscular corset leads to an increase in the angle of inclination of the pelvis. In this case, the pelvic ring, as it were, shifts downwards. As a rule, with flaccid paralysis and paresis, closure in the joints of the legs is impossible. Overextension is often noted, more often in the knee joints, a valgus or varus setting is formed here, as well as a genu recurvatum. Muscles undergo great stretching and even overstretching. In the feet, valgus and equinus also occur, and in some patients, adduction varus deformity.

With spastic paresis of the lower extremities, the muscles are in high tension mode, their reflex resistance to stretching is pronounced. Hip flexors are involved in pathological synergy, triceps shins. The most common contractures of the hip joints are flexion-adductive and rotational. Bending unit in hip joint due to the formed persistent pathological synergy, it changes the direction of muscle contraction: biceps hips, semimembranosus and semitendinosus at the same time act as flexors of the lower leg, and not extensor of the thigh, becoming synergists of the gastrocnemius and soleus muscles. This distribution of thrust causes flexion contracture in the knee joints. At the same time, the adductor set of the hips is formed, since the synergy also captures the large adductor muscle of the thigh. The tension of the calf muscle creates a fixed vicious flexion set in ankle joint(plantar flexion). This leads to the development of an adductor contracture. A sharp combined tension of the muscles of the lower leg (triceps and muscles of the anterior group) form a flat-equino-valgus foot, when the calcaneus, talus and cuboid bones are displaced downward, and the navicular is deformed.

With flaccid paresis, standing and moving without improvised means, as a rule, are not feasible. muscle weakness, sensory disturbances, the impossibility of closing the joints, their overextension, drooping foot impede the spatial movement of the limbs, reduce stability, and make it impossible to coordinate the center of gravity. For motor acts, the reduction or loss of some elements is characteristic. With spastic paresis in a vertical position, flexion attitudes and often internal rotation of the limbs are preserved. Such attitudes lead to functional decompensations. In those cases where walking is possible, it is almost always pathologically perverted. Despite the difference in the mechanisms underlying motor disorders in flaccid and spastic paresis, many characteristics of the locomotor act are similar in both cases. With both types of paresis, the support period increases, while the two-support time increases, and the single-support step time is relatively shortened, the support time for the entire foot increases, which achieves stability when walking. The movements of the fly leg of knitting, synergy create resistance to movement, the pace of movement is slow, the stride length is shortened. The range of motion in the joints is sharply reduced: up to 7-12° in the ankles (normal - 25°) and 17-24° (normal - 32°) in the knees. Support phases shift. The support on the heel is shortened, the roll of the foot is carried out through the toe. The turn of the feet also changes, more often it is internal rotation. As a rule, there is an asymmetry in the amplitude of the curves of angular displacements, angular velocities and accelerations in the joints of the limbs. With gross flaccid paresis, individual elements of the kinematic curve may disappear. So, plantar flexion is impossible, with a back push, flexion of the knee joint is not possible during the roll over the back of the foot. In patients with flaccid paralysis, the ability to maintain an upright posture and move is completely lost. They have denervated muscles under the influence of antagonists, the mass of the limbs and various mechanical moments are overstretched, which leads to their rebirth. In cases of pronounced spasticity, accompanied by severe disorders, protective tonic and adjusting reflexes, flexion-adducting contractures, walking is also impossible. When using improvised means, from 20 to 60% of body weight falls on additional support. In some patients, certain parts of the feet are not loaded at all. More often this happens with vicious installations and deformations.

Thus, as a result of gross morphological and functional disorders in spinal cord injury, biomechanics and dynamic stereotypes change. Locomotion disorders in spinal patients are manifested by a disorder in the function of support, walking and grasping, the formation of complex combinations of movements, a slowdown in the pace of walking, a change in its pattern, spatial and temporal asymmetry, a decrease or loss of some elements of the movement cycle.

Reflexology for spinal injuries

Reflexotherapy methods include Japanese kuatsu, reflexology according to Bonnie, Abrams spondylotherapy, application of metal plates (Lenslo method), fixation of depressed balls (tsubo), magnetic lights, shiatsu, do-in, acupressure, rotational, oriental massages, patches. In recent years, reflexology has been replenished with the methods of electropuncture, laser reflexotherapy, and electroanalgesia.

The idea of ​​mechanical excitation of nerve receptors in certain parts of the body in order to evoke the most pronounced reflex responses in the corresponding organs has received the greatest recognition. When exposed to acupuncture zones, nerve impulses arise - biocurrents. At the same time, when tissue elements are destroyed (or irritated) when a needle is inserted, biologically active substances such as necrohormones, traumatocins, and histamine series products appear. In the future, irritation is transmitted by the type of axon reflex, causing visceral-segmental and general autonomic reactions. According to A. P. Romodanov and co-authors (1984), the primary mechanism of reflexology is electrothermal effects, biologically active points (BAP) react by changing the thermal regime of tissues. During acupuncture, heat is removed, and during cauterization and electropuncture, it is introduced, that is, the tissue is heated.

According to ancient Eastern doctors, "vital energy" - "chi", obeying the main principle "shen", spreads through the "channels" of the body (meridians) and ensures the normal functioning of both individual organs and the whole organism as a whole. Difficulty in the passage of "energy" through the "channels" causes the state of "yin", and the formation of an excess of "energy" leads to the state of "yang" (Zhu-lian, 1959; Wei Zhu-shu, 1959; G. Luvsan, 1980). Currently, it is believed that the states of "yin" and "yang" reflect the predominance of the tone of one or another section of the autonomic nervous system, which determines the balance of excitatory or inhibitory processes in the central nervous system.

The therapeutic effect of reflexology is obviously associated with the elimination of the pathological dominant, breaking the vicious circle that has developed during the course of the disease.

In our opinion, the plaster method, Chinese acupuncture, shiatsu and new methods of reflexology - electro- and laser analgesia are of the greatest importance. However, these methods can only be used as auxiliary, symptomatic treatment methods and only for some syndromes at a certain stage of their formation. These methods should by no means be regarded as a panacea. Their undifferentiated use can only discredit the method and aggravate the patient's disbelief in restoring health. So, the period of general enthusiasm for magnetophores was replaced by expectant restraint, and in some cases - by a certain negativism. Meanwhile, the use of magnetic applicators in 60-70% of cases can relieve pain, swelling, and accelerate the healing of ulcers.

Before embarking on reflexology, it is necessary to solve five main questions:

1. choice of syndrome;
2. choice of method of influence;
3. accounting of the initial state of the organism;
4. choice of prescription points-zones of influence;
5. accounting for the time of application of irritation.

Methods of reflexology are used in a number of syndromes of traumatic spinal cord disease. The best results were obtained in patients with traumatic spinal cord disease in the presence of pain, trophic and pelvic disorders. An attempt to use it in 30 patients as a remedy for motor disorders had no effect, and further work was abandoned by us as unpromising: we did not note the appearance of active movements in any case. Encouraging results are obtained when trying to normalize muscle tone. No relationship was noted with the timing of the injury.

With pain syndrome, the use of electropuncture is more effective. Laser reflexotherapy can also be used.

The use of reflexology for intense pain in patients with spinal cord injury does not solve the problem of pain relief, however, it can reduce or stop pain for a while. Now it is generally accepted that the basis of the analgesic effect of reflexology is the release of endogenous opiates (endorphins), in particular enkephalin.

With trophic disorders, including muscle hypo- and atrophy, a certain result can be achieved with the help of corporal and auricular acupuncture. According to V. A. Bersenev (1980), the therapeutic effect is based on the excitation of neurons of the spinal nodes, the activity of which suppresses nociceptive impulses. Acupuncture is also applicable for pelvic disorders.

The Japanese doctor Tokuiro Namikoshi in 1972 revived in the modern clinic the ancient method of treatment - "shiatsu", the essence of which lies in the pressure (finger pressure) of the zone of active points. In Chinese medicine, this method corresponds to "finger zhen". To perform pressing, you can also use special needles with a blunt working end. The purpose of the "shiatsu" method is the same as other methods of reflexology. Pressing can be used for massage in its pure form (acupressure) or in combination with rotation, vibration, etc. We consider the method of cauterization (jiu-therapy) unacceptable in patients with spinal cigarettes, but mainly because of the difficulty of choosing a stable heating regime and the undesirability of the formation of "jiu-tsuan" (bubbles from cauterization).

Ear acupuncture, or auriculopuncture (the traditional Chinese name is er-zhen-lyao), is a form of reflexology. In some cases, this method is preferred due to the developed aurovisceral and nerve connections of the auricle.

It should be borne in mind that weak stimuli have an excitatory effect, while strong ones have an inhibitory effect. Ancient Eastern healers believed that the effect of acupuncture on a particular organ would be greatest if it coincided with the period of the highest functional tension of this organ, that is, for the success of acupuncture, “mastering the moment of irritation” is important (D.N. Stoyanovsky, 1977). Optimal time for the effect on the large intestine there will be a period of time between 13 and 15 hours, on the bladder - 15-17 hours, on the kidneys - 17-19 hours, on the genitals - 19-21 hours. special guides.

Irritation of certain points causes a strictly defined viscerosensory reflex. With a reduced function of the organ, it is advisable to use stimulation techniques (excitation), in hyperreactive states, soothing techniques (inhibition), which in Chinese folk medicine is usually listed as "bu-se" - the addition and subtraction of "energy". According to A.P. Romodanov et al. (1984), the calming effect of needles is associated with an increase in the excitation threshold in BAP. The excitatory action increases the temperature and potential of BAP. With the syndrome of redundancy, the method of dispersion is used, with the syndrome of insufficiency, the method of toning.

The role of physiotherapy and exercise therapy after spinal injury

The main directions of physiotherapy and exercise therapy in restoring lost functions

Restoring functions lost after a spinal injury is a very difficult task. The difficulty lies primarily in the fact that the material basis for recovery should be the connection of damaged conductors and the formation of new cell formations, that is, the morphological structure of the tissue, which ensures its normal functioning. The possibility of reparative-regenerative reconstruction of nervous structures has been proven by many researchers (L. A. Matinyan, 1965; T. N. Nesmeyanova, 1971, etc.). However, this process is difficult due to the growth of glial tissue in the area of ​​spinal cord rupture and the formation of cavities in the damaged area. One of the reasons that impede regeneration is hemodynamic disturbance in the area of ​​damage as a result of breaks, thrombosis, desolation in the capillary network, which leads to the shutdown of a part of the vascular collector, hypoxia, and delays the growth and myelination of regenerating axons.

As mentioned, in spinal cord injury, around the focus of destruction, there is an area of ​​morphologically intact, but functionally inactive structures that are in a state of deep congestive depression of functions. The neurons located here are refractory to excitation impulses that have become subthreshold for the cell, as a result of which the dropout zone significantly exceeds the area of ​​true damage. Physical therapeutic factors and means of exercise therapy can greatly contribute to overcoming these difficulties of plastic tissue construction instead of destroyed and stability of alteration of reversibly damaged structures. Physical methods enhance the resorption of destructive tissues, infiltrates, hematomas, scars, adhesions, accelerate the regeneration of nerve fibers; stimulation of reparative processes in bedsores and trophic ulcers; increased metabolism in the denervated muscle; normalization of muscle tone; prevention and treatment of contractures and positional pathology of the joints; stimulation of the functions of the organs of departure; removal or reduction of pain; increase the tone and defenses of the body.

According to modern ideas about the essence of the biological action of physical factors, they are based therapeutic effect lies the property of changing the chemistry of tissue colloids and thus effecting the transition of tissues from one reactive state to another. The mechanism of action of physical factors is complex. It consists of humoral-reflex reactions, the formation of biologically active substances that stimulate cells and tissues, and change the course of the pathological process.

The body responds to the use of physiotherapy with differentiated reactions of both local and general order. Under their influence, complex transformations occur in the material structures of the pathological focus. As P. G. Tsarfis points out (1983), "... under the influence physical methods treatment, the relationship between various adaptive systems, homeostasis and cellular metabolism is restored. "It has been established that therapeutic physical factors also contribute to an increase in cellular structures and, thus, an increase in the functional potency of tissues.

The action of such a strong biological stimulus as an electric current causes cellular-tissue and molecular-metabolic reactions. Under the influence of direct current, there is a directed movement of tissue electrolytes in the zone between the electrodes. According to the observations of V. S. Ulashchik (1979), a change in the "ionic conjuncture" increases the physiological activity of the tissue. At the same time, microcirculation and regional hemodynamics improve, the barrier function and absorption capacity of tissues change. The movement of ions and charged protein particles causes afferent stimulation of the receptor apparatus, in response to which complex biophysical processes arise in organs and tissues. In addition, at the same time there is an increased formation of biologically active substances (histamine, acetylcholine, adenylic acid), which provokes reactions specific to these substances. In this case, one feature is manifested that is of fundamental importance for rehabilitation therapy. The fact is that electrodes of different poles cause unequal physico-chemical changes in the underlying parts of the body. K ions accumulate under the cathode, the permeability of cell membranes increases, the level of cholinesterase decreases (IG Shemetilo, 1980). A drop in cholinesteral activity leads to the accumulation of acetylcholine quantums on the synapses, that is, tissue excitability increases. Ca ions are concentrated under the positive electrode (anode), membrane permeability decreases, cholinesterase activity increases, acetylcholine content decreases, and the excitability of nerve structures decreases. Electric current is able to stimulate the energy of tissues and the whole organism as a whole, increase resistance to external influences, change the reactivity of the immunocompetent system. In the experiment it was established (Z. N. Ostapyak, 1983) that galvanic current enhances biosynthesis and that tissue reactions when exposed to it have an anabolic orientation. Thus, galvanic current can promote intracellular regeneration (BV Bogutsky et al., 1983). Electric current is used as an anesthetic. Sinusoidal modulated and diadynamic currents have a particularly pronounced effect. The analgesic effect is achieved by the rhythmic flow of high-power impulses from receptors irritated by the current, which suppress the pain dominant in the first phase of action. The influence of the sympathetic nervous system on the vessels is suppressed, which leads to an increase in the parasympathetic effect, as a result of which the tone of the vascular wall decreases and its peripheral resistance decreases. Improving the conditions of blood supply and enhancing lymph circulation contribute to the reverse development of the pathological focus, as a result of which the pain impulse from the focus decreases (the second phase of the current action). Better delivery of oxygen to tissues and accelerated transport of metabolites contribute to the normalization of trophism. Electric stimulation of the neuromuscular synapse stimulates the release of acetylcholine, which allows the reproduction of movements in the paretic muscle. Regular operation of the synapse by the method of rhythmic excitation of the nerve and contraction of the muscle by electric current maintains the working tone of the muscle and promotes the regeneration of the nerve fiber that innervates this muscle (G.V. Karepov, 1985). Low-frequency pulsations of alternating current irritate the sarcoplasmic reticulum of the muscle fiber, resulting in the training of the contractile mechanism of the muscles. Reproduction of movements in paretic muscles, increasing microcirculation, reduces vasospasm, swelling of tissues, increases metabolic processes in them, improves trophism. Alternating current causes vasodilation (through inhibition of the sympathetic part of the autonomic nervous system), and also gives a pronounced analgesic effect (L. Nikolova, 1971). There are indications that under the influence of interference currents, the processes of regeneration of the nervous and bone tissue are activated. This increases the activity of tissue enzymes, normalizes the metabolism of proteins and nucleic acids.

An electric field of ultrahigh frequency (UHF ep) causes a persistent expansion of blood vessels, an increase in blood flow and an acceleration of blood flow. At the same time, the phagocytic activity of leukocytes increases, the dispersion of blood serum proteins increases, tissue respiration increases, biochemical and enzymatic processes accelerate.

The ability of an electric current to dissociate it into electrically charged particles of molecules (ions) when passing through a solution is used to administer medicinal substances. Drug electrophoresis has the following advantages. First of all, the pharmacodynamics of administered drugs changes: it is well known that the pharmacological activity of ions of substances is much higher than that of their molecular counterparts. In addition, with this method of introducing drugs into the body, the threshold of its sensitivity to a given substance increases sharply, since it has been established that the electric current itself changes the susceptibility of the receptor apparatus. This allows to achieve a good therapeutic effect with the introduction of smaller amounts of the drug. This circumstance is especially valuable in the clinic of spinal injuries, since due to polysymptoms, severe complications, and duration of treatment, the patient's body is usually oversaturated with drugs, while the filtering and detoxification mechanisms are functionally inhibited. Medicinal substances, penetrating the skin by electrophoresis, form a depot, from where they then, continuously diffusing, maintain a constant concentration. It is also important that with this method it becomes possible to saturate a certain part of the body with the medicine (the area of ​​the pathological process). This circumstance is important, for example, when antibiotics are administered directly to the zone of trophic disorders (pressure sores, ulcers).

The action of the magnetic field consists mainly in the occurrence of eddy currents and induction of an electromotive force, resulting in an oscillatory movement of ions and dipoles of protein-colloidal elements of cells (Yu. A. Kholodov, 1977; M. G. Vorobyov, 1980). Under the influence of a high-frequency magnetic field, deep hyperemia occurs in the tissues, blood and lymph circulation increases, the phagocytic activity of leukocytes increases, and enzymatic activity increases. V. A. Matyushkin and co-authors (1983) in an experimental study of the influence of a magnetic field on the ultrastructure of the nervous tissue established the phase of response reactions with the final restorative effect: regeneration of cell organelles, activation of mitochondria and an increase in the number of synaptic vesicles. Electromagnetic waves of the decimeter range cause an increase in tissue heat production (V. G. Yasnogorodsky, 1983), which increases circulation in the vascular collector. These moments are leading in the mechanism of reducing the excitability of gamma motor neurons and allow the use of decimeter electromagnetic waves (UHF) to reduce spasticity. An improvement in blood flow and intensification of metabolism in this regard give reason to use UHF to enhance reparative tissue regeneration, in particular, to stimulate the growth of conductors in the damaged area of ​​the spinal cord and treat pressure sores. The experiment established the ability of UHF to stimulate the secretion of oxycorticosteroids, which reduce the permeability of cell membranes, as a result of which the release of mesosomal enzymes decreases, thereby stopping the destruction of collagen fibers of the connective tissue (PG Tsarfis, 1983). Under the influence of UHF, a structural reconstruction of the nervous tissue occurs in the area of ​​damage: the amount of DNA and its activity increase, tissue regeneration from neuroblasts and glial cells (O. A. Krylov, 1983). According to Yu. N. Korolev (1983), the nature of structural and metabolic rearrangements when using UHF depends not only on the originality of the forms of regeneration of certain tissues, but primarily on the site of the factor. Local localization and application of UHF to the area of ​​the adrenal glands stimulate intracellular processes, while the effect on the area of ​​the thyroid gland is accompanied by an immunostimulating effect (V. M. Bogolyubov, I. D. Frenkel, 1983). At the same time, there is an increase in the level of thyroxin in the blood against the background of a decrease in prostaglandins, inhibition of the kallikrein-kinin system, a decrease in the glucocorticoid and an increase in the mineralocorticoid function of the adrenal glands, and an increase in testosterone levels. The impact of UHF on the projection area of ​​the adrenal glands causes an increase in their glucocorticoid function, while the activity of the thyroid gland decreases and the level of prostaglandins increases, thymus function is inhibited, the number of antibody-forming cells in the spleen decreases, the content of neuraminic acid and seromucoid increases in the blood.

The biological action of ultrasound (US) is based on wave-like vibrations of the medium, the formation of heat due to the conversion of mechanical energy into thermal energy and the phenomenon of cavitation at the interface of contiguous media. L. D. Glushchenko et al (1983) found that ultrasound can potentiate spinal circulation. MA Aliakhunova (1983) in experiments on animals observed a significant increase in the level of 11-0KS in the blood serum after exposure to US. With the help of ultrasound, it is possible to carry out drug phoresis (phonophoresis), while medicinal substances penetrate deeper, accumulate in the depot for a longer period and in more, mainly concentrating in the organs of the impact zone. The therapeutic effect is even more pronounced with the combined use of ultrasound, medicinal substances and direct current.

The therapeutic use of light radiation is based on the ability of tissues to absorb radiation with a change in the electronic structure of atoms and molecules. The photobiological reactions of the organism consist in: 1) excitation of the molecules of tissue substances due to the absorption of quantum radiation; 2) the ability of excited molecules to superordinary reactions with the formation of a new organization; 3) a change in the function of molecules in cells due to the emergence of a new organization; 4) tissue response to functional rearrangement in cells.

The tissue response is expressed in the formation of biologically active substances, primarily vasotropic ones, due to the breaking of bonds in protein molecules under the influence of absorbed energy, increased activity of thermoregulatory mechanisms, destructive processes in biological substrates (photolysis, denaturation) due to anatomical and molecular rearrangements, functional reflex rearrangement in systems and organs that are metamerically associated with the reflex zones of the skin segments, vasoactive substances cause vasodilation with the formation of erythema. This increases the permeability of the vascular wall, increases the migration of leukocytes. Penetrating into the bloodstream and spreading through the bloodstream throughout the body, photolysis products have a humoral effect on all organs and systems, including the nervous and endocrine. Under the influence of increased blood circulation, increased tissue temperature, oxidative and metabolic processes, the regeneration of the epithelium and the formation of connective tissue are accelerated (MG Vorobyov, 1980). This circumstance is important in the practice of rehabilitation therapy for spinal cord injury, since it can be used to heal bedsores and ulcers. contributes to this and general action light on the body, increasing the protective and trophic function of the nervous system. It was established (L. M. Gakh, 1983) that as a result of ultraviolet irradiation, the activity of acid phosphatase, NAD-diaphorase decreases, the permeability of lysosomal membranes of macrophages, polymorphonuclear leukocytes and lymphocytes decreases, that is, inhibition of exudative processes develops, including purulent-necrotic. At the same time, biosynthesis rates increase, which indicates proliferative activation. The light-stimulating effect of the conversion of skin provitamins (7-dehydrocholesterol, ergosterol, etc.) into vitamin D and the normalization of phosphorus-calcium metabolism are also important, since in the process of developing a traumatic disease of the spinal cord, mineral metabolism is disturbed in patients, the absorption of phosphorus and calcium decreases, it is noted osteoporosis, bone regeneration, osteomalacia and other metaplastic changes. The analgesic effect of UVR is based on the reshaping of dominant relationships and the suppression of a congestive focus of pain.

Given the particular importance of motor disorders, the restoration of motor functions should be given the main attention. The means of physiotherapy exercises (LFK) come to the fore here.

There are 4 main mechanisms of action of physical exercises:

1. tonic;
2. trophic;
3. formation of functional compensations;
4. normalization of functions and integral activity of the body (V. K. Dobrovolsky, 1970).

Since exercise therapy increases the viability of the body in adverse conditions, all patients with spinal cord injury need a set of general strengthening and mobilizing measures that remove the negative effects of physical inactivity. Rational styling is just as necessary. The functional and physiological position, taking into account the cordance of muscle lesions and deformities, provides optimal conditions for treatment. When spinocortical connections are damaged, the flow of impulses from proprioreceptors located caudal to the injury decreases. At the same time, the impulse from the damaged area sharply increases, forming a pathological dominant in the cerebral cortex, which suppresses the activity of cortical structures. These circumstances lead to a weakening of the regulatory influence of the cortex on the functions of the body. Tonic physical exercises can reduce this inhibition. Regular systematic repetition of exercises excites the corresponding motor cells of the cortex and keeps them in a state of functional activity. Physical exercises bring metabolic and energy processes in the muscles to a new level, contribute to increased blood circulation.

Thus, the tasks of exercise therapy in the clinic of spinal cord injuries are general strengthening measures, ensuring functional and physiological positions, activation of the motor centers of the cortex, and improving blood circulation in the area with impaired innervation.

Based on the clinic of movement disorders in patients with spinal cord injury, obviously, special attention should be paid to breathing exercises, orthostatic training, and coordination exercises. Special exercises are important to improve intestinal motility, with reflux and urolithiasis, to increase blood supply to the spinal cord. When drawing up a treatment plan, specific plasticity is taken into account, as well as the ability of the musculoskeletal system to realize the functions of grasping, standing and walking in pathological conditions.

Exercise therapy techniques are multidirectional depending on the type of flaccid or spastic paralysis. With flaccid paralysis, the selection of exercises is carried out in such a way that the flow of impulses from the proprioreceptors of the paretic limbs increases. In spastic paralysis, efforts are directed at relaxing and stretching the muscles. In both cases, functionally defective muscles are the object of training. With gross injuries (unresolved compression, crushing of structures, anatomical break), when recovery is impossible, exercise therapy solves the problems of substitution of functions (compensation), neuromotor re-education of muscles that are not normally involved in this motor act, and adaptation to the defect. In each period of traumatic disease of the spinal cord exercise therapy has its own characteristics. They concern both the goal and the choice of a set of movements, their pace, volume and strength, as well as the amount of private and general load.

There is an opinion that exercise therapy should not be performed in the early period of spinal injury, it is even considered contraindicated (V. N. Moshkov, 1972, etc.). Meanwhile, the beginning of physical therapy classes immediately after the complex of urgent life-saving measures is advisable. At the same time, classes have a preventive focus and are focused on the early warning of bedsores, contractures and congestion in the lungs. The patient is provided with physiologically rational laying, breathing exercises are performed (if he is not intubated), passive movements in the joints of the limbs. V. A. Epifanov (1983) introduced physical exercises into the complex of resuscitation measures for spinal injuries. The tactic was tested with good results in 186 patients with injuries of the cervical spine and spinal cord. The use of exercise therapy during a critical period for patients can significantly reduce postoperative complications and mortality. Exercise therapy during the debut period has a positive effect on the manifestation of the main clinical syndromes of the emerging traumatic disease of the spinal cord, and on the functional prognosis. Of course, we are talking O exercise adequate to the condition of the patients.

At the same time, it must be borne in mind that in the early period of a traumatic illness, the patient is in a state of spinal shock and additional afferent signaling in the form of strong and frequent irritations can deepen parabiosis. Therefore, with early motor activation of the patient, overloads are unacceptable.

Overloads generally cause asynchronization of the rhythms of equal body systems. It is known that intense exhausting excitation leads to a change in protein metabolism towards catabolism, causes structural changes in protein molecules, a decrease in glycogen in brain tissues, deposition of ammonia in nervous tissue, and a decrease in ATP in brain structures, which leads to a decrease in excitability and increased inhibition. Therefore, it is important to carry out mobilizing activities, static and passive exercises, breathing exercises in the acute stage of injury, limiting motor activity in volume and loads. In this regard, I would like to warn against an uncritical attitude to some authoritarian statements such as the slogan put forward by N. A. Shestakova (1978): "Maximum intensification of rehabilitation measures at all stages of rehabilitation treatment is the basis for early restoration of functions."

In the subacute stage of the early period of traumatic disease, exercise therapy is focused on functional restitution. Classes become more complicated, parametric indicators increase - strength, amplitude and speed of exercises. Strengthening of afferent signaling from the periphery contributes to the restructuring of the integrative activity of the spinal cord. An increase in the activity of centers of various modalities in the process of reintegration leads to an increase in the flow of efferent impulses.

The chronic stage of the late period of traumatic disease of the spinal cord requires a complex correction of stimulating, restructuring and normalizing afferent impulses aimed at vicarious replacement. The most adequate therapeutic measures in this case will be those that increase the flow of excitatory impulses and block inhibitory ones. In spastic paralysis and paresis, the first priority are techniques that eliminate or reduce the imbalance of antagonist muscles. With flaccid paresis, increased afferentation from proprioreceptors, stimulating exercises, and posture regulation will play a leading role.

It has been established that when movements are used as a therapeutic factor in the muscles, glycogen resynthesis and the utilization of protein-free nitrogen increase, protein synthesis and oxygen consumption increase. This circumstance is of fundamental importance. V. V. Portugalov and A. V. Gorbunova (1974), when studying the effect of hypokinesia on the metabolism in the motor neuron of the anterior horns of the spinal cord, found that under conditions of reduced motor activity, the metabolism of RNA and proteins is disturbed, while muscle atrophy is ahead of the atrophy of the corresponding motor neurons. In the denervated muscles, an even deeper restructuring is noted. Therefore, the normalization of metabolic processes in the muscles plays an important role in the recovery process. Under the influence of exercise therapy, pronounced humoral shifts occur, accompanied by the activation of hormones, enzymes, potassium and calcium ions. The main difficulty in the rehabilitation therapy of patients with the consequences of spinal cord injury is the transfer of excitation from the proximal segment of the spinal cord to the distal one. Training with passive and active movements, accompanied by afferent and efferent impulses, promotes tissue regeneration at the site of damage, disinhibition of morphologically intact but functionally inactive neurons in the area of ​​functional asynapsia, and the development of new pathways of impulse transmission. The afferent discharge is multi-segmented, the issue of "multisensory convergence on afferent neurons" is widely discussed by physiologists, which is considered one of the main factors in the activity of sensory systems in pathological conditions.

With partial injuries of the spinal cord, when some conductors are preserved, the inclusion of additional interneurons in the formation of new reflex reactions to replace the lost ones ensures the development of movements in a volume sufficient for functional recovery. When the cord is ruptured, impulse transmission from the center to the periphery is carried out along extramedullary connectives, which leads to the activation of adaptive mechanisms and compensation of the formed defect, "to the development of motor functions even in conditions of anatomical interruption of the spinal cord" (T. N. Nesmeyanova, L. S. Goncharova, 1971).

In the residual stage of traumatic disease, exercise therapy is aimed at consolidating the achieved level of motor activity and adapting the patient to the existing defect. Nevertheless, at this stage, we and in the literature noted cases of functional recovery.

Restoration of movements in the distal parts of the upper limbs is a very difficult task. Movements in the hands are the most coordinated, plastic and finest in terms of structural pattern locomotor act. At the same time, they have a high functional significance, and therefore, in the medical rehabilitation of patients with damage to the cervical spinal cord, the restoration of motor activity in the hands plays a paramount role at all stages of treatment.

After a spinal cord injury, the ability to move independently is lost or walking is specifically disfigured: arrhythmic, accompanied by a violation of the support function, temporal and spatial asymmetry, a change in the structure of movement, vertical or lateral swaying of the body, tension, a change in the postural characteristics of the legs and is most often possible with improvised means. Walking is a movement with the transfer of the general center of gravity of the body, while alternately and sequentially the limbs perform support and transfer of the leg. The stance phase is formed by such components as the front push, foot roll and back push. In the swing phase, the leading moment will be the extension moment and the vertical moment. The displacement of the general center of gravity of the body occurs when walking in the vertical, forward and lateral directions, causing certain deviations (oscillations) of the body.

In the process of step-by-step exercises for teaching patients to walk, efforts should be focused on improving kinematic characteristics - straightening the leg during the reference period of the step, increasing the range of motion in the transfer phase. This ensures the development of the correct dynamic stereotype of movement. At the same time, the time indicators of the step improve, the posture of the leg normalizes, and the pattern of walking improves.

The phasing of classes provides for a sequence of power and temporary loads, dynamic complications and the inclusion of different muscle groups in voluntary motor activity. All this ultimately leads to the release of the patient from improvised means of support. The development of a vertical posture and movement is also important because it contributes to the restoration of the function of the pelvic organs, improves the activity of all vital systems of the body. Therefore, training in movement is necessary even in the residual stage, even with gross and functionally irreversible changes. In these cases, efforts are directed to the elimination of pathological relationships between the muscles of the limbs, discordant contractures, the restoration of support ability, the inclusion in the movement of muscles that are not normally involved in it, and the provision of the possibility of orthograde movement. A new walking stereotype is created, requiring additional muscle work.

During training and retraining of the patient, orthopedic means are widely used - prosthetic devices and support devices. Rational prosthetics improves the conditions of limb support, helps to reduce asymmetry in all respects. Additional reliance on auxiliary handy devices reduces the frontal component, lateral torso sway and foot turn, and makes it easier to keep the body in balance.

Thus, the use of exercise therapy as a differentiated system for the use of movements for therapeutic purposes, used in appropriate combinations and in a certain sequence, makes it possible to selectively influence denervated and altered muscles. The effect is provided by the restoration or reconstruction of lost functions, their replacement by others or the formation of new ones with the help of orthotics.

Spine and back injuries

Characteristics of structural changes, clinical forms and symptoms

In spinal injury, the damaging agent, abruptly and with great strength acting on the spine and associated morphological formations (intervertebral discs, ligaments, contents of the spinal canal), causes their structural failure. The focus of spinal cord injury is heterogeneous. Its core is a zone of tissue destruction - ruptures, injuries by embedded bone fragments, crushing, compression of the brain substance by displaced fragments of a vertebra or a disc during its interposition. Damage occurs not only at the site of application of force, but also at a distance due to disturbances in the vascular collector (stasis, thrombosis, microcirculation disorders). Sometimes the ischemic zone extends over a fairly large area. Perifocally from these areas there are more or less extensive areas of structures that are morphologically preserved, but in a state of congestive depression of functions due to massive wound impulsation. Since the spinal cord is a cable system for connecting the periphery with the center, functional loss is noted in the tissues and organs associated with the lesion according to the principle of metamerism. In the clinic of vertebral-spinal injury, motor, sensory, trophic and pelvic disorders are leading.

Motor disorders are manifested by paralysis or paresis with changes in muscle tone and tendon reflexes. Loss of sensitivity, including muscle-articular feeling, is accompanied by gravitational disorders, in which the feeling of heaviness of the limbs and their spatial position is lost. The patient cannot stand, the functions of walking and grasping are disturbed, self-service becomes impossible. Often, radicular pain develops. Trophic disorders lead to the development of muscle hypo- and atrophy, tissue breakdown with the formation of bedsores, ulcers. Bursitis, abscesses, fistulas are formed in dystrophically changed tissues. Frequent degenerative changes in bones. In some cases, cachexia occurs. The functions of the pelvic organs are violated by the type of delay or incontinence, sexual function is upset. The activity of internal organs is disturbed, the conditions of blood circulation worsen, visceral-vegetative symptoms occur. At the same time, the nature of metabolism changes, hormonal restructuring occurs, the vitamin balance and the content of macro- and microelements are redistributed, and immune responses are rebuilt.

The degree of manifestation of these symptoms depends on the level of injury along the length and diameter of the spinal cord, the clinical form of the injury, the nature, severity and extent of it. Spinal cord injury can be complete or partial. A complete violation of the conduction of the spinal cord occurs as a result of its anatomical break. At the same time, there are gross defects in the functions of organs, the innervation of which is carried out by segments of the spinal cord located below the level of injury, pronounced neurodystrophies and automatism of dispatches. The clinical picture of a partial injury to the spinal cord will depend on which area of ​​the spinal cord is affected across the diameter. Here, anterior-lateral, postero-lateral and posterior-columnar syndromes are distinguished. Injuries to the cervical segments lead to loss of functions over a large area of ​​the body, motor disorders of all 4 limbs, dysfunction of the pelvic organs in the central type, pronounced autonomic disorders are noted. Damage to the thoracic localization, in addition to locomotor disorders and changes in muscle tone of the lower extremities, is often accompanied by severe neurotrophic disorders, which is due to the topographic and anatomical features of the spinal cord (vegetotrophic centers are located at this level). Disorders of departures in this case also have a conductive character. When the lumbar spinal cord is damaged, motor, tonic and trophic disturbances are especially severe. Pelvic functions are disturbed by the peripheral type. Damage to the cone is accompanied by a loss of sensitivity in the perineal region, peripheral pelvic disorders while maintaining motor functions. When the cauda equina is damaged, motor disorders are relatively mild, the motor defect extends to the distal parts of the limbs. Pelvic disorders develop according to the type of true incontinence. As a rule, the symptomatology is asymmetric. Sharply expressed radicular pain.

The following forms of spinal injuries are distinguished: concussion, bruise, rupture, compression, hematomyelia. A concussion of the spinal cord is characterized by transient symptoms, since with such damage, the traumatic agent causes only functional changes in the morphological structures. With a spinal cord injury, tissue destruction is significant, an injury of this kind is accompanied by crushing of the tissue, hemorrhages, and necrosis of brain regions. The loss of functions is significant, the defect is persistent. Tears and tears of the substance of the brain are accompanied by the same changes as bruises, but in addition, some part of the spinal cord is cut off (usually as a result of the introduction of bone fragments of the vertebra into the spinal cord). The clinical manifestations of such an injury are usually severe. Spinal cord compression is the most common form of traumatic spinal injury. Acute compression can be caused by the vertebrae or their fragments in case of dislocation of the vertebrae, crushing them under the influence of a wounding moment, with spondylolisthesis, disc interposition, insertion of the yellow ligament into the spinal canal, foreign injuring objects. Delayed, or subacute, compression of the spinal cord is observed most often as a result of meningeal hemorrhages and hematomas. Later, or secondary, compression is caused by traumatic deformity of the spine, graft, callus, herniated protrusion of intervertebral discs, adhesions and scarring in the injury site, cystic-adhesive processes, epiduritis. Compression is a constant source of pathological irritation and therefore aggravates clinical symptoms and injury. With hemorrhages in the spinal cord (hematomyelia), the gray matter is impregnated with blood, its subsequent destruction and compression of the conductors (usually lateral columns) by intramedullary hematoma, as a result of which both segmental and conduction disorders are noted.

A feature of spinal injury is that as a result of damage to a certain area of ​​the spinal cord, disorders (not only functional, but also morphological) occur in areas of the body that have not been subjected to mechanical stress, the innervation of which is carried out from the focus of damage. Disorders in the activity of a number of organs and systems that were not directly affected by trauma create a variety of new pathological situations. In the damaged area, inflammatory and adhesive processes develop, blood circulation is disturbed, blockade of the subarachnoid space and secondary compression of the spinal cord occur, muscle contractures, organ-functional transformations in the urinary system are formed, characterized by stone formation, reflux, inflammation, and renal failure. Bedsores and trophic ulcers often lead to osteomyelitis of the bones, where, in addition to inflammation, heterotopic transformations are noted, accompanied by the occurrence of paraosseous and paraarticular ossifications. Disorders of mineral metabolism contribute to the occurrence of osteoporosis, osteomalacia, dystrophic calcification of interstitial tissue. As a result of violation of reciprocal relations, weakness of the muscular corset, under the influence of mechanical force and forced position of the body, in some cases, spondylolysis, spondylolisthesis, scoliosis, severe kyphosis, S-shaped kyphoscoliosis develop, and pelvic curvature occurs. All this can cause new complications - articular contractures, ankylosis, pathological fractures, limb deformities. New mutual ties are being formed that are destructive in nature.

The development of such a stable pathological state is accompanied by disorganization in the activity of homeostatic mechanisms. There is an imbalance between the peripheral and central mechanisms of regulation and, as a result, there is a breakdown of the adaptive reactions of the somatic and vegetative systems. At the same time, immune reactivity undergoes a change. In the early lines of trauma, it is oppressed (O. G. Kogan, A. F. Belyaev, 1984). Cellular cooperation is disturbed: the content of T-lymphocytes in the peripheral blood falls, they move to the traumatic focus. There is a redistribution of their populations: a decrease in T-suppressors contributes to the influence of T-helpers on the proliferation of B-lymphocytes, their transformation into plasma cells and increased antibody genesis. Increased antibody formation leads to the fact that tissues that are not even structurally altered in trauma are exposed to antibodies, that is, there is an increase in tissue destruction in the spinal cord and in tissues with impaired spinal innervation.

In the late period, the indicators of autoimmune reactions level off. Concentrating in the focus of damage, T-lymphocytes stimulate the elimination of antigens from destructive tissues. Functional activity increases during spontaneous blast transformation. The intensity of antibody formation decreases. The immune response is suppressed. The number of T cells increases due to the proliferation of T suppressors. The content in the peripheral blood of T-, B-, D-, O-lymphocytes is normalized. As a result, dystrophic processes slow down and stop, which contributes to the regenerative potency of tissues, including damaged structures of the spinal cord. In inflammatory complications, excessive intake of microbial antigens contributes to an increase in the content of B-lymphocytes due to the stimulation of specific antibody genesis and antimicrobial antibodies.

Thus, spinal cord injury leads to neurological deficit, the development of infectious-toxic complications, and trophic disorders. Functional defects are persistent and deep, the course is progressive. Paralysis and paresis, pelvic dysfunctions, dystrophies are not the end result of the impact of the breaking force. Once arising under the influence of a traumatic agent, they act as a trigger mechanism for new forms of pathology, when the elements are damaged. physiological systems play the role of a direct pathogenic factor. In parallel, another dynamic line is being formed - restorative-adaptive functional changes. A struggle develops between the inflammatory flora and the reactivity of the organism. There is oppression and functional loss of a number of systems that were not directly affected by the injury. At the same time, there is a restructuring of the mechanisms for ensuring adaptation to the environment to the optimally possible in conditions of deep pathology. The body moves to a new level of homeostasis. Since, under the influence of a continuous stream of afferent impulses, active nerve structures fall into a state of refractoriness and become immune to specific impulses, a polysensory convergence of afferent signals occurs with a polysensory nature of responses to stimuli of various modalities. Under these conditions of hyperreactivity and tension, a traumatic disease of the spinal cord is formed.

Occupational therapy after spinal injury

Occupational therapy is one of the most effective means of rehabilitation treatment. However, this type of treatment can retain such a role in the therapeutic arsenal only with a reasonable approach to its use. The fact is that most often there is a shift in concepts - employment by labor, treatment by labor, labor expertise, career guidance, professional retraining, productive (industrial) labor. So, T. N. Kukushkina and co-authors (1981) writes: "Occupational therapy is an active therapeutic method for restoring lost functions in patients with the help of full-fledged, reasonable work aimed at creating a useful product," and further: "products must be marketed .. ., it must be of high "quality, pass the Quality Control Department, have a production stigma". Such an approach to business transfers occupational therapy from the medical sphere to the sphere of activity of social security authorities, whose competence includes vocational guidance for disabled people, their professional retraining and organization of the use of feasible labor.

Almost all authors who have written about occupational therapy point to its beneficial effect on the psycho-emotional sphere, in particular, "mobilization of the will", "improvement of mood", the emergence of "a mental prerequisite necessary for the restoration of working capacity", "suppression of feelings of inferiority", "satisfaction with creativity" , "the joy of work", etc.

Let us doubt the absolute justice of these stereotyped tenderness. It is unlikely that, say, a former pilot who received an injury to the cervical spinal cord will be delighted with weaving baskets, a sailor with knocking together boxes, and a ballerina with knitting scarves. The point here is not in the "mobilization of the will", "improvement of mood", "the emergence of psychological prerequisites", but in understanding the expedient need for these labor processes in the general complex of rehabilitation treatment. And if we talk about the emotional and psychological impact of occupational therapy from the recommended positions and the positions of commodity production, then we should not underestimate the negative aspects: poor-quality, rudely performed work is perceived by the patient as a result of his physical disability and may adversely affect his active attitude to rehabilitation treatment, which requires great physical and volitional loads. As a rule, handicrafts of patients are clumsy (due to a motor defect, lack of dexterity, professionalism), they may have a low commodity value or not have a market price at all, but they are useful for the treatment of motor deficiency. In our opinion, this is the main and fundamental.

In the very name "occupational therapy" an extremely clear definition of the subject is given, the content of which is treatment by labor. Only this and nothing more. All other issues - labor expertise, career guidance, professional retraining, commodity production, restoration of labor skills in an enterprise (the so-called industrial rehabilitation) - should be considered separately, since they are of independent importance. Obviously, it is impossible to refer to occupational therapy and employment, aimed at distracting the patient from the hospital environment, thoughts about the disease and filling the time free from procedures, although employment is usually considered as one of the areas of occupational therapy.

The use of labor in treatment is a pathogenetic effect that restores impaired motor functions. In essence, occupational therapy is therapeutic gymnastics, including labor movements.

Result-oriented labor activity consolidates the achieved movements, works them out in a complex way, using movements as a physiological stimulator, helps to increase the amplitude of movements, develop automatism, reduce muscle rigidity, increase muscle strength and plasticity. In the process of performing certain works, contact with diverse materials, different from each other in shape, volume, elasticity, stimulates the restoration of sensitivity. Various labor processes include muscles in work with varying degrees of activity. Therefore, when prescribing occupational therapy, labor operations should be specially selected taking into account the biomechanical features of a particular technology, focusing on a functional defect, taking into account the clinical features of the case and the patient's motor capabilities.

Restoring lost functions by using differentiated types of labor in its main provisions is as follows. Therapeutic labor procedures are divided: according to the power load, focus, degree of inclusion in the work of certain muscles. Labor operations can be facilitated, with a normal power load and with an increased load. Work processes performed in isometric mode increase muscle strength. Processes associated with frequent repetition of movements of low intensity increase endurance. Lightweight classes last 15-20 minutes with a break of 10-15 minutes. During operations with a normal power load, the training time is extended to 40 minutes with a break of 15 minutes. Classes with an increased load are held for 45-60 minutes with a break of 15-20 minutes. In all modes, classes are held 2 times a day. Labor processes can be divided into those that increase the range of motion in the joints, increase muscle strength and endurance, and develop only coordinated movements. Therefore, it is important to determine the therapeutic goal of the sessions and the sequence of efforts from the very beginning.

The most common operations in the medical use of labor processes are cardboard and bookbinding, cutting and sewing, knitting, weaving, arts and crafts, typing, carpentry and metalwork. For these purposes, weaving, pottery, cooking vegetables, cooking certain dishes (for example, salads), table setting, ironing, drawing, assembling small parts are used. Any feasible work of interest to patients can also be used. As our experience shows, the most suitable for this are radio engineering, photography, making art crafts, toys and souvenirs, and knitting. Strengthening the muscles of the shoulder girdle is facilitated by work with a planer, hacksaw, file, which requires great muscle tension. The performance of these operations is associated with keeping the hands hanging and the power grip of the tool. This static tension increases muscle endurance. Working with the vertical position of the hands contributes to an increase in the range of motion in shoulder joint. Carpentry work (with a hacksaw, planer, jointer, fitting parts, their cleaning) is appropriate for developing movements in the shoulder and elbow joints. In addition, these labor operations involve the muscles of the neck, shoulder girdle, and back in vigorous activity. Manual drilling of holes (with a brace, drill, centering) develops rotational movements of the forearm. Winding on a drum or spool of wire, winding threads into a ball or unbraiding, wrapping bolts, nuts, working with a screwdriver, chasing train movements in the wrist joint. This is also facilitated by burning, coloring, working with a jigsaw, various types of knitting (knitting, shuttle, on a loom). Functional restoration of the hand can be carried out with the help of such labor operations as cutting, basting, hand sewing, buttonholes, sewing on buttons, grinding, polishing, typing, pottery, working with a nail puller and tongs, weaving. Weaving (nets, baskets, macrame), assembling the designer, sorting small parts, modeling help the formation of finely coordinated movements in the fingers. A kind of mechanotherapeutic training of the lower extremities is work on a foot sewing machine, a machine for processing pottery, on a grinding and weaving machine. This effect is also achieved when inflating rubber cylinders with a foot pump.

It should be borne in mind that with spastic paresis, it is advisable to choose labor operations in which static loads would be excluded, and with flaccid paresis, isometric stresses would be carried out simultaneously or alternately with movements. At the same time, at the first stage of training (lightweight procedures), it is necessary to apply operations that do not require fine coordination. It is advisable to start occupational therapy at the end of the subacute stage of the early period or at the beginning of the chronic stage of the late period of traumatic spinal cord disease, when the minimum volume of active movements in the paretic limbs and a sufficient level of self-care have already been achieved. Classes are held in specially equipped rooms - occupational therapy rooms, but in some cases for some types of work (for example, knitting) they can also be held in wards using bedside tables as a workplace. Treatment programs for occupational therapy are strictly individual with the inclusion in the work of certain muscles with various types labor activity and on the basis of a biomechanical analysis of the defect of functions in each specific case.

A compression fracture of the spine in children and adults is one of the types of back injury. This injury is characterized by a fracture and damage to one of the vertebrae. This injury is very dangerous, since the damaged vertebra can move into the canal with cerebrospinal fluid and cause paralysis.

When treating this injury, the doctor and his patient must make joint efforts, this is the only way to achieve the desired result, since the restoration of the bone structure takes for a long time and complications can be severe.

A compression fracture with spinal cord injury can lead to lifelong disability.

In what cases is exercise therapy prescribed for damage

Exercise therapy for a compression fracture of the lumbar spine helps the victim restore the flexibility and strength of the spine, and when the spinal cord is ruptured, it helps the patient adapt to his new position with limited abilities. It must be remembered that only specialists should prescribe treatment for spinal injuries, otherwise there may be negative consequences.

It is also necessary to mention that there are a number of contraindications to the appointment of exercise therapy after a compression fracture of the spine:

• Pain syndrome aggravated during exercise therapy exercises.
• Increased body temperature during and after exercise.
• Drops in blood pressure.
• Deterioration of the general condition in the form of a decrease in sensitivity in the legs and arms.

Important! Physiotherapy exercises should be selected individually for each patient, based on the structure of his body.

Rehabilitation after a compression fracture of the spine of the lumbar spine or another area of ​​it takes a long time - it depends on the degree of damage to the patient's fracture. In childhood, a spinal fracture recovers from 4 to 6 weeks, in middle-aged people this process can take a year, but most often it is five months until the patient is fully restored to work.

Exercise therapy for compression fracture of the spine

There are a number of rules for exercise therapy for spinal fractures that must be observed.

• After an injury, you can not sit for a long time.
• It is allowed to move to a vertical position without a sitting down phase.
• You can only get up from the knee-wrist position.
• Forward bends are prohibited.
• You can't make sudden movements.
• Exercises should be performed carefully, smoothly, as if the patient is in the water.
• Walking is allowed after tests on the back muscles give a positive result.
• Walking should be long, until the appearance of pain at the site of the fracture of the spine.
• The duration of walking gradually increases to 10 km per day.
• It is necessary to evenly distribute the load on the spine while standing, and this can only be achieved with proper posture.

Exercise therapy for a compression fracture of the thoracic spine, as well as the thoracic, is divided into three types:

• Special exercises for stable uncomplicated fractures of the spine without a plaster cast.
• Therapeutic exercise for stable uncomplicated fractures of the spine with walking in a corset.
• Exercise therapy for complex spinal injuries.

If there was damage to the thoracic vertebrae or lower back, the complex of physical culture will consist of four stages.

First stage

Exercise therapy for a fracture of the lumbar spine or thoracic at this stage is prescribed from the first day. The direction of physical therapy in the first period is to restore the body after an injury - improving the patient's well-being, increasing the speed and volume of blood flow, increasing oxygenation by improving respiratory movements and oxygen consumption by cells.

An equally important role in the recovery period is played by the work of the digestive system of the victim, since without sufficient activity of gastric motility, constipation and stagnation can occur, and the lack of nutrient cells quite strongly affects the effectiveness of the entire treatment in the future. Leads to degradation of the epithelium long delay in activity.

To another task exercise therapy first stage includes maintaining tone and preventing the development of atrophy of the muscles of the hips, shoulders, neck. Loss of strength and endurance leads to painful and long rehabilitation, which often ends in disability and loss of all functions of the lower extremities.

Rehabilitation after a fracture of the thoracic spine or lumbar at this stage consists of breathing exercises and a number of activities that are aimed at developing the strength of muscle tissue of small and medium size.

Conventionally, exercises for compression fractures of the spine are divided into dynamic static. Dynamic exercise therapy after a fracture of the lumbar spine and other parts of it in this case is carried out in a lightweight version, without muscle overload.

Mostly practiced inhalation and exhalation, training fine motor skills with the help of tension and relaxation of different muscle groups and raising the legs at a right angle. Much attention is paid to the lower extremity girdle. A loss muscle mass in the hips leads in the future to a longer and more difficult rehabilitation, which is limited not only by physiotherapy exercises, but also requires the use of special techniques and equipment.

A set of exercises for the first period:

Breathing exercises:

• In the first three days, perform only diaphragmatic breathing for five minutes 5-6 times a day.
• Starting from the 4th day, the time increases breathing exercises up to 7 minutes and chest breathing is introduced into the complex, combined with raising the knees in turn and full breathing with increased exhalation.

Gymnastics for the joints is performed 3 times a day for 6 sets with a gradual increase in 12 sets. The following exercises make up the complex:

• Without taking your hands off the bed, gently bend them at the elbows. You can add weights.
• Bending the legs at the knees alternately, and then simultaneously.
• Lifting the lower limb up alternately and together with a gradual increase in amplitude to an angle of 40-45 degrees.
• Retraction of straightened legs to the side.
• Bend your legs at the knees, rest your feet on the bed. In this position, spread your knees to the side.
• Squeeze your fingers and toes.
• Make circular movements with the foot.
• You should slowly strain your fingers for 5-7 seconds.
• Bend your knees while sliding your foot along the bed.
• The patient lies, and slowly strains the oblique muscles of the back for 5-7 seconds.

Gymnastics should be carried out calmly without unnecessary loads with moderate pauses for rest. At the same time, it is important to observe even breathing, all tasks are repeated 5-6 sets several times a day.

Second phase

The second stage takes 4 weeks.

The second period of exercise therapy for a compression fracture of the spine begins a month after the injury and lasts 4 weeks. By this time, the vertebrae are already actively growing together and forming calluses. Exercise therapy in case of spinal injury is due to the formation of an anatomical direction of vertebral growth, which is very important for future rehabilitation.

The performance of breathing exercises as an independent form of physical therapy is canceled, but they are included in gymnastic complex, which must be performed 6 times a day for 25 minutes and the number of approaches: respiratory - 3 times, dynamic - 6 times, static - 4 times.

Class time increases to 40 minutes, and the number is reduced to 4, and the number of repetitions dynamic exercises increases to 12, and static to 6. At the same time, one new movement is added to the complex daily.

The main goal of the second stage of rehabilitation is the development of a muscular corset of the back, which will subsequently stop the development of additional curvature of the spine and lumbar. A well-timed corset will make it possible to refuse exercise therapy for kyphosis and prevent its possible development due to a violation of the spine.

Exercises are selected for a group of long muscles of the back, transverse short ones, as well as an oblique straight line. All muscles are responsible for the mobility of the vertebrae relative to the axis, which is very important when doing special physical education and subsequent therapy for spinal cord injuries.

The muscular corset effectively affects not only the positive result of treatment after an injury, but is also recommended for maintaining healthy people good posture and spinal cord health.

It is extremely important to monitor the condition during the session - if pain occurs, you must immediately stop exercising, which will help avoid damage to the spinal cord.

A set of exercises for the second period:

For the starting position - lying on your back with a roller under the lower back:

• Bend your elbows slowly. Put your hands on your shoulders. You need to do the exercise while inhaling.
• On a full exhale, stretch your arms towards the ceiling, and the palms should look at each other.
• Spread your arms to the side as you exhale.
• While inhaling, return the arms to the starting position No. 1.
• Slowly straighten your arms, put them along the body, palms on the bed.

Starting position - lying on your back, legs bent:

• As you inhale, spread your arms out to the sides.
• At the moment of holding your breath, put your hands under your head.
• Make a smooth full exhalation with the simultaneous return of the hands to the position along the body, passing them through the sides. Everything must be done smoothly.

To complicate the exercises, do the leg extension up alternately:

• It is necessary to take the starting position, lying on the stomach with straight arms forward. Your toes should rest on the bed. The coup on the stomach must be performed, observing the technique for fractures.
• When inhaling, tear your forehead off the bed, and strain all the muscles of the body for 7 to 10 seconds. After that, exhale, lowering your forehead to the bed, straightening your feet. Next, you should lie down, completely relaxing all the muscles and breathing calmly for 15 seconds.

Dynamic exercise with two cyclic execution:

• At the same time, while raising your forehead, you should raise the opposite arm and leg. Make 16 smooth movements at an average pace and with a small amplitude. Rest for 10 seconds and then perform 8 more movements, but at a slower pace and with greater amplitude.
• The number of repetitions is from 1 to 4.

Exercise "Scissors" should be performed by increasing the number of movements and the number of approaches, between which it is necessary to pause for rest.

This exercise should be performed lying on your stomach, with your hands under your forehead, only after the permission of the doctor. And before that, it is necessary to lie with your arms along the body and your head, which is first turned to one side and then returned to the other side.

Third stage

The third stage begins approximately 50-60 days after the injury.

It takes two months to start the third stage of treatment. Exercises against the curvature of the upper spine become more frequent and longer. If the victim can support his body and back with a compression fracture of the lumbar spine vertically without outside help, then you should move on to light walks and warm-ups of the back, which quickly give a positive therapeutic effect.

Period 3 - the load increases, therapeutic effect increases due to a set of exercises with resistance, weights and isometric uniform exercises that contribute to the development of the tone of the muscle corset. If at this stage the victim already has formed back muscle groups, the treatment is much faster and easier.

The transition to a new load package should be gradual. The exercise therapy specialist introduces new types of exercises that were not previously available to the patient. The starting position of this complex is on your knees and on all fours. Swings, movements of arms, legs, deflections in this position have a very beneficial effect on the spine.

A set of exercises of the third stage:

• Tilts back, forward.
• Tilts to each side or left, right.
• Walking back and forth on your knees.
• Crawl on all fours left and right.
• Tilts back.
• Flexion of the elbow joint with a weighting agent up to 2-3 kg.
• Diaphragmatic breathing.

All of the above exercises must be performed in 6 sets, at least twice a day. The duration of one exercise should not exceed 20 seconds.

The main tasks of exercise therapy at this stage of therapy are to prevent the development of postural disorders, increase the reactivity of the whole organism and completely restore all functions of the spine.

Fourth stage

It begins after the patient gets out of bed on his own. The timing of this period depends on the effectiveness of exercise therapy and the severity of the damage. At the fourth stage, the specialist begins gymnastics with kyphosis or lordosis. These pathologies developed in the patient immediately upon rupture, with a fracture of the spine.

It is advisable to carry out exercises for kyphosis of the thoracic spine in this period in the conditions of an exercise therapy room - otherwise the patient may not have enough space and equipment. It is allowed to replace many special devices with auxiliary ones. For example - a gymnastic rack on the windowsill.

The fourth stage is allowed, with a number of exceptions, to take place at home. But it is important that the care is carried out properly. Lifting weights, jumping, fast run- this can provoke damage to the newly fused vertebrae. If possible, it is advisable to stay in a rehabilitation center, especially if the victim lives far away from him and does not have the opportunity to visit a surgeon or traumatologist.

A set of exercises of the fourth period:

• Tension for 7 seconds muscle tissue.
• Make small translational movements of the pelvis forward, backward.
• Rolling from toe to heel do 8 times.
• Tighten the muscles of the buttocks for 7 seconds.
• Starting position - the back is straightened. Do semi-squats on toes - inhale, the starting position is exhale.
• Pull back the leg with resistance.
• Tighten the muscle tissue of the thighs for seven seconds.
• Passive rest.

Also at this stage, it is possible to carry out massage in case of a fracture of the thoracic vertebrae and its other zones. used classic look massage and acupressure. Massage improves blood circulation and metabolism in the body.

Massage must be performed smoothly, in stages without haste.

For each patient, the doctor makes an individual rehabilitation complex, which includes:

• Physiotherapy procedures.
• Walks, including dosed walking, health path, therapeutic walking on the stairs or on the step platform.
• Exercises that can be done in the gym.
• Scheme of training in dosed swimming.

The benefits of physical therapy

The purpose of therapeutic exercises depends entirely on the degree of injury. With a compression fracture, the course of treatment is on average one year. Special physical education is able to return to the patient all the anatomical functions of the spine and excellent health without discomfort in one year.

Exercise therapy will help to stop all the negative consequences after the violations of muscle activity that have occurred. It also helps to stabilize various nervous processes, and also normalizes the work of various systems in the body after a long lying down. Increases the rate of regeneration of damaged bones of the spinal column. Exercise therapy has a complex effect on the body as a whole, eliminating negative consequences.

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Spinal injuries such as compression fractures have haunted mankind since time immemorial.
Most compression fractures result in post-traumatic spondylosis deformans and kyphotic deformity that disrupts the normal biomechanics of the spine. Simply put, when the body of one vertebral section is damaged, dystrophic changes occur in undamaged sections. As a result, people with this kind of injury experience constant discomfort in the spine; pain, interseasonal exacerbations, various complications (sciatica, osteochondrosis, etc.).

Unfortunately, a complete restoration of the functions of the spine is possible only in children and young people with a small degree of compression. What about people who do not fall into one of these categories? Definitely need to continue to live a full life! But how to maintain your health and prevent exacerbations? Physiotherapy- one of the most effective methods of treatment and prevention of any diseases, including the musculoskeletal system. There are a number of simple but effective exercises, which can significantly improve the health of not only people with injuries of the musculoskeletal system, but also each of us.

Exercises are performed lying on your back:

1. Alternately press on the floor: head, shoulder blades, lower back, buttocks, under the knee, heels.
2. Alternately stretch the legs forward (the leg does not come off the floor, but slides).
3. Raise the straight leg up, reach for the toe with your hands, raising your back and head (hold for five counts).
4. Raise your right straight leg up and put it to the left side, trying to reach it with your toe (shoulders do not come off the floor), turn your head to the right.
5. Straight arms to the sides. With the right hand, with a turn to the left, we try to get the left hand (we do not tear the pelvis off the floor).
6. Bend your knees. We rest our hands on bent knees, we pull our legs towards us, we don’t give with our hands (static stress) and vice versa we push our knees with our hands, we don’t give with our feet.
7. Dilute bent legs wider. We put our knees to the right, trying to get the floor. We do not tear our shoulders off the floor. The head is turned to the left and vice versa.
8. Feet a little narrower. Raise the pelvis and hold for 5 seconds.
9. The same, but with the simultaneous lifting of the leg (keep the leg at the level of the knee).
10. Raise it up and lead it parallel to the floor to the right - lower it, also to the left.
11. Raise the pelvis up. Steps back and forth (4 steps each).
12. Raise the pelvis up.

Exercises are performed lying on the stomach:

1. Arms along the body with palms down. Raise the straight leg up (hold for 5 seconds).
2. The same, but raise 2 legs up (hands under the pelvis).
3. Stretch your straight arms forward. Raise your arms, head, shoulders up (hold for 5 seconds).
4. The same, but put straight arms through the sides on the buttocks and back.
5. Straight arms to the sides. Raise your straight arm (right) up. The pelvis does not come off, look at the hand. Also with the other hand.
6. Bend your arms to the back of your head. Raise your head, elbows, shoulders up (hold for 5 seconds).
7. The same, but tilt left and right parallel to the floor.
8. Hands under the chest, palms forward. From this position, sit on your heels. Hands are straight. Head to knees. Without moving your hands, lie down again.

Exercises are performed on all fours:

1. Heaviness on the hands, push up from the floor.
2. Raise right hand and left leg, stretch parallel to the floor.
3. "Kind cat", "evil cat" (the thoracic region works).
4. Knee to the forehead, then straighten the leg back, raise the head (hold for 5 seconds).
5. See the left heel through the right shoulder and vice versa.
6. Circular movements of the pelvis.
7. Toes under you. Straighten your knees, lift your pelvis up and straighten your arms. The head tends to the knees, and the heel to the floor.

Exercises are performed on the side:

1. Lying on your side, legs are straight and extended. Raise straight legs up (hold for 5 seconds).
2. Lying on the right side left leg bent at the knee in front of you. With the left bent elbow with a turn to the left, we try to get the floor (the lower back does not twist, the thoracic region works). Then, with a turn to the right with the left shoulder, we get the floor.

Exercises are performed on the back:

1. Straight legs. We lean on the back of the head, shoulders, heels. Pelvis up (hold 5 seconds).
2. Hands in the lock behind the head with palms forward and in this extended position, raising the shoulder, try to body to the right. Don't lift your pelvis off the floor

These simple exercises will help you to always be in good shape, they strengthen the muscular corset of the spine well. What is a good prevention and treatment of back pain, of a very different nature.

Therapeutic exercise is an important component of non-drug treatment of injuries and diseases of the musculoskeletal system. In diseases of the spine, exercise therapy is carried out taking into account the type and stage of the pathological process. A set of exercises is prescribed only by a doctor. An important point is the principle of regularity of classes with a gradual increase in load.

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Therapeutic exercise and diseases of the spine

Exercise therapy for osteochondrosis of the spine, despite modern methods of therapy, remains the only way to stop the progression of the disease. Usage special exercises contributes to the formation of the muscular corset of the entire spine. For the prevention of exacerbations of osteochondrosis, exercise therapy is the main method of treatment.

A set of exercises is selected depending on which part of the spine is affected.

So, for example, the exercise therapy complex for the cervical spine consists of the following exercises:

• In a standing position - put your palm to your forehead and press it on your palm, thus creating resistance to head movement. Hold tension for 5-7 seconds, after rest, repeat the exercise 3 times.
  
  
• In the same position, place the palm on the back of the head and press it on the palm. Overcome resistance 3 times for 5-7 seconds.
  
• Carry out the same exercise with the right and left temple (alternately). The time frame is the same.
  
• Slowly tilt your head back and lower it forward, while trying to reach your chest with your chin. The exercise can be repeated more than 5 times.
  
  
• Head turns - as far as possible to the right, then to the left. Repeat 5 times.
  
  
• Starting position - the head is lowered down, the chin is pressed to the neck. In this position, perform head turns to the right and left (alternately, with pauses).
  
  
• Tilt your head back and try to touch your right shoulder with your right ear, and then touch your left shoulder with your left ear. Repeat at least 5 times.

Exercise therapy and osteoporosis

Osteoporosis is a metabolic disease (progressive), with a pronounced decrease in bone density. As a result, the risk of bone fractures increases.

Risk factors that contribute to the development of osteoporosis include:

• menopause in women (decrease in estrogen production);
• removal of the ovaries or uterus;
• endocrine diseases (diabetes mellitus, thyrotoxicosis);
• old age and heredity;
• long-term treatment with diuretics, hormonal drugs;
• diet with the exclusion of dairy products;
• smoking, alcohol abuse;

Getting rid of bad habits, rational nutrition helps to prevent osteoporosis. In some cases, the doctor prescribes drug therapy. Exercise therapy for osteoporosis of the spine is one of the conditions for a speedy recovery. Exercises consist of twists, stretching the torso.

With their help, the flexibility of the spine increases and the muscular corset is strengthened, thereby reducing the risk of bone fractures. Below is a complex of exercise therapy for osteoporosis of the spine.

The structure of exercises for a hernia of the spine is determined by the location intervertebral hernia. A specialist in exercise therapy individually selects a set of physical therapy exercises for a hernia of the spine of the thoracic, cervical or lumbar spine.

In the photo you can see the general exercise therapy exercises for spinal hernia.

There are contraindications for performing exercise therapy exercises for vertebral hernia:

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• malignant tumors and infectious diseases;
• bleeding and thrombosis;
• heart disease, stroke;
• pronounced pain syndrome.

Exercise therapy and spinal deformity

Physiotherapy exercises for hernia or curvature can be an assistant in correcting pathological bends of the spinal column. Exercise therapy for curvature of the spine helps in the correction of both excessive bends (lordosis and kyphosis) and lateral deviations (scoliosis). This pathology can affect not one, but several segments of the spine, which leads to a change in the internal organs.

First of all, you need to know those exercises, the implementation of which is strictly prohibited for scoliosis:

1. All exercises on the horizontal bar.
2. There should be no rotational movements in the complex.
3. Exclusion of exercises aimed at stretching and increasing the flexibility of the spine.
4. Excluded exercises with weights (barbell, weights). Training in the gym can lead to a deterioration in the patient's condition.
5. sparing strength exercises are allowed only with the permission of the physical therapy instructor.

For exercise therapy for scoliosis of the spine, symmetrical exercises are selected that give uniform loads on both halves of the body. Positive effect gives a combination of physiotherapy exercises and swimming.

A set of exercises for scoliosis should begin with a warm-up. First you need to straighten your back, straighten your shoulders and then perform several circular motions shoulders. The following warm-up exercises are raising straightened arms up (alternately), squats and torso forward. After that, you can proceed to the main exercises shown in the figure.