In weight training, one of the most common injuries is a back injury. The cervical and lumbar spine are more commonly affected than the thoracic.

After an injury, in order to get back in shape, it is important to remember a few important aspects that will help athletes.

Getting injured involves a number of stages of recovery, which go in strict sequence:

1. professional medical examination after immobilization of the injured area and medical intervention (if necessary);
2. passive rehabilitation- a period that includes the implementation of a set of recommendations of the traumatologist, which are aimed at restoring the damaged area;
3. recovery training, implying two sub-stages: a return to the "zero" level of physical fitness, characteristic of any healthy untrained person, and work aimed at restoring the results that were available before the injury.

First two stages- this is the patrimony of professional doctors, whose knowledge and available diagnostic capabilities should in no case be neglected if the injured person is really interested in a full and high-quality cure, which will eventually return to full-fledged training.

The third stage- recovery training after obtaining permission from the doctor largely depends on the athlete himself.

All of the above applies to injuries in general. To recover from back injuries, there are some nuances, whether it be damage to tendons, ligaments or vertebral discs.

There is a huge variety of possible traumatic factors and the adverse consequences caused by them - from minor to very severe. But, based on the fact that the athlete has already overcome medical rehabilitation and received admission to recreational physical education, you need to draw up a plan according to which classes will be held that do not mean the usual hard training aimed at sports results.

Back injury recovery plan

First of all it is necessary to review or re-form (if the trauma was severe) “motor habits” that involve, one way or another, the spinal column in movement. It is possible that in the past it was the inability to take care of the spinal skeleton that caused the injury.

Secondly, at this stage, no less importance is given to strengthening the paravertebral muscles, which create a natural “rigidity” corset for the spine. There is no doubt that those exercises that do not carry a compressive load (compression) are best suited for this, but create a “natural” load vector for the entire core. This load vector allows the spinal column to become a "single whole" again, and not divided into separate sections: cervical, thoracic, lumbar, which creates pathological tension at individual points.

Third, you need to understand that it is possible to proceed to the introduction of the existing skills in classical traction exercises on the back only after the formation of the correct motor habits (in other words, after obtaining a certain skill of their “meaningful” reproduction) and the primary strengthening of the rigidity corset formed by the paravertebral muscles. It is clear that at first, preference should be given to those exercises that do not create an excessive load on the spine. These include those that are performed in positions: lying, reclining, half hanging, hanging and their variations. Vertical compressive load is not allowed.

A set of exercises for recovery after a back injury

One of the variants of the recovery complex is offered below. It takes from three to twelve weeks (if necessary, and more). It all depends on the severity of the injury, the remaining motor activity and pain syndrome.

The first exercise - alignment of the spinal column

The purpose of this exercise is to align the spine. It is performed while standing against the wall. The heels should be pressed against the wall. Also, the sacrum, shoulder blades, and back of the head should be pressed against it (in some cases, the exercise is performed while lying on the floor). The arms hang down at the sides.

Having taken the starting position, you additionally need:

1. tighten the muscles of the buttocks, and slightly move the coccyx up and forward, without changing the position of the nape, shoulder blades, heels, sacrum (they are still pressed against the wall / floor);
2. keeping the pelvis in this position, move the chest slightly up and forward (as if protruding the chest). At the same time, the chin should fall into the hole between the collarbones (infrajugular). Again, it is necessary to check that the heel, sacrum, shoulder blades, back of the head are on the same vertical line and pressed against the wall.

It takes several minutes to stand in this position to feel the whole body from the bottom up: feet, pelvis, chest and chin. Having achieved a sense of "integrity", you need to smoothly separate from the wall, taking a step forward, and repeat the alignment procedure. This exercise helps to restore and form the skills of correct posture. It requires, despite its seeming simplicity, patience and attention, and all its nuances are important for subsequent exercises.

The second exercise - knee raises

The initial version (lightweight) is also performed while standing against the wall. But, the feet from it (unlike the previous exercise) are fifteen to twenty centimeters apart. The back of the head, shoulder blades and sacrum are still firmly pressed against the wall. We alternately pull our knees to the stomach. Raising the knee, hold it with both hands in the upper position, and then slowly lower it.

The essence of the exercise is similar to the previous one:

1. the sacrum when raising the knee must be slightly forward and upward;
2. pulling the knee to the stomach with the help of the hands, the chest rises slightly forward and up. At the same time, the chin descends into the infrajugular fossa.

You need to hold out in position for two to three seconds. In total, lifts-holds need to be performed 5-15 on each leg. Depending on how you feel, everyone individually selects the number of repetitions. But, more than four approaches do not need to be done.

With classes three to four times a week, the technique of movements against the wall can be mastered in one to three weeks, after which it will be time to move on to hanging exercises on special press bars or a crossbar. You can also perform exercises on an inclined plane: pull up your knees (one and two at a time). The main emphasis should be on bringing the sacrum forward, slightly lifting the chest forward and lowering the chin.

The number of repetitions is the same: one to four sets of five to fifteen reps. At the same time, it is better to perform them in smaller quantities, but with high quality. All movements should serve the only purpose - to collect the spine into a "single whole". If, while training on the bar or the press bars, this feeling is lost, “refresh your memory” by returning to the wall. We must not forget that in the recovery period the goal is not to pump up the press, but to learn how to align and control the skeleton. These things are fundamentally different.

The third exercise - hyperextensions on the bench

Having taken an emphasis on the hips on the hyperextension bench, additionally tighten the gluteal muscles while in the lower position. After that, smoothly begin to lift the body up (as if pressing the pelvis into the bench with force). Approximately in the middle of the rise, you need to slightly up and forward to move the chest, while lowering the chin into the subjugular fossa. When the back reaches the midline of the legs (visible when viewed from the side), you need to pause for a second and start moving e in the opposite direction (down). Try to do a maximum of four sets of 5-15 repetitions each (better quality, even at the expense of quantity). This exercise, like the previous ones, is aimed at leveling the "integrity" of the skeleton, and not at "pumping up the lower back."

What's next?

Having thoroughly worked out the above complex and “built” the necessary foundation, you can gradually include more complex exercises:

• Thrust to the chest of the upper block.
• Rowing (preferably with an emphasis on the stomach) of the lower block.
• Pull-ups to the chest.

Of course, these exercises should be performed in the same manner as the three preparatory ones. The “integrity” of the core is also a fundamental factor here, to which both the number of repetitions and the number of approaches must be sacrificed. In this manner, the training takes place until the full restoration of sports form.

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 the respiratory muscles and additional 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 R. F. Jones (1982) points out as an important factor in the rehabilitation of the disabled. 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 Paraplegic Olympic Games, which have been held every 4 years since then. 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. The first sports competitions were held in 11 sports: combined relay, basketball, shot put, javelin or discus throw, shooting from pneumatic guns, throwing rings and the ball at the target, 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, the degree of recovery and the level of compensation and such sports exercises that would be adequate to the motor-motor defect in terms of biomechanical indicators, 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. Elements The mechanism of its action perfectly meets 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, in combination 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, vibration, 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 recent years, interest in hardware types of massage has increased.

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 of self-service contributes to an increase in existing movements and, on this basis, in a number of cases, contributes to the development of new motor acts. At home, the patient can pay more attention to these issues. Of great importance in this case are 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 there is none, 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 a spinal injury has its own complex of exercise therapy, which should be based on the features of the development and course of a traumatic disease, general state patient, functional characteristics of the level of motor reactions and the patient's capabilities.

The question of the time of inclusion of patients in motor activity 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 restructuring of the bones of the knee joint, deformities, and the 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 can be enabled 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 art of the doctor, probably, will consist in a differentiated selection of exercises, their complex combination and rational sequence based on a deep and detailed analysis 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 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 of the 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 exercises of this type 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 medical complexes should not be complete: subsequently, the exercises alternate with more or less frequency. Technique performing general strengthening exercises are outlined 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. Damage to the thoracic 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 motor neurons 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 main properties of the 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 of the scapula, subscapularis causes 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 biceps and brachioradialis muscles, in addition to flexing the forearm, are involved in its supination, this function suffers, being provided only by the long and short supinators 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 the wrist joint is especially great. 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, the motor defect in the proximal parts of the upper limbs is compensated to a greater or lesser extent, in the distal parts, especially in the fingers, functional losses are persistent, manipulative abilities are sharply suppressed, keyboard movements of the fingers are difficult, dilution, 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 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. The flexion set in the hip joint, due to the formed persistent pathological synergy, changes direction muscle contraction: the biceps femoris, 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 the 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 body;
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. Best Results 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 were 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), healing 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 trauma, not only because of the difficulties in obtaining wormwood cones and 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 (traditional Chinese name- er-zhen-lyao), is one of the forms 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.

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, their therapeutic effect is based on the ability to change the chemistry of tissue colloids and thus carry out 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 rhythm of impulse flows high power 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 when 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 an 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, at the same time the activity of the thyroid gland decreases and the level of prostaglandins increases, the function of the thymus 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 greater quantities, mainly concentrating in the organs of the affected area. 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 rupture of bonds in protein molecules under the action 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 reflexogenic zones of skin segments. Vasoactive substances cause vasodilation with the formation of er items. 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 pressure sores and ulcers. This is also facilitated by the general effect of light on the body, the increase in the protective and trophic functions 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, osteoporosis, bone rereferencing, osteomalacia and other metaplastic changes are noted. 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, it is obvious that 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. Tactic 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 about physical exercises that are adequate to the condition of 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 important role in the process of recovery. 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. 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 the most 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 phased exercises to teach 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 swing 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 various muscle groups in voluntary 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 case of spinal injury, the damaging agent, sharply and with great force 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 departures. 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). Clinical manifestations such injuries 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. Late, 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.

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 elements of damaged physiological systems act as 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 healing method restoration of lost functions in patients with the help of full-fledged, reasonable work aimed at creating a useful product", and further: "products must find a market ..., they must be of high" quality, pass the Quality Control Department, have a production stigma. This approach to business transfers occupational therapy from the medical sphere to the sphere of activity of social security bodies, whose competence includes career guidance for disabled people, their professional retraining and the 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 “psychic prerequisite necessary for the restoration of working capacity”, “suppression of feelings of inferiority”, “satisfaction with creativity”, “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 the negative aspects should not be underestimated: poor-quality, rudely performed work is perceived by the patient as a result of his physical inferiority and can adversely affect his active attitude to rehabilitation treatment, which requires great physical and volitional stress. 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 a lot of 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.

Spinal injury are the most severe injuries of the musculoskeletal system. Physiotherapy for spinal injuries, it is 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 using exercise therapy (physiotherapy exercises) And LG ( physiotherapy) with spinal injuries the most favorable conditions will be created for the restoration of anatomical relationships, as well as the prevention of relapses and secondary damage to the nerve elements, it is necessary to proceed to next step- the use of a set of physical exercises for spinal injuries, 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.

Consider exercise therapy complexes for various spinal injuries:

1. Injuries of the cervical spine.

As a rule, the most mobile vertebrae, C5-C6, are exposed to this injury. With such an injury, treatment should be conservative. In case of a flexion fracture of the bodies of the cervical vertebrae, the patient must be laid on a hard bed, while a small pillow should be placed under his shoulders, and traction should be applied for the parietal tubercles (this can also be done using the Glisson loop). Thus, this extension in the position of the patient with the head bent anteriorly contributes to the fact that the angle that is open backwards straightens out.

Therapeutic exercises for this spinal injury usually prescribed 2-3 days after injury for prevention possible complications associated with prolonged immobilization. Classes contain a complex of elementary general developmental exercises intended for the distal parts of the limbs, as well as breathing exercises (static and dynamic) in the ratio of first (in the first days) 12, and then 31 and 41. At the same time, leg movements should be performed only in facilitated conditions, in order to avoid pain syndrome that may occur due to tension long muscles back when lifting a straight leg.

An approximate complex of exercise therapy during the stretching period:

1. Lie on your back, stretch your arms along the body. Then start doing the exercises:

2. Diaphragm breathing (4-5 times)

3. Foot flexion (plantar and dorsal)

4. Squeezing and unclenching fingers

5. Circular foot movements

6. Flexion and extension of the arms in the elbow joints

7. Flexion of the legs at the knee joints (alternately), while the foot slides along the plane of the bed

8. Diaphragm breathing

9. Flexion and extension of the hands in the wrist joints

10. Abduction and adduction of the legs (alternately), while not tearing them off the plane of the bed

11. Circular movements of the hands in the 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.

Therapeutic exercises (exercise therapy) for spinal injuries sets itself the following tasks: improving blood circulation in the area of ​​damage in order to stimulate regeneration processes, preventing atrophy of the neck muscles, as well as the muscles of the shoulder girdle and upper limbs. With the help of therapeutic exercises and physiotherapy exercises, the muscles of the entire body are strengthened, correct posture and walking skills are restored. Physical therapy exercises for spinal injuries include general strengthening exercises that cover all muscle groups and are performed in the initial position lying, sitting and standing, with support (you can use the back of a chair or bed as a support). Remedial exercises with light weights and light resistance are also used. Patients are advised to perform isometric muscle tension in order to strengthen the muscles of the neck and shoulder girdle. The duration of such tensions should be at first 2-3 seconds, and then at least 5-7 seconds.

There are also contraindications, namely, the movement of the body forward.

When the fixing plaster cast is removed after 8-10 weeks, the goal of therapeutic exercises will be to strengthen the muscles of the neck, shoulder girdle and upper limbs, and work will also be done to restore movements in the cervical spine.

During the first few days after the termination of immobilization, in order to eliminate the additional vertical load on the cervical spine, classes should be carried out only from the initial lying position, then sitting and standing. The complex of physical exercises for spinal injuries in this period includes isometric tension of the muscles of the neck, shoulder girdle and upper limbs, active dynamic exercises for all muscle groups and joints, as well as static holding of the limbs (at least 5-7 seconds). Massage of the collar zone of the muscles of the back and upper limbs is used.

In the future, exercise therapy uses exercises that are aimed at increasing the mobility of the spine. These exercises include various tilts, turns of the head and torso. The patient performs them in the initial position lying and sitting. The classes also include exercises for coordination of movements, for developing a sense of balance, as well as exercises that help normalize posture and gait. You can conduct classes in the pool and labor workshops (carpentry and plumbing, pottery, typing, etc.).

Surgery. After the operation, the patient should be placed on a functional bed on his back. And the head and neck on both sides are fixed with sandbags. The first two days of exercise therapy include general tonic and breathing exercises. Exercises for the lower extremities are performed in light conditions, the legs must move along the plane of the bed (the exercises include: flexion and extension of the legs at the knee joints, abduction and adduction of the legs, back and plantar flexion of the feet, etc.). Also, the patient is recommended exercises for the distal parts of the upper limbs, raising the pelvis based on the shoulder blades and feet.

Contraindications: movements in the proximal parts of the upper limbs, as well as the shoulder girdle and neck.

On the 3rd-4th day, the patient should perform the same therapeutic exercises, but with a greater amplitude and a greater number of repetitions. Leg movements are carried out alternately, without the use of relief. Therapeutic exercises include isometric tension of the muscles of the trunk, pelvic girdle, thigh and lower leg. Static breathing exercises are also used, which alternate with dynamic ones.

On the 5-7th day, provided that the patient's condition is satisfactory, after therapeutic exercises, the patient should be put on a fixing collar of the Shants type and “sit down” in bed several times a day. From the 7-10th day, the tasks of physiotherapy exercises include improving the activity of the cardiovascular system, as well as the respiratory system, strengthening the muscles of the trunk, shoulder girdle and limbs. Also, thanks to exercise therapy for spinal injuries, there is an acceleration of regeneration in the area of ​​operation. On the 7-8th day after the operation, the patient can be transferred to a vertical position, and in the complex therapeutic exercises introduce exercises that are performed in the initial position standing by the bed. These exercises include: abduction and adduction of the leg, half-squats, tilts to the sides and back, rotational movements of the body, etc.

The early postoperative period is characterized by the fact that head movements are contraindicated in it, as well as isometric tension of the muscles of the neck and shoulder girdle. After the patient can get out of bed, he is recommended dosed walking within the ward, and then the hospital department.

From the 10th day until discharge from the hospital, therapeutic exercises contribute to further training of the muscles of the upper limbs and torso. Also, thanks to physiotherapy exercises and gymnastics, the patient's ability to work is restored. In this period, exercise therapy classes are already held in the gym, a group method is used with the initial position lying on the back, sitting and standing. Therapeutic exercises for spinal injuries in this period include exercises with light weights, gymnastic apparatus, as well as exercises using a gymnastic wall.

On the 14th-16th day, provided there are no contraindications, the patient is usually discharged from the hospital, while a craniothoracic plaster cast is applied to him. During this period, the exercise therapy complex recommended to the patient includes physical exercises that train the cardiovascular and respiratory systems, help strengthen all muscle groups, as well as dosed walking. And 4-5 weeks after the operation, isometric tension of the muscles of the neck and shoulder girdle is included in the classes.

In the post-immobilization period, exercise therapy for spinal injuries is carried out according to the method similar to that indicated above.

2. Injuries to the bodies of the thoracic and lumbar vertebrae.

The most common is a compression fracture of the vertebral body.

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 the 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 physical therapy and therapeutic exercises include normalizing the activity of 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 exercises of exercise therapy in this period, the patient develops a “muscle corset”, and the body prepares for a further expansion of the motor regimen. 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 an axial load, the exercises begin 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.

A set of exercise therapy exercises used in the second period of treatment:

Exercises begin from the starting position lying on your back, arms extended along the body.

1. Spread your arms to the sides, take a breath, return your hands to their original position (do 3-4 times)
2. Bend the arms at the elbow joints, slowly with tension, bring the hands to the shoulders (perform 4-6 times)
3. Foot flexion (dorsal and plantar) (perform 6-8 times)
4. Leading the arms to the side, while turning the head in the same direction. Raise your hands, take a breath. Lower your hands - exhale. (do 4-6 times)
5. Bend the leg at the knee joint, then stretch it up and lower (perform 4-6 times)
6. Abduction and adduction of the straight leg (repeat 4-6 times)
7. Spread straight arms to the sides at shoulder level and slightly pull back. Perform small circular motions hands, slightly straining the muscles of the back and shoulder blades (do 6-8 times)
8. Bending in the thoracic spine, relying on the elbows and shoulders, while the arms are bent at the elbows, the elbows rest on the bed (perform 4-5 times).

Spinal injuries are one of the most dangerous and complex injuries. So, when the correct arrangement of its constituent bones is violated. In severe situations, when the spinal cord is injured, damage leads to disability. In order to return the vertebrae to their normal state with a compression injury, a lot of time and intense joint work of the doctor and patient is required.

Exercise therapy and its stages

In a compression fracture of the spine, one vertebra of the spinal column is damaged. The situation is not critical, and quite amenable to correction if the displacement of the vertebrae does not exceed 35% of their normal height. For the rehabilitation of a patient after a fracture of the spine, a special physical education is used, consisting of a whole complex of exercises adjusted to the load.

The developed methods of rehabilitation are caused by the need to restore the natural mobility of the spine. They include special gymnastics, dosed walking, massage, swimming lessons.

General rehabilitation exercise therapy for a compression fracture of the spine is divided into 4 stages, which are designed for 1 year of classes. Each stage has its own estimated timeframes:

1. for the 1st stage - is prescribed on the 1st week after injury (bed rest lying on the back);
2. 2nd stage - follows the first and lasts up to a month after a fracture of the spine;
3. time of the 3rd stage - takes the entire 2nd month rehabilitation period(getting up on all fours and knees);
4. The 4th stage is carried out until the patient leaves the hospital (the “standing” position is mastered).

Complex of physical culture and its stages

Given the variety of traumatic injuries, general exercises have been developed for compression fractures, lumbar and other parts of the spine. The main goal of exercise therapy is to return the muscular system of the fortress, and prepare the patient to return to the state of walking and standing on two legs that is familiar to a person. Let's consider in detail each stage of the training.

Stage 1

First aid for a mild fracture of the spine in terms of physical education consists of gentle movements. At the 1st stage, the doctor sets several goals:

• increase the overall tone of the body;
• normalize the breathing process and the functioning of the circulatory system;
• keep normal;
• eliminate muscle weakness.

The patient has to perform all exercises while in the "lying on his back" position. It fits into an optimally comfortable and correct position, the head rises by 50-60 cm. With pre-prepared devices (belts), the spine is stretched in the longitudinal direction for a person. To reduce the load on the parts affected by the fracture, rollers twisted from cotton wool and gauze are placed under them. Classes are held separately with each patient 2-3 times a day for 10 minutes each.

With complicated compression fractures, the recovery period begins later than with minor injuries. First, the doctor must prescribe painkillers and anti-inflammatory drugs, relieve the state of shock of the injured. People who have been severely traumatized may become lethargic or show emotional instability.

Basic exercises of the 1st stage:

1. Recovery of diaphragmatic breathing. A weighted object weighing 1.5 kg (a bag of sand) is placed on the patient's stomach. While exhaling, the patient lifts the load, holds the breath for 10 seconds, lowering the abdomen while inhaling.
2. Working with fingers that need to be squeezed and unclenched.
3. The transition to the feet, they are bent and rotated.
4. We return to the hands. We spread them apart and rotate.
5. Bend the lower extremities at the knees so that the foot does not come off the surface of the bed.
6. Raising the pelvis, with an emphasis on the couch with shoulders and elbows.
7. Muscles tense in static.

Stage 2

By building a certain physical load on the spine at the 2nd stage of exercise therapy, the attending physician understands that other organs of the patient may be affected by trauma with a violation of their functions. The objectives of the lessons are:

• restoration of the normal functioning of the internal organs affected by the injury;
• return of firmness and elasticity to the muscle corset;
• putting in order the blood supply in the damaged parts of the spine;
• preparation of the patient for the motor process.

The time for completing the complex is increased from 10 to 25 minutes per lesson. All movements continue to be performed in the “lying” position, but gradually turn over on the stomach and low raising of the limbs are added.

The exercises shown include:

1. For exercise therapy for compression fractures, training of the lung diaphragm with weighting is mandatory.
2. After inhaling, the arms should be moved apart to the sides, while exhaling, stretch them forward and down.
3. The upper limbs are bent, rotations are made by them. Compression and extension of the fingers continues.
4. The knees and feet are bent, they are pulled up alternately, the straight leg is deflected to the side and returned back.
5. The body curve is added. When performing a deflection, the patient rests on his elbows and shoulders.
6. The lower limbs imitate cycling, slowly lifting them from the couch.
7. providing muscle tension.

Raise one leg 45 degrees and hold it at that height for 7 seconds. Important movement in exercise therapy used for a compression fracture

Useful video - After a fracture of the spine. 3 period. Full range of therapeutic exercises

Stage 3

The 3rd stage of exercise therapy, prescribed for fractures of the spine, includes exercises designed to facilitate the patient's transition from a lying state to a standing one. For this period of exercise therapy, the following goals are set:

• develop the muscles of the pelvis and limbs;
• restore motor coordination;
• improve overall mobility.

Now classes last 30 minutes, resistance is added. Experts attribute the 3rd stage to the transitional period, when a recumbent person is preparing to return to the vertical given by nature to Homo sapiens. The complex includes movements from several starting positions:

1. "Lying on your back":

• Inhaling, you should spread your arms to the sides, while exhaling they stretch forward and fall down;
• bending the arms with weighting (load of 3-4 kg);
• legs must be bent, then pulled up (using an elastic band);
• legs stretching, lift up, trying to maintain an angle of 45 degrees relative to the couch;
• the body bends, shoulders and elbows rest against the couch, the doctor counteracts.

2. "Standing on all fours":

• Getting down on all fours, it is necessary to make movements forward, then backward, then left, then right.

3. "Lying on the stomach":

• the head and shoulders are raised as far as possible, the doctor counteracts;
• changing legs, take them back, the doctor makes resisting movements;
• a "boat" is performed when the head and shoulders are in a raised state, and the arms are pulled back (the pose is held for 2 minutes).

4. "Kneeling":

• for stability, the patient should insure with his hands over the edge of the couch to make shallow inclinations, first to the sides and then back;
• kneeling, movements are made to the sides, then you need to move back and forth;
• bending the leg, deflect it to the side.

Stage 4

The fourth, final stage for the hospital, involves consolidating the progress made and further developing the entire muscular system. Its goals include correcting posture and starting walking. Each lesson is 45 minutes 2 times a day. The patient is allowed to carry out the lifting of the body from the couch, only it must be performed while remaining alone on the stomach. The lifting begins with a careful lowering of the leg, which lies on the edge of the couch, while you need to rest with your hands, then the other leg goes down.

In the case of a compression fracture of the vertebrae, the patient is strictly forbidden to move to a sitting position.

The increase in study time is due to the fact that exercise therapy complex introduce movements that allow you to develop walking skills and restore the correct posture. It is customary to start and end the lesson in the same way as in the previous stages: diaphragmatic breathing, bending the arms with weighting, alternately abducting the legs using a tourniquet and synchronously lifting them by 45 degrees, static muscle tension. In addition, do the following:

1. the patient, lying on his stomach, raises his shoulders and head, and the doctor counteracts these movements;
2. legs need to be taken back with simultaneous opposition;
3. "boat" with a 2-minute hold.

Added moves include:

1. sitting in a rack at the couch, roll the feet from heel to toe;
2. using the load, produce an alternate abduction of the legs back;
3. make backward bends;
4. half-squat on toes with a weight of 5-6 kg.

Video - The basics of effective rehabilitation after a compression fracture of the spine

Contraindications

In case of severe injury to the spinal column, exercise therapy is not performed. It is also contraindicated when:

• the patient has a feeling of pain after exercise;
• an increase in temperature was detected;
• there is a clear increase or decrease in pressure;
• there are neurological disorders;
• diagnosed as paralytic.

The time spent in the hospital is only the beginning of a long recovery work. Massage courses for a fracture of the spine will speed up the rehabilitation period and help strengthen weakened muscles. The key to a successful return to normal life is the observance of the recommendations given by specialists not only during the year, but also in later life.

A spinal fracture is a very serious injury that requires long-term treatment, patience and a strong desire to restore health. Fractures of the spine are different: from compression - to a fracture with a rupture of the spinal cord, in which a person becomes disabled. Physiotherapy exercises play a significant role in the rehabilitation of patients with spinal fractures. For stable, uncomplicated spinal fractures, the recovery process takes approximately one year. Fractures complicated by an incomplete rupture of the spinal cord will take longer, but the goal is complete rehabilitation. And with fractures of the spine with a rupture of the spinal cord, the task of exercise therapy is to adapt the patient to life with limited mobility. Therapeutic exercise for fractures of the spine is based on an individual approach to each patient, which depends on the degree of damage to the vertebrae and spinal cord, neurological symptoms, as well as the discipline of the patient. Therefore, the article discloses only the principles and stages of exercise therapy for this injury. Attention is paid, which greatly accelerates the recovery of patients and enhances the effectiveness of therapeutic exercises, massage and other procedures. After recovery, it is recommended to regularly perform and engage in a health group in the pool. Unfortunately, spinal injuries are common, they have complications, it is not easy to treat patients with spinal fractures, but imagine what joy both you and your “student” have when movements appear, when he can walk. This is the second birth! We do miracles with our own hands. You need to start, do and believe that everything will work out.

The article has three main parts:
Exercise therapy for stable uncomplicated fractures of the spine without plaster fixation;
Exercise therapy for stable uncomplicated fractures of the spine with wearing a corset;
Exercise therapy for complicated fractures of the spine.

Spinal fractures often occur as a result of indirect trauma: when falling from a height onto the legs, buttocks, head; less often - with direct trauma - a direct blow to the back. Vertebral fractures can be compression (along the axis of the spine), comminuted with damage to the vertebral bodies, arches and processes.

With fractures of the spine, the ligamentous apparatus is also injured. In this regard, there are stable fractures (without rupture of ligaments) and unstable ones, in which ligament rupture occurred, and there may be a secondary displacement of the vertebrae and damage to the spinal cord.

Spinal fractures are divided into uncomplicated (without damage to the spinal cord) and complicated (with damage to the spinal cord). Spinal cord injury can be incomplete or complete. Manifestations of traumatic injuries of the nerve pathways of the spinal cord depend on the location and depth of the injury. With a complete rupture of the spinal cord, neurological symptoms are detected immediately: the patient does not feel his legs. With an incomplete rupture of the spinal cord, neurological symptoms increase over several days, as there is swelling and hematoma, which increase the compression of the nervous tissue. After about a week, it is clear to the traumatologist at what level the spinal cord injury occurred.

Neurological symptoms in spinal fracture at various levels.

I - IV cervical vertebrae	Spastic paresis of all limbs, loss of all kinds of sensitivity, pelvic disorders. The prognosis for life is unfavorable, as there is edema ascending to the brain.
V - VII cervical vertebrae	Flaccid paralysis of the upper extremities and spastic paresis of the lower extremities develops. Loss of all kinds of sensitivity. Pelvic disorders.
I - IX thoracic vertebrae	The upper limbs are not affected. Spastic paralysis of the lower extremities. Pelvic disorders.
X chest - II sacral	Flaccid paralysis of the lower extremities. Pelvic disorders. Bedsores of the lower extremities appear early, as the vegetative section is damaged.
III - V sacral	Only pelvic disorders.

Therapeutic exercise for fractures of the spine.

With a fracture of the spine, the patient is hospitalized.
The patient lies on a mattress on a wooden shield.
The fracture site is fixed and a muscular corset of the spine is created.
Patient care and treatment depends on the severity of the injury.
If there is a complete or partial rupture of the spinal cord and paralysis, then special attention is paid to the prevention of bedsores, since with this injury not only motor and sensory functions suffer, but autonomic disorders also occur, metabolism and blood microcirculation in the tissues below the site of damage to the spinal cord are disturbed.
Produced with the help of pillows, prevention of sagging feet, as well as prevention of congestion in the lungs.

Inflating balloons.
- Blowing air out of the lungs through a long tube (from a drip system) into a bottle of water.
- Diaphragmatic breathing.
- Full breath with a sound on exhalation (u-u-uff, u-u-uhh, chizhzh, chizz, r-r-r-rrr).

An application is recommended in which the head and foot end of the bed can be raised to redistribute blood in the body to avoid stagnation.
Physiotherapy exercises with passive and active movements and therapeutic massage of the affected limbs are carried out.
First you need to remember the rules, which must be sacredly observed.

1. You can not sit for a long time after an injury.
2. Forbidden bending forward.

Therapeutic exercise in stable uncomplicated fractures of the spine.

For stable, uncomplicated fractures, a plaster corset is usually not applied. (In the case when the patient is undisciplined, a special corset is put on. Then the patient does not stay in the hospital for long).

Applies physiotherapy exercises for spinal fractures in order to create a muscular corset, muscles - rectifiers of the back (posture), prepare for getting up, and then for walking.

You can't sit for long! The doctor allows you to sit down when the patient can walk for 1.5 hours without rest without pain. This is usually possible by the end of 4-5 months.

I period. First week after spinal injury. Exercise therapy is prescribed from the first day.
Tasks: to activate the respiratory and cardiovascular systems, to prepare the patient for the main activities.
Includes exercises for small and medium muscle groups in combination with breathing exercises. Leg movements in light conditions: without lifting the heels from the bed, only alternating movements (either with one foot or the other). Exercises with raising and holding a straight leg are excluded. You can lift your pelvis.
The duration of classes is 10 - 15 minutes on the bed.
At the end of the first week, the patient should raise one straight leg by 15 0 and not experience pain.

II period. The goal of the second period is to strengthen the muscles of posture and corset of the spine, to promote the formation of physiological curves of the spine and to prepare for standing up.

Until the end of the first month from the moment of injury physical activity gradually increases (and the number of repetitions of exercises, and the time of classes).
Approximately two weeks after a stable, uncomplicated spinal fracture, the patient is allowed to roll onto their stomach. At this time, position correction begins: a roller is placed under the chest and shoulders (the height of the roller changes under the supervision of a doctor), a roller 10–15 cm high is placed under the feet. The patient lies in this position of slight extension of the spine for 20–30 minutes several times a day.

This stage includes "extension" exercises for the back muscles with holding the position with extension of the spine for some time to strengthen the muscles of the back.

1). Starting position lying on your back. Extension in the thoracic region with support on the elbows.

We complicate the task. Starting position lying on your back, legs bent at the knee joints, feet on the bed. Extension of the spine with support on the elbows and feet.

2). Starting position lying on the stomach. Raising the head and upper shoulder girdle with support on the forearms.

We gradually complicate the task: the same without relying on hands.

Then raising the head and upper shoulder girdle without resting on the hands, holding the position for 5-7 seconds.

Extension in the thoracic region, leaning on the arms extended forward (that is, a stronger extension than leaning on the forearms).

Extension in the thoracic region with the separation from the bed of the arms extended forward.

Extension in the thoracic region with the separation of the arms extended forward + lifting one straightened leg.

This period includes leg lift exercises. We remember the task - to strengthen the muscular corset of the spine.

1). "Bicycle" alternately with each foot.

2). Lying on your back, legs bent, feet on the bed. Put the heel on the knee of the other leg (alternately with each leg).

3). Lying on your back, legs bent, feet on the bed.
1 - Take the straightened right leg to the side, put it.
2 - Put the right foot on the left (foot on foot), relax the muscles.
3 - Again, take the straightened right leg to the side, put it.
4 - Return to the starting position.
The same with the other leg.

4). Sliding feet on the bed with alternating-oncoming movements of the legs.

5). Lying on your back, move your legs to the sides at the same time: sometimes legs apart, sometimes together, sliding your feet on the bed and slightly raising them to reduce friction and provide tension to the muscles of the abdomen and the front surface of the thighs.

6). Lying on your back, closed legs are straightened. Move opposite arm and leg to the sides:
1- right hand+ left leg
2 - return to the starting position;
3 - left arm + right leg,

7). Imitation of walking lying on your back.
1 - Simultaneously raise up the straightened right arm and left leg.
2 - Return to the starting position.
3 - Simultaneously raise up the straightened left arm and right leg.
4 - Return to starting position.

8). Lying on your back, legs straightened, lie on the bed.
1 - Put the right foot on the left, try to raise the right foot, and the left foot prevents this, there is no active movement. Hold tension for 7 seconds.
2 - Return to starting position.
3 - Put the left foot on the right, try to raise the left foot, and the right foot prevents this, resists. Hold tension for 7 seconds.
4 - Return to starting position.

9). Lying on your back, legs bent at the knees, feet on the bed, raise the pelvis.

10). Lying on your back, bend your legs at the knees and hip joints, then straighten your legs up (feet to the ceiling) and hold them in a vertical position for 10 seconds, gradually increasing day by day to 3 minutes.

We gradually train holding straightened legs at an angle of 45 0. While lifting and holding straightened legs at an angle, it is necessary to press the lower back to the bed with the abdominal muscles as much as possible.

At the end of the first month from the onset of the disease are connected spinal fracture exercises in the knee-hand and knee-elbow positions. The task of exercise therapy at this stage is preparation for getting up becomes the main target. You should continue to strengthen the muscular corset of the spine, posture, leg muscles. Particular attention should be paid to the formation of physiological curves of the spine.

Recall the order in which the physiological curves of the spine are formed in baby from birth to one year of age and take this sequence as a principle for the recovery of patients with spinal fractures.

At 2 - 3 months, the child keeps his head lying on his stomach, physiological lordosis of the cervical spine is formed.

At 4 months - rests on the forearms, rolls from the stomach to the back.

At 5 months - lying on his stomach, he leans on his palms, raising his head and upper shoulder girdle, rolls from the stomach to the back and back, the skill of crawling on the stomach is formed.

At 6 months - the baby stands in the knee-wrist position, at this time he can release one hand to take a toy.

At 7 months in the knee-carpal position, crawls first back, then forward, sits down. At that time physiological kyphosis of the thoracic spine is formed.

At 8 months - improvement of crawling, attempts to get up.

At 9 months - the baby stands and walks at the support. At that time physiological lordosis of the lumbar spine is formed.

So let's conclude:
cervical lordosis is formed when the head is raised in the supine position;
thoracic kyphosis - when sitting down;
lumbar lordosis- when getting up.
The development of the child goes from the head to the legs and from the proximal limbs to the distal (the distal limbs are the hands and feet, the proximal parts are closer to the body). Approximately in this order, you need to add new exercises in adult patients, gradually complicating the tasks daily and striving to prepare for getting up. An important exception - you can not sit for a long time until the doctor allows.

Thus, first therapeutic exercises for fractures of the spine limited to exercises in the supine position without taking the legs off the bed;
after two weeks - exercises are added lying on the stomach with raising the head and chest;
by the end of the month, it is allowed to raise the legs in the supine position and lying on the stomach, as well as exercises in the knee-wrist position.
Train the patient to stand up first on your knees, then get up near the bed, but not from a sitting position, but from a standing position in the knee-wrist position. The patient stands on the floor first with one foot, then lowers the other leg, squats slightly and, pushing off the bed with his hands, straightens up on his feet. First, it stands for 5 - 10 minutes, then the standing time gradually increases. You can connect exercises for the legs: rolling from heel to toe, “trampling” - transferring the weight of the body from one foot to another, walking in place with hands on the high back of the bed or the bar of the Swedish wall with a high raising of the thigh, overlapping the shins back alternately with each foot, training balance in the form of standing on one leg. Preparation for getting up requires special attention, the terms are individual depending on the severity of the patient's condition under the supervision of a doctor.

Conducted periodically back muscle function test. If the test is positive, then you can walk.

1). Lying on his stomach, the patient raises his head, shoulders and both legs. The test is considered positive if it can hold this position for 2-3 minutes, up to 14 years old - 2 minutes, children under 11 years old - 1.5 minutes.

2). Lying on your back, raise straightened legs at an angle of 45 0 and hold in this position for 3 minutes.

III period. From this moment, when you can walk, exercises lying on your back, lying on your stomach and standing in the knee-hand position become more difficult, the number of repetitions increases, exercises in the initial standing position are added. These are tilts back and to the sides, half-squats with a straight back and half-hangs on the bar with bent legs(feet touching the floor).

! You can not do exercises in the starting position sitting and bending forward, even if the patient is allowed to sit.

IV period. Complete recovery of the vertebrae occurs approximately one year after the fracture. Further classes in the group of post-traumatic osteochondrosis are performed. Particular attention is paid to posture. The muscles that support posture are strengthened by exercises in the starting positions lying on the stomach and standing in the knee-wrist position.

Therapeutic exercise for stable uncomplicated fractures of the spine when wearing a corset.

The corset is used when the patient is indisciplined. If immobilization is carried out with the help of a corset, then the patient does not stay in the hospital for long. This means that the spinal injury was with a slight compression fracture.

While wearing a corset Exercise therapy for spinal fractures aims to improve the functioning of the respiratory and cardiovascular systems, to prevent the appearance of excess weight due to the patient's low mobility. We take into account that when wearing a corset, patients are worried about shortness of breath.

Such patients are engaged in a group method 3 times a week for 35 - 40 minutes.
Exercises for arms and legs are included in combination with breathing exercises.
The starting positions are used lying down, in the knee-hand position and then gradually standing up.
You can't sit!
Apply isometric abdominal exercises to strengthen the abdominals. For example.

1). Starting position lying on your back, legs bent at the knees, feet on the floor, arms along the body.
1 - raise your head, shoulders and arms, look forward, linger in this position for 7 seconds (you need to count like this: "Twenty-one, twenty-two, twenty-three ...", etc.).
2 - Return to the starting position, relax (relaxation occurs better on the exhale).
3 times.

2). Starting position lying on your back, legs straightened, arms along the body.
1- Raise your head, shoulders and arms, stretch your arms forward, look at your feet, stay in this position for 7 seconds. (You can use the feet, for example, do the extension of the feet (feet on yourself)).
2 - Return to the starting position, relax on the exhale.
3 times.

3). The starting position is lying on your back, legs are straightened, the right leg lies on the left.
1 - Raise your head, shoulders and arms, stretch your arms forward, look at your feet. The left leg tends to rise up, and the right one prevents it. Stay in this position for 7 seconds.
2 - Return to the starting position, relax on the exhale.
3 - The same, putting the left foot on top of the right. Raise your head, shoulders and arms, stretch your arms forward, look at your feet. Right leg tends to rise up, and the left prevents this. Stay in this position for 7 seconds.
4 - Return to the starting position, relax on the exhale.
3 times.

The corset is usually removed after 2-3 months, but not immediately, but first they are allowed to sleep without a corset, then stand without a corset for 15 minutes, and so on, gradually increasing the time spent without a corset. Therapeutic gymnastics is carried out first in a corset, then without a corset, gradually expanding the motor regime: the initial positions are lying - in the knee-wrist position - standing.

We orient patients to a long walk until pain appears at the site of a spinal fracture. You can gradually increase walking up to 10 km per day.

Then (about a year later) Exercise therapy for spinal fractures IV period: therapeutic exercises as in osteochondrosis of the spine, of course, without a corset. If you want to wear a corset for some more time, then it is put on after therapeutic exercises. You need to know that the corset is put on and taken off in the supine position. Get recommendations for wearing a corset from your doctor on an individual basis.

By this time, patients have acquired the skill of exercise therapy, and they can exercise at home on their own every day, strengthening the muscular corset of the spine, posture and performing exercises to stretch the spine and relax tense back muscles, since back pain causes protective muscle tension, in which the body seeks to immobilize the sore spot. This tension must be able to be relieved by consciously relaxing the muscles; this will help reduce pain and improve blood microcirculation in the damaged area. That is, we strengthen muscle strength and physiological tone and remove the pathological (excessive) tone of the back muscles.

Open articlePay attention to the alternation of exercises with load and relaxation. This technique helps to relieve tension in the muscles of the back, calms down nervous system, the consequences of stress reactions recede, and other tasks of PH in osteochondrosis of the spine are also solved: strengthening the muscular corset of the spine and posture, stretching the spine. This therapeutic gymnastics has a therapeutic effect on all parts of the spine: on the cervical, and on the thoracic, and on the lumbar. All exercises are performed slowly, smoothly, without sudden movements, as if you are in the water. Periodically, there are clicks in the spine - this means that the vertebrae have fallen into place, that you are doing the exercises correctly.

* I want to give you good advice from an experienced exercise therapy instructor: this set of exercises can be successfully used for many other diseases. For example, neurosis, VVD, hypertension, diseases of the kidneys, joints and paralysis. The secret of the positive effect lies in the fact that the patient holds the problematic organ with his inner gaze during the exercises; then the healing energy of movement is directed to the right place. Attention to the diseased organ makes it work precisely those muscle groups that need to be affected in a particular disease. So, with urinary incontinence, attention is on pelvic floor, with nephroptosis, thoughts about correct position kidneys (posture is strengthened and abdominal Press). In this case, if the spine is damaged during therapeutic exercises, attention should be focused on the fracture site.

Efficiency recommendation Exercise therapy for spinal fractures. Before therapeutic exercises, influence the spinal area in the "Insect" system on the fingers from . It is not difficult, does not take much time, and the benefits are great: you will significantly speed up the healing process and reduce the likelihood of complications during exercise.

So, on each finger, imagine a little man - your double, who, as it were, sits with arms and legs folded. In this position, he looks like an ant. Therefore, the correspondence system is called "Insect". It is easy to determine the zone of the spine in it and act on it with the usual self-massage of the fingers. You just need to understand that you are not massaging your fingers, but the spinal area on your fingers. Your fingers are now the body's control panel. During self-massage of the spine zone on all fingers, you need to think that the spine is healthy; intervertebral discs are young, elastic; the ligamentous apparatus of the spine is strong, holds the vertebrae well in place; the posture is correct, the muscular corset is strong; microcirculation of blood in the tissues of the spine is excellent; the fracture site successfully “heals”. What you imagine, what information you put in with the help of thought, then it will happen in the body. It really does work. Be sure to test the effectiveness of this method for yourself.

* In addition to the "Insect" system, there are many different systems correspondences of the human body on different parts of the body: on the hands, on the feet, on the ears, and so on. The system in which the organ that needs to be treated is most pronounced is selected. In one procedure, you cannot use several different systems at the same time, only one.

Therapeutic exercise for unstable complicated fractures of the spine (with spinal cord injury).

Therapeutic exercises are prescribed immediately after determining the level of damage to the spinal cord, taking into account neurological symptoms: spastic or flaccid paralysis. For both types of paralysis, positional treatment is used (laying the limbs in a physiological position and frequent changes in body position in bed), therapeutic massage, passive and active gymnastics, ideomotor exercises with the sending of impulses, in which the patient mentally performs any movements.
Restoration of walking after a stroke.

Do not be surprised that exercise therapy is recommended for strokes, since the principles of restoring the nervous system are the same. With flaccid paralysis, recovery is longer and more difficult than with spastic ones. Therapeutic exercises for fractures of the spine differs in that you can’t sit for a long time, so sitting exercises will have to be replaced with exercises lying on your stomach, standing in a knee-wrist position and standing when you can stand.

I very much welcome the exercises lying on the floor: the patient feels spacious and desires to move, there is a psychological separation from the bed, with which he subconsciously associates his illness, when parting with the illness, there is hope for recovery (at least not boring!), And the effectiveness of classes increases.

Patient with flaccid paralysis we give the task lying on the floor to roll from one edge of the carpet to the other and back, helping him move his limbs and encouraging him verbally: “Come on, come on, come on!”. That is, we activate the “student”, encouraging him to make maximum efforts for independent movement.

Besides, good exercise lying on the floor, crawl in a plastunsky way (on the stomach). It is necessary to bend one leg of the “student”, put your foot to the patient’s foot for support and instruct to push off to move forward. It's okay if it doesn't work right away. Day by day the result will be. Especially if you use Su-jok therapy before class. If paralysis is incurable, it doesn't matter therapeutic exercises for fractures of the spine will benefit, as all body systems are activated, and the nervous system too; improves tissue trophism, eliminates congestion; as well as improving the mood of the patient.

See the article for other exercises. . Do what works, gradually adding more complex exercises to simple movements.

In the patient's bed, make arrangements so that he can use his hands to pull on the strap attached to the horizontal bar above the bed. Wide leg straps can be attached to the same crossbar: the patient tries to move the legs placed in the loops of the straps back and forth, straightening and bending the legs, and spreading the legs. You can purchase a novelty - a sling system (the complex is equipped with special suspensions that support arms and legs, you need to perform exercises lying down).

This concludes the lecture. Let's summarize briefly.

Let's remember the important points of exercise therapy for fractures of the spine, they need to be learned by heart.

You can't sit for long!
The transition to a vertical position is carried out bypassing the sitting down phase.
Getting up is performed from the knee-carpal position.
Forbidden bending forward.
No sudden movements are allowed.
Exercises are performed carefully, smoothly, as if you are in the water.
You can only walk after a positive functional test on the muscles of the back.
Walking for a long time until pain occurs at the site of a spinal fracture.
Walking gradually increases to 10 km per day.
Emphasis on correct posture to evenly distribute the load on the spine while standing.

Information on Exercise therapy for spinal fractures a lot, as you can see, you need to study a few more articles, but this is necessary. You may need to re-read them periodically. You may have some idea. This is cool. I will be glad if you share your experience.