RU2476195C1 - Method of treating vertebroneurological diseases of lumbosacral spine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely vertebroneurology, spine manual therapy. A local functional disorder and regional functional disorders are correction by pelvic ring treatment followed by functional recovery of intervertebralis. Thereafter, spinal motion segments and iliopsoas muscle are treated. Ah the following stage, phrenic and pelvic diaphragms are relaxed. Then tripper points in muscles, fascias and ligaments are exposed. Then, structural and respiratory rib dysfunctions are corrected. To this end, a dynamic stereotype is corrected by manual treatment of the remote regions - feet, neck, craniovertebral junction and skull.

EFFECT: method enables prolonging a remission.

1 cl, 2 ex

Description

The invention relates to clinical restorative medicine and vertebro-neurology, namely to manual therapy of the spine, and can be used both on an outpatient basis and in hospitals.

Manual therapy is a method of rehabilitation treatment based on the achievements of clinical vertebroneurology, orthopedics, neurology and neurophysiology (Levit K., Zahse I., Yanda V. Manual medicine. - Translation from German I.I.Skvortsova. - M .: Medicine, 1993). The modern concept of manual therapy is based on the theory of reversible motor disorders, i.e. functional disorders of the motor system, formulated and founded by a school of Czech and German researchers (WolfJ. The reverse deformation of the joint cartilage surface and its possible role in joint blockage // In: Functional Pathology of the Motor System. Rehabilitacia. - Bratislava: Obzor, 1975 - Suppl. 10-11. P.30), (Lewit K., Janda V. Entwicklung von Gefugestorungen der Wirbelsaule im Kindesalter und die Grundlagen einer Pravention vertebragener Beschwerden // Hippokrates - 1963. - Bd. 34. - S.308) . Manual therapy is used to treat vertebral neurological diseases of the lumbosacral spine.

There is a method of treating vertebro-neurological diseases of the lumbosacral spine (Veselovsky VP Practical vertebro-neurology and manual therapy. - Riga, 1991. p. 286), which consists in carrying out manual therapy depending on the stages, changing the motor stereotype in patients with vertebral nervous diseases systems in the following sequence with an interval of several days: mobilization of the mid-chest PDS, mobilization in the transitional vertebral-motor segments - cervicothoracic, lumbar ore and lumbosacral mobilization of the affected spine, pelvis mobilization.

The disadvantage of this method is that the treatment of pathogenetic dysfunction is not carried out, and the treatment of remote regions is stretched in time by several stages.

There is also known a method of comprehensive rehabilitation treatment of patients with osteochondrosis (RF Patent No. 2306916, publ. September 27, 2007),

consisting in the fact that at the first stage the balance of functions of the musculoskeletal system is leveled by means of traction therapy, hardware massage, manual therapy, laser puncture and physiotherapy exercises aimed at correcting and forming correct posture, correcting muscles and the lumbosacral spine. At the second rehabilitation stage, the natural muscular corset is strengthened through physical exercises, the results of which are determined by tests of the static endurance of the back muscles. At the third preventive stage, the results of rehabilitation treatment are recorded.

This method is quite time-consuming, requires the use of additional equipment and performing active physical exercises, which can cause pain in the patient.

There is also a method of treating vertebral neurological diseases of the lumbosacral spine, based on the use of medical treatment algorithms to increase the efficiency of recovery (Popelyansky Y. Orthopedic neurology (vertebro-neurology): A manual for doctors. - 3rd ed. Revised. And add. - M., MEDpress-inform, 2003. P.499.). In this method, manual therapy is performed to correct a key lumbosacral segment with blocked joints at different levels, which often contributes to the release of other segments.

The disadvantage of this method is the lack of correction of pathogenetic dysfunction, a multi-stage treatment period for remote regions, possible side effects, a long period of therapy, unstable remission, the need for frequent repeated procedures.

Closest to the claimed is the method described in (Ivanichev G.A. Manual medicine (manual therapy) - M .: LLC "MEDpress", 1998 - 412 S.). It consists in the treatment of vertebral neurological diseases with manual therapy. This method describes an algorithm for influencing the structure of the motor system. To solve the algorithm, it is proposed:

1. Correction of local functional disorders (elimination of functional blockade of the spinal motion segment, trigger points).

2. Correction of regional functional disorders (elimination of secondary blockade of the vertebral-motor segments, coordination disorders of antagonist muscles by relaxation of shortened and increased activity of the flaccid muscles).

3. Correction of the disturbed dynamic stereotype by sensory-motor activation.

However, this method is of a generalizing nature of the effects, the correction of the disturbed dynamic stereotype is carried out by sensorimotor activation, through the implementation of active isometric exercises by the patient, which, if performed independently, without medical supervision, increases the likelihood of exacerbation, reduces the effectiveness of treatment and increases the treatment time.

The objective of the proposed method is to develop a standardized algorithm for manual therapy of vertebral neurological diseases of the lumbosacral spine, which can reduce treatment time, increase efficiency and increase the period of remission.

The essence of the invention lies in the fact that in the method of treating vertebral neurological diseases of the lumbosacral spine, manual manipulations are performed on certain structures of the musculoskeletal system by correcting local functional disorders and correcting regional functional disorders, including the impact on the vertebral motor segments and trigger points in muscles, fascia and ligaments, then correct the disturbed dynamic stereotype. What is new is that the correction of local functional impairment and the correction of regional functional impairment is carried out by first acting on the pelvic ring, followed by restoration of the function of the intervertebral joints, and then effecting the vertebral-motor segments and the ileum-lumbar muscle. The next step is the relaxation of the thoracic and abdominal and pelvic diaphragms, and then act on the trigger points in the muscles, fascia and ligaments. After that, structural and respiratory costal dysfunctions are corrected. In conclusion, the correction of the dynamic stereotype is carried out by manual impact on the remote regions - feet, neck, craniotebral junction and skull.

In addition, the correction of these structures is carried out on the basis of manual diagnostics.

The method is as follows.

Prior to the treatment by the claimed method, it is necessary to have the results of modern clinical and instrumental studies for the diagnosis and determination of treatment tactics. Absolute contraindications for the claimed method are active tuberculosis, malignant neoplasms, pregnancy, acute infectious and chronic in the stage of exacerbation of the disease, spinal circulation disorders.

Manual therapy for certain structures of the musculoskeletal system is carried out in a certain algorithm, taking into account the violations identified during the diagnosis. Correction of local functional disorders and correction of regional functional disorders are performed, starting with the impact on the pelvic ring, then the function of the intervertebral joints, vertebral-motor segments and the iliopsoas muscle is restored. After this, the chest and abdominal and pelvic diaphragms are relaxed and then act on the trigger points in the muscles, fascia and ligaments. Then, structural and respiratory costal dysfunctions are corrected and, finally, the dynamic stereotype is corrected by manual action on the distant regions - feet, neck, craniovertebral junction and skull.

This algorithm has been developed and tested empirically and is performed in the following sequence:

1. Correction of the pelvic ring;

2. The restoration of the function of the intervertebral joints, vertebral-motor segments and the iliopsoas muscle;

3. Relaxation of the abdominal and pelvic diaphragms;

4. Impact on trigger points in muscles, fascia and ligaments;

5. Correction of structural and respiratory costal dysfunctions;

6. Correction of the dynamic stereotype by manual exposure to remote regions - feet, neck, craniovertebral transition and skull.

The course of treatment begins with the correction of the pelvic ring, taking into account the presence of muscular-ligamentous relationships and biomechanical interactions between the pelvis and other parts of the spine, the role of the pelvis as a connecting link between the lower back and lower extremities and the performance of the supporting function for the spine.

The next step is to restore the function of the intervertebral joints, vertebral-motor segments and the iliopsoas muscle, which may be the root cause of allergic syndromes.

After this, you should relax the chest and abdominal and pelvic diaphragms. The relaxation of the pectoral diaphragm helps to restore the mobility of the psoas-lumbar junction, the function of external respiration, the improvement of the gas composition of the blood, the drainage of the chest and abdomen due to the secondary effect on the blood circulation and lymphatic system. Relaxation of the pelvic diaphragm helps to reduce venous stasis in the pelvis, increase the mobility of the sacroiliac joints and the lumbosacral junction. These factors contribute to the reduction of pain in the patient.

They act on trigger points in the muscles, fascia and ligaments to reduce the nociceptive irritation of these points.

After working with soft tissue structures, structural and respiratory costal dysfunctions are corrected to restore the activity of the autonomic nervous system. This normalizes the nociceptive system and muscular-tonic disorders in general.

The treatment is completed by correction of the dynamic stereotype by manual action on remote regions - feet, neck, craniovertebral transition and skull, while having a positive effect on the primary link of axial load when standing and walking, and on the source of muscular-tonic reflexes, including postural ones.

A chiropractor, when performing this algorithm, can use various approaches generally accepted in chiropractic therapy.

Correction of biomechanical disorders involves the use of a therapeutic approach, which depends on the preferences and experience of the doctor. The following techniques of manual therapy and osteopathy were used in our work:

1. Pelvic ring correction (including craniosacral asynchronism correction) is performed using craniosacral techniques, muscle energy techniques or articular mobilization and manipulations on the sacroiliac joints and symphysis.

2. To restore the function of the intervertebral joints, mobilization and manipulation techniques, muscle energy techniques were used, and, if necessary, myofascial release techniques, emphasis techniques. The ileo-lumbar muscle was relaxed by isometric exercises, and strengthened by isokinetic.

3. Release techniques have been used to relax the abdominal and pelvic diaphragms.

4. Trigger points in muscles, fascia and ligaments were inactivated by ischemic compression, myofascial release.

5. Structural and respiratory costal dysfunctions corrected with the help of muscle energy techniques, manipulation and mobilization techniques, emphasis techniques.

6. Remote regions were affected by craniosacral, muscular-energetic, manipulation, mobilization, and release techniques.

The therapeutic course consists of three sessions: the effect is on 1, 6, 11 days of treatment. The first session is carried out immediately after a standard examination to exclude contraindications. In patients with discogenic pathology, manipulation techniques are not used during manual treatment.

Example 1

Patient V., male, born in 1952. He went to the clinic on March 29, 2010 complaining of constant moderate to moderate intensity pain in the lumbar spine radiating along the posterior-outer surface of both legs through the buttocks to the calf muscles, intensifying during physical and static stress. When walking, the pain sharply intensified in the legs - after 50-70 meters of walking, the patient is forced to squat, which contributes to a slight decrease in pain.

Diagnosis: Dorsopathy. Neural bilateral, more pronounced on the left, lumbar ischialgia against the background of polydiscopathy L2-S1, osteochondrosis of the lumbar spine, spondylarthrosis L3-S1, absolute stenosis of the spinal canal, a chronic, often recurring course with a transition to a stationary stage of prolonged exacerbation, dysfunctional vertebral syndrome medium intensity, intermittent claudication syndrome. Rear diffuse disc herniation L4-L5 5 mm with compression of the dural sac and spreading into both intervertebral foramen with their narrowing (more than the left). Rear diffuse protrusion of the discs L2-L3, L3-L4, L5-S1 up to 3 mm with distribution into the intervertebral. holes on both sides. Spinal stenosis at the level of L4-L5 (constitutional and discogenic) up to 7 mm.

According to the above algorithm, treatment was performed.

The first session: a) diagnosis and correction of craniosacral asynchronism (phase displacement of the primary respiratory mechanism of the sacrum was diagnosed by about a quarter of a cycle); b) correction by the manipulation technique of the upper displacement of the right ilium and the technique of muscular energies of the torsion of the sacrum; c) myofascial release of the interspinous spaces L4-L5 and L5-S1, as well as paravertebral lumbar muscles; d) correction by the muscular-energetic technique of the blockade in flexion, rotation and lateroflexion to the left of the PDS L3-L4;

d) myofascial release of the abdominal diaphragm; e) ischemic compression of the trigger points of the gluteal muscles; g) mobilization and manipulation of the joints of the feet, muscle-energy technique at the level of CO-C1, craniosacral techniques of balanced tension of the membranes of the skull.

Second session: a) diagnosis of pelvic ring dysfunction; b) correction by the muscular-energetic technique of torsion of the sacrum to the right along the left oblique axis, control and correction of the sacral component of the craniosacral rhythm; c) myofascial release of the interspinous spaces L4-L5 and L5-S1, as well as paravertebral lumbar muscles;

d) correction by the muscular-energetic technique of the blockade in flexion, rotation and lateroflexion to the left of the PDS L3-L4; d) myofascial release of the abdominal diaphragm; e) myofascial relaxation of the active trigger points of the gluteal muscles; g) mobilization and manipulation of the joints of the feet, myofascial release at the level of CO-C1, craniosacral techniques to enhance the amplitude of the cranial rhythm (frontal bone lift).

Third session: a) diagnosis of pelvic ring dysfunctions; b) control and correction of the sacral component of the craniosacral rhythm;

c) myofascial release of the interspinous spaces L4-L5 and L5-S1, as well as paravertebral lumbar muscles; d) fascial techniques for relaxing the periosteum of the spinous processes of the L3-L5 vertebrae; correction by the muscular-energetic technique of the blockade in flexion, rotation and lateroflexion to the left of the PDS L3-L4, mobilization at this level;

d) myofascial release of the abdominal diaphragm; e) postisometric muscle relaxation of the gluteal muscles; g) mobilization and manipulation of the joints of the feet, myofascial release at the level of C0-C1, muscle energy technique for C0-C1, craniosacral techniques to enhance the amplitude of the cranial rhythm (frontal bone lift), venous sinus technique.

After the third session, there is a decrease in the severity of myofixation and its transition to the regional lumbar, the appearance of lumbar lordosis, the relief of hyperalgesia during palpation of the spinous processes, the increase in gait range to 400-450 meters (squat until necessary). Biomechanically - the blockade in flexion, rotation and lateral flexion to the left of the PDS L3-L4, restriction of movements in the PDS С0-С1, restriction of the amplitude of the craniosacral sacrum rhythm, is preserved. During follow-up observation during the year: the absence of requests for inpatient medical care, the preservation of working capacity with some limitations of the labor process, the preservation of walking distance to the first stop up to 400 meters.

Example 2

Patient Sh., Male, born in 1973. I went to the clinic on March 3, 2010 with complaints of constant moderate intensity pulling and aching pain in the lumbar region and the upper outer quadrant of the left buttock; pain radiates along the back surface of both legs, more on the left; the pain intensifies during physical and static stress, when walking, bending forward; decreases in sitting and lying; notes that after a night's rest the pain is less; at the time of examination, weakness in the legs, sensitive and pelvic disorders are not noted.

Diagnosis: Dorsopathy. Bilateral vertebrogenic muscular tonic, more pronounced on the left, lumbar ischialgia against the background of osteochondrosis of the lumbar spine, L5-S1 discopathy, spondylarthrosis L4-S1, PBMI of the lumbar spine and pelvis, chronic recurrent course, stage of prolonged vertebral muscular exacerbation, dysfunction, dysfunction, tonic disturbances of medium intensity. Dorsal diffuse protrusion of the L4-L5 disc 0.7 cm with a pronounced left-sided paramedian component with compression of the left roots and the adjacent part of the dural sac with pronounced narrowing of the spinal canal (1.2 × 1.1 cm).

According to the above algorithm, treatment was performed. After the third session, there is a complete relief of pain, the transition of polyregional fixation to local at the level of L5-S1, normalization of lumbar lordosis, relief of muscle-tonic and sensitive disorders; gait without restrictions on duration and distance. Biomechanical - sanogenetic block in the extension of rotation and lateral flexion to the left in the L5-S1 PDS. During follow-up observation during the year: the absence of requests for inpatient and outpatient medical care, the preservation of working capacity, the absence of pain.

The medical and social effect of the proposed method consists in expanding the possibilities of treating vertebroneurological diseases of the lumbosacral spine widespread among the population (30-80%). From the above examples it follows that the claimed method allows to reduce the duration of therapy, in this regard, reduce the cost of treatment, increase the effectiveness of therapy and increase the period of remission. The use of the manual therapy algorithm in patients with vertebral neurological diseases of the lumbosacral spine and the impact on the “problem-causal” zones of a particular patient (which are not always directly related to complaints) allows us to achieve compensation at the level of the body as a whole, since it is gradually exposed during the therapy diagnosis and correction of the entire biokinematic chain, and not just the lumbosacral spine.

Claims (2)

1. A method for the treatment of vertebral neurological diseases of the lumbosacral spine, which consists in the manual effect on certain structures of the musculoskeletal system by correcting local functional disorders and correcting regional functional disorders, including the impact on the vertebral-motor segments and trigger points in muscles, fascia and ligaments , then carry out the correction of the disturbed dynamic stereotype, characterized in that the correction of local functional impairment and to The correction of regional functional disorders is carried out by first acting on the pelvic ring and then restoring the function of the intervertebral joints, then acting on the vertebral-motor segments and the ileo-lumbar muscle, the next step is the relaxation of the pectoral and abdominal and pelvic diaphragms, and then affect the trigger points in the muscles , fasciae and ligaments, after that they carry out the correction of structural and respiratory costal dysfunctions, and at the end the correction of the dynamic stereotype of the pr drive manual treatment to remote regions - foot, neck and skull kranivertebralny transition. 2. A method for the treatment of vertebral neurological diseases of the lumbosacral spine according to claim 1, characterized in that prior to exposure to certain structures of the musculoskeletal system, the correction of these structures is carried out on the basis of manual diagnosis.