RU2537070C2 - Method of treating patients with myofacial pain-dysfunction syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, physiotherapy. A method involves a manual therapy, therapeutic exercises, a balneotherapy; cream containing iodide-bromide ingredients is applied on the skin in a projection of a trigger point and compressed by kneading circular motions. That is followed by manipulations on muscles by doing therapeutic exercises. Doing the therapeutic exercises involves using the techniques for postisometric relaxation for tensed muscles, and for reinforcing of the weak muscles. The balneotherapy is ensured by taking A.S. Zalmanov's turpentine baths.

EFFECT: method reduces the length of treatment by the exposure on the trigger points prolonging the myofascial pain, extends the range of patients without regard to the skin type, including children and adolescents.

4 cl, 2 ex

Description

FIELD OF TECHNOLOGY.

The present invention relates to medicine, in particular to neurology and orthopedics, in particular to the treatment of trigger points of stages I and II, and can be used in the treatment of patients with myofascial pain dysfunction syndrome of various localization.

BACKGROUND OF THE INVENTION

Myofascial pain syndrome is a complex psychophysiological process, which is manifested by pain caused by nonspecific skeletal muscle damage and the formation of trigger points in the tense muscles that develop and maintain pathological reflex connections, being primary generators. Irritation from trigger points is transmitted along a segmental reflex chain, conducting spinal mechanisms are activated, then supraspinal structures of the brain, thus developing a circle that supports myofascial pain.

A known method of treating myofascial pain syndrome (RF patent No. 2181995, publ. 05.10.2002), including conducting courses of manual and drug therapy, providing for relaxing massage, muscle compression with gradually increasing effort, passive and active muscle stretching with additional traction of the joint, which transmitted reflected pain, and the introduction of trigger points to corticosteroids.

However, this method does not take into account the staged state of the trigger points, which does not allow a differentiated approach to their inactivation.

At the same time, the disadvantages of this method include the fact that it is difficult to justify the feasibility of reflexology and the use of chondroprotectors to relieve myofascial pain syndrome, since it is known that reflexology involves exposure to acupuncture points located on the skin, while trigger sources are myofascial pain points (local compaction in the muscles). These are anatomical formations that are different in their topical location and structure.

Chondroprotectors are also indicated for dystrophic diseases of the musculoskeletal system, the point of application is the affected cartilage tissue. These drugs do not affect the trigger factor of the myofascial pain component - trigger points.

The use of medical bile, especially in the category of outpatients, is also not advisable because of its sharp unpleasant odor.

A known method of treating myofascial pain syndrome (Trewell G. G., Simone DG Myofascial pain: in 2 volumes. - M .: Medicine, 1989. / 1 volume - p. 78-154), providing for cryotherapy before performing manual therapy. to trigger zones. However, this kind of effect causes a violation of microcirculation and spasm of blood vessels in the area of the trigger point. The consequence of this is the compaction of soft tissues, which prevents manual exposure to the trigger zone and reduces the effect of such exposure.

The closest analogue (prototype) is a method of treating patients with myofascial pain dysfunctional syndrome according to the patent for the invention of the Russian Federation No. 2284176, published September 27, 2006. This method provides for parallel courses of manual, medical and physiotherapeutic effects on trigger points. Moreover, before performing and during a session of manual therapy, the active trigger zone is heated respectively by ointment application and a hypertonic compress, while with its organic changes during manual therapy sessions, immediately before postisometric relaxation, steroidal and / or analgesic drugs are introduced into the active trigger zone, and physiotherapeutically affect all trigger points with ultrasound. Warming up the active trigger point before performing manual therapy is carried out by applying for 5-7 minutes an ointment containing iodine-bromine, vasodilating and warming components on the skin surface in its projection, or using a hypertonic compress during a manual therapy session after ischemic compression of the active trigger point for 10 minutes.

The disadvantage of this method is the negative effect of Capsicam ointment on the skin of patients, which is used in the above method as the basis for ointment application. In patients with sensitive and oily skin, irritation, burning, itching occurs at the site of application of the ointment. The skin of children and adolescents reacts similarly. This reaction makes it impossible to perform subsequent manipulations, which excludes the possibility of using this method of inactivation of trigger points in 30-32 percent of patients.

In addition, the regular use of Kapsikam ointment in work causes constant intense burning in the fingers of the hands of medical personnel.

The use of one hypertonic compress, without the parallel use of Capsicum ointment, does not give the necessary result that warms and relaxes soft tissues. The application of a hypertonic compress to certain parts of the body makes it impossible to simultaneously affect all problem muscles (as a rule, trigger points in the same patient are located in the muscles of the shoulder girdle, and in the buttocks, and in the muscles of the limbs). The doctor is forced to choose the most relevant two or three zones; accordingly, the rest is forced to disregard.

At the same time, the improvement of the patient's condition during physiotherapeutic exposure to trigger points with ultrasound has not been proved in practice.

The task underlying the present invention is to create a highly effective method of treating patients with myofascial pain dysfunction syndrome, which makes it possible:

- expand the circle of potential patients, regardless of skin type, including children and adolescents;

- act on all trigger points that support myofascial pain in a particular patient;

- reduce the time and cost of the procedure;

- eliminate side effects from medical personnel performing medical procedures,

- eliminate these disadvantages inherent in the methods representing the prior art.

This problem is solved by eliminating Capsicam ointment from the recipe, replacing hypertonic compresses with Zalman baths, and eliminating ultrasonic effects on trigger points.

A method of treating patients with myofascial pain dysfunctional syndrome includes a course of ongoing balneological procedures, manual therapy and individual physiotherapy exercises in the amount of 5-10 sessions daily.

Balneotherapy is represented by turpentine baths according to A.S. Zalmanov followed by rest. Manual therapy includes applying to the skin in the projection of the trigger point of a cream containing natural iodine-bromine components and its subsequent compression with kneading spiraling, gradually deepening movements. During the course of physiotherapy exercises, methods of post-isometric relaxation of tense and strengthening weakened muscles are used.

The technical result of the invention is that:

- this method effectively treats patients regardless of their skin type, including children and adolescents, due to the fact that safe means are applied to the skin of patients, manual therapy and individual complexes of physiotherapy exercises are applied, the active trigger point is pressed in a certain mode;

- this method allows you to simultaneously affect all the trigger points that support myofascial pain in a particular patient, due to the fact that Zalman turpentine baths, manual therapy and physiotherapy exercises are used in parallel using postisometric contractile relaxation techniques and strengthening weakened muscles;

- also this method does not cause side effects in medical personnel performing medical procedures, due to the fact that safe means are used;

- the time of the procedures in this method is reduced, and their cost is significantly reduced, since the development of active trigger points is performed without preliminary heating of the zone of manual exposure, and relief of myofascial pain syndrome is carried out without the use of ultrasound.

SUMMARY OF THE INVENTION

The invention is illustrated by a description and examples of practical use.

A method of treating patients with myofascial pain dysfunction syndrome is as follows.

When contacting the Rehabilitation and Wellness Center, the patient undergoes a comprehensive clinical examination and biomechanical testing by a doctor to determine the location of active trigger points and the stage of their development. Based on the examination data, the patient is prescribed the appropriate treatment, consisting of a course of turpentine baths according to A.S. Zalmanov, manual therapy and physiotherapy exercises using methods of post-isometric relaxation of tense and strengthening weakened muscles in the amount of 5-10 sessions.

The proposed method allows you to act on both primary trigger points, which are usually located in the paravertebral soft tissues, and secondary, distal, which are usually localized in the muscles of the extremities. In the process of performing physiotherapy exercises, not only pathologically strained muscles are stretched, but weak ones are also strengthened.

Thus, it is possible to improve capillary blood flow in all problem areas and to harmonize the motor stereotype as a whole.

Turpentine baths according to A.S. Zalmanov is released as follows: a bath of warm water (temperature 37 degrees Celsius) is drawn up to half, the initial water level is selected so that after the patient is completely immersed, the water does not reach the safety drain hole by about 7-10 centimeters. Next, the desired amount of the mixture is measured out with a beaker (for the first procedure - 25 milliliters, increasing by 5 milliliters with each subsequent procedure, bringing to 50 milliliters), it is poured into a special enameled container for mixing, hot water from the tap is also poured to dilute the mixture and stir well with a spoon. The volume of a special enameled mixing container is at least 2-3 liters, so that the treatment mixture can be mixed well. Then the resulting mixture is poured from the tank into the bath evenly over the entire surface of the water.

The patient needs to immerse himself in the resulting aqueous solution to the level of the chin. On the hourglass, which should be in front of the eyes of the doctor, it is necessary to note the time the procedure began. After the patient is in the bathroom for 3 minutes at a water temperature of 37 degrees Celsius, you can begin to pour hot water.

When taking a "white" turpentine bath according to A.S. Zalmanov’s water temperature is usually brought up to 39 degrees Celsius. The “white” turpentine bath in terms of temperature is warm and is intended for patients with low blood pressure.

When taking a "yellow" turpentine bath according to A.S. Zalmanov’s water temperature is usually brought up to 42 degrees Celsius. The “yellow” turpentine bath in terms of temperature is hot and is intended for patients with high blood pressure.

At the first sign of sweat in the patient, the procedure must be completed.

After completing the procedure, the patient must carefully rise and exit the bath: turpentine baths are oil, so the walls and bottom become slippery.

After passing the bath, the patient rests in bed for 1 hour.

Manual therapy is carried out as follows: Chazhemtovsky cream is applied to the skin in the projection of the trigger point, which does not have side effects, does not cause allergies and is used at any age. The cream is applied as follows: with the small finger of the first finger, the active trigger point is pressed against the nearest bone protrusion and its pressure is carried out by kneading spiral, gradually deepening movements, and the finger moves at a rate of 4 millimeters per second, which corresponds to the rate of lymphatic drainage massage.

Chazhemtovsky cream produced by SibMinVody LLC, Tomsk was made using natural underground healing mineral water belonging to the iodine-bromine group. The composition of the cream is characterized by the presence in it of unchanged natural chemical components of mineral water - Na, Ca, Mn, K, Cl, Br, I, B, silicic acid, in microgram quantities more than 20 elements of the periodic table (Cu, Zn, Co, Li and the like ) The total amount of natural substances in 50 grams of Chazhemtovsky cream is 120 micrograms.

Then, prostysometric relaxation of tense and strengthening of weakened muscles with an instructor of physiotherapy exercises is carried out for 30 minutes.

Medical inactivation of trigger points of stage II, if necessary (in the case of maintaining the activity of the points, giving pronounced pain symptoms) is carried out after the fifth day of treatment. Diprospan 1.0 + 0.5% novocaine solution is used - 2-3 ml.

This method allowed to abandon the use of ultrasound for the relief of myofascial pain.

Clinical observation of 60 patients with a diagnosis of “Cervical osteochondrosis of the II-III period” was carried out. In 30 patients, relief of myofascial pain syndrome was performed without the use of ultrasound, in 30 (control group) - with ultrasound exposure to trigger points.

Observation result: relief of myofascial pain syndrome during a 10-day course of treatment in the first group was noted in 96.7% of cases; in the second - in 93.4% of cases.

DETAILED DESCRIPTION OF THE INVENTION

The practical implementation of the method is illustrated by the following clinical observation:

1. Patient Tatyana N., 48 years old, turned to the Rehabilitation and Wellness Center on February 25, 2010, with complaints of pain in the left knee joint without a clear connection with physical activity, lameness.

Pain manifested 1.5 years before treatment, exacerbation - in the spring and autumn. Decreased on the background of non-steroidal anti-inflammatory therapy. Last exacerbation - within 1 month. Conservative treatment was carried out (diclofenac intramuscularly 3.0 N5, laser therapy on the knee joint area, massage to the left to / to N 10) - without effect.

When handling: the contours of the joint are smoothed. Bending is limited to 70 'degrees, extension is 180' degrees.

Pathological tension of the large and midgluteal muscle, semitendinous and adductor thigh muscle. Trigger points of I and II stages in them. The quadriceps muscle of the left thigh is hypotrophic, its muscle strength is reduced to four points.

On R'o - grams - a uniform narrowing of the joint space to 3.0 mm, subchondral sclerosis of the articular surfaces.

DIAGNOSIS: Left-sided exchange-dystrophic gonarthrosis of the I-II stage. Myofascial pain dysfunction syndrome with aztocompression of the left knee joint, extensor contracture of the knee joint, impaired joint function of the II degree.

A ten-day course of treatment was performed using the above method. The patient took Zalman baths daily, an ischemic compression of the active trigger points with the Chazhemtovsky cream was performed. Physical therapy was carried out with an instructor with relaxation of tense and strengthening of weakened muscles. Conducted 10 sessions. Once, on the sixth day of treatment, a medical inactivation of a trigger point of stage II was performed in the medium-bruised muscle with diprospan 1.0 with the addition of 0.5% novocaine in an amount of 3 ml

As a result, the pain stopped, the movement in the joint - in full, the muscle strength of the quadriceps femoris - five points.

Recommendations are given on kinesitherapy (an individual complex of physiotherapy exercises) - do it yourself. The long-term result is tracked for 1.5 years. There is no pain in the joint, tolerance to physical activity is high.

2. Patient Sergey, 10 years old, turned to the Rehabilitation and Health Center on August 1, 2008 with complaints of headaches accompanied by nausea, rarely vomiting, which does not bring relief, nosebleeds, drowsiness, drowsiness, pain in the cervical spine, and decreased appetite.

It is observed by a neurologist with a diagnosis of intracranial hyperthesis. It receives vascular drugs, neurotropic, antispasmodic, diuretic. Over the past year, there has been no decrease in headache against a background of drug treatment.

Objectively: S-shaped thoracolumbar scoliosis of the first degree. Pronounced pathological asymmetric tension of the paravertebral muscles, active trigger points - in the supraspinatus, trapezius, extensors of the hand, the muscle straightening the spine, the large and small round, square muscle of the lower back, mid-bones, calf, and soleus. The muscle that straightens the spine is hypotrophic, the “boat” test holds 15 seconds.

DIAGNOSIS: S-shaped thoracolumbar scoliosis of I degree. Myofascial pain dysfunction syndrome with autocompression of the cervicothoracic and lumbosacral spine. Secondary intracranial hypertension, cervicocranialgia.

A course of treatment was carried out by the above method. The patient took Zalman baths daily, followed by rest for 1 hour, performed ischemic compression of the active trigger points with Chazhemtovsky cream. Physiotherapy exercises with an instructor were carried out using the methods of post-isometric relaxation of contractile muscles and strengthening of the extensors of the back.

5 sessions completed. The headache was stopped, nosebleeds were not noted. Significantly improved appetite. It was possible to achieve symmetry of the shoulders, the angle of the scapula. The boat test holds 65 seconds.

Dynamic observations for 3 years. The child is engaged with a trainer in the recommended program. He does not complain; he does not need medical support. The axis of the spinal column is correct.

In this way, for 5 years, 3964 patients with myofascial pain syndrome of various localization were treated. Relief of pain symptoms during treatment occurred in 1990 (50%), pain reduction - in 1955 (49.5%), 19 patients did not note positive dynamics (0.5%). After the end of the treatment course, all patients were given recommendations on an individual supportive kinesitherapy complex. Long-term results were monitored in 112 patients who followed the recommendations for 2 years. No relapse of myofascial pain was noted.

Thus, the use of the proposed method for the treatment of myofascial pain dysfunctional syndrome provides high treatment efficiency, allows you to affect all the trigger points that support myofascial pain in a particular patient; makes it possible to expand the circle of potential patients regardless of skin type, including children and adolescents; does not cause side effects in medical personnel performing medical procedures.

Claims (4)

1. A method of treating patients with myofascial pain dysfunctional syndrome by performing manual therapy, including applying to the skin in the projection of the trigger point of a cream containing iodine-bromine components, and its subsequent compression with kneading circular movements, followed by muscle manipulation by performing physiotherapy exercises, characterized in that the course of physiotherapy exercises is carried out using methods of post-isometric relaxation of tense and strengthening weakened muscles and They carry out balneological therapy by holding turpentine baths according to A.S. Zalmanov followed by rest. 2. The method according to claim 1, characterized in that patients with low blood pressure spend a "white" turpentine bath, and patients with high blood pressure - a "yellow" turpentine bath. 3. The method according to claim 1, characterized in that while maintaining severe pain symptoms of the trigger points, diprospan 1.0 is introduced into them in 2-3 ml of a 0.5% solution of novocaine. 4. The method according to claim 1, characterized in that the speed of the finger when pressing the trigger point is 4 millimeters per second.