RU2841462C1 - Method of treating chronic back pain - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: present invention refers to medicine, namely to orthopaedics and physiotherapy. It may be used for chronic back pain treatment. Method involves the patient’s step-by-step performance of the patient’s dance movements. Duration of each stage is not less than one week. Exercises are daily for 5-30 minutes. At the first three stages, the patient uses a vertical flat support. At the first stage, the patient builds a vertical body axis along reference points by weight transfer along foot on 3 points – a heel and heads of 1st and 5th metatarsal bones, then knees are bent, and a chest is inclined towards a pelvis on exhalation. Aligned vertical body axis is preserved by the patient when making the motions at the following stages. At the second stage, the patient makes a sequential lower chest motion to the left and to the right in a frontal plane. At the third stage, the patient moves his/her lower chest in a frontal plane to the left and to the right, and then moves his/her pelvis to the left and to the right. At the fourth stage, the patient performs frontal plane frontal plane movements to the left and to the right with his/her lower chest, and then with his/her pelvis, while simultaneously bringing the shoulder blades together, then lowering them down, and then bringing them together with an arched movement. Straight arms are separated in a frontal plane from the body, and the hands are fixed rigidly. Elbows are turned up and down while the shoulder blades are brought together. At performing movements at last three stages shoulders and upper part of chest are fixed.

EFFECT: method is accessible, provides higher therapeutic effect of chronic back pain treatment.

1 cl, 4 dwg, 1 tbl

Description

The invention relates to medicine, namely to orthopedics and physiotherapy, and can be used for the treatment of chronic back pain, in the practice of rehabilitation centers.

There are several basic approaches to treating back pain:

1. Drug treatment of back pain;

2. Surgical intervention;

3. Massage therapy;

4. Therapeutic physical culture.

A well-known and widely used method of treating back pain is the drug treatment (“Causes of Negative Outcomes of Back Pain Treatment and Ways to Overcome Them” by A.N. Barinov, E.V. Parkhomenko, K.A. Makhinov), which includes the earliest possible prescription of drugs that primarily affect the pathophysiological mechanisms of pain, regardless of the etiological nature of their development.

At the first stage of treatment, if the pain is nociceptive, in which the main mechanism of activation of pain receptors is the inflammatory process, non-steroidal anti-inflammatory drugs (hereinafter - NSAIDs) are prescribed. The duration of administration should not exceed 10-14 days.

At the second stage of treatment for muscle-tonic pain syndromes and chronic back pain, when NSAID monotherapy becomes insufficiently effective, muscle relaxants are prescribed. The main mechanism of action of muscle relaxants is to inhibit the excitation of the motor neuron in response to pain stimuli and emotional discomfort.

At the third stage of pain treatment, short-term doses of narcotic analgesics are prescribed (for example, tramadol 50-200 mg/day).

Basic drug treatment of chronic back pain accompanying degeneration of the spinal joints includes taking symptom-modifying slow-acting drugs - SYSADOA, in particular those containing glucosamine and chondroitin sulfate. These drugs also have analgesic and anti-inflammatory properties, are devoid of side effects typical of NSAIDs, since the mechanism of their anti-inflammatory action is not associated with the suppression of prostaglandin synthesis, but is due to the blocking of nuclear factor kappa B (NF-kB), which initiates the breakdown of cartilage tissue. The feasibility of their use is confirmed by both the results of their long-term, safe and successful use in osteoarthritis (level of evidence 1A), and the commonality of inflammatory-degenerative processes occurring in the joints of the extremities and intervertebral (facet) joints.

An additional and most effective minimally invasive method of treating musculoskeletal back pain within the framework of a drug approach at any stage of treatment is a local injection of a drug (blockade) that has an anti-edematous and anti-inflammatory effect into the focus of disc-radicular conflict or the epicenter of inflammation and persistent muscle spasm. Local anesthetics, as well as NSAIDs and glucocorticosteroids are administered epidurally, foraminally, paraarticularly into the facet joints and myofascial trigger points.

Disadvantages of drug treatment:

- when taking NSAIDs, patients often experience: gastropathy, increased blood pressure, thrombosis, allergic reactions, nephropathy, bleeding. NSAIDs can cause nausea, flatulence, diarrhea or constipation. More serious complications are also not uncommon: ulcers and bleeding.

- when taking muscle relaxants, patients often experience: drowsiness, impaired concentration, limited ability of patients to drive vehicles (when taking baclofen, for example). If it is necessary to maintain high physical and intellectual activity during the treatment period, then gamma-amino-beta-phenylbutyric acid preparations can be used. However, the high acidity of the active substance can aggravate dyspeptic phenomena, especially in patients with NSAID-induced gastropathy.

- when taking narcotic analgesics, patients experience temporary relief, but these drugs are addictive (each time, larger doses are required) and cause drug dependence (the patient can no longer do without these drugs). In this regard, the use of opiates for more than ten days is not recommended and is permissible only for the most intense (> 70 mm on a visual analogue scale) back pain when NSAIDs and adjuvant analgesics are ineffective as the third stage of pain relief therapy recommended by WHO.

- blockades - in addition to the side effects from the administered drugs, this procedure requires special skills, and in some cases high-tech equipment is needed to ensure that the needle reaches the affected area correctly.

There is a known surgical method of treating back pain (discectomy) - this is a neurosurgical operation during which the vertebral disc or its fragment is removed. The technique of performing decompression (open surgery or microdiscectomy) does not affect the outcome of the surgical intervention. The expediency of discectomy is very questionable in cases where the pain syndrome is not associated with disc-radicular conflict.

Disadvantages of surgical treatment: relapse of pain after anatomically successful discectomy is referred to as "failed spine surgery syndrome" or "post-discectomy syndrome". Post-discectomy syndrome occurs in 20-50% of patients and is caused by various factors (impaired biomechanics of movement in the operated segment of the spine, adhesions, chronic epiduritis), is difficult to treat, condemning most patients to lifelong use of analgesics (including narcotics) in ever-increasing doses. Surgical treatment can also have a short-term effect, because the compression load created by muscle weakness, lack of spine mobility and poor posture is not surgically removed.

Massage therapy is known for its use in the treatment of back pain - one of the manual techniques, which is a set of methods of mechanical and reflex action on tissues and organs in the form of rubbing, pressure, vibration, carried out directly on the surface of the human body both by hands and by special devices through air, water or other media in order to achieve a therapeutic or other effect (access mode: https://ru.wikipedia.org/wiki/%D0%9C%D0%B0%D1%81%D1%81% D0%B0%D0%B6, access date: 05.08.2024). In addition to mechanical effects, to enhance the effect, to achieve a certain effect, creams, powders, and various massage oils can be used - aromatic, fragrant oils, medicinal ointments, gels, other drugs and various physical factors: temperature effects (for example, cryomassage), vibration (for example, a percussion massager). External stimuli are perceived by skin and muscle receptors, reflex points, and transmitted to the central nervous system. The flow of impulses, depending on the technique and massage techniques used, can stimulate and increase the tone of the central nervous system, or, conversely, have an inhibitory and relaxing effect on it, which has a positive effect on the activity of all physiological systems of the body. At the same time, the correct use of massage creams, oils, ointments, gels or powders can both enhance the above effects on the desired areas of the human body and reduce them. In order to create such an additional effect, massage oils are used, which include natural active components.

The disadvantage of massage technique for treating back pain is that massage is a procedure that is limited in its impact, since it affects only the muscles of the body; as for joints, intervertebral hernias, tendinopathies, ligament problems - massage is not effective. Massage can help relieve back pain during recovery after physical exertion and relieve muscle tone, spasm (15-30% of all causes of back pain). In other cases: with discopathy, ligament damage, joint inflammation, radicular syndrome (70% of cases of back pain), massage has no pathogenetic basis and is not effective. Another significant disadvantage of massage technique for treating back pain is addiction to passive treatment techniques and the formation of psychological dependence on massage in the patient. After all, trigger points and spasms are subject to muscles that are not used and most often they are observed in a hypodynamic person. But instead of loading and training the muscles correctly, a person goes to a massage and relaxes these structures even more, which leads to even greater addiction and dependence. Another significant disadvantage of massage is that it requires considerable financial investment, and not all people can afford massage courses.

There is a known method of treating back pain with the help of therapeutic physical culture (hereinafter referred to as LFK) - a medical procedure that uses physical culture means (mainly physical exercises) for the purpose of treating and rehabilitating patients and disabled people, as well as preventing diseases (access mode: https://ru.wikipedia.org/wiki/%D0%9B%D0%B5%D1%87%D0%B5%D0% B1%D0%BD%D0%B0%D1%8F_%D1%84%D0%B8%D0%B7%D0%B8%D 1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F_%D0%BA%D1%83 %D0%BB%D1%8C%D1%82%D1%83%D1%80%D0%B0, access date: 05.08.2024). To increase the effectiveness of exercises, the tasks of therapeutic physical training include the use of pedagogical means of influence: developing self-confidence in the patient, a conscious attitude to the classes and the need to take an active part in them. therapeutic physical training involves conscious and active performance of appropriate physical exercises by patients. During the classes, the patient acquires skills in using natural factors of nature for the purpose of hardening, physical exercises - for therapeutic and preventive purposes. This allows us to consider therapeutic physical training classes as a therapeutic and pedagogical process.

The main disadvantage of exercise therapy is low compliance: a person stops doing the exercises as soon as he feels a little better. Rarely will a person implement exercise therapy exercises into everyday life. When doing exercise therapy, a patient often has to force himself to do the exercises, which can cause stress. And stress, as we know, is also a cause of back pain. That is, for such a patient, it is important to find not only therapeutic physical gymnastics, but gymnastics that would make him happy and want to do it.

For the purposes of this description, it is important to note that back pain can be acute and chronic. Acute back pain (primary sensitization) is an increase in the sensitivity of peripheral nociceptors with the development of primary hyperalgesia. The sensitivity of mechanical, thermal, chemical receptors located in body tissues is regulated by algogens (prostaglandins, leukotrienes, thromboxanes). These substances increase the sensitivity of receptors locally, in the damaged area. Due to this, they perform their protective function of the body from further damage and create a condition so that a person does not get injured again in the same place, which promotes healing of the injury. Acute pain lasts less than 3 months, and is usually local at the site of injury. Any acute pain that lasts more than 3 months is doomed to become psychogenic. This process is called chronization of pain, i.e. central sensitization appears. The pain that occurs at the very beginning, primary, is simple and understandable in its essence. It can be mechanical, i.e. dependent on the position of the body in space. This or that pose can cause irritation of the muscular, skeletal tissues of the body or nervous tissues. And a person perceives this as pain. But if this continues for a long enough time, then restructuring begins in the brain. The brain has neuroplasticity and is capable of learning. In the case of chronic pain, the brain learns to reproduce pain itself. If a person's attention is constantly focused on pain and its provocation, for example, a person constantly checks with provocative poses whether his pain has passed, then the mechanisms of primary peripheral sensitization cannot cope and central sensitization occurs. The brain's pain-relieving systems begin to switch off and sensitivity to all provocative stimuli increases. Sensitization ceases to be local. In such a person, you can see that the primarily locally focused pain after a month or more spreads to other parts of the body, increases. And the pain is reproduced almost constantly, even by non-painful stimuli. Central sensitization occurs.

Mechanisms of development of central sensitization: central sensitization is little connected with local inflammation, it is already a change at the level of the brain, nervous system. Substance P (formed by the intestinal walls, in the posterior horns of the spinal cord, in the neural ganglia) is a neurotransmitter transmitting information from nociceptors in the spinal cord. Its production increases and, consequently, the transmission of impulses from the nociceptors of the damaged zone, as well as other neighboring zones, increases. Secondary hyperalgesia occurs. Such pain is not relieved by painkillers. But substances with a tranquilizing effect, for example, alcohol, work well. Because the pain control mechanisms are realized through antinociceptive systems, the main structures of which are neurons of the posterior horns of the spinal cord, the arcuate nucleus of the hypothalamus, the periventricular and periaqueductal gray matter, the raphe nuclei. Transmitters of these structures are endorphins, enkephalins, norepinephrine, serotonin. In central sensitization, the resources of these substances are depleted. And tranquilizing substances stimulate their production (source of fame: Povoroznyuk V.V. LOWER BACK PAIN. PREVALENCE, CAUSES, DEVELOPMENT MECHANISMS AND DIAGNOSTIC FEATURES). And all this is based on the negative neuroplasticity of the brain, which learns to reproduce pain and read many signals as from a source of pain, suppresses the activity of motor neurons and a person develops kinesiophobia, he is afraid of movement, abandons physical activity, but the pain still increases.

Signs of central sensitization.

1) The presence of musculoskeletal pain.

2) Disproportionate perception of pain on a 10-point pain scale.

3) Increased area of pain, diffuse pain.

The peculiarity of the treatment of chronic back pain (central sensitization) is that classical methods of treating back pain (medicinal, surgical, based on the pathological model) do not affect it. A temporary improvement in the condition is possible from changing pills, injections, etc., but then the pain will return. To obtain a stable positive result from the treatment, it is necessary for the patient to approach the treatment comprehensively and pay attention to the psycho-emotional state, the state of the nervous system.

For the purposes of this description, compliance should be understood as “the patient’s precise and conscious implementation of the doctor’s recommendations during treatment; adherence to treatment is the degree of correspondence between the patient’s behavior and the recommendations received from the doctor” (access mode: https://cyberleninka.ru/article/n/komplaentnost-kak-medikosotsi alnaya-i-eticheskaya-problema-pediatrii/viewer, access date: 05.08.2024).

The technical challenge is to develop an effective and affordable method for treating chronic back pain with high compliance.

Technical results of the invention:

- increasing the therapeutic effectiveness of chronic back pain treatment through balanced physical activity and maintaining activity;

- increasing treatment compliance due to the high emotional component: during the process of dance movements, the patient’s mental state is balanced;

- increasing the availability of treatment: the proposed method can be practiced during the day at a convenient time, without the use of special equipment or apparatus, and can be easily integrated into a person’s daily life due to the low time investment (3-5 minutes of practice daily is enough).

Technical results are achieved by the patient consistently completing the following stages over a period of at least a week:

- At the first stage of the application of the dance method of treating chronic back pain, the patient builds the vertical axis of the body (lateral part of the ankle - upper lateral point of the fibula - greater trochanter of the femur - shoulder - earlobe) by successively transferring weight along the foot, bending the knees to the state of "shock absorption", connecting the front part of the pelvis and chest on exhalation.

- At the second stage of the application of the dance method of treating chronic back pain, the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane, while the movement is performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper part of the chest remain fixed at one point; at the same time, the patient leans his back against a vertical flat support, which allows maintaining the vertical axis of the body and performing movements strictly in the frontal plane.

- At the third stage of the application of the dance method of treating chronic back pain, the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane, and then a movement of the pelvis to the left and to the right in the frontal plane; in this case, the movement is performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper part of the chest remain fixed at one point; in this case, the patient leans his back against a vertical flat support, which allows maintaining the vertical axis of the body and performing movements strictly in the frontal plane.

- At the fourth stage of the application of the dance method of treatment of chronic back pain, the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane, and then the pelvis to the left and to the right in the frontal plane; at the same time, the shoulder blades move - the shoulder blades are sequentially brought together without bending the chest, then lowered down, then spread apart and again connected with an arcuate movement; at the same time, the straight arms are spread apart in the frontal plane from the body, the hands are fixed motionless, and the elbows are turned sequentially up and down when the shoulder blades are pulled towards each other; at the same time, the movement is performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper chest remain fixed at one point.

The description of the invention may be used as an example for a better understanding of its essence and is set out with references to the figures attached to the present description. At the same time, the details given below are not intended to limit the essence of the invention, but to make it clearer.

The proposed method can be implemented in accordance with Fig. 1-4, which show:

- Fig. 1 - diagram of the implementation of the first stage of the application of the dance method of treating chronic back pain by the patient - alignment of the vertical axis of the body;

- Fig. 2 - diagram of the implementation of the second stage of the application of the dance method for treating chronic back pain by the patient - sequential movement of the lower part of the chest to the left and right in the frontal plane;

- Fig. 3 - diagram of the implementation of the third stage of the application of the dance method for treating chronic back pain by the patient - sequential movement of the lower part of the chest to the left and to the right in the frontal plane, and then movement of the pelvis to the left and to the right in the frontal plane;

- Fig. 4 - a diagram of the implementation of the fourth stage of the application of the dance method of treating chronic back pain by the patient - movement of the shoulder blades - the shoulder blades are successively brought together without bending the chest, then lowered down, then spread apart and again connected with an arcuate movement; while the straight arms are spread apart in the frontal plane from the body, the hands are fixed motionless, and the elbows are turned successively up and down when the shoulder blades are pulled towards each other.

The dance method of treating chronic back pain includes 4 modules and lasts 4 weeks, respectively - one module per week. This approach ensures a gradual complication of movements from simple to more complex and comprehensive, which allows patients to easily remember and learn to move properly. It is difficult for a person with back pain to perform multitasking functions with the body, so it is important to gradually form a neuromuscular connection that will allow you to quickly adapt to the exercises, remove the symptoms of pain and teach the person to move correctly in the future. The exercises are performed by the patient daily, each session takes from 5 minutes (minimum) to 30 minutes (optimal).

At the first stage (first week of classes) the patient builds the vertical axis of the body. First, a vertical line is built from the feet to the pelvis. This is done by transferring weight along the foot. The patient distributes the weight along the foot over 3 points of the foot: the heel and the heads of the 1st and 5th metatarsal bones. For better weight retention, the patient can lift the toes so that the weight along the foot is not transferred predominantly to the front of the foot. This is necessary so that when the chest moves, the vertical of the body is stable and the thoracic spine is better isolated from the pelvis and lower back. This also allows you to engage the gluteal muscles and increase the mobility of the hip joints, which reduces the anterior tilt of the pelvis and increases the mobility of the pelvis for dancing.

The vertical axis reference points of the body: the lateral part of the ankle, the upper lateral point of the fibula, the greater trochanter of the femur, the shoulder and the earlobe - should tend to a vertical line (not strictly). The knees should be bent to the state of "amortization". On exhalation, the patient connects the front part of the pelvis and the chest - this activates the abdominal muscles and stretches the lumbar muscles. This reduces the anterior tilt of the pelvis. Most often, patients have a backward-leaning chest. As a rule, this is caused by muscle imbalance. The pectoral muscles, intercostal muscles - are shortened, and the muscles of the shoulder blades in the thoracic region of the back are stretched. It is difficult for the patient to hold the chest with the abdominal muscles. Therefore, to build the vertical axis, it is necessary to use a vertical flat support, for example, a wall. The shin should be vertical, i.e. the knees should be located above the heels.

At the second stage of the application of the dance method of treatment of chronic back pain (second week of classes, Fig. 2) the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane. The movement is performed while maintaining the vertical axis of the body, built at the first stage, and the shoulders and upper part of the chest remain fixed at one point. In this case, the patient leans his back against a vertical flat support, for example, against a wall, which allows the patient to maintain the vertical axis of the body and perform movements strictly in the frontal plane. It is necessary to ensure that the back is pressed tightly against the wall. Then, when a person has felt the frontal plane of chest and pelvic movements, the patient can begin to perform these movements without support from the wall. With increased mobility of the chest and thoracic vertebrae, the patient's lumbar and cervical spine are relieved, and the abdominal muscles are strengthened.

In the third stage of the dance method for treating chronic back pain (third week of classes, Fig. 3), the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane, and then a movement of the pelvis to the left and to the right in the frontal plane. This helps to stretch the spasmodic muscles of the lower back (especially the quadratus muscles) and strengthens the abdominal muscles. The movement must be performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper chest remain fixed at one point. In this case, the patient leans his back against a vertical flat support, for example, a wall, which allows the patient to maintain the vertical axis of the body and perform movements strictly in the frontal plane.

A common mistake the patient makes when performing this stage is that the patient's anterior iliac axes are not located on the same horizontal line. In this case, the lumbar muscles will not stretch. This happens because the patient cannot control the relaxation/stretching of the lumbar muscles (especially the quadratus lumborum) and abdominal muscles. Instead of horizontal displacement of the pelvis, the patient tilts the pelvis (Fig. 3). A deflection appears in the back and one knee begins to straighten relative to the other. This is a mistake. To correct this, it is important to draw the patient's attention to: a) the position of the knees: the knees should move synchronously and alone; this will remove the tilt of the pelvis, due to which the lower back will be stretched and the abdominal muscles will be included; b) the amplitude of movement: it should be comfortable and pleasant; the sensation of stretching the lumbar muscles should be conscious, excessive amplitude will create an unnecessary tilt of the pelvis.

At the third stage, when the patient has felt the frontal plane of chest and pelvis movements, the patient can begin to perform movements without support on a flat vertical surface: first, the chest is moved, then the pelvis is moved and the two movements are combined. The chest is pulled to the right, the pelvis to the left: the chest and pelvis move in the frontal plane in opposite directions; while maintaining a horizontal position (without tilting). Non-amplitude displacements of the chest and pelvis in the frontal plane. It is important to draw the patient's attention to the fact that the body weight should be placed strictly between the feet, because shifting the weight from one leg to the other following the chest (i.e. lack of stability) will not give the desired effect of isolating the thoracic spine from the lumbar spine and engaging the abdominal and lumbar muscles. It is the balance of weight that will allow the spine to be mobile.

At the fourth stage of the application of the dance method of treating chronic back pain (the fourth week of classes, Fig. 4), the patient makes a sequential movement of the lower part of the chest to the left and to the right in the frontal plane, and then the pelvis to the left and to the right in the frontal plane. At the same time, the shoulder blades move - the shoulder blades are sequentially brought together without bending the chest, then lowered down, then spread apart and again brought together in an arcuate movement; at the same time, the straight arms are spread apart in the frontal plane from the body. At the same time, the hands are fixed motionless.

If the patient is able to fix the ends of the arms in one point in space, while the shoulder blades are moving, then there is no need to fix the arms. But more often, novice patients are not able to fix the arms, so at home, the backs of chairs can be used to fix the arms, in a gym - crossbars installed at a given height. The elbows of the arms are rotated sequentially up and down, when the shoulder blades are pulled towards each other; in this case, the movement is performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper chest remain fixed in one point. The amplitude of rotation should be comfortable for the patient. If he already feels it with a straightened arm, rotation can be omitted. And add gradually with the progression of training.

At the last stage, it is also necessary to turn all exercises into a dance. It should be noted that dancing is a process to music, which many people associate with pleasure, even if considerable effort is invested in this process. A person in a dance stops focusing on the number of actions performed, exercises, focuses on the pleasure that these exercises bring him to his favorite music. And the training itself no longer associates with torture, with a sense of duty, fear of pain, etc. This contributes to the fact that a person devotes more time to training the body with the help of dance.

The declared method was proposed for testing in 2024 to 39 patients aged 16 to 52 years. All patients had non-specific chronic back pain for at least 3 months. Classes began on March 1 and ended on April 1. Patients performed exercises at any convenient time, at any convenient opportunity, for at least 5 minutes. The program of classes was divided into 4 modules - 4 weeks, which correspond to the steps in the description of the method and was built on the principle of gradual complication: classes began with the feet, building the vertical axis of the body. Then, when patients were already accustomed to holding the desired position, they began to add movements with the pelvis, chest, shoulder blades, shoulders, and then combined everything into a dance. To check the technique and reporting, participants sent homework in video format.

For the survey and monitoring of the results, the central sensitization questionnaire CSI was selected (access mode: https://rehab-base.ru/?page_id=1874, access date: 05.08.2024).

The results of all patients who participated in the study are presented in Table 1.

Table 1

Patient No. Number of points before the start of classes using the proposed method, points Number of points after completing classes using the proposed method, points 1 60 31 2 27 11 3 42 30 4 22 11 5 23 10 6 18 11 7 19 15 8 54 45 9 43 33 10 27 11 11 22 13 12 35 31 13 54 53 14 29 30 15 41 31 16 45 32 17 49 50 18 40 38 19 24 19 20 41 27 21 45 25 22 21 11 23 33 28 24 30 30 25 25 13 26 57 13 27 22 9 28 13 11 29 19 13 30 46 42 31 34 38 32 30 35 33 29 23 34 48 44 35 60 33 36 23 12 37 19 16 38 27 12 39 60 30 Sum 1356 996 Average 34.77 25.54

Assessment of the severity of central sensitization

0-29 points - subclinical,

30-39 points - easy,

40-49 points - moderate,

50-59 points - pronounced,

60-100 points - critical.

MDC = 34.77 - 25.54 = 9.23

*MDC (minimum detectable change) from +/- 0.86 to +/- 11.4.

Calculation of the Student's criterion based on the results of the questionnaire cluster: t _emp = 6.2. The obtained empirical value of the Student's criterion is in the zone of significance of the results.

Analysis of the test results of the proposed dance method for treating chronic back pain using the central sensitization questionnaire CSI: the indicators between the results before the start of classes using the proposed method and after the end of classes using the proposed method are clinically and statistically significant. Quantitative indicators indicate the effectiveness of the proposed method despite the short period of exposure (1 month) and short training time (the minimum training time was 5 min/day). The greatest improvements in physical condition were noted by those patients who practiced every day. It can be stated that all patients confirmed an increase in the therapeutic effectiveness of chronic back pain treatment due to balanced physical activity and maintaining activity.

A more detailed analysis of the questionnaire results shows that the technique has most significantly reduced pain, emotional stress, improved sleep, increased vigor, decreased anxiety, decreased headaches, improved cognitive abilities, and decreased gastrointestinal discomfort. Based on these data, it is possible to confirm an increase in treatment compliance due to the high emotional component: the process of dance movements balances the patient's mental state.

It is also necessary to note that treatment according to the proposed dance method is very accessible: it can be practiced during the day at a convenient time, without the use of special equipment or apparatus, and is easy to integrate into a person’s daily life due to the small time investment (3-5 minutes of practice daily is enough).

In a month of classes, the use of a dance method for treating chronic back pain allowed us to significantly reduce chronic back pain and improve the condition of the central nervous system of all observed patients.

Claims (5)

A method for treating chronic back pain, which includes the patient performing dance movements step by step, each step lasting at least a week, the exercises are performed daily for 5-30 minutes, while: at the first stage, the patient, using a vertical flat support, builds the vertical axis of the body along the reference points: the lateral part of the ankle, the upper lateral point of the fibula, the greater trochanter of the femur, the shoulder and the earlobe, by transferring the weight along the foot to 3 points - the heel and the heads of the 1st and 5th metatarsal bones, then bends the knees, tilting the chest towards the pelvis on exhalation; at the second stage, the patient presses his back against a vertical flat support and makes a sequential movement with the lower part of the chest to the left and right in the frontal plane, while the movement is performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper part of the chest are fixed; at the third stage, the patient presses his back against a vertical flat support and in the frontal plane to the left and to the right makes a sequential movement of the lower part of the chest, and then moves the pelvis to the left and to the right in the frontal plane, while the movements are performed while maintaining the vertical axis of the body, built in the first stage, and the shoulders and upper part of the chest are fixed; at the fourth stage, the patient makes a sequential movement in the frontal plane to the left and to the right with the lower part of the chest, and then with the pelvis to the left and to the right in the frontal plane, while simultaneously bringing the shoulder blades together, then lowering them down, after which they are spread apart and again connected with an arcuate movement, while the straight arms are spread apart in the frontal plane from the body, the hands are fixed motionless, and the elbows are turned up and down when bringing the shoulder blades together, and the movements are performed while maintaining the vertical axis of the body, built in the first stage, the shoulders and the upper part of the chest are fixed.