RU2847869C2 - Method for rehabilitation of patients with lumbosacral radiculopathy in the acute phase - Google Patents

Abstract

FIELD: restorative medicine.

SUBSTANCE: invention relates to medicine, namely to restorative medicine, and can be used in neurology, traumatology, physiotherapy, and orthopaedics. The method consists of the patient performing a set of Vojta therapy exercises adapted for the rehabilitation of patients with cervical radiculopathy in the acute phase. The adaptation of Vojta therapy exercises consists of the following: 1st phase of rotation - during activation at the level of the 6th-7th intercostal space at the nipple line in men and the costal angle in women, the leg is bent at an angle of 90° in the hip joint, with external rotation of 5-20°; 2nd phase of rotation - activating the anterior superior iliac spine area of the upper leg, it is bent at an angle of 90° in the hip joint, with external rotation of 5-15°; the therapist places their leg under the patient's knee joint; as the pain subsides, the upper leg is lowered onto the couch; Reflex crawling phase - the activated leg is bent at the knee joint so that the heel and ischial tuberosity are in line, the leg and shin are raised, excluding movement of the pelvis, and the heel area is activated. Each exercise is performed 2-3 times alternately, first for one leg and then for the other, 2-3 times. Each zone of each leg is activated for 0.5-1.5 minutes in each exercise, and the total number of rehabilitation sessions is 4, with 1 session per week.

EFFECT: rehabilitation of patients with lumbosacral radiculopathy, specifically in the acute phase, has a simple exercise technique, minimises pain during procedures, increases the percentage of clinically verified root compression recovery, reduces the indications for surgical treatment, and shortens the overall rehabilitation period.

1 cl, 7 dwg, 3 ex

Description

Radiculopathy is a serious complication of degenerative lesions of the lumbosacral spine, accompanied by pain syndrome, which not only physically disables the patient, but also reduces adaptive resources and quality of life.

Lumbosacral radiculopathy is a significant cause of disability and morbidity, accounting for 23% to 57% of cases in patients with low back pain and resulting in significant hospital and medical expenses. This pathological process can affect various lumbar roots and can cause radiating symptoms manifesting throughout the lower limb, including the affected root. According to some studies, the prevalence in the general population ranges from 1.6% to 13.4%, with the predominant age range being 45 to 64 years, and men are more frequently affected than women.

The search for new methods of restorative therapy for patients with lumbosacral radiculopathy, based on the principles of ensuring the safety of treatment with minimal risks of complications, in particular through the use of physiotherapy, with a long-term rehabilitation effect and a reduction in the frequency of relapses of the disease, is a necessary and urgent task for practical healthcare.

The prior art provides various methods for the rehabilitation of patients with lumbosacral radiculopathy, including those involving the implementation of a set of manual therapy techniques, massage, breathing procedures and therapeutic gymnastics exercises, or those carried out by using a combination of several physical factors that have a combined effect on the peripheral and central nervous systems, transdermally, reflexively normalizing blood circulation and metabolism in the area of the affected tissues.

Thus, a method for the rehabilitation of patients with lumbosacral radiculopathy is known from the prior art, which consists in the fact that, against the background of climate therapy, therapeutic gymnastics, magnetic therapy, massage, dry-air thermal baths with an aerosol of an aqueous extract of antler concentrate, differentiated acupressure of the paretic limb is additionally carried out for 20 minutes in a course of 14 procedures daily. In patients with vertebrogenic radiculopathy of the fifth lumbar nerve root (L5), tonic effects are exerted on the BAP on the stomach meridian - E 36, E 41, E 44 and on the liver meridian - F 2, F 3, F 4, F 5. Relaxing effects are exerted on the BAP on the gallbladder and liver meridian - VB 34, VB 39, VB 40, F 8. In patients with vertebrogenic radiculopathy of the first sacral nerve root (Si), tonic effects are exerted on the BAP on the bladder meridian - V 36, V 37, V 40, V 57, V 60, V 62 and on the gallbladder meridian - VB 34, VB 39. Relaxing effects are exerted on the BAP on the gallbladder meridian - VB 30, VB 31, VB 32, on the stomach meridian - E 36, E 41, E 44, on the liver meridian - F 6, F 3, F 4, F 5 (see patent RU No. 2791807, IPC A61H7/00; A61H1/00, published 03/13/2023).

The method increases the effectiveness of rehabilitation of patients with lumbosacral radiculopathy and reduces the risk of relapse in patients with this pathology.

However, this well-known method is recommended for use only in the comprehensive rehabilitation of patients with lumbosacral radiculopathy, and in the subacute period, the period of incomplete and complete remission, which makes it unsuitable for use in the rehabilitation of such patients during the acute period of the disease.

In addition, the use in the known method of dry-air thermal baths with a highly dispersed aerosol of an aqueous extract of antler concentrate from natural, preserved according to GOST 4227-76 powder of spongy substance of maral antlers, produced according to TU 9219-001-58279751-11, using the physiotherapeutic device "Two-mode thermal chamber for dry-air thermal baths with highly dispersed aerosols AKOKF-01" with a procedure duration of 40 minutes, a course of treatment of 8 daily procedures, significantly increases the cost and duration of the procedures.

Furthermore, as noted by the authors of this well-known study, a positive clinical effect was observed in only 87.8% of patients, with significant improvement observed in only 55.2%. An unchanged condition was reported in 12.2% of patients. No deterioration in condition was observed.

A known method of therapeutic and health-improving treatment involves a combination of manual therapy, massage, breathing exercises, and therapeutic gymnastics. This method involves various modes of treatment, a specific sequence, and a combination of these procedures, aimed at altering the patient's consciousness and awakening their interest and will to heal (see RU 2121332 C1, IPC: A61 H 1/00, published November 10, 1998).

However, the known method does not completely eliminate the causes of the disease and is not very effective for patients with increased emotionality and an unstable nervous system, and is not suitable during the acute phase of the disease.

Information about a pilot quasi-experimental study was identified from the prior art, in which the effectiveness of Vojta therapy in the treatment of lumbosciatica was assessed for the first time in a “before and after” manner compared to transcutaneous electrical nerve stimulation (see https://ichgcp.net/ru/clinical-trials-registry/NCT03034681, published on January 31, 2017).

Inclusion criteria for this study were a diagnosis of acute, subacute, or chronic lumbosciatica and referral to the physical therapy department as candidates for any of the therapeutic procedures.

The examination was carried out before/after the intervention to obtain objective clinical analysis (measurements of pain, disability, functionality and joint mobility) using simple patient-administered questionnaires (VAS scale, Oswestry and Roland-Morris questionnaires) and research methods (Lasegue maneuver, Scheber test, fingertip test on the floor and heel-toe walking).

However, this study does not contain data on the evaluation of the effectiveness of Vojta therapy and the results of the studies conducted, which excludes the possibility of a comparative analysis with the claimed method.

The prior art also includes a method for rehabilitating a patient with motor impairments using Vojta therapy (see https://ppt-online.org/741199).

The main goal of this well-known rehabilitation method is the development of motor skills and the restoration of natural movement patterns.

The study group of patients received 15 treatment sessions, each lasting 30 minutes.

During rehabilitation with Vojta therapy, targeted pressure was applied to specific areas of the patient's body while they were lying prone, supine, or lateral. Such stimulation, in people of all ages, reflexively elicited two movement patterns:

- reflex crawling in the prone position and,

- reflexive turning over from a position on the back and side.

According to this well-known method, the reflex turn includes the following sets of techniques:

1st phase of rotation:

- The 1st phase begins with activation in the supine position of an adult, arms and legs extended;

- by irritating the chest area in the intercostal space

(7th/8th rib) under the nipple on the nipple line, turning to the side is achieved;

- inhibit head turning by providing resistance.

Important reactions:

- straightening of the spine;

- bending the legs at the hip, knee and foot joints;

- keeping the legs in this position against the force of gravity outside the supporting base, which is the back;

- preparation of hands for subsequent support function;

- eye movements to the side;

- the appearance of swallowing movements;

- deepening of breathing;

- coordinated, differentiated activation of the abdominal muscles.

2nd phase of the turn.

The 2nd phase of the reflex turn begins with activation in the lateral position:

- includes motor processes used during spontaneous coup;

- crawling on all fours and walking sideways;

The body rests on the lower shoulder and lower leg, which move it upward and forward against gravity. Muscle activation in the lower arm progresses from the shoulder to the elbow and then to the hand, and the patient leans on the hand. The movement is complete when the inversion process ends in a position on all fours.

Important reactions:

- flexion and extension movements of the upper and lower arms and legs in

in the opposite direction with strengthening of the support function on the lower shoulder and then sequentially to the hand, as well as on the lower side of the pelvis and then sequentially to the leg;

- straightening of the spine during the entire turning process;

- keeping the head in a position on the side against gravity.

Reflexive crawling.

Reflexive crawling is a motor process that contains essential components of movement:

- specific position control;

- straightening against gravity and,

- purposeful stepping movements of the arms and legs.

The starting position was on the stomach, with the head turned to the side and lying on the base.

In adults, a combination of several pressure points is required to activate reflexive crawling.

The movement was mainly carried out crosswise, that is, the right leg and the left arm move simultaneously and vice versa. One leg and

The opposite arm supports the body and moves the torso forward.

However, this well-known method is recommended and used only for adult patients, which include, in particular, patients with cervical radiculopathy - motor and/or sensory disturbances in the neck and shoulder girdle, arising as a result of external compression on the cervical nerves, usually by osteophytes or disc fragments, and has not been tested in the rehabilitation of patients with lumbosacral radiculopathy in the acute phase.

Thus, the state of the art does not yet provide any rehabilitation methods using Vojta exercises for patients with lumbosacral radiculopathy, particularly during the acute phase. The currently known rehabilitation methods for patients with lumbosacral radiculopathy are time-consuming, as they involve additional manipulations such as manual therapy, massage, breathing exercises, therapeutic exercises, and medication. Furthermore, they are generally not recommended for patients with lumbosacral radiculopathy, particularly during the acute phase.

Thus, the problem addressed by the claimed invention is the creation of a rehabilitation method using the Vojta therapy technique, adapted for the rehabilitation of patients with lumbosacral radiculopathy and specifically in the exacerbation phase, having a simple technique for performing exercises that minimize pain during procedures, allowing for an increase in the percentage of compression recovery of the clinically verified root, reducing the indications for surgical treatment and shortening the overall rehabilitation period.

The technical result of the claimed invention is the creation of an effective method for the rehabilitation of patients with lumbosacral radiculopathy using the Vojta therapy technique, adapted to the rehabilitation of patients with lumbosacral radiculopathy and specifically in the exacerbation phase.

The said technical result is achieved by the fact that the method of rehabilitation of patients with lumbosacral radiculopathy in the acute phase consists of the patient performing a set of Vojta therapy exercises, including the first phase of rotation, the second phase of rotation and reflex crawling, adapted to the rehabilitation of patients with lumbosacral radiculopathy in the acute phase, carried out in the following manner:

1st phase of rotation:

- the patient lies on his back, his head turned towards the side where the therapist is standing;

- the legs are bent at the knees so that the patient with severe pain can lie on his back without symptoms of tension;

- activate the chest area at the level of the 6-7 intercostal space at the level of the nipple line in men and the costal angle in women;

- during the activation process, when the pain syndrome, according to the patient’s complaints, decreases in intensity, the leg on the therapist’s side is bent at an angle of 90° at the hip joint with external rotation of 5-20°;

- the therapist holds the leg in the air, continuing to activate the chest area,

2nd phase of rotation:

- the patient lies on his side, the lower arm is bent at an angle of 90° at the shoulder joint, at an angle of 90° at the elbow joint;

- the lower leg is bent so that the heel and the ischial tuberosity are on the same line;

- the upper leg is bent forward, the knee lies on the couch, in this position the patient may experience slight tension;

- activate the area of the anterior superior iliac spine of the upper leg, the most protruding bone of the pelvis;

- continuing to activate the zone, the therapist bends the upper leg at an angle of 90° at the hip joint, makes an external rotation of 5-15° and places his leg under the patient’s knee joint; in this position, the patient does not feel pain;

- during the activation process, when the pain sensations decrease, the upper leg, after the therapist checks for tension, is lowered onto the couch;

- activation is carried out until the pelvis reaches a neutral position, in which the greater trochanter of the upper leg lies in line with the greater tubercle of the humerus, in the absence of forward lean,

reflex crawling phase

- the patient lies on his stomach, his head is turned to the side, opposite to the side of the activated leg, on the same side the arm is extended forward so that the hand and shoulder are in line;

- the activated leg is bent at the knee joint so that the heel and ischial tuberosity are in line;

- the therapist raises the activated leg and lower leg, excluding movement of the pelvis;

- activate the heel zone;

- after the activation begins and the pain syndrome decreases, the heel gradually moves down without movement of the pelvis,

Each exercise is performed 2-3 times alternately, first for one leg and then for the other, activation of each zone of each leg in each exercise is carried out for 0.5-1.5 minutes, and the total number of rehabilitation sessions is 4, 1 session per week.

The applicant has experimentally selected the techniques, quantitative and time intervals for their implementation, described in the claimed method, which have been tested on patients who applied to Sonar LLC, Chelyabinsk, in the period 2022, 2023 and 2024.

As the results of the rehabilitation sessions have shown, it is the stated sequence of exercises, adapted for the rehabilitation of patients with lumbosacral radiculopathy, that allows for achieving high and stable results, especially during the acute period.

This is explained by the fact that when the zones specified in the claimed method are activated using Vojta Therapy exercises adapted for lumbosacral radiculopathy, spinal straightening mechanisms are activated, which helps significantly reduce radiculopathy symptoms from the first sessions. Furthermore, all activation methods are achieved through a reflex, eliminating the need for active exercises that could aggravate pain. The claimed combination of essential properties improves the mobility of the lumbar spine's motion segments, allowing the spine to stretch and twist segmentally, thereby increasing functional mobility.

This sequence and technique of performing the stated exercises helps relieve pain and relax muscles during the acute phase, reduce pressure on the discs and release pinched, pathologically altered nerve roots, reduce tension in the intervertebral discs and spinal joints, reduce the negative impact on the nerve root, and increase range of motion in the affected part of the spine. Along with stretching the affected spinal segment, it helps strengthen the abdominal muscles and oblique muscles of the trunk, promoting the correction of spinal deformities without causing pain. Combining and varying activation and resistance zones, as well as changing the direction of pressure and the angle of joint flexion in the positions during the stated exercises, allows the stated method to be tailored specifically for patients with lumbosacral radiculopathy, particularly during the acute phase. By targeting specific areas of the body (Voight zones), ingrained movement patterns are retrained to more physiologically rational ones, which manifests itself in the acquisition of flexibility and naturalness in movements. By normalizing muscle tone and the balance of agonist-antagonist muscles, flexibility, coordination, balance, spatial orientation, and a sense of inner space are improved.

This is precisely what ensures the effectiveness of the rehabilitation method for patients with lumbosacral radiculopathy in the acute phase. Eliminating the need for active exercises reduces the trauma of the rehabilitation process and eliminates the painfulness of the procedures. This method reduces the time needed to treat radiculopathy symptoms, especially in the acute phase, which is also a positive aspect for the patient, as they experience rapid pain relief, improving their physical and emotional well-being.

The claimed invention is explained by drawings No. 1-No. 7.

Fig. 1 shows an image of the patient's initial position in the 1st phase of rotation; Fig. 2 shows an image of the patient's posture with bent knees; Fig. 3 shows an image of the final position of the patient's leg when performing the 1st phase of rotation by the claimed method; Fig. 4 shows an image of the patient's initial position in the 2nd phase of rotation; Fig. 5 shows an image of the patient's leg position when performing the 2nd phase of rotation by the claimed method; Fig. 6 shows an image of the initial position when the patient performs the crawling phase; Fig. 7 shows an image of the patient's leg position when performing the reflex crawling exercise by the claimed method.

The claimed method is carried out as follows.

During a neurological examination, a neurologist analyzes the clinical manifestations of lumbosacral radiculopathy: muscle strength, reflexes, sensitivity, symptoms of tension, the presence of compression of the clinically verified root on MRI.

After analyzing the clinical manifestations of radiculopathy, the therapist begins performing exercises to rehabilitate the patient.

The rehabilitation procedure is carried out as follows.

First, the Vojta therapy exercise is performed - the first phase of rotation, adapted for the rehabilitation of lumbosacral radiculopathy.

The first phase of the turn.

The starting position for the first phase of the rotation: the patient lies on their back, head turned toward the therapist (see Fig. 1). The therapist begins activating points located in the chest area: at the level of the 6th-7th intercostal space, at the level of the mammary line in men, and at the costal angle in women. The adaptation of the Vojta Therapy technique for the first phase of the rotation is as follows. Lying on their back, the patient, either independently or with the therapist's assistance, begins to bend their knees. The criterion for stopping further knee flexion is the patient's ability to lie on their back with bent legs, despite severe pain, without experiencing tension symptoms (without increasing pain) (see Fig. 2). Activation of the points continues even when, during the activation process, the patient begins to feel a decrease in pain intensity. When the pain intensity subsides, the therapist's leg is flexed 90 degrees at the hip and externally rotated 5-20°, holding the patient's leg in this position while continuing to activate the thoracic region at the points indicated above (see Fig. 3). The exercise is performed 2-3 times on each side (left and right) of the patient, with the activation time for each exercise zone on each side being 0.5-1.5 minutes. It is recommended to begin the exercise with the leg experiencing lumbosacral radiculopathy.

After completing the first phase of the turn, performed on each side of the patient 2-3 times, the therapist begins performing the second phase of the turn.

The second phase of the turn

The patient lies on their side, with the lower arm bent at a 90° angle at the shoulder and at a 90° angle at the elbow. The lower leg is flexed so that the heel and ischial tuberosity are in line. The upper leg is positioned forward, with its knee resting on the couch, due to the fact that the knee joint of the upper leg is slightly flexed more than that of the lower leg (see Fig. 4). To perform the second phase of the rotation, the area of the anterior superior iliac spine (the most prominent bone of the pelvis) of the upper leg is activated. Lying on their side, with the upper leg bent and resting on the couch, the patient may experience slight tension, but care should be taken to avoid this tension. Adaptation of the Vojta Therapy technique for the second phase of the rotation is as follows. The therapist flexes the upper leg at a 90° angle at the hip, externally rotates the upper leg by 5-15°, and places their leg under the patient's knee (see Fig. 5). In this position, the patient feels no pain. During activation, as pain subsides, the upper leg is lowered to the table. Activation continues until the pelvis reaches a neutral position, with the greater trochanter of the upper leg aligned with the greater tuberosity of the humerus, and no forward lean.

The second phase of rotation is performed 2-3 times on each side of the patient (left and right). Each zone on each side is activated during the second phase of rotation for 0.5-1.5 minutes. It is recommended to begin the exercise with the patient lying on their side, with the leg with lumbosacral radiculopathy on top.

After completing the exercise of the 2nd phase of turning, on each side of the patient (left and right) 2-3 times, the therapist begins to perform the exercise of the reflex crawling phase.

Reflex crawling phase

The reflex crawling phase begins with the patient lying prone, head turned to the side opposite the starting point. The arm on the same side is extended forward so that the hand and shoulder are aligned. The opposite leg is bent at the knee so that the heel and ischial tuberosity are aligned (see Fig. 6). The heel zone is used for activation. Adaptation of the reflex crawling phase involves performing the exercise as follows. The therapist, activating points in the heel zone, lifts the leg and lower leg, preventing pelvic movement (see Fig. 7). As pain subsides during activation, the heel gradually begins to lower itself, without pelvic movement.

The reflex crawling phase is performed 2-3 times on each side (left and right) of the patient. It is recommended to begin the exercise with the patient lying prone, starting with the leg that exhibits lumbosacral radiculopathy. Activate each zone on each side during the reflex crawling phase for 0.5-1.5 minutes.

Each exercise in each phase on both sides averages 3-5 minutes. The total time for all rehabilitation exercises, including performing them 2-3 times on each side, is 15-20 minutes.

The total number of rehabilitation sessions is 4, 1 session per week.

Clinical examples

Case Study #1. Patient K., 41, presented with complaints of acute back pain radiating to her left leg and numbness. VAS score: 7. Neurological examination revealed a decreased Achilles reflex on the left and hypoesthesia in the S1 root dermatome on the left. Lasegue's sign was positive on the left at a 50-degree angle. An MRI of the lumbar spine revealed a 6.5 mm extrusion at the L5-S1 level (left paramedian). The patient underwent Vojta therapy with exercises adapted for lumbosacral radiculopathy as follows.

1st phase of the rotation: the patient lies on her back, her head turned towards the therapist (see Fig. 1). The therapist activates points located in the thoracic region at the level of the 6th-7th intercostal space at the costal angle. Lying on her back, the patient, independently or with the therapist's assistance, flexed both legs at the knees and stopped flexing after she could lie on her back without symptoms of tension (without increasing pain) (see Fig. 2). The therapist continued activating the points until the patient began to feel a decrease in the intensity of the pain syndrome. During the activation process, when the pain syndrome decreased in intensity, the therapist flexed the leg located on his side by 90 degrees at the hip joint and gave it an external rotation of 5°, the leg was held in this position in the air with continued activation of the thoracic region in the above-mentioned zone (see Fig. 3).

After completing the exercise for the right leg, the therapist moved to the other side of the patient and performed the entire exercise sequence on the other side for the patient's left leg. Then, the therapist returned to the patient's right leg and repeated the same exercise for the right leg. The therapist then repeated the same exercise for the left leg. The first phase of the rotation was performed three times for each leg on each side (left and right). Activation of the exercise zones for each leg on each side lasted 0.5 minutes.

After completing the exercises of the first phase of the turn three times, the therapist began performing the exercises of the second phase of the turn.

Phase 2 of the rotation: The patient lies on their side, on the side recommended for beginning the exercise in this phase. The leg with radiculopathy is positioned above, the lower arm is flexed at a 90° angle at the shoulder joint and at a 90° angle at the elbow joint. The lower leg is flexed so that its heel and ischial tuberosity are in line. The upper leg is positioned anteriorly, i.e., its knee rests on the couch, due to the fact that its knee joint is slightly flexed more than that of the lower leg (see Fig. 4). To perform the second phase of the rotation, the area of the anterior superior iliac spine (the most prominent bone of the pelvis) of the upper leg was activated. The patient experienced a slight stretch. Next, the therapist flexed the upper leg at a 90° angle at the hip joint, applied 15° of external rotation, and placed their leg under the patient's knee (see Fig. 5). The patient did not experience pain. During activation, the therapist lowered the upper leg onto the examination table. Activation was continued until the pelvis reached a neutral position, with the greater trochanter of the upper leg aligned with the greater tuberosity of the humerus, and without forward lean. After completing the exercise for the left leg with radiculopathy, the therapist moved to the other side of the patient and performed the entire exercise sequence on the other side for the patient's right leg. Afterward, the therapist returned to the patient's left leg and repeated the same exercise again for the left leg. The same exercise was then repeated for the right leg. The second phase of rotation was performed twice for each leg on each side (left and right). Activation of the exercise zones for each leg on each side lasted 1.5 minutes.

After completing the 2nd phase of turning exercise, the therapist began performing the reflex crawling phase exercise.

The reflex crawling phase began with the patient lying prone, head turned to the right, opposite the position of the left leg on which the exercise began. The arm on the same side was extended forward so that the hand and shoulder were in line. The opposite (left) leg was bent at the knee so that the heel and ischial tuberosity were in line (see Fig. 6). During this exercise, the heel zone of the left leg was activated. Then, the therapist raised the left leg and the lower leg of the left leg, excluding pelvic movement (see Fig. 7). After activation began and pain decreased, the heel gradually began to lower downwards on its own, without pelvic movement. After completing the exercise for the left leg with radiculopathy, the therapist moved to the other side and performed the entire exercise sequence on the other side for the patient's right leg. After this, the therapist returned to the patient's left leg and repeated the same exercise for the left leg. I then repeated the same exercise for the right leg. In total, the reflexive crawling exercise was performed three times for each leg on each side (left and right). Activation of the exercise zones for each leg on each side lasted 1.5 minutes.

The time to complete each exercise in each phase on both sides was 3 minutes. The total time to complete all rehabilitation exercises was 15 minutes.

The patient underwent four rehabilitation sessions using the prescribed method, performed once a week. After completing the rehabilitation course, a follow-up neurological examination was performed, which revealed a reduction in pain on the VAS scale to 3 points. The Achilles reflex was restored, and hypoesthesia regressed. Lasegue tension symptoms decreased from an 80-degree angle.

Case Study #2. Patient V., 64, presented with acute back pain radiating to the right leg. VAS score: 5. Neurological examination revealed decreased hallucis extensor strength (3 points) and hypoesthesia in the L5 root dermatome on the right. Lasegue's sign was positive on the right at 70 degrees. MRI of the lumbar spine revealed a 5 mm extrusion at the L4-L5 level (paramedian on the right). The patient underwent Vojta therapy with exercises adapted for lumbosacral radiculopathy. For the exercise sequence, see Case Study #1. Difference from Case Study #1:

- activation of the chest area is carried out at the level of the 6-7 intercostal space at the level of the nipple line,

- the total number of exercises performed on the left and right sides of the 2nd phase of the turn is 3;

- activation time during one exercise: in the 1st phase 1.5 minutes

- rotation during the 1st phase of the turn - 20°, during the 2nd phase of the turn - 5°;

The patient underwent four sessions of the proposed method, performed once a week. Following rehabilitation, a follow-up neurological examination revealed a reduction in pain (VAS score 1). Muscle strength was restored, hypoesthesia regressed, and tension symptoms regressed.

Case Study #3. Patient N., 48, presented with acute back pain radiating to her left leg. VAS score was 7. Neurological examination revealed decreased hallucis extensor strength (4 points) on the left and hypoesthesia in the left L5 root dermatome. Lasegue's sign was positive on the left at 60 degrees. Lumbar spine MRI revealed a 5.6 mm extrusion at the L4-L5 level (left paramedian). The patient underwent rehabilitation using Vojta therapy with exercises adapted for lumbosacral radiculopathy. For the exercise sequence, see Case Study #1. Difference from Case Study #1:

- the number of exercises on the left and right sides of the first phase of the turn - 2,

- activation time during one of the exercises in the 1st phase is 1.5 minutes, in the 2nd phase 0.5 minutes, in the reflex crawling phase 0.5 minutes;

- the total number of exercises on the left and right sides in the 2nd phase of the turn is 3,

- activation time during one exercise on one leg: in the 1st phase 1.5 minutes, in the 2nd phase 0.5 minutes, in the reflex crawling phase 0.5 minutes;

- rotation during the 1st phase of the turn - 20°, during the 2nd phase of the turn - 5°;

The patient underwent four sessions of the proposed method, performed once a week. Following rehabilitation, a follow-up neurological examination revealed a reduction in pain (VAS score 2). Muscle strength was restored, and hypoesthesia regressed. Tension symptoms decreased to 90 degrees.

Claims (22)

A method for the rehabilitation of patients with lumbosacral radiculopathy, which consists of the patient performing a set of Vojta therapy exercises adapted for the rehabilitation of patients with lumbosacral radiculopathy, including the first phase of rotation, the second phase of rotation and reflex crawling, carried out as follows: 1st phase of rotation: the patient lies on his back, his head turned towards the side where the therapist is standing; the leg on the affected side is bent at the knee so that the patient with pain can lie on his back without symptoms of tension; pressure is applied to points in the chest area at the level of the 6-7 intercostal space - at the level of the nipple line in men and the costal angle in women; during the process of pressing, when the pain syndrome, according to the patient’s complaints, decreases in intensity, the leg on the affected side is bent at an angle of 90° at the hip joint with external rotation of 5-20°; the therapist holds the leg in the air, continuing to apply pressure to the chest area, 2nd phase of rotation: the patient lies on his side, the lower arm is bent at an angle of 90° at the shoulder joint, at an angle of 90° at the elbow joint; the lower leg is bent so that the heel and the ischial tuberosity are on the same line; the upper leg is bent forward, the knee lies on the couch, in this position the patient may experience slight tension; the therapist bends the upper leg at an angle of 90° at the hip joint, makes an external rotation of 5-15° and places his leg under the patient’s knee joint; in this position, the patient does not feel pain; pressure is applied to the area of the anterior superior iliac spine of the upper leg, the most protruding bone of the pelvis; during the process of pressing, when the pain sensations decrease, the upper leg, after the therapist checks for tension, is lowered onto the couch; pressure is applied until the pelvis reaches a neutral position, in which the greater trochanter of the upper leg lies in line with the greater tubercle of the humerus, in the absence of forward tilt, reflex crawling: the patient lies on his stomach, his head is turned to the side opposite to the affected side, on the same side the arm is brought forward so that the hand and shoulder are in line; the opposite leg is bent at the knee joint so that the heel and ischial tuberosity are in line; the therapist raises the leg and lower leg on the affected side, excluding movement of the pelvis; apply pressure to the heel area; after the pressure begins and the pain subsides, the heel gradually moves down without movement of the pelvis, Each exercise is performed alternately, first for one leg and then for the other, repeating them for each leg 2-3 times, activating each zone of each leg in each exercise for 0.5-1.5 minutes, and the total number of rehabilitation sessions is 4, performed 1 per week.