RU2847889C1 - Method for reducing lumbar pain with irradiation in athletes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to physiotherapy, sports medicine, medical rehabilitation, and neurology, and can be used in the treatment of pain syndrome in the lumbosacral region in athletes experiencing high statodynamic loads (weightlifters, powerlifters, etc.) both in medical and preventive institutions and in specialised sports centres. CO₂ injection is performed into acupuncture points 2 cm from the top of the posterior edge of the piriformis muscle (the injection point is located at the border of the lateral 1/3 line connecting the sacrum and the greater trochanter in the projection 2-3 cm paravertebrally from the L45 level), the depth of administration is 1-2 cm, the volume is 3.0 ml, needle length 12 cm, course of 10 procedures, every other day. Injection carboxytherapy is performed in the iliopsoas muscle (the point is located 3-4 cm lateral to the pulsation of the femoral artery, immediately below the inguinal ligament), injection depth up to 1-2 cm, volume 3.0 ml, needle length 12 cm, course of 10 procedures, every other day. Injection carboxytherapy is performed in the quadratus lumborum muscle (in 2-3 trigger points that correspond to the areas lateral to the spinous processes, at the L1 level, 5-6 cm lateral to the spinous processes, at the L4 level 1-3 cm above the posterior crest of the ilium, at the level of the transverse processes of L3 and 2 cm above the posterior superior iliac spine), volume 3.0 ml, needle length 12 cm, course of 10 procedures, every other day. Acupuncture with CO(2)is performed in accordance with the method proposed by the authors: in cases of L4 root damage and pain on the inner side of the leg, the points of the liver, spleen and pancreas meridians were used: liv 2, 3, 7, 9; SP 3, 5, 8, 11, injecting 0.5 ml of CO₂. Then, the gallbladder meridian points were toned: gb 40, 43, by injecting 0.1 ml of CO₂ into each point. In cases of L5 root damage and the appearance of pain syndrome along the anterior lateral surface of the leg, a meridian sedation technique was used: 0.5 ml of CO₂ was injected into the AT of the stomach and gallbladder meridians: st 42, 45, 36; GB 30-34, 36-40. To prevent pain syndrome, the points of the liver, spleen, and pancreas meridians were toned: liv 1, 3, 8; SP 3, 6, 12, by administering 0.5 ml of CO₂ into the AT. When pain appeared on the lateral surface of the leg affecting the S1 root, sedation of the bladder meridian was applied: bi 23-26, 36, 37, 40, 54, 55-60, 63-67, by administering 0.1 ml of CO₂ into the AT and toning the kidney meridian: k 7, 10, 13, by injecting 0.5 ml of CO₂ into the AT. To enhance the preventive effect, several general effect points were used: li 4, 11; Si 3, 4; TN 5, 8; Lu 7, by injecting 0.3 ml of CO₂ into the AT. The course consisted of 10 procedures, every other day. The total dose of CO₂ injected per procedure did not exceed 20.0 ml.

EFFECT: elimination of the risk of developing spinal stenosis and chronic lumbosacral pain, improvement in the quality of life of athletes.

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Description

The invention relates to medicine, specifically physiotherapy, rehabilitation medicine, and sports medicine. It can be used in the treatment of athletes (powerlifters, kettlebell lifters, etc.) whose training subjects certain muscle groups to extremely high physical loads, which is associated with the development of nociceptive pain associated with the sudden development of excitations in peripheral pain receptors. The relevance of this work is determined by the significant social and governmental demand for high athletic achievements and their economic contribution to the image of the Russian Federation. Furthermore, the increased demand for sporting events among individuals of various ages is associated with a high risk of nociceptive pain (up to 8-15%) and its complicated course in the form of dysmetabolic and traumatic dysfunctions of the central nociceptive and antinociceptive systems at the spinal and cerebral levels.

Neurology's position on such one-time disorders is unambiguous: early prevention of potential dysmetabolic and traumatic dysfunctions is essential to avoid their transformation into a more complicated course. This is extremely difficult to achieve, since this type of pain syndrome occurs suddenly during exercise, is poorly localized in terms of the patient's subjective complaints, and typically arises against the background of additional stress and somatosensory disorders (after a viral infection, alcohol consumption, against the background of vascular shifts, etc.). According to a survey of athletes - kettlebell lifters and powerlifters - up to 80% of them previously experienced various nociceptive pains, including before and after sports competitions, and with increasing intensity of the training process, especially during short training megacycles [1]. Moreover, almost all of them take drugs approved by WADA to relieve local muscle nociception, which allows them to compete in the tournament, but does not alleviate the problem in the long term. Moreover, up to 65.0% of athletes note that, against the background of the excitement of the competitive process, pain disappears spontaneously, which emphasizes the role of somatosensory disorders in their development.

It has been proven that the development of nociceptive pain during strength training is directly correlated with somatosensory disturbances, which is caused by both direct stimulation of sensory neurons (A-delta and C-fibers) and activation of sensory neurons in response to mechanical stress, irritation, nerve stretching, and compression. Such stresses lead to uncontrolled neural impulses developing in nerve tissues exposed to the greatest external influence, accompanied by increased expression of sodium channels and voltage-gated calcium systems (α-28). A one-time occurrence of nociceptive pain was experienced by 72% of athletes in Sweden, 55% in France, 45% in Austria, 40% in Germany, and 28-40% in Russia. This is accompanied by central sensitization and the formation of trigger zones of increased reactivity: the location of the piriformis muscle, iliopsoas muscle, quadratus lumborum muscle, and knee muscles, which causes an increase in the activity of the autonomic centers of nervous regulation, which are triggers for local temperature changes and somatosensory disorders. The main reasons for the development of triggers are hyperirritability, impaired microcirculation, increased metabolism, and the presence of a palpable local muscle cord, indicating damage to muscle tissue as a result of dystonic or dystrophic processes [1]. The formation of trigger zones is accompanied by local tissue vasomotor dysfunction and reflex tonic changes in certain muscles that experience the most tension, which is accompanied by the appearance of a large number of under-oxidized metabolic products in muscle tissue, contributing to the compression of nerve trunks and blood vessels [2].

It has also been established that the development of neuropathic pain is accompanied by increased production of autoantibodies to excitatory and inhibitory neurotransmitters, and increased induction of autoantibodies to neurotransmitters of the antinociceptive system contributes to the chronicity of pain [3-4].

Against the background of sports-traumatic damage to the nervous and muscular tissues in athletes experiencing high loads associated with weight lifting, there is a high risk of progression of dysfunctions of the central nociceptive and antinociceptive systems at the spinal and cerebral levels, which is largely due to abdominal reflexes associated with increased pressure in the abdominal cavity - activation of reflex reactions from nociceptive fibers from the skin of the abdominal wall. The concept of nociceptive pain with the formation of a certain receptor deficiency has been developed, as a reflection of disturbances in physiological reactions during pain modulation during severe physical overexertion [3]. It is also impossible to exclude disturbances associated with metabolic and trophic processes in microglia under high statodynamic loads, when, under physiological norms, the production of adenosine phosphate (ATP) is constantly activated in the nervous tissues, the production of which changes linearly during the training and competitive process [4]. Therefore, maintaining a certain level of brain-derived neurotrophic factor (BDNF), adenosine phosphate (ATP), and neurotrophins ensures normal nociceptive transmission along nerve fibers experiencing high static-dynamic tension. Moreover, many acupuncture points correspond to areas of localized pain and interact with meridian systems [5].

Currently, according to WADA, no pain-relieving medications (narcotic, hormonal, stimulant, and other categories) can be used to relieve even occasional nociceptive pain, or when it develops spontaneously in athletes experiencing high static-dynamic stress [4]. Permitted for one-time use are ibuprofen, aspirin, indomethacin, and single local lidocaine injections, which do not contribute to the prevention of nociception and do not ensure the full recovery of athletes [5].

Over the past 15 years, non-drug methods of physiotherapy have come into widespread use: autogenic training, special physical relaxation exercises, transcutaneous methods of transdermal electrical nerve stimulation (TENS), laser therapy (LLLT), cryotherapy, drug phoresis (magnetophoresis, electrophoresis, laser phoresis, phonophoresis, etc.), alternating magnetic field, reflexology [6-7].

Laser pulse therapy (LLLT - 904 nm, 10-15 Mv, frequency 50-80 Hz) for myofascial pain is performed paravertebrally in its projection L3-S1 with an effect on several points for 1-2 minutes, the total duration of illumination of up to 8-10 points is no more than 8-10 minutes [9]. To enhance the analgesic effects, laser therapy is also recommended to be performed at puncture points projectionally associated with the lesion of the spinal motor segments [10].

It has long been proven that laser acupuncture, in contrast to classical acupuncture techniques, is both painless and safer [7-11]. It is important to use a continuous spectrum of laser radiation with low-power nozzles (2-3 mW) and exposures from 20 to 50 sec, depending on the goals of the intervention (toning/sedation) [10-12]. Puncture methods of influence, from the point of view of many specialists, are highly active, since they are associated with 12 paired meridians and 2 unpaired ones (anterior and posterior), providing a single functional system with a targeted effect on zones of tension or excitation [9-10]. In this case, the correct choice of acupuncture points is important: locally associated with nociceptive pain, segmental points - in the projection zones of segmental innervation of the spinal cord, distant points and a wide spectrum - in the distal structures of the body and limbs. A reduction in the severity of the inflammatory process with the use of acupuncture has been confirmed in many experimental and clinical studies. The therapeutic effect of acupuncture is also due to an increase in the number of immunopositive cells, an increase in the level of protein B1 (HMGB1) in the blood plasma, a decrease in the severity of the autoimmune process, a decrease in the concentration of tumor necrosis factor-α (TNF-α) and monocyte chemotactic protein-1 [10].

Acupuncture points recommended for painful nociception in athletes largely depend on the clinical picture and the severity of negative and positive sensory symptoms [13, 14]. Acupuncture is recommended to be performed every other day, with a total of 15 procedures. The duration of each procedure is from 20 to 40 minutes, during which it is recommended to act on no more than 8 to 12 points. The most frequently recommended acupuncture points for nociceptive pain are those of the following meridian systems: Lungs (LU), Large Intestine (LI), Stomach (ST), Spleen (SP), Heart (HT), Small Intestine (SI), Bladder (BL), Kidneys (KI), Pericardium (PC), Triple Warmer (TE), Gallbladder (GB), Liver (LR) []. A large proportion of specialists focus on the following points: Dan-shu (BL19), Pi-shu (BL20), Wei-shu (BL21), Nei-ting (ST44), Da-dun (LR1), Jiu-san li (ST36), Gan-shu (BL18), Yong-quan (KI1), I-she (BL49), Kun-lun (BL60), Wei-zhong (BL40) [14-16].

Transcutaneous methods of transdermal electrical nerve stimulation (TENS) have come into widespread use in the treatment of nociceptive pain and for sports purposes following the studies by the authors [17-21]. Transcutaneous electrical nerve stimulation is recommended [10, 22] as a combined effect of high-frequency and low-frequency TENS. High-frequency TENS is administered at a frequency of 100 Hz and a pulse duration of 100 μs with a current amplitude achieving a painless sensory response. Low-frequency TENS is administered at a frequency of 1 Hz and a pulse duration of 200 μs with an amplitude achieving a painless motor response [10]. The duration of the procedure is 20 minutes, every other day. The current strength was selected in the range of patient comfort with a constant frequency of 77 Hz. The procedure time was 20 minutes in the paravertebral zone and 10 minutes in the trigger zones of the lower extremities, for a course of 10 daily procedures.

A method for the complex treatment of nociceptive pain using pulsed infrared laser radiation (903 nm) is known, which is presented in the works of Kanda M. et al. (1996), which ensures the activation of intraepidermal nociceptors that form a synchronous afferent flow of pulsations in the form of activation of A-delta and C-fibers, mainly peripheral afferentation [23].

Later, these scientific concepts of laser regulation were expanded and supplemented by the works of Moskvin S.V., Korchazhkina N.B., Vorobyov D.V., and others, which testify to the provision of normative-spatial mechanisms of electrotherapeutic and laser control of nociceptive pain indicators [24-25].

Research in this area was previously conducted by the authors Romanova-Salmina V.D., physician, candidate of medical sciences, Kovalenko E.B., physiotherapist, candidate of medical sciences, and Vorobyov D.V., professor, doctor [co-author], who investigated the effectiveness of laser radiation in the treatment of pain syndrome in patients with dorsopathy of the lumbosacral spine [26-27].

Previously, laser studies on athletes were conducted by S.M. Dorogovoz, which contributed to the expansion of the use of low-intensity laser therapy (LILT) in sports practice due to the high analgesic potential of this physical factor [29]. However, in the pre-competition period, the use of LILT in athletes is limited due to frequent vasovagal reactions and the lack of a preventative component in relation to dysmetabolic and post-traumatic dysfunctions in nerve structures experiencing high static-dynamic loads.

Cryotherapy provides an analgesic effect by blocking pain receptors in the skin, normalizing the antidromic excitability of spinal cord neurons and the functional state of the suprasegmental and segmental parts of the autonomic nervous system, changing the humoral-hormonal link with the participation of the neuropeptide system and endogenous opioids, breaking the vicious circle "pain-muscle spasm-pain" [13]. Cryotherapy is carried out using cryogenic agents in solid, liquid, and gaseous states. For local exposure, solid, liquid, and gaseous refrigerants are used to remove heat from various areas of the human body surface. For general CrT, patients are kept in a cryochamber with a temperature of -110 to -160 °C for 1-3 minutes. After exposure to a cooled air stream (-30 °C) on the painful segments of the spine for 5 minutes during a course of treatment in patients with DDZP, a decrease in pain, a significant decrease in tension during physical exercise and an increase in the range of motion by 38-59% were noted [24-26]. However, many experts note that in order to enhance the analgesic effect, before cryotherapy it is advisable to carry out acupuncture with needles cooled to a temperature of +4 to +8 °C [14]. However, the specificity of cold effects, the presence of cold allergy in some individuals, and insufficient study of the pathophysiological mechanisms of adaptive capabilities in athletes when exposed to extremely low temperatures require further clinical and experimental studies specifically examining the physiological, biological, clinical, psychological and biophysical effects of this method in sports practice [14].

Autogenic training and special physical relaxation exercises, despite their widespread use in sports, do not solve the preventive and pain-relieving problems of athletes experiencing high static-dynamic loads [23-25].

For the relief of nociceptive pain syndrome, puncture methods of influence were previously proposed. Thus, for the treatment of pain syndromes in the lumbosacral region, including in athletes, methods of electrical nerve stimulation (DENS), which have rapid analgesic, anti-inflammatory, anti-edematous, and antispasmodic effects on skeletal muscles, have become increasingly used [26-30]. However, not everything is clear here, Richardson R.R. et al. (1980), Bertalanffy A. et al. (2005) and Khadilkar A. et al. (2005) believe that the effectiveness of transcutaneous electrical nerve stimulation, as an isolated method of influence in the treatment of chronic back pain, is limited and contradictory, especially in athletes [22-23].

Previously, a method of acupuncture administration of botulinum toxin type A (Lantox) was also proposed in the form of a single application, which, however, cannot be recommended for individuals actively realizing their physical capabilities in the conditions of mass competitive tournaments, since it does not address the issues of preventing dysmetabolic and traumatic dysfunctions in nerve structures experiencing large static-dynamic loads [30-31].

The closest to the technical solution we developed, adopted as a prototype, is the method of introducing Lantox (40.0-100.0 U) into acupuncture points and trigger zones (piriformis, iliopsoas, quadratus lumborum muscles), provided that the drug is introduced into one or several points depending on the severity of the pain syndrome upon palpation [32].

Piriformis - the injection point is located on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter, the injection depth is up to 5 centimeters.

Iliopsoas muscle - the point is located 3-4 centimeters lateral to the pulsation of the femoral artery, immediately below the inguinal ligament, insertion depth up to 5 centimeters.

The quadratus lumborum muscle contains 2-3 trigger points, which correspond to areas lateral to the spinous processes at the L1 level, 5-6 cm lateral to the spinous processes, at the L4 level, 1-3 cm above the posterior iliac crest, and at the level of the transverse processes of L3, 2 cm above the posterior superior iliac crest. Injections are performed at a depth of up to 3-5 cm.

Recommendations after Lantox injection: do not rub the area where the drug was administered for 3-4 hours, do not use warming compresses, baths, saunas, or tubs during the first day after the injection [33].

The disadvantage of the prototype is that Lantox injections belong to the category of botulinum toxin type A, which has significant limitations for use in sports practice, according to WADA requirements, as well as for a number of other reasons related to neurotoxicity [34].

Injection carboxytherapy was previously recommended for pain relief by specialists such as Mirzoev O.M., Drogovoz S.M., Kulikova N.G., including for pain syndrome in the intervertebral joints [29]. These authors proposed the introduction of injection carboxytherapy (CO2) lateral to the intersection of the vertical and horizontal lines of the spine, along L3, L4, L5 and into the triangle (projection of the iliopsoas muscle to the right/left of the spinous processes by 2-3 cm. Needle angle - 45°, injection dose 5-10 ml, needle length 12 mm) along the line L5, L4, L3 [34]. The course of treatment is 10 procedures.

For painful trigger syndrome in the iliopsoas muscle and piriformis muscle with irradiation to the sacroiliac joint, the authors recommended using a CO2 injection 2 cm from the apex along the posterior edge of the piriformis muscle and in a projection 2-3 cm paravertebral from the L4-5 level with a needle angle of 45°. The CO2 dose is 5-15 ml, the needle length is 12 cm [27].

Injection carboxytherapy procedures into the most painful points of the lumbosacral region were also proposed by authors such as Lavrukov A.M., 2003; Grigorieva G.S, 2003; Kostareva E.V., 2004; Savko I.D., 2004; Cheing G.L.C, et al., 2004); Meizerov E.E., et al., 2003; Kibisa R., et al. 2004; Tukov A.A., 2006). However, not everything is clear here either, Richardson R.R. et al. (1980), Bertalanffy A. et al. (2005) and Khadilkar A. et al. (2005 Nathew N.T., Kalasam J., Meadors L. Botulinum toxin type A for the treatment of nummular headache: Headache 2008; 442-447; Song P.C., Schwartz J., Bilzger A. The emerging role of Botulinum toxin in the treatment of temporomandibular disorders. Oral Dis. 2007; 13(3): 253-260The use of carboxytherapy in sports / H. Zelencova et al. // J.Derma.- 2018. Vol.XVIII, N1-2.- P. 64-65; Mechanisms of carboxytheray action with diseases of the nervous system / H. Zelencova et al. 66-70. Dorogoz S.M. [co-authors], without projecting this method onto athletes [27]. The authors note that after a course of carboxytherapy, the intensity of the pain syndrome decreased on average by 3 times, amounting to 1.83 points on the VAS, compared to the initial values before treatment - 5.71 points (p < 0.05).

The authors did not obtain any trace effects in the exposed tissues, except for the physiological acid-base regulator in the form of Verigo-Bohr effects, aimed at increasing the oxygen potential in tissues and blood, which is not a violation, according to WADA recommendations.

In connection with the above, the use of injection carboxytherapy can be recommended as a safe, highly effective and traceless method for preventing dysfunctions of the central nociceptive and antinociceptive systems at the spinal and cerebral level in athletes.

The objective of the invention is to prove and scientifically substantiate the high metabolic, analgesic and antioxidant regulatory capabilities of injection carboxytherapy in athletes with high static-dynamic loads, including the possibility of preventing probable traumatic dysfunctions of the central nociceptive and antinociceptive systems at the spinal-cerebral level.

The technical result of the proposed invention is the elimination of the risk of developing spinal stenosis and chronic lumbosacral pain, and an improvement in the quality of life of athletes.

The technical result is achieved by proposing a method for reducing lumbar pain with irradiation in athletes, which consists of injecting CO2 into acupuncture points,

characterized in that injection carboxytherapy is carried out in the areas of the piriformis, iliopsoas and quadratus muscles, in a course of 10 procedures carried out every other day, with a 12 cm long needle, by introducing CO2 into the following corresponding points:

- in projection 2-3 cm paravertebral from the level of L4-5 on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter, along the posterior edge of the piriformis muscle, injection depth up to 1-2 cm, volume 3.0 ml;

- 3-4 cm lateral to the pulsation of the femoral artery immediately under the inguinal ligament, insertion depth up to 1-2 cm, volume 3.0 ml;

- in 2-3 trigger points corresponding to the zones lateral to the spinous processes of the lumbar vertebrae, volume 3.0 ml: 5-6 cm lateral to the spinous processes at the level of L1, 1-3 cm above the posterior iliac crest - at the level of L4, 2 cm above the posterior superior iliac spine at the level of the transverse processes of L3.

Acupuncture with CO2 is carried out: in case of damage to the L4 root and the appearance of pain on the inner side of the leg, the points of the meridian of the liver, spleen and pancreas were used: Liv 2, 3, 7, 9; SP 3, 5, 8, 11, introducing 0.5 ml of CO2.

Then, the points of the gallbladder meridian were toned: GB 40, 43, by introducing 0.1 ml of CO2 into the point.

In case of damage to the L5 root and the appearance of pain syndrome along the anterior lateral surface of the leg, the meridian sedation technique was used: 0.5 ml of CO2 was introduced into the AT of the stomach and gallbladder meridian: St 42, 45, 36; GB 30-34, 36-40. To prevent pain syndrome, the points of the liver, spleen, pancreas meridian were toned: Liv 1, 3, 8; SP 3, 6, 12, by introducing 0.5 ml of CO2 into the AT.

When pain appeared on the lateral surface of the leg affecting the S1 root, sedation of the bladder meridian was used: BI 23-26, 36, 37, 40, 54, 55-60, 63-67, by introducing 0.1 ml of CO2 into AT and toning of the kidney meridian: K 7, 10, 13, by introducing 0.5 ml of CO2 into AT.

To enhance the preventive effect, several common action points were used: Li 4, 11; Si 3, 4; TH 5, 8; Lu 7, by introducing 0.3 ml of CO2 into the AT. The course was 10 procedures, every other day. The total dose of CO2 introduced per procedure does not exceed 20.0 ml.

According to the study, the use of injection carboxytherapy (up to 10-15 ml of CO2) in local pain-providing doses using the acupuncture technique (0.1, 0.3 or 0.5 ml per point) provides: a decrease in the levels of radical products in the form of superoxide dismutase (SOD) by 75.5% (p <0.01) and diene conjugates (DC) by 65.5% (p <0.001), as well as an increase in catalase (Cat) levels by 2.8 times (p <0.05), which contributes to the restoration of membrane-cellular respiratory systems, including in tissues experiencing maximum static-dynamic loads and overstrain.

The mechanism of action of injection carboxytherapy and its puncture application are based on anti-inflammatory effects, antioxidant management of physiological reactions in the area of action, pronounced microcirculatory and hemoregulatory processes, which significantly increases athletic reserves and the quality of life of athletes, which is confirmed by previously conducted laboratory and functional studies: elimination of hypoxia according to LAC data by 45%, improvement of microcirculation by 30%, regulation of the pH of the environment to the alkaline side of 7.41, reduction of SOD levels by 25%.

When using the proposed method, any domestic or foreign carboxytherapy device can be used that generates a gas emission (CO2) for acupuncture subdermal-cutaneous administration and into local zones of spastic segments in a dose of 0.3 ml, 0.5 ml, which allows it to be dosed into the underlying spastic muscle tissue.

In athletes experiencing maximum static-dynamic loads, including in the period before competitions, injection carboxytherapy is used 2 cm from the apex along the posterior edge of the piriformis muscle (the injection point is on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter in projection 2-3 cm paravertebral from the level of L4-5), the injection depth is up to 1-2 centimeters, the volume is 3.0 ml, the needle length is 12 cm. The course is 10 procedures, every other day.

Injection carboxytherapy is administered into the iliopsoas muscle (the point is located 3-4 centimeters lateral to the femoral artery pulse, immediately below the inguinal ligament), with an injection depth of up to 1-2 centimeters, a volume of 3.0 ml, and a needle length of 12 cm. A course of 10 procedures is administered every other day.

Injection carboxytherapy is performed in the quadratus lumborum muscle (in 2-3 trigger points that correspond to the zones lateral to the spinous processes, at the level of L1, 5-6 cm lateral to the spinous processes, at the level of L4 1-3 cm above the posterior iliac crest, at the level of the transverse processes of L3 and 2 cm above the posterior superior iliac spine), volume 3.0 ml, needle length - 12 cm. Course - 10 procedures, every other day.

Acupuncture treatment with CO2 was performed in accordance with the technique previously proposed by the authors: in case of damage to the L4 root and the appearance of pain along the inner side of the leg, the points of the liver, spleen and pancreas meridian were used: Liv 2, 3, 7, 9; SP 3, 5, 8, 11, introducing 0.5 ml of CO2. Then, the points of the gallbladder meridian were toned: GB 40, 43, by introducing 0.1 ml of CO2 per point. In case of damage to the L5 root and the appearance of pain along the anterior lateral surface of the leg, the meridian sedation technique was used: 0.5 ml of CO2 was introduced into the AT of the stomach and gallbladder meridian: St 42, 45, 36; GB 30-34, 36-40. For prevention of pain syndrome, tonification of points of the meridian of the liver, spleen, pancreas was performed: Liv 1, 3, 8; SP 3, 6, 12, by introducing 0.5 ml of CO2 into AT. When pain appeared along the lateral surface of the leg affecting the S1 root, sedation of the meridian of the urinary bladder was used: BI 23-26, 36, 37, 40, 54, 55-60, 63-67, by introducing 0.1 ml of CO2 into AT and tonification of the meridian of the kidneys: K 7, 10, 13, by introducing 0.5 ml of CO2 into AT. To enhance the preventive effect, several points of general action were used: Li 4, 11; Lu 7, by introducing 0.3 ml of CO2 into the AT. The course is 10 procedures, every other day. The total dose of CO2 introduced per procedure does not exceed 20.0 ml.

The developed formula of the invention can use any domestic or foreign device for injection carboxytherapy, generating a gas emission (CO2) for acupuncture subdermal-cutaneous administration and into local zones of spastic segments.

The invention is confirmed by clinical examples.

The study verified that piriformis syndrome occurred in 35.5% of athletes, and iliopsoas muscle pain syndrome occurred in 38.9%. Periodic complaints of hypoesthesia were reported by 25.5% of athletes.

Example 1.

A 31.5-year-old powerlifter, M., presented with complaints of intermittent low back pain radiating down the lateral surface of her left leg. The pain develops at various times, including with increasing static-dynamic loads. She has a history of one pregnancy and no comorbidities. She has been involved in sports for the past 14.7 years. Treatments were performed using a certified INSO device (Nizhny Novgorod).

Injection carboxytherapy was performed 2 cm from the apex along the posterior edge of the piriformis muscle (the injection point is on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter in projection 2-3 cm paravertebral from the level of L4-5), the injection depth is up to 1-2 centimeters, the volume is 3.0 ml, the needle length is 12 cm. Injection carboxytherapy was performed in the iliopsoas muscle (the point is 3-4 centimeters lateral to the pulsation of the femoral artery, immediately under the inguinal ligament), the injection depth is up to 1-2 centimeters, the volume is 3.0 ml, the needle length is 12 cm. Injection carboxytherapy was performed in the quadratus lumborum muscle (in 2-3 trigger points, which correspond to the zones lateral to the spinous processes, at the level of L1, at 5-6 cm lateral to the spinous processes, at the level of L4 1-3 cm above the posterior iliac crest, at the level of the transverse processes of L3 and 2 cm above the posterior superior iliac spine), volume 3.0 ml, needle length - 12 cm. Acupuncture exposure to CO2 was carried out at the points of the liver, spleen and pancreas meridian: Liv 2, 3, 7, 9; SP 3, 5, 8, 11, by introducing 0.5 ml of CO2; points of the gallbladder meridian: GB 40, 43, by introducing 0.1 ml of CO2 per point and the meridian of the stomach and gallbladder: St 42, 45, 36; GB 30-34, 36 – 40, by introducing 0.5 ml of CO2 per point. To enhance the preventive effect, the following general action points were used: Li 4, 11; Si 3, 4; TH 5, 8; Lu 7, by introducing 0.3 ml of CO2 into the AT. The course was 10 procedures, every other day. The total dose of CO2 introduced per procedure does not exceed 20.0 ml.

During treatment with the proposed method, the patient not only experienced the absence of pain syndrome throughout the entire month-long observation period, but also an increase in overall strength indicators: (p <0.01).

Example 2.

Patient S., 28.5 years old, involved in weightlifting, presented with complaints of periodic lumbar pain with irradiation, which often developed in the pre-competition period against the background of sports-related psychoemotional stress. Injection carboxytherapy was used by introducing CO2 2 cm from the apex along the posterior edge of the piriformis muscle (the injection point is on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter in projection 2-3 cm paravertebral from the level of L4-5), the injection depth is up to 1-2 centimeters, the volume is 3.0 ml, the needle length is 12 cm. CO2 in a volume of 3.0 ml was injected into the iliopsoas muscle (the point is 3-4 centimeters lateral to the pulsation of the femoral artery, immediately below the inguinal ligament) and into the quadratus lumborum muscle (in 2-3 trigger points, which correspond to the zones lateral to the spinous processes, at the level of L1, 5-6 cm lateral to the spinous processes, at the level of L4 1-3 cm above the posterior iliac crest bones, at the level of the transverse processes of L3 and 2 cm above the posterior superior iliac spine), in a volume of 3.0 ml, needle length - 12 cm. Course - 10 procedures, every other day. Acupuncture effect of CO2 was carried out in the form of tonification of the points of the gallbladder meridian: GB 40, 43, by introducing 0.1 ml of CO2 into the point, sedation of the meridian of the stomach and gallbladder: St 42, 45, 36; GB 30-34, 36-40, introducing 0.5 ml of CO2 into the AT of the meridian; and tonification of the points of the meridian of the liver, spleen, pancreas was also carried out: Liv 1, 3, 8; SP 3, 6, 12, by introducing 0.5 ml of CO2 into AT. To enhance the preventive effect, the following points of general action were used: Li 4; Si 3; TN 5; Lu 7, by introducing 0.3 ml of CO2 into the AT. The course was 10 procedures, every other day. The total dose of CO2 introduced per procedure did not exceed 20.0 ml.

Example 3.

Patient A., 26.7 years old, involved in weightlifting (kettlebell lifter), complained of periodic lumbar pain with irradiation, which often developed in the pre-competition period against the background of sports-related psychoemotional stress. Injection carboxytherapy was used by introducing CO2 2 cm from the apex along the posterior edge of the piriformis muscle (the injection point is on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter in projection 2-3 cm paravertebral from the level of L4-5), the injection depth is up to 1-2 centimeters, the volume is 3.0 ml, the needle length is 12 cm. CO2 in a volume of 3.0 ml was injected into the iliopsoas muscle (the point is 3-4 centimeters lateral to the pulsation of the femoral artery, immediately below the inguinal ligament) and into the quadratus lumborum muscle (in 2-3 trigger points, which correspond to the zones lateral to the spinous processes, at the level of L1, 5-6 cm lateral to the spinous processes, at the level of L4 1-3 cm above the posterior iliac crest bones, at the level of the transverse processes of L3 and 2 cm above the posterior superior iliac spine), in a volume of 3.0 ml, needle length - 12 cm. Course - 10 procedures, every other day. Acupuncture exposure to CO2 was carried out at the points of the meridian of the liver, spleen and pancreas: Liv 2, 3, 7, 9; SP 3, 5, 8, 11, introducing 0.5 ml of CO2; acupuncture points of the meridian of the stomach and gallbladder: St 42, 45, 36; GB 30 - 34, 36 - 40 for the purpose of its sedation, introducing 0.5 ml of CO2 into AT. For the prevention of pain syndrome, toning of the points of the meridian of the liver, spleen, pancreas was carried out: Liv 1, 3, 8; SP 3, 6, 12, by introducing 0.5 ml of CO2 into AT and sedation of the bladder meridian: BI 23, 36, 54, 60, by introducing 0.1 ml of CO2 into AT; as well as correction of general action points: Li 4, 11; TH 5, 8, by introducing 0.3 ml of CO2 into AT. The course is 10 procedures, every other day. The total dose of CO2 introduced per procedure does not exceed 20.0 ml.

The developed formula of the invention can use any domestic or foreign device for injection carboxytherapy, generating a gas emission (CO2) for acupuncture subdermal-cutaneous administration and into local zones of spastic segments, which contributed to the healing of 69 patients, sports in their professional activities, aged 25.5-43.6 years, who received the injection method of carboxytherapy at one of the sports facilities in the Moscow region.

The proposed method allows for the elimination of cellular hypoxia in the musculoskeletal system, which experiences maximum static-dynamic loads, and also improves the functioning of the membrane respiratory system by regulating the acid-base balance and modeling antioxidant reactions in tissues and systems, which significantly increases the level of the respondents' athletic resource potential.

In the control group (22 people), patients trained without using the developed method, using WADA-approved anti-inflammatory and analgesic drugs. During the development of pain syndrome, all athletes who received injection carboxytherapy, after the 2nd procedure, noted higher athletic reserves and motivational indicators than athletes from the comparison group. Moreover, in patients of the main group, a decrease in the average pain level according to VAS was noted from 2.2 [1.9; 2.6] points to 0.2 [0.1; 0.3] points (p < 0.01), against similar values in the comparison group: from 2.3 [2.1; 2.56] points to 1.2 [1.1; 1.4] points (p < 0.05).

The positive effect is also confirmed by the objective indicator of the average value of superficial skin impedance (ALT), which in all probands at all measurement points of the lumbar spine decreased after treatment from 40.3 (38.5; 43.5) conventional units (p <0.01).

The proposed method can be used in the period before competitions, at the initial manifestations of pain in the lumbar and sacral spine.

Thus, the use of the proposed method provides a direct influence on local and reflexively related structures that experience the greatest static-dynamic loads and overstrain, which changes the nature of these reactions, both at the biochemical and meridian-energy levels, and does not form a negative trace potential prohibited by WADA.

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Claims (5)

A method for reducing radiating low back pain in athletes, which consists of injecting _CO2 into acupuncture points, characterized in that injection carboxytherapy is carried out in the areas of the piriformis, iliopsoas and quadratus muscles, in a course of 10 procedures carried out every other day, with a 12 cm long needle, by introducing _CO2 into the following corresponding points: - in projection 2-3 cm paravertebral from the level of L4-5 on the border of the lateral 1/3 line connecting the sacrum and the greater trochanter, along the posterior edge of the piriformis muscle, injection depth up to 1-2 cm, volume 3.0 ml; - 3-4 cm lateral to the pulsation of the femoral artery immediately under the inguinal ligament, insertion depth up to 1-2 cm, volume 3.0 ml; - in 2-3 trigger points corresponding to the zones lateral to the spinous processes of the lumbar vertebrae, volume 3.0 ml: 5-6 cm lateral to the spinous processes at the level of L1, 1-3 cm above the posterior iliac crest – at the level of L4, 2 cm above the posterior superior iliac spine at the level of the transverse processes of L3.