RU2847902C1 - Method for correcting pain syndrome in the lumbar spine - Google Patents

Abstract

FIELD: non-drug medicine.

SUBSTANCE: invention relates to a comprehensive method of patient recovery through the combined use of therapeutic physical training, manual treatment methods and high-intensity pulsed magnetic therapy (HIPMT). The treatment is carried out using manual techniques, high-intensity magnetic therapy and strengthening of the postural muscles through therapeutic physical training, characterised by a cycle of four consecutive stages, including the following algorithm of actions. In the first stage, is applied to the trigger points of the iliopsoas muscle using a series of actions. The patient's position is supine; the doctor's position is to the side of the patient; the doctor's hands are placed with the thumbs of both hands close together on the projection of the muscle. Ischemic compression is performed for 30 seconds, up to 3 times. During the correction, the tissues are followed for an indefinite period of time until the muscle in the trigger point area feels relaxed. In the second stage, the trigger points of the quadratus lumborum muscle are treated using a series of actions. The patient's position is lying on their stomach; the doctor's position is to the side of the patient; the doctor's hands are placed with the thumbs of both hands close together on the projection of the muscle. Ischemic compression is performed for 30 seconds, up to 3 times, and during the correction, the tissues are followed for an indefinite period of time until the muscle in the trigger point area feels relaxed. In the third stage, the lumbar spine is treated with high-intensity magnetic therapy procedures, magnetic induction 2.5 T, frequency 3-10 pulses depending on the individual tolerance of the patient, with a total duration of 10-15 minutes. The fourth stage involves therapeutic exercises to strengthen the postural muscles of the back and torso, exercises to strengthen the transverse abdominal muscles, side planks, and dynamic limb movements while maintaining a static torso position. This cycle of sessions is carried out over 4 months, with 1 session every 10 days for 1 month, and then after 3 months for monitoring purposes.

EFFECT: achievement of an analgesic effect and improvement in range of motion due to a complex effect on the structures of the musculoskeletal system, significant improvement in the functional state of large and small joints, regulation of blood circulation, normalisation of blood pressure and muscle tone, psycho-emotional state and sleep.

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Description

The invention relates to the field of non-drug medicine, and more specifically to a comprehensive method of improving patient health through the combined use of therapeutic exercise, manual treatment methods and high-intensity pulsed magnetic therapy (HIPMT).

In the modern world, numerous methods have been developed and used for the treatment and rehabilitation of patients, employing manual interventions and preventing functional disorders based on palpation diagnostics of biomechanical disorders of body structures [1]. However, these methods, when used in isolation, are localized and do not always achieve global effects or relieve pain.

It is known that, along with various types of massage and physical treatments, lymphatic drainage, exercise, and diet are used, but these also have a limited scope of application. Current European guidelines for the treatment of back pain recommend daily physical activity, exercise therapy, and motor training as some of the most effective treatment and prevention methods, as well as simple and low-cost ones [2]. Physical activity improves spinal mobility, impacts quality of life, helps reduce psychological stress, and helps overcome kinesiophobia [3]. Physical activity is an important component of low back pain treatment. Exercise helps strengthen back muscles, improve posture, and increase spinal flexibility and mobility. One of the most popular types of exercise is Pilates, which is actively used to stabilize the lumbar spine and reduce pain.

Research confirms that Pilates is an effective treatment method. One study by Alpay and Dekmetash (2020) found that "Pilates exercises can be recommended as an effective and safe method for improving pelvic lumbar stability and reducing pain" in women suffering from low back pain [7]. These exercises also help improve physical mobility and reduce disability, making Pilates a useful method for patients with chronic back pain.

However, physical activity does not always produce the expected results. For example, a study by Kavanagh and Morrison found that "participation in regular group fitness classes during pregnancy did not change the proportion of women reporting pelvic girdle or low back pain" [8]. This highlights the importance of choosing the right type of physical activity and tailoring it to the patient's condition.

In addition to physical activity and exercise therapy, cognitive behavioral therapy, massage, manual therapy, acupuncture and yoga [4] are considered as restorative treatment methods, which also give good results.

Among drug therapy, non-steroidal anti-inflammatory drugs (NSAIDs) are actively used along with selective norepinephrine reuptake inhibitors (SNRIs) [5].

However, a number of authors point out the presence of side effects and complications when taking these drugs [6].

In clinical practice, muscle relaxants, opioids, anticonvulsants, and epidural injections of glucocorticosteroids (GCS) are also used, although not widely [9,10].

However, due to the heterogeneity of patients complaining of low back pain (LBP), the most promising model is a multidisciplinary management model for such patients using various treatment methods [1].

Similar prototypes of the proposed invention exist, employing therapeutic exercise, massage, and post-isometric relaxation (a manual therapy method). However, the integrated approach lacks physiotherapy, particularly high-intensity magnetic therapy (HIMT), which influences the pathogenesis of this disease and is capable of more effective treatment. There is also no clear sequence for applying therapeutic exercise after manual therapy, resulting in low muscle strengthening effectiveness without manual correction.

Manual therapy and osteopathy are the most effective non-drug treatments and preventions for lower back pain. They aim to eliminate the mechanical cause (working with trigger points) that triggered the condition. This approach is based on correcting structural abnormalities in the body, and there is a cause-and-effect relationship between the body's physical state and its structure [11]. Manual therapy was approved as a medical specialty in 2022 by Order No. 292n of the Russian Ministry of Health dated April 28, 2022, "On Approval of the Procedure for Providing Medical Care to the Population in the Field of Manual Therapy with Higher Medical and Pharmaceutical Education." Manual correction involves diagnostic and therapeutic techniques. A wide range of manual techniques is available, the choice of which is determined by the location and nature of the identified biomechanical disorders.

Although manual therapy meticulously studies and utilizes the entire arsenal of available techniques and tests, all work is based on the concept of human biomechanics, which in many cases fails to explain the therapeutic effects. It should also be noted that manual treatment is performed in a manner that is as gentle and comfortable as possible for the patient. Manual stimulation is a mechanical action that the therapist transmits to the patient's tissues, evoking physicochemical, electrical, energetic, and psychoemotional reactions in the living organism. In this sense, the interaction of the therapist's sensitive hands with the body's tissues simultaneously serves as both diagnosis and correction.

One new and promising physiotherapy method that achieves an analgesic effect without side effects is high-intensity pulsed magnetic therapy (HIPMT) with a magnetic induction of up to 1.5-3 T. In terms of its stimulating, analgesic, and anti-inflammatory effects, HIPMT is many times superior to all known forms of low-frequency magnetic therapy [12, 13]. The advantages of pulsed magnetic therapy include the possibility of a wider variation of dosimetric parameters, the ability to affect deeper organs and tissues, and a more pronounced specificity and physiological effect. Modern devices utilize a high-intensity electromagnetic field of up to 2.5 T and frequencies of up to 150 Hz without direct contact with the skin. Thus, to achieve an analgesic effect, the procedure uses frequencies in the range from 2 Hz to 10 Hz, which stimulates the release of endogenous opiates, 60-70 Hz, which promotes the activation of the gate control system, and 120-140 Hz, which leads to the blocking of nociceptive signals.

In addition to relieving pain, VIMT also causes a reaction in muscle tone and regional blood circulation in the affected area, which is important for pain relief [14].

International studies demonstrate the high effectiveness of SIS therapy in the treatment of musculoskeletal diseases [15,16]. According to literary data, the analgesic effect is observed in 50-74% of patients with musculoskeletal pathology.

The objective of the present invention is to create a method for improving patient health, consisting of muscle relaxation using high-intensity pulsed magnetic therapy (HIPMT), manual techniques, and strengthening of muscles using therapeutic exercise, which can be recommended to the greatest number of patients with LBP and which will allow for effective, global and in the shortest possible time, using the body's self-regulation mechanisms and its natural immune properties.

The technical result of the proposed invention is the achievement of an analgesic effect and improvement of the range of motion due to the complex effect on the structures of the musculoskeletal system, a significant improvement in the functional state of large and small joints, regulation of blood circulation, normalization of blood pressure and muscle tone, psycho-emotional state and sleep.

The technical result is achieved by a method for improving the health of a patient with lower back pain using manual techniques, high-intensity magnetic therapy and strengthening of postural muscles through therapeutic exercise, characterized by a cycle of four consecutive stages, including the following algorithm of actions:

At the first stage, the trigger points of the iliopsoas muscle are affected by using sequential actions:

patient position: lying on his back; doctor’s position: on the side of the patient; doctor’s hand position: the thumbs of both hands placed close together are placed on the muscle projection;

correction: ischemic compression for 30 seconds, carried out up to 3 approaches, during the correction, follow the tissues for an indefinite time until a feeling of muscle relaxation in the area of the trigger point (myofascial release),

At the second stage, the trigger points of the quadratus lumborum muscle are affected by using sequential actions:

patient position: lying on the stomach; doctor position: at the side of the patient; doctor hand position: the thumbs of both hands placed close together are placed on the muscle projection;

correction: ischemic compression for 30 seconds, carried out up to 3 approaches, during the correction, follow the tissues for an indefinite time until a feeling of muscle relaxation in the area of the trigger point (myofascial release),

At the third stage, the lumbar spine is exposed to high-intensity magnetic therapy procedures, magnetic induction of 2.5 T, frequency of 3-10 shocks depending on the individual tolerance of the patient, with a total duration of 10-15 minutes,

At the fourth stage, therapeutic physical training exercises are carried out to strengthen the postural muscles of the back and core according to Stuart McGill: an exercise to strengthen the transverse abdominal muscle, a side plank, dynamic movements of the limbs taking into account the static position of the body.

The specified cycle of sessions is carried out over 4 months sequentially, 1 session every 10 days for 1 month, and then after 3 months for control purposes.

A session according to the proposed invention primarily includes correction of the intervertebral joints of the lumbar spine and pelvic bones, through work with the trigger points of the iliopsoas, quadratus, and IMMT muscles, as well as strengthening of the postural muscles through therapeutic exercise, which are responsible for stabilizing the body in space.

As a rule, before the first session, the patient is diagnosed to determine the nature and extent of the disorder of the musculoskeletal system.

Thus, the method of healing according to the present invention is carried out in the following sequence of stages:

Before the first session, the patient is diagnosed to determine any biomechanical impairment. Diagnostics of the musculoskeletal system is described on page 474 of the source [Novosel'tsev S.V. Osteopathy 1: Textbook / S.V. Novosel'tsev. - 2nd ed. - Moscow: MEDpress-inform, 2022 (ISBN 978-5-907504-20-2)].

Next, work is carried out with trigger points of the iliopsoas muscle and the quadratus lumbar muscle of the patient’s spine.

Then the VIMT procedure is performed by directly affecting the patient’s lumbar spine.

Finally, exercise therapy exercises are performed to strengthen the postural muscles of the back and core by Stuart McGill: an exercise to strengthen the transverse abdominal muscle, a side plank, and dynamic movements of the limbs taking into account the static position of the core.

Trigger point therapy on the iliopsoas and quadratus lumborum muscles takes 60 minutes. The session cycle is performed over four months, with one session every 10 days for one month. Then, after three months, one session is performed for control purposes.

During the process of manual examination and treatment, any additional techniques may be used, the choice of which for influencing a particular element is not the subject of the proposed invention.

After completing manual and physical therapy, the patient should strengthen the postural muscles of the lower back, core, and hamstrings. Physical therapy (PT) can be performed 2-3 times a week for prevention and to consolidate the effects of the treatment.

The method proposed by the present invention can be used both for the treatment of various pathological conditions and for their prevention.

The course of treatment can be repeated several times a year to consolidate the effect.

Step 1:

Technique for working with trigger points of the iliopsoas muscle of the lower back.

Patient position: lying on the stomach.

Position of the doctor: at the side of the patient.

Position of the doctor's hands: the thumbs of both hands, brought together, are placed on the projection of the muscle.

Fig. 1 shows the projection of the quadratus and iliopsoas muscles of the lumbar region [David G. Simons, Janet G. Travell, Louis S. Simons "Myofascial Pain and Dysfunction. A Guide to Trigger Points. In 2 volumes. Volume 1. 2005], where: 1 - projection of the quadratus muscle, 2 - iliopsoas muscle.

Correction:

Ischemic compression for 30 seconds. Perform up to 3 sets.

Note: During the correction, we can follow the tissues for an indefinite period of time until we feel the muscle relax in the area of the trigger point (myofascial release)

Referred pain:

Pain in the groin, scrotum, testicles, sciatic nerve, SIJ, lower parts of the buttocks, greater trochanter of the femur

Note: The technique is accompanied by a powerful parasympathetic effect at the beginning of the technique, ending with improved circulation and reduction of pain in the lower back.

Step 2:

Technique for working with trigger points of the quadratus major muscle

Patient position: lying on his back.

Position of the doctor: at the side of the patient.

Position of the doctor's hands: the thumbs of both hands, brought together, are placed on the projection of the muscle.

Fig. 2 shows the projection and referred pain of the iliopsoas muscle [David G. Simons, Janet G. Travell, Louis S. Simons "Myofascial Pain and Dysfunction. A Guide to Trigger Points. In 2 volumes. Volume 1. 2005].

Correction:

Ischemic compression for 30 seconds. Perform up to 3 sets.

Note: During the correction, we can follow the tissues for an indefinite period of time until we feel the muscle relax in the area of the trigger point (myofascial release)

Referred pain:

Pain along the lumbar spine on the side of the affected muscle, in the area of the SIJ and upper buttocks, in the groin and anterior-inner thigh, along the front of the thigh.

Note: The technique is accompanied by a powerful parasympathetic effect at the beginning of the technique, ending with improved circulation and reduction of pain in the lower back.

Step 3:

Lumbar spine treatment technique using VIMT

Patient position: lying on the stomach.

Position of the doctor: at the side of the patient.

Position of the VIMT sensor: on the lumbar spine.

Fig. 3 shows the projection of the impact zone for VIMT.

Treatment parameters: magnetic induction 2.5 T, frequency 3-10 beats, depending on the individual tolerance of the patient, treatment time 10-15 min.

Note: The treatment technique is accompanied by a powerful parasympathetic effect at the beginning of the technique, ending with neurostimulation and pain relief in the lower back.

Step 4:

Physical therapy to strengthen the postural muscles of the back and core

Fig. 4 (A, B, C) shows therapeutic exercise exercises for strengthening the postural muscles of the back and core by Stuart McGill.

Fig. 4 (A) shows an exercise to strengthen the transverse abdominal muscle.

Fig. 4 (B) shows the side plank exercise.

Fig. 4 (B) shows the dynamic movement of the limbs taking into account the static position of the body.

Sequence of exercise therapy:

In Fig. 4 (A), we tone the transverse abdominis muscle by inhaling, drawing in our stomach, pressing our lower back into our hand resting on the couch, and tensing our lower abdomen. Hold the muscle statically for 10 seconds – 3 sets.

In Fig. 4 (B), get into a side plank position, engaging your transverse abdominis and bending your knee. The main focus should be on your glutes, but you're working your entire core on one side. Perform 3 sets of 10 seconds on each side. If desired, you can add dynamic kicks with your top leg, 10 times per set.

Fig. 4 (B) shows the most difficult exercise, which should not be performed if the first two (Fig. 4 A, B) cannot be performed. This exercise (Fig. 4 C) should engage the transverse abdominis and all core muscles, while maintaining a stable core and dynamically moving the limbs forward and backward 10 times per set, 3 sets.

The proposed method provides increased activity The parasympathetic nervous system is stimulated by relaxing muscles and improving blood circulation in the lumbar spine and pelvis. This reduces sympathetic nervous system activity, ultimately leading to pain reduction and improved range of motion. Physical therapy also promotes local and general changes in the patient's body by targeting postural muscles, including altering postural and psychoemotional balance.

The health complex has a positive effect on water-salt metabolism, carbohydrate, fat and protein metabolism, thermoregulation, sleep, blood pressure and heart rate, sweating, the menstrual cycle, sexual function, hematopoiesis, psycho-emotional state, assimilation and dissimilation processes in bone tissue, striated muscles, etc.

The use of the proposed method, along with general manual diagnostics, allows for a reduction in treatment time and a significant increase in treatment effectiveness, as it allows for the precise determination of the involvement of a specific area of the lumbar spine in the pathology and the painless and effective correction of that area.

The proposed method provides comprehensive disease prevention due to its complex effect on the body by influencing the biomechanics of the lumbar spine and postural balance.

The proposed method, through a comprehensive approach to the lumbar spine structures and postural muscles involved in the genesis and maintenance of pathology, allows for the biomechanics of the musculoskeletal system to be influenced, enabling effective and rapid recovery. Moreover, the treatment is delivered in the most gentle manner possible.

The invention is confirmed by a clinical example.

A 40-year-old woman complained of intermittent lower back pain (VAS score 5). She had limited range of motion in the lumbar spine when bending forward and to the right side for 3 years, along with sleep disturbances and emotional instability. Diagnosis: M94.5 Lower back pain. Insomnia. Complex treatment was prescribed. Trigger point correction techniques (iliopsoas muscles, quadratus lumborum muscles) and HIMT were used: magnetic induction of 2.5 T, frequency of 6 beats, depending on the patient's individual sensitivity, treatment time of 10 minutes. Physical therapy was also performed under the doctor's supervision. After the first session, the pain decreased (VAS score 2), and sleep became longer. Range of motion in the lumbar spine increased. Subsequently, the patient underwent treatment according to the plan, as a result of which the pain completely disappeared, the range of motion in the spine was restored, and sleep returned to normal. Emotional lability has decreased.

Thus, the proposed invention helps to achieve a powerful non-invasive therapeutic effect on the entire patient’s body.

The method proposed by the invention, through an integrated approach and VIMT, quickly normalizes the mobility of the spinal joints, improving innervation and blood supply, reduces sympathetic activity in skeletal muscles, and relaxes myofascial structures.

Sources of information

1. Burdino F. Osteopathic techniques applied to periarticular tissues, in 2 volumes. - M.: Editus, 2019.

2. Zadorina-Negoda, G.N. Features of complex physical therapy in the rehabilitation of patients with nonspecific back pain / G.N. Zadorina-Negoda, E.E. Achkasov // Bulletin of Restorative Medicine. - 2021. - Vol. 20. - No. 2. - P. 94-103.

3. Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. Lancet 2012; 379:482-91.

4. Drivotinov B.V., Gamanov Flament-Durand J. The hypothalamus: anatomy and functions. Acta Psychiatr Belg. 1980 Jul-Aug;80(4):364-75.

5. Becker B.A., Childress M.A. Nonspecific Low Back Pain and Return to Work // Am Fam Physician. 2019. No. 1(11).

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7. - https://pubmed.ncbi.nlm.nih.gov/32986655/Kavanagh, S., Morrison, A. - Participation in regular group fitness classes during pregnancy did not change the proportion of women reporting pelvic girdle or low back pain -

8. https://pubmed.ncbi.nlm.nih.gov/32072792/Stegenga, J. T., Werden, M. T. - Exercises similar to Pilates, but with different effects

9. Deyo, R.A. Opioids for low back pain / R.A. Deyo, M. Von Korff, D. Duhrkoop // BMJ. - 2015. - No. 350. - g6380.

10. Dowell, D. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 / D. Dowell, T.M. Haegerich, R. Chou // JAMA. - 2016. - No. 315 (15). - P. 1624-1645.

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Claims (2)

1. A method for correcting pain syndrome in the lumbar spine, characterized by four successive stages: at the first stage, the trigger points of the iliopsoas muscle are affected with the patient lying on his back; the position of the physician: to the side of the patient; the position of the physician's hands: the thumbs of both hands are placed close together on the projection of the muscle; in this case, ischemic compression is performed for 30 seconds, up to 3 approaches are carried out until the muscle in the area of the trigger point is felt to relax; at the second stage, the trigger points of the square muscle of the lumbar region are affected with the patient lying on his stomach; the position of the physician: to the side of the patient; the position of the physician's hands: the thumbs of both hands are placed close together on the projection of the muscle; In this case, ischemic compression is performed for 30 seconds, up to 3 approaches are carried out until the muscle relaxation is felt in the trigger point area, at the third stage, high-intensity magnetic therapy is performed in the lumbar spine, magnetic induction of 2.5 T, frequency of 3-10 impacts depending on the individual tolerance of the patient, with a total duration of 10-15 minutes, at the fourth stage, therapeutic physical training exercises are performed: - exercise to strengthen the transverse abdominal muscle: in a supine position, with your hand on the couch under your lower back, inhale, pull your stomach in and press with your lower back into your hand, which is on the couch and strain your lower abdomen, statically hold the muscle for 10 seconds - 3 approaches; - get into a side plank, while straining the transverse abdominal muscle, perform for 10 seconds - 3 approaches on each side; - perform dynamic movements of the limbs forward and backward in a static position of the body 10 times per approach, 3 approaches. 2. The method according to paragraph 1, characterized in that the said cycle of sessions is carried out over the course of 4 months, sequentially, 1 session every 10 days for 1 month, and then, for control purposes, is carried out after 3 months.