RU2804185C1 - Method for optimizing balance of muscles of lower limb of athletes using robotic mechanotherapy - Google Patents

Abstract

FIELD: rehabilitation medicine.

SUBSTANCE: invention can be used to restore the musculo-ligamentous system after physical activity and rehabilitation after injuries caused by a violation of the biomechanics of movement in the joint due to an imbalance in the strength of the antagonist muscles. The muscles of the knee joint are trained in an isokinetic mode, the training profile is sinusoidal, the athlete’s position is sitting, movement is limited at a speed of 60 degrees per second, the type of movement in the joint is flexion and extension, the amplitude of movement does not exceed 90 degrees. In this case, motion resistance modes are sequentially applied: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, the torque limits are 300 Nm, number of repetitions is 20 times, activation of the biofeedback mode, a break between sequential application of motion resistance modes is 15 seconds, the total training time for the muscles of the knee joint is 15-20 minutes, the course is 10 procedures. Training of the muscles of the ankle joint occurs in an isokinetic mode, the training profile is sinusoidal, the athlete’s position is lying, movement is limited at a speed of 60 degrees per second, the type of movement in the joint is flexion and extension, the amplitude of movement does not exceed 30 degrees. In this case, sequential application of motion resistance modes is carried out: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits of 300 Nm, number of repetitions is 20 times, a break between sequential application of motion resistance modes is 15 seconds, activation of the biofeedback mode connection, the total training time for the muscles of the ankle joint is 15-20 minutes, the course is 10 procedures.

EFFECT: method ensures an increase in the effectiveness of therapeutic and preventive measures, optimization of the balance of the muscles of the lower extremities, the formation of the correct dynamic stereotype of movements not only in everyday life, but also at the training and competitive stage of sports training.

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Description

The invention relates to the field of medicine, in particular sports and rehabilitation medicine, and can be used to restore the muscular-ligamentous apparatus after physical activity and rehabilitation after injuries caused by a violation of the biomechanics of movement in the joint due to an imbalance in the strength of the antagonist muscles. The invention can be used in the practice of sports medicine and physical therapy doctors, orthopedic traumatologists, therapists, physiotherapists, specialists involved in therapeutic activities, prevention and/or issues of recovery and rehabilitation in the field of sports and rehabilitation medicine.

Systematic physical activity with the same direction of the training process contributes to the compensatory strengthening of some muscle-ligamentous structures at the expense of others, which ultimately often leads to decentralization of the axes of movement and increased load on a certain part of the articular surface, resulting in the inevitable occurrence of destructive and inflammatory changes specifically in this part of the joint. The inflammatory processes that initially arise, and subsequently the degenerative-dystrophic phenomena of the muscular and capsular-ligamentous apparatus, are currently treated primarily with the help of physiotherapeutic procedures, therapeutic effects of which have an anti-inflammatory focus, as well as by taking non-steroidal anti-inflammatory drugs. However, the most commonly used treatment methods listed are symptomatic, not pathogenetic, since they do not eliminate the cause of the disease, but only help eliminate its symptoms.

Optimizing muscle balance and movement abilities is of paramount importance in the prevention of fatigue and musculoskeletal injuries in athletes [1]. It is the degree of conscious control of various muscle groups in static and dynamic work that affects sports performance [2]. Formation of muscle tension adequate to the actions performed is a task, the solution of which will allow the formation of not only correct motor skills, but also increase the coordination capabilities of the muscular system of athletes [3,4].

To correct muscle balance, proprietary sets of physical exercises are being developed aimed at strengthening weaker muscle groups [2,5]. The use of high-tech methods of recovery and rehabilitation is relevant. To reduce the load and maintain muscle tone, underwater treadmills, cryosaunas, and vacuum therapy are used [6]. The scientific literature describes a method for the isolated use of vibration training and its combination with magnetotherapy in athletes to increase muscle strength [7].

State of the art.

Currently, both in sports practice and in clinical medicine, methods for treating muscle weakness and increasing muscle strength are widely used.

There is a known method (RU 2754558 C2) for treating muscle weakness or improving the condition of muscle weakness in people suffering from muscle weakness or with a tendency to develop it, including the administration of a therapeutically effective amount of alkaline phosphatase, which is at least 95% identical to SEQ ID NO: 1 .

The disadvantage of this method is the lack of data on its use in sports practice and its effect on the muscular system in athletes.

There is also a known method for restoring motor activity using a robotic kinesisimulator (WO 2017106953 A1) by forming a matrix of motor stereotypes in the form of an individual virtual motor image, which is transmitted through the visual channel to the patient with a signal to trigger the movement of the corresponding part of the body. The method provides easier dosing of gravitational load, preservation of the patient’s individual position in space, the selected direction of movement, the possibility of training in any body position, passively and actively, and adaptation of the system to a specific patient.

The disadvantage of this method is the lack of data on its use in sports practice and its effect on the musculoskeletal system in athletes.

There is a known method of passive mechanotherapy (RU 2401091 C1) aimed at rhythmic stimulation of neurotrophic reflexes, stretching muscles simultaneously in various parts of the spine, joints of the limbs and in the main muscles of the body. Alternating loads are created by reciprocating movement of individual parts of the support in the vertical direction. The upper part of the body and lower limbs perform in-phase back-and-forth movements, and the pelvic region - anti-phase to them. Passive muscle stretching causes reflex currents that have a beneficial effect on the neuromuscular regulation systems, and therefore on the processes of regeneration and recovery.

The disadvantage of the method is the isolated passive mobilization of the torso and limbs without the possibility of active movement, which excludes the optimization of the balance of antagonist muscles, as well as the lack of data on the use of the method in sports practice.

There is a known method for training the ligaments and muscles of the lower extremities (RU 2406553 C1). The training method involves performing a cycle of active exercises aimed at developing and restoring the ligaments, muscles, joints and bones of the lower extremities. With such training, specific biomechanical conditions are created for the formation and training of the proprioceptive jumping system, which make it possible to adequately change the blood supply and innervation of the trained organs and the coordination of movements, including for jumping.

The disadvantage of this method is the inability to regulate the balance of the muscular system of the joints of the lower extremities.

The technical result to which this invention is aimed is to optimize the functioning of the musculo-ligamentous apparatus of the joints of the lower extremities, to ensure the possibility of rapid recovery of the musculoskeletal system of athletes after intense physical activity and to reduce the risk of fatigue injuries and damage.

The technical result is achieved by the fact that the method of optimizing the balance of the muscles of the lower extremities of athletes using robotic mechanotherapy includes active and passive movement in the knee and ankle joint with a given speed and adjustable resistance.

What's new is that:

- training of the muscles of the knee joint occurs in an isokinetic mode, the training profile is sinusoidal, the athlete’s position is sitting, movement is limited at a speed of 60 degrees per second, the type of movement in the joint is flexion and extension, the amplitude of movement does not exceed 90 degrees, sequential use of movement resistance modes : passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits 300 Nm, number of repetitions 20 times, activation of the biofeedback mode, break between successive application of movement resistance modes - 15 seconds, total training time for the knee muscles joint - 15-20 minutes;

- training of the muscles of the ankle joint occurs in an isokinetic mode, the training profile is sinusoidal, the athlete’s position is lying down, movement is limited at a speed of 60 degrees per second, the type of movement in the joint is flexion and extension, the amplitude of movement does not exceed 30 degrees, sequential application of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits - 300 Nm, number of repetitions - 20 times, break between successive applications of resistance modes - 15 seconds, activation of biofeedback mode, total muscle training time ankle joint 15-20 minutes.

To achieve the most pronounced effect, the course must be at least 10 procedures.

Efficiency lies in:

- optimization of muscle balance, strengthening weak muscle groups, leveling out areas of muscle tissue;

- prevention of fatigue injuries and damage to the musculoskeletal system during intense physical activity, due to impaired biomechanics of movement in the joint;

- normalization of blood flow and neuromuscular transmission, and as a result, acceleration of recovery after intense physical activity.

A method for optimizing the balance of the muscles of the lower extremities of athletes using robotic mechanotherapy is implemented on a robotic biomechanical complex with biofeedback Con-trex, the main tasks of which are diagnosis and objective functional assessment of the condition of the patient’s musculoskeletal and neuromuscular systems based on the volume of movement performed, recorded effort of the patient and determination of the optimal speed characteristics of his movement. These technologies are implemented through special modules; in our method, the MJ module was used - for training and diagnosing the joints of the lower extremities, which has the following characteristics: modes - isokinetic, isotonic, isometric, passive mobilization; profile sinusoidal, rectangular; resistance - eccentric, concentric, torque limits - from 0 to 300 Nm, speed of movement from 0 to 180 degrees per second, amplitude of movement from 0 to 180 degrees, type of movement in the joint - flexion, extension, abduction, adduction, rotation.

A course of procedures in order to optimize the balance of the muscular system of the knee joint, normalize blood flow and neuromuscular transmission is carried out using the Con-trex module MJ complex using an isokinetic mode, a sinusoidal training profile, in the athlete’s sitting position, with a speed limit of 60 degrees per second, type of movement in the joint - flexion and extension, range of motion does not exceed 90 degrees, sequential application of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, with specified torque limits up to 300 Nm, number of repetitions 20 times, activation of the biofeedback mode, break between successive application of movement resistance modes - 15 seconds, total training time for the muscles of the knee joint - 15-20 minutes.

A course of procedures in order to optimize the balance of the muscular system of the ankle joint, normalize blood flow and neuromuscular transmission is carried out using the Con-trex module MJ complex using an isokinetic mode, a sinusoidal training profile, in the athlete’s lying position, with a speed limit of 60 degrees per second, type of movement in the joint - flexion and extension, range of motion - does not exceed 30 degrees, sequential application of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, with specified torque limits up to 300 Nm, number repetitions - 20 times, activation of the biofeedback mode, break between successive application of movement resistance modes - 15 seconds, total training time for the muscles of the knee joint 15-20 minutes.

Achieving a technical result is also ensured by the fact that the course of procedures for optimizing the balance of the muscles of the knee joint and ankle joint is at least 10 procedures.

The physiological effect is ensured by the fact that in the area of influence the imbalance in the strength parameters of the antagonist muscles is eliminated, muscle fatigue is reduced, microcirculation is improved, arterial inflow and venous outflow are normalized, the bioelectrical activity of the neuromuscular system is improved, the speed of propagation of electrical impulses along the motor fibers of the nervous tissue increases, as well as along axon terminals that do not have a myelin sheath.

Indications for using the method:

- physical activity that is large in volume and intensity;

- conditions of overstrain and overtraining of the musculoskeletal system and their prevention;

- the need to increase the functional capabilities of the musculoskeletal system of athletes;

- muscle imbalance, insufficient level of development of individual muscle groups.

Contraindications to using this method:

- acute injuries;

- painful conditions accompanied by acute pain syndrome, feverish conditions

The inventive method was tested to optimize the balance of the muscles of the lower extremities in 44 athletes specializing in athletics. Carrying out one session of robotic therapeutic exercises promotes an increase in the strength indicators of muscle tissue, an increase in the speed of propagation of an electrical impulse along the terminals of axons that do not have a myelin sheath, an increase in muscle coordination and normalization of arterial blood flow parameters.

A dynamometric study after a course of robotic mechanotherapy (10 procedures) made it possible to identify the optimization of the balance of the muscular system of the knee and ankle joints, which occurred due to changes in the power parameters of muscle tension for movement. It was noted that the difference between the parameters of the maximum and average application of force during the exercise was leveled, which indicates that the athlete applied the same uniform force during prolonged physical activity. At the same time, the load during mechanotherapy sessions, although it was dynamic, however, active compensation was carried out for the effort exerted by the athlete, as a result of which control was exercised over the strengthening of weak muscle groups and relaxation of the grooved areas of the muscles. As a result of such a load, the correct dynamic stereotype of movements was formed, while the conscious control of muscle tension contributed to the formation of correct motor skills not only in everyday life, but also at the training and competitive stage of sports training. The data obtained from the results of electromyographic and rheovasographic studies indicate the consolidation of the positive effect of mechanotherapy on the functional state of the neuromuscular system (increased amplitude (P<0.03), motor response area (P<0.001), decreased latency (P<0.04) , increasing the speed of propagation of excitation along nerve fibers (P<0.03)) and peripheral hemodynamics of athletes (improvement in indicators: rheographic index on the right foot (P<0.01), elastic modulus on the right leg (P<0.003), propagation time rheographic waves (P<0.001), elastic modulus (P<0.01) and venous outflow on the left foot (P<0.04), propagation time of rheographic waves on the left leg (P<0.03)).

Consequently, by comparing the indicators of electroneuromyography, rheovasography, dynamometry, before and after application of the claimed method, one can conclude that there is a significant statistically significant improvement in the indicators, and, consequently, a positive effect of its use for optimizing the balance of the muscles of the lower extremities of athletes. As a result of a course of robotic mechanotherapy, the functional state of the neuromuscular system, as well as peripheral hemodynamics, improves.

Examples of implementation of the invention are as follows

It is obvious that the combination of physical characteristics of the effects, the duration of individual procedures and courses in this invention ensure the achievement of the stated technical result. The use of this method shows the effectiveness and high potential of this invention. Thus, the proposed method for optimizing the balance of the muscles of the lower extremities of athletes using robotic mechanotherapy has new properties that provide a positive effect.

Example 1

Athlete V., 22 years old, is involved in athletics, specializes in short-distance running, master of sports. Observed during training camps in mid-mountain conditions (1240 m) in Kislovodsk. Dynamometry of the muscles of the lower extremities showed that the maximum torque of the muscles of the extensors of the knee joint on the right was 117 Nm, the flexors - 44 Nm; on the left, the maximum torque of the extensor muscles is 101 Nm, the flexor muscles are 42 Nm. The average torque of the knee extensor muscles on the right is 82 Nm, the flexor muscles are 38 Nm; on the left extensors - 78 Nm, flexors 34 Nm. A dynamometric study of the muscles of the ankle joint showed that on the right, the maximum torque of the plantar flexion muscles of the foot was 61.5 Nm, the average was 46.8 Nm; the maximum torque of the plantar extensors of the foot is 46.1 Nm, the average torque of the plantar extensors is 38.2 Nm. On the left, the maximum torque of the plantar flexion muscles of the foot was 58.6 Nm, the average was 42.1 Nm; the maximum torque of the plantar extensors of the foot is 44.2 Nm, the average torque of the plantar extensors of the foot is 37.1 Nm. The conducted electromyographic study revealed a decrease in the amplitude of the motor response at the points of stimulation of the deep peroneal nerve “head of the fibula” - 3.61 mV and “popliteal fossa” - 3.88 mV on the right. On the left, the amplitude of the motor response at the stimulation point “head of the fibula” was 4.02 mV, and at the stimulation point “popliteal fossa” - 4.11 mV. On the right, the speed of excitation propagation along the nerve fiber in the area “tarsus” - “head of the fibula” is 51.2 m/s, “head of the fibula” - “popliteal fossa” - 52.6 m/s. The speed of propagation of the electrical impulse along the motor fibers of the peroneal nerve on the left in the area “tarsus” - “head of the fibula” was 50.8 m/s, “head of the fibula” - “popliteal fossa” - 49.2 m/s. Residual latency on the right is 2.84 ms, on the left -2.96 ms. A study of peripheral circulation using the method of rheovasography of the lower extremities (shin abduction, foot abduction) showed that the athlete had an increased rheographic index on the right foot to 1.96 c.u. (norm 0.9-1.3 c.u.).

After athlete V. underwent a course of 10 procedures of robotic mechanotherapy of the lower extremities (isokinetic training mode, sinusoidal training profile, the athlete’s position for training the muscles of the knee joint - sitting, ankle joint - lying down, limitation of movements - at a speed of 60 degrees per second, type of movement in the joint - flexion and extension, range of motion - 90 degrees in the knee joint, 30 degrees in the ankle joint, sequential application of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits - 300 Nm, number of repetitions - 20 times, activation of the biofeedback mode, break between successive applications of resistance modes of movement 15 seconds, total training time for the muscles of the knee joint - 15 minutes, ankle joint - 15 minutes), the dynamometry indicators changed as follows: maximum torque the extensor muscles of the knee joint on the right were 52 Nm, flexors 51.8 Nm; on the left, extensors 51.9 Nm, flexors 51.6 Nm. The average torque of the muscles of the extensors of the knee joint on the right was 48.9 Nm, flexors 48.8 Nm; on the left extensors 49.1 Nm, flexors 48.6 Nm. The maximum torque of the plantar flexion muscles of the foot on the right was 42 Nm, the extensor muscles were 41.6 Nm; on the left extensors 40.1 Nm, flexors 40.2 Nm. The average torque of the plantar flexion muscles of the foot on the right was 39.1 Nm, flexor muscles 38.4 Nm; on the left extensors 39.8 Nm, flexors 39.6 Nm. A repeated study of the bioelectrical activity of the muscles revealed an increase in the amplitude of the motor response at the stimulation points “head of the fibula” on the right up to 5.6 mV, on the left up to 5.2 mV, “popliteal fossa” on the right up to 5.3 mV, on the left - 5.8 mV . The peripheral blood circulation indicators of athlete V. changed as follows: the rheographic index on the right foot returned to normal and amounted to 0.92 c.u. These changes indicate optimization of muscle balance, peripheral circulation in the lower extremities and increased functionality of the neuromuscular system of the athlete’s lower extremities.

Example 2

Athlete E. 24 years old, engaged in athletics, specializing in long jump, international master of sports. Observed during training camps in mid-mountain conditions (1240 m) in Kislovodsk. A dynamometer study of the muscles of the lower extremities showed that the parameters of the maximum torque of the muscles of the extensors of the knee joint on the right were 98.1 Nm, flexors 54.2 Nm; on the left, the maximum torque of the extensor muscles is 104.6 Nm, the flexor muscles are 52.1 Nm. The average torque of the knee extensor muscles on the right is 79.8 Nm, the flexor muscles are 40.2 Nm; on the left extensors 82.1 Nm, flexors 42.4 Nm. A dynamometric study of the muscles of the ankle joint showed that on the right, the maximum torque of the plantar flexion muscles of the foot was 59.8 Nm, the average was 44.2 Nm; the maximum torque of the plantar extensors of the foot is 47.1 Nm, the average torque is 41.1 Nm. On the left, the maximum torque of the plantar flexion muscles of the foot was 58.2 Nm, the average was 44.2 Nm; the maximum torque of the plantar extensors of the foot is 46.1 Nm, the average torque of the plantar extensors is 38.2 Nm. The electromyographic study revealed an increase in the residual latency of the motor response on the right to 4.01 ms and on the left to 3.98 ms. Parameters of the amplitude of the motor response on the right at the points of stimulation of the deep peroneal nerve “head of the fibula” - 5.12 mV and “popliteal fossa” - 5.84 mV. On the left, the amplitude of the motor response at the stimulation point “head of the fibula” was 5.02 mV, and at the stimulation point “popliteal fossa” - 5.11 mV. On the right, the speed of excitation propagation along the nerve fiber in the area “tarsus” - “head of the fibula” is 58.9 m/s, “head of the fibula” - “popliteal fossa” - 59.6 m/s. The speed of propagation of the electrical impulse along the motor fibers of the peroneal nerve on the left in the area “tarsus” - “head of the fibula” was 59.8 m/s, “head of the fibula” - “popliteal fossa” - 60.2 m/s. Study of peripheral circulation using the rheovasography method of the lower extremities (shin abduction, foot abduction) showed that the athlete had an increased rheographic index on the right foot to 2.04 c.u. (norm 0.9-1.3 cu).

After the athlete E. underwent a course of 10 procedures of robotic mechanotherapy of the lower extremities (isokinetic training mode, sinusoidal training profile, the athlete’s position for training the muscles of the knee joint while sitting, the ankle joint lying down, limitation of movements - at a speed of 60 degrees per second, type of movement in the joint flexion and extension, range of motion 90 degrees at the knee joint, 30 degrees at the ankle joint, sequential application of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits 300 Nm, number of repetitions 20 times, activation of the biofeedback mode, a break between successive application of motion resistance modes - 15 seconds, total training time for the muscles of the knee joint - 15 minutes, ankle joint - 15 minutes), the dynamometry indicators changed as follows: the maximum torque of the knee extensor muscles on the right was 62.9 Nm, flexors 62 Nm; on the left extensors 61.9 Nm, flexors 61.4 Nm. The average torque of the muscles of the extensors of the knee joint on the right was 58.2 Nm, flexors 58.4 Nm; on the left, extensors 59.2 Nm, flexors 58.9 Nm. The maximum torque of the plantar flexion muscles of the foot on the right was 46 Nm, the extensor muscles were 45.4 Nm; on the left extensors 47.1 Nm, flexors 46.2 Nm. The average torque of the plantar flexion muscles of the foot on the right was 44.1 Nm, extensor muscles 43.4 Nm; on the left extensors 45.1 Nm, flexors 45.6 Nm. A repeated study of muscle bioelectrical activity revealed a decrease in residual latency to normative values - 3.01 ms on the right, 2.98 ms on the left. A rheovasographic study of the lower extremities of athlete E. after a course of mechanotherapy revealed a decrease and normalization of the rheographic index on the right foot to 1.01 c.u. These changes indicate optimization of muscle balance, normalization of peripheral blood flow and bioelectrical activity of muscles.

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Cited patents (4)

Claims (1)

A method for optimizing the balance of the muscles of the lower extremities of athletes using robotic mechanotherapy, including active and passive movement in the knee and ankle joint, characterized in that muscle training occurs using the Con-trex complex with the MJ module, while for the muscles of the knee joint - in isokinetic mode , training profile – sinusoidal, athlete’s position – sitting, movement limitation – speed 60 degrees per second, type of movement in the joint – flexion and extension, range of motion does not exceed 90 degrees, sequential use of movement resistance modes: passive mobilization, active movements in eccentric and concentric resistance mode, passive mobilization, torque limits - 300 Nm, number of repetitions - 20 times, activation of the biofeedback mode, break between successive application of resistance modes - 15 seconds, total training time for the muscles of the knee joint - 15-20 minutes , course – 10 procedures; training of the muscles of the ankle joint occurs in an isokinetic mode, the training profile is sinusoidal, the athlete’s position is lying, movement is limited at a speed of 60 degrees per second, the type of movement in the joint is flexion and extension, the amplitude of movement does not exceed 30 degrees, sequential use of resistance modes movements: passive mobilization, active movements in eccentric and concentric resistance modes, passive mobilization, torque limits - 300 Nm, number of repetitions - 20 times, break between successive applications of resistance modes - 15 seconds, activation of biofeedback mode, total time ankle joint muscle training – 15-20 minutes, course – 10 procedures.