Each segment of the spine is of great importance for normal work the entire spinal column and spinal cord, since the stability of each segment depends on other vertebrae and discs and, only in this way, the spine can function fully. Over time, the spine undergoes constant stress, trauma or other influences, it is exposed to various diseases such as degeneration of discs, vertebrae, arthritis, etc. These conditions can cause the appearance of pain, dysfunction.
Spine diseases quite a lot, but most often there are a number of diseases that are of clinical importance.
Ankylosing spondylitis (ankylosing spondylitis). This disease is a type of arthritis in which there is chronic inflammation of the joints of the spine, sacroiliac joints. Initially, the inflammation occurs in the sacroiliac joints, then spreads to the spine, leading to stiffness and limited mobility. With prolonged inflammation of the joints of the spine (spondylitis), calcium deposits are formed in the ligaments around the intervertebral discs, which leads to weakening of the discs and a decrease in their depreciation and support functions. As calcium deposits accumulate in the ligaments, there is a significant decrease in both range of motion and flexibility in the spine. The disease can progress to fusion of the vertebrae, which is called ankylosis. As a result of ankylosis, the spine loses mobility, the vertebrae become fragile, and the risk of vertebral fracture increases. Besides damage spine disease Ankylosing spondylitis leads to disruptions in the work of other organs, since the disease is systemic.
Disc protrusion
Disc protrusions are not uncommon and are often visualized on MRI or CT scans. But the very presence of protrusion is not a clinically particularly significant finding, especially if it is found in elderly patients, since more often the presence of protrusion indicates degenerative involutional changes in the spine. Protrusion is of clinical significance only if there is pain.
Osteochondrosis
Over time, the spine is subjected to daily stress and minor trauma, which ultimately leads to wear and tear of the intervertebral discs and their degeneration. The fibrous ring of the intervertebral disc is damaged under loads, micro-ruptures of the fibrous tissue occur, and then the damaged area is replaced by scar tissue, the elastic properties of which are much worse than those of fibrous tissue. Such changes in the annulus fibrosus lead to a decrease in the cushioning functions of the disc and a greater risk of repeated disc ruptures. As the annulus fibrosus heals, the gelatinous part of the disc (nucleus) also gradually shrinks, which in turn leads to a decrease in the height of the disc. As the height of the disc and the cushioning functions decrease, the vertebrae begin to influence each other more under stress, which leads to the formation of bone growths (osteophytes). Violation of the integrity of the annulus fibrosus leads to the formation of disc herniation. Herniated discs and osteophytes can have a compressive effect on the roots or stenosis, which leads to the appearance of neurological symptoms.
Facet joint syndrome
Facet joints connect the vertebrae to each other and provide stability and mobility of the vertebrae. Like any other joints in the body, facet joints are subject to degenerative changes in cartilage tissue. With arthritis of the facet joints, both a violation of the normal functions of movement in the spine and the development of a clinical picture (back pain, limitation of mobility) occur.
Foraminal stenosis
Foraminal stenosis is a narrowing of the vertebral foramen through which the spinal cord root passes as it exits the spine. As a rule, foraminal stenosis occurs against the background of degenerative changes in the spine. Herniated discs, protrusions, soft tissue edema and excessive bone growth (osteophytes) can lead to the development of foraminal stenosis and root compression.
Spinal stenosis
Stenosis is a narrowing of the space in the spine where the spinal cord and spinal roots pass. The space of the spinal canal, as a rule, is initially not very large, especially in the cervical and thoracic spine, and becomes critically small with various pathological changes in the spine. These can be both degenerative changes in the spine and injuries. Significant narrowing (stenosis) of the spinal canal leads to a compressive effect on the spinal cord, which will manifest itself as pain, weakness in the limbs, impaired sensitivity, in severe cases of dysfunction of the bladder and intestines. Many elderly people have stenosis of the spinal canal, to one degree or another. Unlike a herniated disc, in which one or two nerves are compressed and a picture of radiculopathy occurs, with stenosis, a compression effect occurs simultaneously on many nerves, and this condition is called myelopathy. With stenosis, conservative treatment is possible if the symptoms are moderate. If there are severe neurological symptoms, then surgical treatment is usually recommended, the purpose of which is to decompress the spinal cord.
Herniated disc
Herniated discs rupture of the annulus fibrosus that surrounds the intervertebral disc. This rupture causes the release of the central portion of the disc, which contains a substance called the gelatinous nucleus pulposus. With pressure from the vertebrae from above and below, the nucleus pulposus comes out, puts pressure on the nearest nerve structures and causes severe pain and nerve damage. Herniated discs most commonly occur in the lumbar spine and are sometimes referred to as disc extrusion.
Radiculopathy
The term radiculitis (radiculopathy) is widespread, meaning root compression. Radiculitis can be both in the lumbar and in the cervical, or much less often in the thoracic spine. Root compression occurs when there is excessive pressure on the nerve root. Excessive pressure can be from both bone tissue and soft tissue (muscles, cartilage, ligaments). This pressure disrupts nerve function, causing pain, tingling, numbness, or weakness.
Osteoporosis a disease in which there is a weakening of bone tissue, including the vertebrae, which increases the risk of vertebral fracture, even with minor loads. Compression fractures of the spine are the most common type of fracture due to osteoporosis, and fractures of the hip and wrist are also possible in osteoporosis. These vertebral fractures can change the shape and strength of the spine, especially in older women, who often experience spinal deformities in the presence of such fractures. The spine becomes excessively tilted in the thoracic region (kyphosis) and the shoulders bulge forward. In severe osteoporosis, even simple movements, such as bending forward, can fracture the vertebrae.
Lumbosacral sciatica
Lumbosacral sciatica (sciatica) is associated with compression or damage to the sciatic nerve. This nerve runs from the lower part of the spinal cord, down the back of the leg, to the foot. Injury or pressure on the sciatic nerve can cause pain characteristic of sciatica: sharp or burning pain that radiates from the lower back to the thigh and along the path of the sciatic nerve to the foot.
Spondylosis
Spondylosis is a degenerative disease of the spine, often leading to impaired mobility of the spine, and is caused by changes in the bone tissue of the vertebrae and the development of bone growths (osteophytes).
Spine fractures
The vertebrae are very strong and can withstand a lot of pressure, while the spine does not lose flexibility. But, like other bones in the body, they can break with extreme excess pressure, injury, or disease. In such cases, vertebral injuries or fractures can be both minor and severe.
Compression fractures
As the name suggests, compression fractures occur from excessive axial loads, which violates the integrity of the vertebral body. Osteoporosis is one of the leading causes of compression fractures, as there is a decrease in the ability of the vertebrae to withstand stress. In such cases, even a slight fall or even a cough can lead to a compression fracture. People often perceive back pain as a normal aging process, and sometimes compression fractures go unnoticed. Repeated compression fractures can lead to a decrease in the height of the spine. Another common cause of a compression fracture is injury such as a fall.
Often, compression fractures of the spine will eventually consolidate on their own (without treatment). To relieve pain, NSAIDs (for example, aspirin) can be prescribed. For severe fractures, surgical methods (vertebroplasty and kyphoplasty) can be used.
Explosive fractures
Explosive fractures usually occur in the event of a serious injury (such as an accident or a fall from a height). Explosive fractures are significantly more dangerous than compression fractures, as the anterior and middle parts of the vertebral body are split into several fragments, and this is likely to lead to spinal cord injury. In addition, due to the fact that the vertebral body loses its integrity, the spine becomes unstable. In some cases, with explosive fractures, if there is no effect on the spinal cord, conservative treatment can be carried out. If there are loose fragments or damage to nerve structures, then surgical treatment is necessary.
Flexion-extension fractures
Such fractures are sometimes called Chance fractures, occurring with sharp flexion-extension. Most often, this type of injury occurs in car accidents, in people wearing a seat belt, and there is not only a fracture of the vertebrae, but also ligaments, discs, and sometimes internal organs. These fractures are usually unstable and require surgical treatment. This type of fracture occurs in 5-10% of cases of spinal fractures.
Dislocated vertebra fracture. Such fractures occur when exposed to great force, and there is not only a violation of the integrity of the vertebral body, but also its displacement (due to rupture of ligaments, discs). These fractures often require surgery.
Fractures are also classified as stable or unstable. Compression fractures are generally considered stable and do not require surgery. In contrast, unstable fractures (eg, explosive or Chance fractures), as a rule, require surgical treatment, often emergency intervention.
Spondylolisthesis
Spondylolisthesis is a condition where one vertebra slides forward (subluxation) in relation to another. Degenerative spondylolisthesis of the lumbar vertebrae is often the cause of acquired stenosis of the spinal canal in the lumbar spine, especially at the L4 and L5 levels, and may manifest clinically with neurogenic intermittent claudication.
Spondylolysis
This is a violation of the integrity of the vertebral arch. This disorder can be either congenital or acquired during life. Spondylolysis can lead to slipping of the vertebra (listez), especially if spondylolysis is bilateral. Acquired spondylolysis, as a rule, occurs after stressful exertion and occurs in people with intense physical exertion, such as athletes (especially weightlifters, football players, gymnasts). In severe spondylolysis, treatment, usually operational.
Myelopathy
When the spinal cord is compressed by a herniated disc or stenosis of the spinal canal, characteristic neurological symptoms of spinal cord injury (myelopathy) appear. The symptomatology of myelopathy is variable and is characterized by motor impairments in the limbs, impaired sensitivity, and sometimes impaired function of the pelvic organs. When serious damage spinal cord may be lack of reflexes.
Cauda equina syndrome
In fact, the spinal cord ends at L2 and branches into a bundle of nerves that resembles a cauda equina in its entire shape. Cauda equina syndrome is manifested by a certain group of symptoms (impaired urination, defecation, numbness of the inner thighs, perianal region, weakness in the lower extremities). As a rule, with such a syndrome, emergency surgery is indicated.
Spine deformities
A deformity of the spinal column means any significant deviation from the normal curves of the spine. The most common are
- Scoliosis
- Hyperkyphosis
- Hyperlordosis
There are various causes of pathological curvature of the spine. Some babies are born with congenital scoliosis or congenital hyperkyphosis.
Sometimes nerve and muscle diseases, trauma, or other diseases cause deformities of the spine (for example, cerebral palsy).
Most often (up to 80-85%) scoliosis occurs "idiopathic" (without an obvious reason). Idiopathic scoliosis develops gradually, but can progress rapidly during growth during adolescence.
Scoliosis
The term scoliosis was first used to describe this deformity of the spine by Hippocrates in 400 BC. It is a progressive disease, the cause of which is unknown (idiopathic) in 80% of cases, although there is evidence of a specific role for genetic factors and nutrition. Women are 10 times more likely to develop scoliosis than men. Scoliosis is often accompanied by twisting of the spine, which leads to deformation of the costal arches and chest. Scoliosis usually begins during adolescence. Conservative treatment is quite effective for 1-2 degrees of scoliosis. With severe deformity (3-4 degrees) and with progressive scoliosis in adolescence, surgical treatment is recommended (the earlier the surgical treatment is carried out, the longer the results are much better).
Hyperkyphosis
Slight kyphosis is the natural curvature of the thoracic spine, while hyperkyphosis is excessive tilt of the spine forward in the thoracic spine (stoop). Hyperkyphosis is common in the elderly and is usually associated with osteoporosis and previous compression fractures of the vertebrae. The causes of hyperkyphosis can also be trauma, endocrine system diseases and other diseases. In adolescence, hyperkyphosis such as Scheuermann Mau's disease can occur, for which the character is wedge-shaped deformity of three or more vertebrae in the thoracic spine. As a rule, in case of Scheuermann Mau's disease, conservative treatment is quite effective, but with an angle of deviation from the axis of more than 60 degrees, surgical treatment is recommended.
Hyperlordosis
Lordosis is a natural inward bend in the lumbar spine, and hyperlordosis is a pathological enlarged bend in the lumbar spine. Hyperlordosis is usually accompanied by an abnormal forward tilt of the pelvis and is often accompanied by excessive bulging of the buttocks. Symptoms may include pain and numbness if there is compression of the nerve structures. As a rule, hyperlordosis is caused by weakness of the back muscles, hyperextension, for example, in pregnant women, in men with excessive visceral fat. Hyperlordosis is also associated with puberty.
Treatment of hyperlordosis is usually not required if the nerve structures are not affected.
Spine tumors
Spinal tumors are rare. Tumors can be benign or malignant. Primary malignant tumors of the spinal cord are very rare. Malignant tumors of the spinal cord are usually metastatic in nature and have a primary focus in other organs and tissues.
From a clinical and anatomical point of view, tumors can be classified as epidural, intradural extramedullary, and intramedullary tumors.
Metastatic tumors of the spine are the most common for bone metastases.
The most common solid tumors secondary to the spine are breast, prostate, and renal carcinoma, which account for nearly 80% of spinal metastases. Tumors of unknown primary genesis account for about 5% -10% of cases. Metastases of neoplasms of the hematopoietic system are about 4% -10%.
According to the recommendations of the III All-Union Congress of Rheumatologists (1985), joint diseases are divided by etiological features into three main groups: inflammatory (arthritis), degenerative forms (osteoarthritis) and mixed inflammatory-degenerative (arthropathies).
Diseases of the joints of an inflammatory nature include: rheumatoid arthritis, or polyarthritis; ankylosing spondylitis (ankylosing spondylitis); arthritis associated with spondyloarthritis; arthritis associated with infection (bacterial, viral).
Degenerative joint diseases include primary osteoarthritis (oligoarthrosis, monoarthrosis, spondyloarthrosis, intervertebral osteochondrosis) and secondary (due to injuries, static disorders).
Joint diseases with a mixed inflammatory-degenerative nature include: microcrystalline arthritis (gout, chondrocalcinosis, hydroxyapatite arthropathy, etc.) and arthropathy due to allergic diseases or metabolic disorders.
Inflammation in arthritis is accompanied by the release of synovial fluid, which stretches the joint capsule. This leads to pain and swelling of the joint, as well as muscle spasm, which, in turn, causes limitation of movement in the joint. With recovery, these changes disappear without a trace. If the disease progresses, the articular cartilage is destroyed, the joint cavity is overgrown with fibrous tissue, which can lead to joint ankylosis, contractures and dislocations.
Arthritis treatment must be comprehensive. For primary nosological forms, use drug treatment, contributing to the elimination of the infectious focus and the reduction of inflammatory changes, diet therapy and (, hydrogen sulfide and radon baths), physical therapy, massage. In secondary arthritis, special attention is paid to the treatment of the underlying disease. Sometimes they resort to surgical treatment of arthritis.
Osteoarthritis is an independent group of diseases characterized by degenerative changes in intra-articular tissues. In this case, the processes of regeneration of cartilaginous surfaces that are erased during movement are disrupted. Cracks, roughness and marginal bone growths appear on the cartilage. Pain and signs of inflammation appear in the joint. Arthrosis often develops in athletes with irrational training.
In the initial stages of osteoarthritis, the main therapeutic measure is the elimination of overloads, a significant reduction in training loads for a period of 4-6 months. Treatment, as a rule, is conservative: drug therapy, physiotherapy, exercise therapy. Sometimes, with severe and poorly treatable diseases, they resort to surgical intervention. Often, the operation is reduced to closing the affected joint (arthrodesis). After the operation, the pain disappears, but the function of the joint is sharply disrupted, because of which the patients have to persistently develop various mechanisms of functional compensation.
Spondyloarthrosis deformans is a pathology in which pain is the main symptom. It is with this complaint that they most often go to the doctor. As a rule, in this case, a person loses his normal working capacity, and only a few can live peacefully with this feeling. Often, the source of pain is malfunctions in the musculoskeletal system, in particular, this determines the diagnosis of spondyloarthrosis.
Description of pathology
Spondyloarthrosis deformans is a disease of the joints, which has several varieties according to the clinical picture and localization. The pathological process, as a rule, affects all components of the joint - cartilage and bone tissue, ligaments and surrounding muscles.
Most often, the spine is susceptible to this disease, and both intervertebral joints and facet joints belonging to the vertebral segments are affected.
Given the complex structure of the structure of the spinal column, it is conventionally divided into sections. Basically, spondyloarthrosis of the spine is classified according to the place of its localization, and its name is the same as that of the affected spine.
It often covers the entire length of the spine:
- Lumbosacral lumbospondyloarthrosis is the most common type. The characteristic symptoms at an early stage are soreness in the lumbar spine, especially when moving and bending. The sore joint gets tired very quickly with any physical activity. If the development of dystrophic processes has begun, then the characteristic manifestations of inflammatory symptoms are sharp pains that reach through the buttock along the entire leg to the very foot. At the same time, the legs may become noticeably weak and numb.
- Cervical spondyloarthrosis (cervicoarthrosis) is when the symptoms of the disease are most pronounced in the cervical spine. Even in this case, the symptom of aching pain cannot be avoided - it is an integral part of any joint disease. Further development of the process is characterized by the growth of osteophytes - bone growths on the vertebrae - and pinching of the nerve processes of the spinal cord. Because of this, pain symptoms spread to the entire arm, scapula and occipital part. This is usually accompanied by spasm of the surrounding muscles, pain in them, restriction of movement and subsequent atrophy. Osteophytes pinch the arteries that feed the brain, which causes symptoms such as chronic headaches, nausea and dizziness, and visual and hearing impairments.
- Thoracic spondyloarthrosis (dorsarthrosis) is a dystrophic pathology of the thoracic spine. It is diagnosed a little less often than everyone else. The ailment is characterized by painful stiffness after a long state of rest. But the structure of this area allows you to avoid pinching the nerves, mainly in the initial stages. The development of the pathological process in any case involves nearby vessels and nerve structures, which causes malfunctions in the work of internal organs - the heart, lungs and the digestive system.
- Spondyloarthrosis of the polysegmental type is arthrosis involving several areas of the spine or its segments at once. The segment includes two vertebrae, an intervertebral disc and ligamentous joints. The degree of manifestation of symptoms depends on the location of the disease.
Symptoms of the disease
The main manifestations of all types of spondyloarthrosis include:
- The main symptom is pain, which is often bilateral in nature. Often the pain goes to the arms and legs.
- With the development of pathology, the spine loses its mobility: the head stops turning, it is necessary to turn around with the entire upper body, and when the process reaches the lumbar spine, it turns around completely. This type of movement is usually seen in older people.
- A sick spine can no longer properly distribute the load on the body - signs of this negatively affect posture and gait. A person cannot stand or sit for a long time, he quickly gets tired and he has to constantly change his position.
The causes of this disease are often:
- Injuries resulting from excessive stress on the spine.
- Osteochondrosis - degenerative changes in the structure of the spinal column, especially in the cervical region, lead to physiological disorders in the rest of its segments.
- Metabolic disorders often associated with old age.
- Professional activity associated with a long stay in one position, for example, sitting at a computer.
- Low mobility, in which the muscles that support the spine become weakened and the joints no longer receive normal nutrition due to the weakened blood supply.
- Unnatural stress when practicing professional sports.
- Poor nutrition can also lead to pathological changes in the structure of the spine and other joints.
It should be noted right away that self-medication at home will not bring sufficiently effective results, and it is simply necessary to consult a specialist.
Any medication used must be approved by the attending physician.
Treatment of spondyloarthrosis has its own specifics, depending on the degree of development of the pathology. Deforming spondylarthrosis has several degrees:
- Spondyloarthrosis of 1 degree. At this initial stage of development, the disease responds best to treatment. The main treatment is competent massage procedures. The massage should be deep but painless. It will gradually relieve the pain symptom and relax the muscles, thereby increasing the mobility of the vertebrae. Regular procedures will prevent them from re-blocking. Drug treatment is also used, in particular, chondroprotectors. They will relieve the joints and increase the amount of fluid in the intervertebral discs.
- Spondyloarthrosis of the 2nd degree. In this case, it will be extremely useful to inject drugs directly into the joint. In the initial stages, this is an extremely effective treatment method. As a rule, drugs from the group of chondroprotectors are used, as a rule. Also, if there is a symptom of acute inflammatory processes, manual therapy will be effective.
- Spondyloarthrosis grade 3. This stage is already considered serious and requires extremely detailed treatment: drugs, manual therapy, massage, reflexology, electrophoresis, etc. It should be noted right away that it will take a long time and purposefully to be treated.
Gymnastics for spondylarthrosis is quite effective treatment articular pathologies. It strengthens the muscles of the back, relieves stress on the joints and eliminates imbalances in the spine.
Exercises for spondyloarthrosis are selected taking into account the physiological characteristics of the patient and are used in parallel with the main treatment. Exercise requires a systematic approach and regular performance, therefore, the most responsible patients are amenable to treatment through exercise therapy. But any exercise recommended should be done with the utmost care.
Doctors have long learned how to treat such ailments with reflexology. Quite a lot of diseases lend themselves to treatment in this way. This method has been used for more than one century and is carried out through the action of various methods on certain biological points. But first of all, it is aimed at relieving the pain symptom.
There are several types of reflexology:
- Acupuncture - the impact on the points using fine needles. This widespread method of treatment was used by ancient Chinese doctors.
- Thermopuncture - warming up specific areas.
- Electropuncture is a point effect by means of an electric current.
- Magnetopuncture - exposure to constant or alternating magnetic field.
Preventive actions
It is important to maintain correct posture in any activity, whether it is driving a car or working in front of a computer. Too soft bed also spoils posture, and if you continue to sleep on the wrong bed, then it will be extremely difficult to treat the disease.
The main thing is not to forget about payloads: morning warm-up, active sports will keep the spine healthy until old age.
If you also eat right, then many joint diseases will bypass your body.
Exercise therapy for patients with ankylosing spondylitis is recommended for systemic chronic diseases of the joints to slow down the processes of ossification and make the skeleton more mobile. The need for therapeutic physical activity is due to the fact that the disease is incurable and has a conditionally poor prognosis. However, ankylosing spondylitis and its destructive effect on the spine can be slowed down with the help of physical therapy, while maintaining the mobility of the affected joints.
The need for exercise therapy
In ankylosing spondyloarthritis, large joints (mainly vertebral and cruciate-iliac, sternoclavicular, costo-sternum) are affected by their own immune system, which perceives the tissues of the joints as foreign. Cells-antigens begin to fight with the body's own tissues, resulting in foci of inflammation, accompanied by the formation of rough fibrous tissue.
Over time, in the absence of proper therapy, in addition to increasing pain and discomfort, a feeling of stiffness and limited mobility appears. As a result, a person is physically unable to move due to hardening of the joints and severe pain.
The disease is hereditary, and there is no sufficiently effective therapy to cure such genetic pathologies. Since a person will have to live with the disease for the rest of his life, it is extremely important to follow some recommendations to improve its quality and maintain joint mobility as long as possible.
Therapeutic gymnastics for ankylosing spondylitis is a necessary measure, since it is a well-chosen set of exercises that allows to ensure sufficient joint mobility, muscle tone and significantly improve the patient's quality of life. In addition to exercise therapy, breathing exercises are often practiced, which allows the large joints of the sternum to be kept mobile.
Sufficient effectiveness of physical activity is achieved with complex therapy, which includes the use of various drugs to relieve pain, inflammation, suppress the destructive activity of the immune system, etc. These drugs include non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, biological modifiers of the immune response. Often, in combination with exercises, courses of manual therapy are prescribed.
Features of physical activity in this disease
It is extremely important that physical exercises for ankylosing spondylitis are gentle and exclude heavy loads on the back, chest and cervical region. Also, the use of active exercises that involve running, jumping or sudden movements is strongly discouraged.
Moderate hardening will be very useful for patients with a similar ailment. Experts recommend visiting the pool with moderately warm water (23 ° C and higher), but for a limited time, since patients prefer to stay in a dry environment.
Physiotherapy exercises for ankylosing spondylitis and any physical activity are aimed at stretching and relaxing the muscles of the core (or trunk, which are responsible for stabilizing the spine, pelvis, hips, shoulder girdle of a person). They support the spine, are responsible for breathing, but can be tense due to inflammation in the joints. The elasticity of muscles and joints, an increase in their blood circulation, including, allows you to slow down the processes of ossification of the latter and maintain mobility for a long time.
It is advisable that the exercises for the patient are developed individually, but exercises in the hall in a group of several people are also possible. The latter option is often used in spa treatment with a group of patients with a similar diagnosis.
The advantage of individual classes is that the load is selected for a specific person, taking into account the following factors:
- stages of the disease;
- conditions of the cardiovascular and respiratory systems;
- mobility of the spinal column and chest.
It is important to exercise daily throughout your life. Experts recommend breaking the daytime complex into 2 sessions a day, lasting about 30 minutes.
Breathing exercises
Your daily workout should include breathing and exercise. A special breathing technique slows down the adhesion of the joint tissue, preventing the deterioration of lung ventilation and the occurrence of diseases of this organ.
Exercising in the morning right after waking up is the ideal time for breathing exercises. Stiffness of movement after a long stay in a stationary position, so disturbing to patients with a similar pathology, disappears after half an hour of exercise.
Inflating regular rubber balls can be a good and simple exercise. Breathing in and out deeply allows air to circulate better in the lungs and expand.
Other breathing techniques include the following:
- deep breath and 3-4 sharp short breaths until the air is completely released;
- take a deep breath with raising your arms above your head, exhaling slowly and lowering your arms along the body;
- smooth inhalation through the nose, while the abdomen is inflated (abdominal breathing), holding the breath for 4 seconds, exhaling smoothly through the mouth.
You can use other breathing techniques combined with gymnastics, the main thing is that the lungs work well enough. As a rule, a set of various exercises is selected individually by an exercise therapy specialist, taking into account the characteristics of the body and the course of the disease.
Physical exercise
An integral part of any physical activity with ankylosing spondylitis is gymnastics and walking. Relaxing pool activities or measured swimming are great alternatives or a good addition to walking.
Walking is useful for any person, but patients with a similar ailment simply need it. It is recommended to walk at least 3-5 km at regular pace every day. It is desirable that these were walks in the fresh air in the park or in nature, you can use special sticks for Nordic walking. In bad weather or when you can't get out into nature, walking on a treadmill is fine.
As examples of exercise therapy, you can use the following set of exercises for ankylosing spondylitis.
- Exercise "cat" perfectly combines elements of gymnastics and breathing techniques. Standing on all fours with a straight back, you need to alternately arch your back with the wheel and flex your lumbar spine.
- Sitting on a chair, smoothly turn your head to the sides, then the whole body.
- Lying on a flat firm surface, stretch your arms along the body, legs together with an emphasis on the heels. You need to try to lift the pelvis up, lingering for a few seconds at the top point.
- Lying on your side, stretch out straight, then curl up into an embryo position, trying to reach your forehead with your knees, linger for 5 seconds, stretch back.
Often with diagnoses of this kind, the technique developed by S.N.Kuzyakov, a specialist in medical physical culture with over 25 years of experience. His own developments allow to alleviate the condition of patients not only with ankylosing spondylitis, but also to recover from injuries of various nature.
3.4. Exercise therapy for diseases of the joints and osteochondrosis of the spine
3.4.1. Diseases of the joints and their types
Joint diseases are etiologically divided into two main groups: inflammatory (arthritis) and degenerative forms (arthrosis, or osteoarthritis).
Arthritis – inflammatory joint disease.
Symptoms accompanying arthritis: pain in the affected joint, an increase in the temperature of the tissues above it, a feeling of stiffness, swelling, restriction of mobility. In some cases, especially with acute development and significant severity of arthritis, arthritis may be accompanied by symptoms such as fever, general weakness, and leukocytosis.
Natural changes in arthritis occur in the joint itself (Fig. 23). Normally, the synovial membrane lining the joint capsule from the inside secretes a lubricating (synovial) fluid that provides good lubrication of the rubbing joint surfaces of the bones forming the joint. In the joint affected by arthritis, erosion (ulceration) of the surface of the cartilage is observed, the synovial membrane thickens and becomes inflamed. As a result, the joint swells and becomes stiff.
Figure: 23. Changes in a joint affected by arthritis
Inflammatory changes occur primarily in the inner - synovial - membrane of the joint. In the articular cavity, inflammatory effusion and exudate often accumulate. The pathological process can spread to other structures of the joint: cartilage, epiphyses of the bones that make up the joint, the joint capsule, as well as to the periarticular tissues - ligaments, tendons and bursae. There are: arthritis of one joint (monoarthritis), two or three joints (oligoarthritis) and many joints (polyarthritis).
Arthritis can start right away and be accompanied by severe joint pain (acute arthritis), or it can develop gradually and last long enough.
Inflammation in arthritis is accompanied by the release of synovial fluid, which stretches the joint capsule. This leads to pain and swelling of the joint, as well as muscle spasm, which, in turn, causes limitation of movement in the joint. With recovery, these changes disappear without a trace. If the disease progresses, the articular cartilage is destroyed, the joint cavity is overgrown with fibrous tissue, which can lead to joint ankylosis, contractures and dislocations.
Rheumatoid arthritis, it is commonly believed to be associated with focal infection (the exact causes are not known), and physical or mental stress is a predisposing factor. Nevertheless, the most common cause of rheumatoid arthritis is chronic tonsillitis, in which the disintegrating tissue of the palatine tonsils entering various organs with the blood stream can cause the development of rheumatism in those of them that have a significant proportion of connective tissue 16. One of these organs is the joint.
The disease begins with acute joint pain and fever.
Symmetrical joints of the limbs are usually affected. In the joints, effusion is noted, the capsule and tissues around them sharply thicken. The expanding synovial membrane destroys the articular cartilage, the cartilage tissue is replaced by scar tissue. As a result, joint stiffness develops and its ankylosis may even develop. The disease proceeds for a long time, then aggravating, then calming down, and often becomes chronic.
Arthritis treatment is complex. In primary forms, medication is used, which helps to eliminate the infectious focus and reduce inflammatory changes, diet therapy and balneotherapy (mud therapy, hydrogen sulfide and radon baths), exercise therapy, massage. In secondary arthritis, special attention is paid to the treatment of the underlying disease. Sometimes they also resort to surgical treatment of arthritis.
Arthrosis - degenerative diseases - are the most common joint diseases; their frequency increases with age.
Arthrosis occurs as a result of metabolic disorders leading to degenerative changes in the joint.
The main research method for arthrosis is radiography, which allows diagnosing arthrosis, establishing the stage of the process, and conducting differential diagnostics.
Depending on the absence or presence of the previous pathology of the joints, arthrosis are divided into primary and secondary.
To primary arthrosis includes forms that begin without a noticeable reason (over the age of 40) in the articular cartilage that has not changed until then. They usually affect many joints at the same time.
Etiology and pathogenesis primary arthrosis is not fully understood. Among the etiological factors contributing to the development of local manifestations of the disease, the first place is taken by the static load, which exceeds the functional capabilities of the joint, and mechanical microtraumatization (this factor is especially significant in athletes). With age, changes in the vessels of the synovial membrane occur. An important role is also given to some endocrine disorders, as well as obesity, when there is not only an increase in the mechanical load on the joints of the lower extremities, but also a general effect of metabolic disorders on the function of the musculoskeletal system. In addition, the importance of infectious, allergic and toxic factors is not excluded.
Primary arthrosis is often accompanied by impaired fat metabolism, arterial hypertension, atherosclerosis and other diseases. Not all patients with arthrosis develop equally quickly: the slower it begins and proceeds, the less pronounced clinical symptoms, since the body has time to use all compensatory adaptations.
Secondary arthrosis develop at any age due to trauma, vascular disorders, static anomalies, arthritis, aseptic bone necrosis, congenital dysplasia.
Secondary arthrosis is characterized by the development of changes in the articular parts of the bones against the background of the primary process, which can be radiologically manifested in the form of bone deformation and changes in its structure. As a result of the main process, one of the bones involved in the formation of the joint changes most dramatically. The articular end of the bone is deformed, flattened, and often destroyed. The normal structure of the cancellous bone changes. In the future, the pathological conditions of the bones that form the joint end with the development of secondary arthrosis, the severity of which depends on the nature of the main process. In secondary arthrosis, narrowing of the joint space and thickening of the surfaces of bones due to marginal bone growths is determined.
In the etiology and pathogenesis of secondary arthrosis, the main role is played by injuries that violate the integrity or congruence of the articular surfaces. Other causes of secondary arthrosis are congenital dysplasias and acquired static disorders, previous arthritis, diseases of the pineal glands of bones, metabolic diseases (for example, gout), endocrine diseases (hypothyroidism, diabetes mellitus, etc.), etc. Congenital and acquired defects of cartilage and other elements of the osteoarticular apparatus are also important.
The articular symptoms of arthrosis consist of pain, a feeling of stiffness, rapid fatigue, stiffness, deformities, crunching, etc. Pain is usually dull. They are unstable, intensified in cold and damp weather, after prolonged exertion (for example, in the evening) and during initial movements after a state of rest ("starting pain"). Very often, especially with senile arthrosis, instead of pain, only aches and a feeling of heaviness in the bones and joints are noted. True limitation of mobility in arthrosis is rarely observed, more often it is about stiffness and rapid fatigue of the joints. All these symptoms are caused by a violation of the congruence of the articular surfaces, changes (thickening, calcification, sclerosis) in the joint capsule, tendons and other soft tissues, and muscle spasm. Joint deformities are especially common in the distal interphalangeal joints of the hands, in the hip joint, and in the knee joints. Rough crunching of joints (most often of the knee) is caused by unevenness of the articular surfaces, lime deposits and soft tissue sclerosis.
Clinical and radiological three stages can be distinguished in the course of arthrosis. Stage one characterized by minor changes. A barely noticeable narrowing of the joint space occurs, especially in places of greatest functional load (for example, in the medial part of the knee joint gap), and minor bone growths (osteophytes) appear, mainly along the edges of the joint cavity. Their appearance is usually caused by damage to the articular cartilage, one of the functions of which is to restrict the growth of bone tissue. Therefore, in the place of damage to the articular cartilage, where it ceases to play the role of such a limiter, and bone tissue begins to grow.
Stage two differs in more pronounced changes. The narrowing of the joint space and the rearrangement of the articular surfaces on the radiograph become clearly visible. The surfaces of the pineal glands become uneven; bone growths reach significant sizes and lead to deformation of the articular ends of the bones, accompanied by a violation of congruence, up to the development of subluxation and dislocation in the joint.
AT third stage the development of the process, changes occur in the deeper parts of the bones. Often in the second and especially in the third stage of arthrosis, intra-articular bodies are detected, formed as a result of the separation of bone growths and calcification of necrotic cartilage.
As a result of prolonged increased and even normal stress on the joints with a simultaneous deterioration in the nutritional conditions of the articular cartilage, the cells of its surface layer die, as a result of which the cartilage loses its elasticity, and small cracks form on its surface. At the same time, the acidity of the joint environment increases and the composition of the synovial fluid changes, which, to a lesser extent, now plays its role as lubrication of the rubbing articular surfaces of the bones, which also contributes to the development of arthrosis.
Osteoarthritis, although they represent an independent group of diseases, they can be considered as a kind of arthrosis, since they are characterized by degenerative-dystrophic processes in the joints. In this case, the processes of regeneration of the cartilaginous surfaces that are erased during movement are disrupted, cracks, roughness and marginal bone growths appear on the cartilage. Pain and signs of inflammation appear in the joint.
In the etiology of osteoarthritis an essential role is played by previous infectious diseases, chronic intoxication, metabolic disorders, excessive physical activity. The joints of the lower extremities are more often susceptible to the pathological process, since they carry a much greater load, especially in obese people. Osteoarthritis of the joints of the upper extremities limits the motor activity, which ensures the performance of labor and household activities, often leads to disability.
Intervertebral osteochondrosis – the most common type of osteoarthritis, which is based on degenerative-dystrophic changes in the most loaded intervertebral discs.
There are many theories of the origin of intervertebral osteochondrosis (infectious, rheumatoid, autoimmune, traumatic, involutive, muscular, endocrine, hereditary and other theories). However, the main focus in the onset of the disease is given to the incorrect loading of the intervertebral discs.
The intervertebral discs, along with the ligaments, connect the vertebrae to each other. The disc itself (Fig. 24) is a fibro-cartilaginous plate, in the middle of which there is a nucleus surrounded by a fibrous ring (tissue resembling tendons). The intervertebral disc does not have its own vascular system and therefore feeds on other tissues. An important source of nutrients for the disc is the back muscles, which are important for the discs to function well.
Figure: 24. Intervertebral disc structure
1 - annulus fibrosus, 2 - nucleus pulposus destroyed by degenerative processes
The roots of the spinal cord, containing sensory and motor nerve fibers, extend between each pair of vertebrae. When the spine is flexed, the intervertebral discs are somewhat compacted on the side of the slope, and their nuclei are displaced in the opposite direction. Those. intervertebral discs play the role of shock absorbers that soften the pressure on the spine during stress.
The transition of a person to an upright position significantly increased the load on the spine and intervertebral discs. With improperly performed motor activity, accompanied by significant instantaneous (jumps, dismounts, jerking movements, etc.) efforts associated with frequent changes in the position of the trunk (flexion and extension, turns), prolonged static (sitting, standing) loads, lifting heavy loads and Carrying them, when playing sports without controlling the influence of large physical exertion, the disk loses the ability to perform its function. In this case, the power supply of the disk is disrupted and its structure is destroyed. After some time, the height of the disc decreases, and the vertebral bodies come closer together, squeezing the blood vessels (which leads to impaired spinal circulation) and the roots of the spinal cord, and sometimes the spinal cord itself. As a result, the disease leads to quite significant health consequences and limitations in everyday life.
Osteochondrosis of the spine is characterized by the defeat of many vertebrae, often even all. First, there are degenerative changes in the pulpous (gelatinous) nucleus and the replacement of dead areas with fibrous connective tissue. In the intervertebral disc, the collagen content increases and the amount of fluid decreases. The disc loses its turgor, flattens, the function of the joint is sharply impaired.
With degenerative changes in the intervertebral discs, physical activity can lead to an increase in intradiscal pressure, protrusion of the discs (disc hernias), fractures of the annulus fibrosus and ruptures of the nucleus pulposus. The protrusion of the disc and a decrease in its height cause convergence of the vertebrae, the development of edema in the intervertebral joints, compression of the roots, and sometimes the spinal cord with corresponding neuralgic disorders. If an intervertebral hernia has affected the nerve processes or roots of a certain segment of the spine, then this leads to disruption of the functioning of that organ, the innervation of which is provided by the damaged segment of the spinal cord. So, intervertebral hernia in the lumbar spine most often causes pain in the legs, in the thoracic spine - disturbances in the respiratory system, in the work of the heart, in the cervical spine can cause headaches and pain in the hands.
With osteochondrosis, degenerative changes occur in the intervertebral discs, which leads to a change in the osteo-ligamentous apparatus of the spine, a decrease in spring function, limited mobility of the spine and the appearance of pain caused by compression of the spinal roots.
With osteochondrosis of the spine, improperly selected or performed physical activity leads to muscle and headaches, sleep disorders, and depressive disorders.
The clinical picture of intervertebral osteochondrosis is characterized by a chronic course of the disease with periods of exacerbation and remission. Usually exacerbations are manifested by severe pain and a sharp restriction of the mobility of a certain part of the spinal column; atrophy of the superficial and deep muscles of the back may develop.
The disease usually begins gradually after static stress or hypothermia.
Quite often, degenerative changes in the vertebral cartilage are accompanied by the development of inflammation of the spinal roots leaving here with their edema - it develops radiculitis. In this case, the roots are affected by a double mechanical effect: on the one hand, due to the destruction of the intervertebral disc, the lumen of the holes through which they leave the spinal cord decreases, and on the other, their own sizes in diameter increase due to edema, and now the root itself presses on the edges of the hole.
The reason for the development of sciatica can be hypothermia, infection, congestion, excessive consumption of table salt, alcohol, etc. That is why most often exacerbations of osteochondrosis are provoked either by sharp mechanical influences (for example, lifting a lot of weight with a load on the spine), or the development of inflammatory processes in the spinal roots, or the wrong way of life (for example, drinking alcohol).
Distinguish osteochondrosis of the lumbar and cervical spine (less often the thoracic).
To cervical osteochondrosis can lead to systematic muscular overstrain when performing labor operations associated with prolonged fixation of the working posture. Of particular importance in this regard for knowledge workers (including schoolchildren and students) is the long-term maintenance of a posture associated with reading, writing, working on a computer, in which the head is tilted forward and, therefore, the cervical lordosis is smoothed out. It provokes the development of cervical osteochondrosis (as well as lumbar osteochondrosis), the reclining posture, which is familiar to many people, in which the head is tilted forward and literally lies with the chin on the sternum (the cervical lordosis is also smoothed out), and the whole body is slightly tilted forward (the lumbar lordosis is smoothed out). In all these cases of smoothing of lordosis, the pressure on the anterior segment of the intervertebral disc increases, the nutrition of which is limited due to the long-term and daily maintenance of this position, and degenerative changes develop in this particular area. It is no coincidence that it is the cervico-brachial and lumbar localization of osteochondrosis that are the most diagnosed.
The main manifestations of cervical osteochondrosis are:
Increased pathological proprioceptive impulses coming from the cervical spine with smoothed lordosis and causing sharp pain sensations along the entire course of the corresponding nerve roots;
Edema in the tissues of the intervertebral foramen area;
Sharp soreness in the upper part of the trapezius muscle;
Dysfunction of the vestibular analyzer.
With osteochondrosis of the cervical spine, the blood supply to the brain may deteriorate and vestibular disorders may appear.
Lumbar osteochondrosis (lumbosacral radiculitis syndrome) ranks first among all the syndromes of osteochondrosis of the spine. Every second adult has a manifestation of this syndrome at least once during his life. Men of the most efficient age (20-40 years old) prevail among patients. As a rule, the first clinical manifestations of discogenic lumbosacral osteochondrosis (often combined with radiculitis) are pain in the lumbar region. These pains can be sharp, sudden (lumbago) or gradual, prolonged, aching nature (lumbodynia). In most cases, lumbago is associated with acute muscle strain.
Since, under normal conditions, the greatest load falls on the lumbar spine, it is in it that intervertebral hernias are most often formed. Especially often, a hernia is formed during the simultaneous tilt and turn to the side, especially if there is a heavy object in the hands. In this position, the intervertebral discs are very stressed; vertebrae press on one side of the disc, and the nucleus is forced to move in the opposite direction and press on the annulus fibrosus. At some point, the annulus fibrosus cannot withstand such a load and the disc protrudes (the annulus fibrosus is stretched, but remains intact) or hernias (the annulus fibrosus breaks, and the nucleus “flows out” through the break).
In compression syndromes, the pain resembles the passage of an electric current ("shooting" pain) along the entire course of the spinal root (for example, when the sciatic nerve is pinched, the pain can radiate up to the heel); there is a sharp tension in the tone of the anterior tibial muscle.
Pain in the lumbar region is strictly localized, aggravated by physical exertion, prolonged preservation of a forced posture. Sometimes, due to pain, the patient cannot turn from side to side, stand up, etc. In addition to pain, the mobility of the lumbar spine is limited, sensory disturbances and trophic disorders appear. The pains are burning in nature, stitching, shooting, breaking. Their localization is possible in the lumbar region, in the buttock, hip joint, back of the thigh (sciatica), lower leg and foot. Often, pain is accompanied by protective tension in the muscles of the lower back. The sitting position is especially dangerous during attacks (when, as already noted, there is significant pressure on the spine), therefore, when trying to get up from this position, the patient experiences severe pain.
Since in lumbar osteochondrosis, the L5 - S1 segments are most often affected, the muscles innervated by the nerves emanating from these segments (sciatic nerve and its branches) atrophy accordingly: gluteal muscles, flexors of the lower leg, feet, extensors of the foot and fingers. Possible lesions of the femoral nerve and atrophy of the quadriceps femoris muscle.
Treatment osteochondrosis is complex. The leading method is conservative, when the main importance is attached to rest, immobilization and unloading of the spinal column and manual therapy, which allows unblocking the movable elements of the vertebral segments. Of undoubted importance is the normalization of the lifestyle, which allows to optimize motor activity and exclude those influences that can lead to the development of inflammatory phenomena in the roots of the spinal cord. In the acute period, medications are used to reduce pain and muscle tension, physiotherapy, warm baths, massage.
Joint diseases - degenerative and inflammatory - have different manifestations, but they also have common features: joint pain, limitation of movement, muscle wasting caused by them, and decreased density of the bones that form the joint.
MOSCOW STATE UNIVERSITY OF PRINT
Department of Physical Education and Sports
Topic: "Physiotherapy exercises for diseases of the spine"
Completed: student of group DKidB2-1
faculty of Publishing and Journalism
Teacher:
head of department
Moscow 2012
Introduction ………………………………………………………………… 3
The structure and functions of the spine …………………………………… 4
Consequences of the disease ................................................ ........................five
Scoliosis................................................. .................................................. ...five
Causes of the disease ................................................ ............................... 6
Structural scoliosis ................................................ ..........................nine
Treatment................................................. .................................................. ...ten
Some facts ................................................ ......................................eleven
Correct behavior in scoliosis .............................................. ........12
Exercise therapy ................................................. .................................................. ....... .fourteen
Conclusion ................................................. ..............................................19
Literature................................................. ...............................................20
Introduction
Spinal problems can affect the functioning of other organs, which can lead to various diseases. But regardless of age, this can be prevented or suspended by observing a balanced diet and performing simple exercises for the spine. Strengthening and stretching the spine, you can preserve the youth and health of the spine and the whole body.
Sports for diseases of the spine is not contraindicated. For those who suffer from back pain, you can take a brisk walk, ski, jog, swim, or bike three times a week. But you should not get carried away with activities associated with heavy loads (weightlifting, high jumping, wrestling, tennis, badminton, golf, hockey, football).
Performing remedial gymnastics, first of all, you do not need to overestimate your physical capabilities, overexert yourself or make too sweeping movements.
Therapeutic gymnastics (exercise therapy) is a set of exercises carried out to get rid of many chronic human diseases related to reducing muscle strength and limiting joint movements. If during his life a person does not care about the health and work of muscles, ligaments and joints, then many body functions cease to be performed:
- musculoskeletal;
- cardiovascular microcirculatory;
- lymphatic microcirculatory;
- immune.
The structure and function of the spine
The vertebral column is the dorsal solid axis of the body of humans and many animals, made up of a number of separate short joints of bones called vertebrae; almost its entire length contains a canal containing the spinal cord. From above it articulates with the bones of the skull, below with the bones of the pelvis. It is divided in humans into the cervical part (7 vertebrae), thoracic (12), lumbar (5), sacral (5 accrete vertebrae) and caudal (5 underdeveloped vertebrae). The SPINE is the basis of the skeleton and performs two important functions in the human body. The first function is musculoskeletal. The second is protective. The spine protects the spinal cord from mechanical damage. It is approached by numerous nerve endings, which are responsible for the work of all organs in the human body. Figuratively speaking, each vertebra is responsible for the work of a specific organ. If the functions of the spine are impaired, it becomes difficult to conduct a nerve impulse to tissues and cells in different parts of the body. Over time, it is in these areas of the body that various diseases will develop. Most often, there are curvatures: 1) scoliosis (lateral), rickety (in children from 3-4 years old, 2) kyphosis (behind), habitual in rickety children, anemic girls due to humpback posture when reading, in old age; 3) lordosis (in front), less common, with hip dislocations.
Scientific works have shown that 86% of school-age children show symptoms that indicate the presence of disorders in the spine. Over the course of life, some of these symptoms disappear, while others transform into scoliosis, kyphosis, poor posture, any additional trauma to the body can intensify these painful manifestations.
People have suffered from diseases of the spine at all times. These diseases are so common that almost everyone suffers from them at some time.
Spinal diseases are almost as common in the young as in the elderly. Men suffer from them almost twice as often as women. This can be explained by the anatomical and physiological features and the fact that many men are engaged in heavy physical labor.
The consequences of scoliosis
Close attention to scoliosis is explained by the fact that in severe forms of this disease there are significant disorders in the most important systems of the body, leading to a decrease in the life expectancy of working capacity and disability. In the literature, changes in the respiratory, cardiovascular and autonomic nervous systems with severe forms of scoliosis. Data on the presence of disturbances in the function of external respiration, heart rhythm and metabolic processes in the myocardium, insufficient adaptation of the cardiovascular system to physical activity, a decrease in a number of indicators of physical development, a later onset of puberty in schoolchildren of 7-16 years old, patients with scoliosis I and II are presented. degree. Unfortunately, there is practically no data on changes in vital systems in case of posture disorders and in the initial degrees of scoliosis in preschoolers and primary schoolchildren.
Scoliosis
The term "scoliosis" refers to the lateral curvature of the spine. Moreover, this term is used both in relation to functional curvature of the spine in the frontal plane ("functional scoliosis", "scoliotic posture", "antalgic scoliosis"), and in relation to a progressive disease leading to complex, sometimes severe deformity of the spine ("scoliotic disease" , "structural scoliosis").
Scoliosis can be simple, or partial, with one lateral curvature of the curvature, and complex - in the presence of several curvature arcs in different directions, and, finally, total, if the curvature involves the entire spine. It can be fixed and non-fixed, disappearing in a horizontal position, for example, when one limb is shortened. Simultaneously with scoliosis, its torsion is usually observed, that is, rotation around the vertical axis, and the vertebral bodies turn out to be facing the convex side, and the axial processes in the concave side. Torsion contributes to deformation of the chest and its asymmetry, while internal organs are compressed and displaced.
Causes of the disease
The initial phenomena of scoliosis can be detected already in early childhood, but at school age (10-15 years) it is most pronounced.
Etiologically, congenital scoliosis is distinguished (but they occur in 23.0%), which are based on various deformities of the vertebrae:
* underdevelopment;
* their wedge-shaped form;
* additional vertebrae and. etc.
Acquired scoliosis includes:
1. rheumatic, usually arising suddenly and caused by muscle contracture on the healthy side in the presence of symptoms of myositis or spondyloarthritis;
2. rickety, which are very early manifested by various deformations of the musculoskeletal system. Bone softness and muscle weakness, carrying a child in your arms (mainly on the left), prolonged sitting, especially at school - all this favors the manifestation and progression of scoliosis;
3. paralytic, more often arising after infantile paralysis, with unilateral muscle damage, but can also be observed in other nervous diseases;
4. habitual, on the basis of habitual bad posture (they are often called "school", since at this age they get the greatest expression). The immediate reason for them may be improperly arranged desks, seating schoolchildren without taking into account their height and number of desks, carrying schoolbags from the first grades, holding the child by one hand while walking, etc. etc.
Of course, this list does not cover all types of scoliosis, but only basic ones.
It is generally accepted that training overloads are the cause of lower back injury. Meanwhile, pain in the lower spine is much more often caused by normal daily activities. This is the explanation for the seemingly strange contradiction, when people who have never known sports complain of lower back pain. The most harmful thing is to sit. Surprisingly, while sitting, the spine is more loaded than when we are standing! However, the increased load is still half the battle. For many hours we have to sit in the most harmful position - leaning forward. In this position, the edges of the vertebrae come together and pinch the intervertebral disc from the cartilaginous tissue. In general, this fabric is remarkable for its elasticity, allowing it to successfully resist compression. However, it should be borne in mind that when sitting, the force of pressure on the outer edge of the disc increases 11 times! Moreover, it continues not only during the working and school day, but often at home.
The spine, when viewed from behind, should be straight. In some, however, it takes an S-shape (scoliosis). In mild cases, this does not lead to any complications. With a significant curvature of the spine, when it turns around its axis, sometimes pain occurs and its ability to function normally decreases. From the point of view of biomechanics, the process of scoliotic deformity formation is the result of the interaction of factors that violate the vertical position of the spine and adaptive reactions aimed at maintaining an upright posture.
The term "scoliotic disease" includes congenital, dysplastic and idiopathic scoliosis (ie, scoliosis of unknown origin). Congenital scoliosis is caused by gross malformations of the skeleton, such as accessory lateral cuneiform vertebrae. In congenital scoliosis, the shape of the curvature is directly dependent on the location and nature of the anomalies.
Scoliotic disease, or scoliosis, in contrast to functional curvature of the spine in the frontal plane, is characterized by a wedge-shaped and torsional deformity of the vertebrae progressing in the process of growth, as well as deformation of the chest and pelvis. Structural scoliosis develops in some metabolic diseases, leading to functional inferiority of connective tissue, rickets. In these diseases, scoliotic deformity acts as structures. Static scoliosis is usually called structural scoliosis, the primary cause of which is the presence of a static factor - an asymmetric load on the spine caused by congenital or acquired asymmetry of the body (for example, asymmetry in the length of the lower extremities, pathology of the hip joint, or congenital torticollis). In static scoliosis, the rate of progression and the severity of the deformity depend on the ratio of the severity of the static factor and the factor of functional failure of the structures that maintain the vertical position of the spine. With a good functional state of the musculo-ligamentous apparatus and intervertebral discs, the curvature of the spine may remain functional for a long time or not at all lead to the development of progressive scoliosis. As long as the nucleus pulposus of the intervertebral disc maintains a central position, the body weight pressure transmitted to the disc is distributed evenly over the entire area of \u200b\u200bthe supporting platform of the underlying vertebra, without causing progressive wedge-torsion deformity. If, in the presence of a slightly expressed static factor, compensatory mechanisms are weak or there is a functional inferiority of connective tissue structures, the scoliotic factor forms and causes the progression of deformity. With functional muscle failure, most of the load to maintain an upright posture is transferred to the ligaments. A sufficient degree of ligament tension is achieved due to a significant increase in the angle of curvature of the spine, leading to an increase in the load on the intervertebral discs, persistent lateral displacement of the nucleus pulposus, and thus the formation of a scoliotic factor. Static compensation for gross asymmetry of the body can be achieved due to significant curvature of the spine. In this case, the intervertebral discs are subjected to a large asymmetric load, which leads to the formation of a scoliotic factor even in the absence of dysplastic changes, muscle weakness and constitutional weakness of the connective tissue structures. With scoliotic disease, allocated in a separate nosological form, curvature of the spine is the main symptom.
Treatment
Scoliosis belongs to the group of diseases of the musculoskeletal
locomotor system associated with changes in posture. These diseases are dealt with by orthopedists, who, after examination, recommend treatment (individually selected physiotherapy exercises, massage, FTL, visiting the pool, wearing a corset, manual therapy, if indicated, etc.).
It is necessary to sleep on a rigid basis, and for softness use cotton or woolen mattresses, but not box-spring mattresses. You need to find a competent sports doctor, and under his guidance, do physical therapy.
Scoliosis treatment consists of three interconnected links: mobilization of the curved spine, deformity correction and stabilization of the spine in the position of the achieved correction. Manual therapy techniques are very effective for correcting spinal deformities. The preservation of the achieved correction with their help can be promoted only indirectly, due to the formation of a new static-dynamic stereotype, adapted to the changes in the shape of the spine. The change in the static-dynamic stereotype is carried out by purposeful impact on the upper and lower in relation to the main curvature of the links of the musculoskeletal system and the regulation of the tone ratios of the conjugated muscle groups participating in the formation of posture. However, the main and most difficult task, the solution of which determines the success of treatment in general, is not the mobilization and correction of the curvature, but the stabilization of the spine in the corrected position. Deformity correction not supported by measures to stabilize the spine is ineffective.
Conservative treatment methods cannot have a direct effect on structural changes in the spine. Therefore, attempts to mechanically "straighten" the curvature of the spine caused by structural rearrangement of the vertebrae and intervertebral discs are senseless. The essence of conservative treatment consists in correcting the curvature of the spine by reducing the functional component of the curvature and stabilizing the achieved correction by improving the functional state of the musculo-ligamentous apparatus or using corsets
The most important point of the therapeutic effect in the treatment of scoliosis is the restoration of muscles in a state of fascial-muscular rigidity, or, more simply, in a state of local spasm. This is achieved with post-isometric relaxation and special exercises. The implementation of special exercises for each patient is individual and depends on the nature of the scoliotic manifestations.
Some facts
The amount of load compressing two vertebrae is largely determined by the position of the body. It is smallest when the body is in a horizontal position. In the standing position, the pressure between the vertebrae increases. In the lower part of the lumbar spine, it is 4 times more when a person is standing than when he is lying. The total load in this case is equal to the total mass of the upper body.
When leaning forward from a standing position, the total load increases enormously, which is due to the effect of a lever formed between the part of the body that leans forward and the vertebra itself. A similar effect leads to the fact that the pressure between two vertebrae in the lower part of the lumbar spine when tilting is 2.5 times more than when we are standing upright, and 10 times more than when we are just lying.
Correct behavior in scoliosis
The pressures on the intervertebral discs (as a percentage of the standing position) are given in Table 1.
Table 1
Lying on your back ....................... 25%
Lying on its side ........................ 75%
Standing ................................ 100%
Standing, leaning forward ............. 150%
Standing, leaning forward, in the hands of the weight. 220%
Sitting ................................ 140%
Sitting forward bend .............. 185%
Sitting forward with weight in hand. 275%
If you work while sitting, periodically "press your back and lower back into the back of the chair, and if there is a high headrest with effort, rest your head against it.
The same strong pressure between two vertebrae occurs when a person sits leaning forward, not leaning on his hands. If you lean on your hands, putting them on a table or the back of a chair, the load on the upper body is reduced, and thereby the pressure on the vertebrae is reduced.
The pressure between the two vertebrae increases when a person picks up an object by leaning forward with their legs straight. In this case, the load on the intervertebral disc is several hundred kilograms.
When stretching the spine, for example, when a person is hanging on his hands without support on his legs, the pressure is less than in the prone position. In this case, a stretching may even occur in the intervertebral disc. This circumstance is sometimes used in the treatment of certain diseases of the spine.
The weight of the head exerts pressure on the cervical vertebrae. Even the arms are a strain on the cervical spine as the shoulder muscles that lift the arms up are attached to the back of the head and neck. When you raise your arms up, these muscles tense and thus weigh down the vertebrae. Many knowledge workers unconsciously lift their shoulders, which puts additional stress on these vertebrae. The cervical vertebrae are exposed to great stress when working with arms raised up (for example, when washing windows), especially if there are heavy objects in the hands.
When the head is tilted down in a sitting position, the load on the cervical vertebrae, according to the principle of the lever, will be many times greater than if you sit with your head up. To keep the head tilted, it is necessary to tighten the neck muscles. Holding this pose for a while, you can feel pain in the back of the head, the reason for which is muscle tension.
The cervical vertebrae are exposed to a particularly strong load during prolonged work with arms and head raised up (for example, for school teachers during long-term work at the blackboard). Many people involved in this kind of work suffer from constant pain in the back of the head.
Exercise therapy
One of the leading means of conservative treatment of scoliosis is physiotherapy exercises. Exercise has a stabilizing effect on the spine, strengthening the muscles of the trunk, making it possible to achieve a corrective effect on deformation, improve posture, respiratory function, and give a general strengthening effect. Exercise therapy is indicated at all stages of scoliosis development.
The complex of remedies for exercise therapy used in the conservative treatment of scoliosis includes:
· Medical gymnastics;
· Exercise in water;
· Massage;
· Position correction;
· Sports elements.
Exercise therapy is combined with a mode of reduced static load on the spine. Exercise therapy is carried out in the form of group sessions, individual procedures, as well as individual tasks performed by patients independently.
The exercise therapy technique is also determined by the degree of scoliosis: in grade I, III, IV scoliosis, it is aimed at increasing the stability of the spine, while in grade II scoliosis - also at deformity correction. Exercises of therapeutic gymnastics should serve to strengthen the main muscle groups that support the spine - muscles that straighten the spine, oblique abdominal muscles, square muscles of the lower back, iliopsoas muscles, etc. Among the exercises that contribute to the development of correct posture, exercises for balance, balancing are used, increased visual control, etc.
One of the means of exercise therapy is the use of sports elements:
· Swimming in the "BRASS" style after a preliminary course of training. Volleyball elements are shown for children with a compensated course of scoliosis.
Prevention of scoliosis involves maintaining correct posture.When sitting for a long time, the following rules must be observed:
· Sit still for no longer than 20 minutes;
· Try to get up as often as possible. The minimum duration of such a "break" is 10 seconds.
While sitting, change the position of your legs as often as possible: feet forward, backward, put them side by side, then, on the contrary, spread and. etc.
· Try to sit "correctly": sit on the edge of the chair so that your knees are bent at exactly right angles, ideally straighten your back and, if possible, take some of the load off the spine, putting your straight elbows on the armrests;
Periodically do special compensatory exercises:
1) Hang and pull your knees to your chest. Do the exercise as many times as possible
2) Take a kneeling position on the floor with outstretched arms.
Try to bend your back up as much as possible, and then bend it down as much as possible.
Morning gymnastics, health-improving workouts, active rest - the motor minimum necessary for every person and it consists of walking, running, gymnastics and swimming.
In addition to general strengthening, health-improving exercises, there are many special ones, for example, to strengthen the muscles of the abdominal press, chest, improve posture ... These exercises allow to some extent correct figure flaws, allow you to better control your body.
The following exercises will significantly strengthen your back muscles and keep your body in the correct position:
1) I. p. - standing, hands behind the head. Move your arms to the sides with force, raising your arms up, bend. Freeze for 2-4 seconds and return to and. p. Repeat 6-10 times. Breathing is arbitrary.
2) I. p. - standing and holding a gymnastic stick behind his back ( top end pressed to the head, the lower to the pelvis). Sit down, return to and. n. Lean forward, return to and. and finally, lean to the right, then to the left. Perform each movement 8-12 times.
3) I. p. - lying on his stomach. Leaning on your hands and without lifting your hips from the floor, bend. Freeze in this position for 3-5 seconds, then return to and. P.
4) I. p. - standing one step from the wall. With your hands touching the wall, bend back, raising your arms up, and return to and. p. Repeat 5-8 times. Standing against the wall, press against it with the back of your head, shoulder blades, buttocks and heels. Then move away from the wall and try to hold this body position as long as possible.
Physical exercises that increase the flexibility of the spine and lead to overstretching are contraindicated.
In addition, it is good to take baths with sea or aqua salt for 20 minutes.
Passive self-extension is necessary: \u200b\u200bfor this, the head end of the bed must be raised by 10-15 centimeters and lie on your back and on your stomach for 40-50 minutes, relaxing. You can add hangs on the gymnastic wall with your back to the wall for 1-5 minutes.
Conclusion
With scoliosis, you cannot sit for a long time, make sudden movements, lift and carry more than 3 kg, you need to play sports only with a qualified doctor, the recommended sport is swimming, you need to use a back support, fixing a belt to relieve the load from the vertebral discs, but only on the recommendation of a doctor, you should take a multivitamin with calcium to strengthen bone tissue.
Literature
1., Isaac production and graphical analysis of frontal radiographs of the spine in scoliosis. Guidelines. Omsk - 1974.
2. Kotesheva method for Scoliosis.
3., scoliosis and kyphosis. M. "Medicine", 1973, 75
4. Great medical encyclopedia.
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