Exercise therapy for injuries and diseases of the musculoskeletal system

Damage to the musculoskeletal system (musculoskeletal system) accompanied by functional disorders, which are based on movement disorders. The reason for their appearance, in addition to anatomical disorders and dysfunctions, is prolonged hypokinesia associated with immobilization of the limb, prolonged bed rest, and the development of secondary changes. These include muscle hypo- and atrophy, various wrinkling and thickening of the joint capsules, loss of its elasticity, fibrous changes in articular cartilage, etc. The main indicators of hemodynamics, external respiration function, nervous system, and gastrointestinal tract also decrease. Well, this can lead to various complications and slow down the regeneration processes.

Physiotherapy, which carries out a local and general healing effect on the patient’s body, is the most important, and sometimes even decisive, method in the comprehensive complex treatment and rehabilitation of injuries and diseases of the musculoskeletal system. Physical exercise improves trophism, blood supply and contractility of muscles, promotes the development of their working hypertrophy, improves the nutrition of cartilage tissue and the elasticity of the ligamentous-capsular apparatus. According to the mechanism of motor-visceral connections, exercise therapy has a training effect on autonomic functions, promoting the revival of organs and tissues.

Exercise therapy for injuries consists of physical therapy, physical exercises in water, walking training, mechanical therapy, training on simulators, games, elements of sports, restoration of social and everyday skills. PH classes include both general strengthening training and special focused exercises. These two groups of exercises should be combined, in some cases giving preference to exercises of general action, in others - to special ones. A reasonable choice of starting position is also of great importance. The dosage of physical exercises must be adequate to the functional state and potential of the patient’s musculoskeletal system, as well as to the repair processes. The most effective is repeated (usually 3-4 times) repetition of LH during the day. The recommended duration of each treatment procedure is no more than 15-20 minutes. An excessively long procedure (more than 30-40 minutes) can lead to overload, and a short-term procedure may not be effective enough. When working on physical exercises, it is important to avoid the appearance or intensification of pain. Physical exercises must be aimed at developing, mastering and consolidating complex, purposeful all-round movements. As a result of systematic training, the patient gradually regains the skills to care for himself without additional outside help.

1. Exercise therapy for bone fractures
2. Exercise therapy for a spinal fracture
3. Osteocondritis of the spine.
4. Exercise therapy for scoliosis

Exercise therapy for bone fractures

The full course of exercise therapy in the treatment of trauma patients is conditionally divided for three periods:

1. immobilization,
2. post-immobilization,
3. restorative.

During the period of immobilization Exercise therapy is prescribed from the very first days of the patient’s admission to the hospital to increase the overall tone of the body, prevent complications, improve the trophism of the immobilized limb, and prevent the development of muscle wasting and joint rigidity. The LH complex includes static and dynamic breathing exercises, general developmental training for a complex of all muscle groups free from immobilization. Among the special ones, exercises are used for a symmetrical limb, exercises for joints of an injured limb that are free from immobilization, isometric muscle tension in damaged segments, and ideomotor movements. Isotonic exercises are prescribed 10-12 days from the start of traction and on the 2-3rd day after osteosynthesis surgery; 5-15 tensions lasting 5-7 seconds with pauses for relaxation repeatedly throughout the day. The duration of the LH procedure is 20-30 minutes and is repeated 2-3 times a day. At the same time, a massage is performed on the symmetrical limb, reflexogenic zones and unaffected segments of the injured limb.

In the post-immobilization period, coinciding in time with consolidation in the area of ​​the fracture, exercise therapy is aimed at preparing the patient to stand up, training the vestibular apparatus, learning to move on crutches, training the supporting function of the limb (for injuries of the lower limb), and normalizing posture. Particular objectives of exercise therapy are restoring the function of damaged limbs, normalizing its trophic processes, qualitatively improving blood and lymph circulation in the area of ​​injury, strengthening muscles, improving mobility in joints, and training household skills. Physical activity gradually increases due to an increase in the number of exercises, their repetition, and the use of weights. Special exercises for all joints of the limb are performed first in lightweight starting positions. Isometric stress, axial load training for injuries of the lower extremities and development of the grip function for injuries of the upper extremities, and exercises with objects are used. Classes are conducted to restore everyday skills and occupational therapy.

Contraindications for prescribing exercise therapy are: general severe physical condition of the patient, aggravated by blood loss, shock, infection, concomitant diseases; the likelihood of bleeding or repeated resumption of bleeding caused by possible movements; persistent pain syndrome, high temperature; the presence of foreign bodies located near large vessels, as well as nerves and other vital organs.

Exercise therapy for a spinal fracture

For spinal fractures, physical exercises are used taking into account the location of the fracture (calving: cervical, thoracic, lumbar), the time since the fracture, the method of treatment used, the nature of complications, the age and condition of the patient.

In the conservative treatment of fractures of the bodies (thoracic and lumbar) without dysfunction of the spinal cord, the objectives of exercise therapy are a general tonic effect on the patient’s body, prevention of complications caused by prolonged bed rest and immobilization, and the gradual formation of a muscle corset. Exercise therapy classes for spinal fractures are carried out in 4 stages:

1. At the first stage (10-12 days) breathing exercises (static and dynamic), general developmental training for muscles (small and medium groups) and joints are used. As for active movements of the legs, they are performed in the most relaxed conditions (sliding the foot along the bed) and exclusively alternately. It is also recommended to briefly tense the abdominal muscles and isotonic tension of the back muscles, extend the thoracic region and raise the pelvis with static support on the elbows and legs bent at the knees. LH is carried out individually for 10-15 minutes, 2-3 workouts per day with the initial position horizontally lying on your back. Do not perform exercises that cause pain in the area of ​​the fracture.
2. At the second stage (until the 30th day) the main goal is to create a muscle corset, normalize the activity of internal organs, prepare the patient to expand and strengthen the motor regime. The complex load on the body increases due to the selection of exercises, increasing the number of their repetitions, and the duration of classes. The duration of classes increases to 20-30 minutes. It is advisable to repeat the LH procedure on your own in the afternoon. 2-2.5 weeks after the injury, turning onto the stomach in an extension position is allowed. In the LH procedure, in addition to the previous exercises, exercises are added to strengthen the muscle corset, extension of the spine with support on the forearms and hands, isometric exercises for the muscles of the back and buttocks (starting from 2-3 s to 7 s); exercises to target the abdominal muscles and lower leg muscles. Extension exercises for the torso muscles are made easier by positioning the bed on an incline. Active movements of the legs are performed alternately with lifting off the plane of the bed.
3. At the third stage (until the 45-60th day after the injury), training is lengthened to 40-45 minutes and carried out 2 times a day. It is envisaged to increase the load due to isometric stress, exercises with load, resistance and all kinds of weights, introducing the initial position vertically, standing on all fours, knees, from which they bend to the sides, backwards, simultaneous lifting of the legs, walking on the bed. When performing exercises, it is necessary to control the correct position of the spine, preventing it from bending. To assess the level of strength endurance of the back muscles, determine the duration of time the body is held in an extended position, lying horizontally on the stomach with arms laid back and legs extended. Strength endurance of the abdominal muscles is assessed by the time spent holding the legs bent at an angle of 45° from a supine position. Samples are considered satisfactory with a retention time of 2-3 minutes.
4. If the test results are positive, you can proceed to fourth stage of treatment (from 45-60 days to 5-6 months after the fracture). The patient is allowed to get out of bed without sitting. You need to rise from a horizontal position lying on your stomach or kneeling, excluding bending forward. Exercise therapy at this stage is aimed at continuing to strengthen the torso muscles, increasing the mobility of the spine, restoring correct posture and walking skills. LH classes are continued according to the method of the third period, to which exercises are added in the initial standing position: dynamic exercises for the upper limbs, half-squats with support, bending the body, walking in place and around the ward. The duration of walking by the end of the 3rd month of treatment can be increased to 1.5-2 hours. Sitting is allowed with good adaptation to walking for 5-10 minutes a couple of times a day with a cushion under the lower back no earlier than 3-4 months after the injury. At the outpatient stage, swimming and skiing on smooth terrain are added. The patient is taught the skills of rational behavior in everyday life.

In case of a fracture of the transverse and spinous processes of the vertebra, the patient is placed in a bed with a shield for 2-4 weeks. Exercise therapy is prescribed for use from the very first days, using the basic methods of treating compression fractures, but the time frame for transferring to increased loads is reduced. Lying on your stomach is allowed only after 4-6 days, the initial position - kneeling - begins to be used only after 8-12 days, the initial position - standing upright and walking - after 2-3 weeks.

Osteocondritis of the spine.

In the case of osteochondrosis of the cervical spine, physical therapy is prescribed already at the stage of the acute period of the disease (already on the 1st - 2nd day) under conditions of axial unloading (starting position - lying down, using a Shants type collar). The treatment complex includes physical exercises for minor muscle groups and medium muscles, as well as joints of the upper extremities, exercises to relax the muscles of the upper shoulder girdle and upper extremities, and static breathing exercises. As the pain subsides, the training complex is expanded with exercises that strengthen the muscles of the shoulder girdle and upper limbs, plus the neck (static tension for 5-7 s); analytical gymnastics, range of motion exercises” in the shoulder joints, coordination gymnastics. Gradually, exercises with various kinds of sports equipment, using a gymnastic wall, on a special table, and exercises in a therapeutic pool are included in the classes. Dynamic exercises targeting the cervical spine are often contraindicated in the acute and subacute phases of treatment, but become available during the period of remission.

Absolute contraindications LH is prescribed by the general severe physical condition of the patient, expressed by elevated body temperature, increasing symptoms of cerebrovascular accident, persistent severe pain syndrome, compression syndrome requiring surgical intervention.

Strictly contraindicated movements to straighten the lumbar spine and tilt the body by more than 15-20°, exercises that increase pain and tension in the paravertebral muscles. Patients who are intolerant of the procedure are also a contraindication.

Exercise therapy for scoliosis

Exercise therapy plays a leading role in the complex treatment of scoliosis. The objectives of physical therapy are to develop and maintain correct posture, create a harmonious muscular corset of the torso, increase the strength and endurance of the muscles of the torso and limbs, improve the function of the cardiorespiratory system, harden the body, and prevent psycho-emotional stress. In PH procedures, corrective, symmetrical and asymmetrical detorsion exercises are used, which are carried out under conditions of axial unloading and traction (starting position - lying down, hanging, on an inclined plane, etc.). Special exercises are prescribed against the background of general strengthening and breathing exercises. Exercise therapy classes for scoliosis should be carried out at least 2 times a day for 30-45 minutes and combined with massage. You need to sleep on a hard bed. Specially selected games, swimming, and skiing are widely used.

To enhance the effectiveness of therapy for scoliotic disease, the addition of various analyzers (tactile, auditory, visual and others) during exercises is used as much as possible. In this regard, training is carried out specifically in front of a mirror, at a support or gymnastic wall. In the motor mode, jumping, exercises with significant forward bends of the body, acrobatics, and carrying large loads are contraindicated; Swimming and active importation procedures are contraindicated in conditions of the patient's spinal instability.