The method of lengthening the shortened lower extremities


(57) Abstract:

The invention relates to medicine, namely to non-surgical treatment of musculoskeletal and massage. Spend the elimination of differences in the relative lengths of the lower limbs with hypercorrection 2 mm. provide therapeutic dosed walking, classic, periosteal massage shortened limbs and vibratory germinative zones of short segments of the limb. The method allows for the prevention and treatment of functional scoliosis. table 2., 8 Il.

This method can be widely used in practical medicine in orthopaedic surgical practice as a universal method of diagnosis, prevention and treatment of functional scoliosis, osteochondrosis, as well as in cosmetic orthopedics.

Theoretical justification of this method is the work of the authors Shatilla Century. And. , brusko A. T., frost N. D., where is reviewed and experimentally proved long ago raised and unfairly rejected by the problem of the influence of functional loads on the structure and adaptive-compensatory changes in tubular bones. These changes occur due to increase or decrease the functional NKNH loads stimulates osteogenesis and its predominance over the resorption and, as a result, the elongation of short segments (femur, tibia), increasing their volume.

Functional overload growing bones cause the destruction of the epiphyseal cartilage [3] and lead to chronic epiphysiolysis, which occurs under the influence of slice or shear forces at an angle to the mechanical axis of the lower limb [3]. Functional for epiphyseal cartilage is cyclic axial load parallel to the mechanical axis. This load occurs when a person step, and consists of three stages: compression segment curved back, the Central compression and compression with bending forward. The increase in the mode and magnitude of functional loads leads to an increase of the hydrodynamic effect of elastic deformation, increase the blood supply to the individual segments of the lower limbs, improves trophic and structural organization and change, at a higher level, the current functional stereotype [1].

Closest to the proposed method to the technical nature and the positive effects are described in the articles Century. And. Isala observations [4,5,6,7] . In his articles, the author defines raznovideosti lower limbs as "statistical factor", cataractes the lower limbs, the author proposes a correction or hypercorrection shortened lower limbs while wearing the Cosquer and increased functional load. But he does not explain the morphological and structural changes in bone and joint tissues of the leg. As an example, the author gives the history of the boy with the shortening of left leg by 12 mm and a curvature of the spine to 19 degrees to the left [4]. The treatment was carried out using a hypercorrection left wearing Cosquer for two years with the dynamics of the spine on x-rays. Subsequent observations revealed a reduction of the static factor" from 12 to 3 mm and the cancellation of the Cosquer three years. This example shows that with metered purpose hypercorrection can significantly reduce the static factor", i.e., to increase the length of the lower extremities. In a subsequent article Century. And. Ical [7] considers the fact of raznovideosti lower limbs in statokinetic of the spine is normal and does not always should be hypercorrection of the lower extremities. In some cases it can have the opposite effect [3]. This conclusion the author made due to the lack of a clear definition of "start-up" hypercorrection and constant monitoring of each patient until its removal.

The method of lengthening the shortened lower extremities consists of several consecutive steps.

Act two:

Measuring the relative magnitude of the shortening of the lower limb.

a) measuring the relative magnitude of the shortening of the femur and tibia. This is the distance from the highest point of the iliac crest to the middle of the heel bone, its supporting surface. Under the bearing surface of the heel and the entire foot, without changing the position of the feet, enclosed insoles height of 1 mm until the air bubble on the scale of the device will not occupy its Central position and measure the height of the padded insoles in millimeters. (Photo 3) [8, c. 133].

b) measuring the relative magnitude of the shortening of the thigh. Is the patient standing on his knees. This is the distance from the highest point of the iliac crest to the tuberosity b/bone. The angle of the femur-tibia should be 90 degrees. To this end both the femur and tibia should closely relate to the vertical and the horizontal plane of support (Fig. 1). Under tuberosity b/bone enclosed insoles height of 1 mm until, when the bubble will take its place in the middle of the scale apparatus. Measuring the height of the padded insoles mm, determine the length of the thigh.

C) measuring the relative magnitude of the shortening of the leg. Is simple arithmetic the treatment of tibia in mm. Upon reaching the horizontal level of the high points of the ridges podezdnyh bones (read more horizontal level correction) mandatory verbal contact between doctor and patient from the beginning to the end of the procedure. Upon reaching the horizontal level correction the patient has a somatic condition "positive static-and-dynamic effect" (the disappearance of a sense of neodinakovo limbs, the disappearance of a sense of muscle pull in oculovestibular areas, the sense of "dropping" shortened limbs when restoring a horizontal correction). In addition to the physical condition of the patient must be considered "positive aesthetic effect" [8, S. 134].

Act three:

The creation of hypercorrection for shortened lower limbs.

To do this, the patient is created orthopedic tab for continuous wear 2 mm higher than the value of the horizontal level correction. The value of 2 mm is selected on the basis of long-term clinical experience, and this value is convenient when working with the machine. Increase height orthopedic tab from the horizontal level correction 2 mm is the value that shifts the air bubble from the average poligraficheskogo discomfort. Finally is the "start" value, which leads to increased functional load in a shortened limb. When a significant difference in the length of lower limbs in addition to orthopedic tabs hold the capacity of the heel (Fig.4). Orthopedic tab is made so that the outer surface of the tab fully complied with all the curves of the support surface of the foot. The maximum height of the tab must match the supporting surface of the calcaneus and gradually decreases to the front 2/3 of the length of the foot. The tab should be made of thick leather or rubber insoles height of 1 or 2 mm, cut around the perimeter of the foot and glued together (Fig. 3b, 4). Height orthopedic tab should match the height of hypercorrection (height horizontal adjustment + 2 mm) and are constantly worn throughout the shoes after finding the patient in an upright position. If necessary, worn shoes with increased heel (Fig.4). Control hypercorrection daily. When increasing the hypercorrection more than 2 mm per day and (or) when static discomfort increased hypercorrection reduced to the original starting value, removing from the orthopedic vklada four:

Dosed walking (appointed after determining hypercorrection and manufacturing orthopedic tab)

Her role is a permanent increase in functional loads, because they are natural biological factor, which is based on the main biological function of the human body and muscle movement. The most natural movement of the person is walking. To accomplish this movement of people from a horizontal position, at birth, becomes vertical when rises to his feet. Therefore, to improve the functional load on the shortened lower limb, appoint an independent form of exercise therapy dosed walking with ascent and descent on special routes (path). If you raise the angle of the route and when it passes at an accelerated pace on lower limb affects significantly higher functional load than when walking on level ground.

The dosage of physical activity on the route of the path is as follows [10, S. 49-50; 73-77; 96-99; 11, C. 140-160].

1. The edit distance (number of stations, route length in metres).

2. Changing the angle of the route (NN 1,2,3,4)

3. Treason is>C) medium (80-100 step/min; 3.5 to 4 km/h)

g) fast (100-120 step/ min; 4.5 to 5 km/h)

d) very fast (more than 120 step/min; more than 5 km/h)

4. The number of stops on the route and duration.

5. The use of breathing exercises while walking on the route and stops at rest.

6. Alternating days with full routes from days or by assigning shorter routes.

When lifting the tempo slows down to a slow or very slow when the slope increases slightly. Down in rapid or very rapid pace not allowed! [3].

Depending on the distance of the route (in metres) and the angle of the route (o) the routes of the path divided by the numbers:

N 1 - up to 500 m; the angle of 2 to 5o< / BR>
N 2 - up to 1000 m; angle of 5 to 10o< / BR>
N 3 - up to 2000 m; angle 10 -15o< / BR>
N 4 - 3000-5000 m; angle of 15 -20o< / BR>
To start dosed walking, it is necessary to route the minimum complexity (N 1), gradually increasing the distance and angle of the route (NN 2,3,4).

If the patient does not have the ability to use the path, adequate physiological load the patient may receive when ascending and descending the steps in stairways is n (30-40 step/min). The stepping movement should be based on the whole foot with the fixation of attention on the quality of the installation of the foot on the surface of the support (mandatory full contact all the supporting surface of the Shoe with the surface until the completion of the walking motion).

The dosage of physical activity when walking up and down the stairs is defined like walking on the path (NN 1,2,3,4).

The distance in meters is determined taking into account the fact that the angle in the stairway does not change and is equal to about 30olength of the route between floors of approximately 6 meters. Therefore, the ascent and descent on the 5th floor will be equal to 60 meters with a slope angle of 30o. Knowing how many times the maximum amount of tilt on the route of the path is less than the 30oin the same time we reduce the distance in meters when climbing stairways.

Example: 30o/5 (maximum angle route. N 1) =6; 500 meters (distance route. N 1)/6= 83 meters (the distance in the stairway); 83 m/12 (up and down between floors)=6 (number of floors). Therefore, the ascent and descent on the 6th floor equal to the load when passing route No. 1.

Dosage power physical exertion when walking on the path and list C. C. for beginners patients previously students, is the value of the 180 - age in years.

Example: 180-20 years = 160. To begin a measured distance should be 50% (80 H. S. C.) to 75% (130 H. S. C.) from the peak, gradually increasing the distance, the angle of the route, pace of walking, reduce the number of stops and rest periods. Stops are made at frequent H. S. C. above permissible limits, or when the deterioration of subjective sensations: increased sweating, feeling of lack of oxygen, dizziness, etc.

Action five:

Combo massage (performed simultaneously dosed walking and consists of classical, periosteal, vibration).

a) Classical massage. Runs on a shortened lower limbs upwards while lying on the back from the knee to the hip and from the ankle to the knee with a predominance of toning techniques (kneading, vibration, Pat). During the massage, the patient should not feel any discomfort, even pain. The intensity of the pressure and pace of the massage increases gradually and the middle of the course should be the maximum. In the course of 10-14 procedures performed daily is ecially massage techniques (periosteal, vibration) after their implementation.

b) Periosteal massage or "crushing". A point impact on the bone and the periosteum. During exposure are excited capillary circulation and regeneration of bone cells, particularly tissue of the periosteum. During exposure, a marked reflex influence on the organs and systems involved in neuro-reflex pathways from the point of impact on the periosteum. The structure of the periosteum and its germ layer is important in the physiology of bone growth. The current stimulus in the form of mechanical pressure is a well-dosed admission to stimulate ledoobrazovanie function germ layer of the periosteum. Impact pressure should be carried out by a special technique, at certain points (germinative zones) on the femur and / or tibia.

Point of impact (germ band) at the hip: a large skewer, medial namyslo, lateral admisison.

Point of impact (germ band) on tibia: medial condyle, the head of the fibula, medial ankle lateral ankle.

The position of the fingers when holding the periosteal massage:

a) phalanges of the specified finger;

(e) the tip of the index and middle finger.

Position of patient: lying with full muscle relaxation, exposed only massaged limb. On or about the point of impact to move the soft tissue in order to achieve better contact with the bone. The pressure increase until you feel resistance bones and make small circular movements. The circle diameter up to 5 mm and Then the pressure is gradually reduced, without interrupting contact with the skin. The cycle of increasing and decreasing pressure lasts 4 to 6 seconds and repeated at the same point 2-4 minutes.

The pressure in any case should not be the nature of the drilling. Sufficient optimality of influence must be felt by the patient without discomfort and pain, and the more vegetative reactions. While the maximum point of pain massage is conducted at such distance from the pain of the heart that the pain would be portable. At the same time from procedure to procedure, we try to approach the pain center closer and closer. At the end of each procedure above each point of impact of the ball of the thumb are strong smoothing movements. Appointed 10-14 treatments a day with vibratory massage to achieve the desired effect [12,13].

The most pronounced physiological changes occur when the frequency of massage is the resonant frequency of oscillations of the massaged tissue.

The choice of equipment is very wide. The author offers the apparatus pulsar with a frequency of vibration of the vibrator 10 to 100 Hz and the changing of the driving amplitude, a large set of vibrators.

Methodology the impact of vibratory massage.

a) mobile - shortened lower limb massaged by analogy with classical massage

b) stable massaged the same region (germ band), and periosteal massage, choosing vibrators in zones of the impact and acceptability of impacts. The exposure duration 3-5 min, a frequency of 25 Hz. Through the day with a periosteal massage.

The treatment is carried out until complete disappearance of the static factor". When determining apparatus of a full horizontal line of the pelvis, the patient will be discharged with the recommendations of the permanent execution dosed codepoetry and increase static factor". On the basis of long-term clinical experience indicated that the appearance of raznovideosti lower extremities after the treatment occurs during the rapid growth of the skeleton. At that moment asymmetric growth of the left and right half of the bones of the trunk, which particularly affects the lower limbs, as they bear more than half the weight of the body. The slightest asymmetry of the lower limbs leads to disruption of hydrodynamic correlations between vascular pools of both limbs and gets hydrodynamic effect of elastic deformations [5,1]. Even a small reduction of the functional load in slightly shortened limbs leads to disruption of tissue metabolism and increases the processes osteoclastic resorption in it. The result is a gradual thinning of the compact substance of bones, thinning of the bone walls and the increase in bone marrow space.

Clinically, we observed a progressive shortening of one lower limb. With our timely intervention we use the proposed method increase hydrodynamic correlations in shortened limbs and increasing mi. Control raznovideosti required to complete cessation of growth of the limb. For even after the closure of growth in more Mature age, the hydrodynamic effect of elastic deformation does so successfully. Even at the age of 30-50 years (observation of the author)possible total correction shortened lower limbs.

As examples of the pictures before and after treatment the patient Christine M.,12 years.

The girl was admitted with complaints of pain in the back and loins, stoop. In the last 7 months the girl has seen very rapid growth (changed clothes and Shoe size). Aimed at medical exercises dispensary diagnosed with scoliosis.

An objective examination of the girl revealed asymmetry of the parts of the body. In standing position: the feet of the usual form, popliteal folds are symmetrical, the gluteal fold to the left lower than right, omitted the left hole of the diamond Michaelis, offset to the right of the upper end of the anal folds, striking asymmetry triangles waist: pronounced on the right, and almost no left asymmetry angles of the blades on the left higher than the right, the left shoulder girdle is higher than the right, the line of the spinous processes of the vertebrae curved to the left in srednjerocnom and passionate girl on her knees with black touch the thighs and shins to the planes of the support there is change in orthopedic status, as in the standing position. When standing, bend forward, when viewed from the rear, marked tarzia Nizhegorodov and lumbar spine left "Lovett - positive [8, S. 69]. Determined the asymmetry of the horizontal line of the pelvis. With the help of the apparatus of the author was determined relative length shortened left leg. It is equal to 24 mm (Photo 11 "C").

When measuring the relative length of the thigh in position on her knees she also equal to 24 mm When viewed from girls with correction of 24 mm is marked "positive aesthetic effect, the disappearance of all the above violations. Creating a hypercorrection plus 2 mm and having orthopedic lining height of 26 mm (Fig. 3, 4), she was prescribed therapeutic physical training in the gym and at home on complex medical exercises dispensary and course combined massage.

During the treatment the girl interrupted the course of medical physical culture and massage, and not regularly wore orthopedic tab due to somatic disease for 34 days, which caused a stop in the growth of a shortened left leg for 48 days.

When resuming treatment in full state of normalize the clutches, diamond Michaelis, anal folds, the asymmetry of the triangle waist, the angles of the shoulder blades, shoulder girdle, disappeared curvature of the spinous processes of the vertebrae, when stooping disappeared tarzia. When measuring horizontal line of the pelvis using the apparatus of the bubble was in the middle of the scale. The girl was discharged with significant improvement, with the recommendations of therapeutic exercises at home and advice in a month to monitor treatment (Photo 11 1 a, 2 a, 4 "a"). In pictures 11 "C" shows the position of the device on the pelvic spines.

Appendix (tables, figures, symbols)

In table 1 and 2, the author proposes an analysis of objective examination of children and adolescents, examined and treated in WFM for 3 years.

All patients for convenience, divided into groups: preschool children and pupils from the first to the tenth grade.

Most aimed at the treatment he admitted with a diagnosis of poor posture, scoliosis - 1020 people(95,4%), fracture of tibia and femur 5 people (0.5%), and 44 people (4,1%) - patients with somatic nediagnostirovanne shortening of the lower limbs (functional scoliosis).

Length shortening is presented in table 1 in millimeters:

From 0 to 5; 6 to 10; 11 to 15;

From 16 to 20; and > 20.

The largest number of patients enrolled in WFM for three years:

2 and 3 class 208 people (19,5%) of them:

boys - 92 (19.2 per cent)

girls - 116 (19,7%)

and of 5,6,7 class 369 people (34,5%) of them:

boys 141 people (29,4%)

girls - 228 people (38,7%)

Table 2 presents the analysis of shortening the segments of the lower limbs (femur, tibia, femur/tibia)

The shortening of left leg

just - 895 people. (83,7%)

hip - 221 people (24,7%)

Shin - 370 people(41,3%)

thigh/drumstick - 304 people(34%)

Shortening of the right lower limb

only 174 people (16,3%)

thigh - 43 people (24,7%)

Shin - 73 people (42%)

thigh/drumstick - 58 people (33,3%)

Given these tables, there is a certain regularity:

1) an absolute increase in orthopedic pathology in the form of a functional scoliosis > 95%;

2) a significant increase of this pathology in the preschool years and 6-8 years (2,3 class) and 10-13 years (5,6,7 class);

3) in the same age group has the highest asymmetry in the lower limbs from 6 to 15 mm;

4) in addition, there is also a stable pattern that left the shortening absolutely prevails over the right;their shins dominates the shortening of the thigh;

joint shortening of the femur and tibia fairly constant value.

From the foregoing it follows that the "functional scoliosis" has recently become the main orthopedic disorders that inadequate treatment and prevention of transitions from youth to adulthood and leads to disability (dysplastic scoliosis, osteochondrosis, and so on)


Table 1

M - male sex

G - female sex

L - the left lower limb

P - right lower extremity

O - 5; 11-15...> 20 - number of millimeters

Name 1 CL, 2 CL,... 10 CL - classes

% percent

Desk. - preschoolers.

Table 2

L - the left lower limb

P - right lower extremity


Mr. Shin

b/g - thigh/drumstick

(1), (2), (3)... - the number of literature data

Photo 11 1,2,3,4 - number of photos before treatment

Photo 11 1 a, 2 a, 3 a, 4 "a" is the number of photos after the treatment.

Fig. 1,2,3,4 - figure and its number

1 2 3 4 5 notation in figure


1 is a vertical bearing area

2 is a horizontal bearing area

3 - nut for establishing and fixing the horizontal surface of a support.

b) apparatus for determining the horizontal surface of the pelvis (top view), 4 - cross lines in the water balance or level 5 of the air bubble


a) position of patient and device at the same lower limbs

b) the position of the apparatus when the shortening of left leg

C) the position of the patient and apparatus for orthopedic tab under the left lower extremity

1) the number of mm and the position of the apparatus in the horizontal position of the line of the pelvis

2) the number of mm and the position of the apparatus during orthopedic tab.

3) orthopedic tab under the left calcaneus

Fig.4 (1 - orthopedic tab, in shoes, in mm; 2 - orthopedic lengthening heel, in mm).


1. On the role of mechanical factors in the mechanism of adaptive adjustment of the bone. C. I. Stallo, A. T. Brusko, N. F. The frost. Orthopaedics and traumatology.- N 8, 1983, S. 10-15.

2. The Lesgaft P. F. Proceedings of the society of Russian physicians NSS. 1880-1881, N 47, S. 579-595.

3. Violation of the structural organization of the epiphyseal cartilage and growth of long bones in funkcial called functional scoliosis. C. A. Ical. Orthopaedics and traumatology N 5, 1983, S. 16-20.

5. To the discussion about scoliosis. C. A. Ical. Orthopaedics and traumatology. N 8, 1986 , S. 63-63.

6. Raznovideosti feet as the cause of a large part of the lateral curvature of the spine. Orthopaedics and traumatology, No. 3, 1985, S. 72-73, a group of authors.

7. To the question about the possibility of conservative treatment of scoliosis. C. A. Ical. Orthopaedics and traumatology, No. 3, 1990.

8. Manual medicine. K. Levit, I., Sachse, C. Janda. M.: Medicine, 1993, S. 51-52, 68-75, 131-134, 193-194.

9. Chiropractic, homeopathic and acupuncture osteochondrosis of the spine. Kiev: Health, 1992, S. 60-61.

10. Therapeutic exercise and C. K. edited by Professor C. A. Epifanov.- M.: Medicine, 1990, S. 49-50; 73-77; 96-99.

11. Basic principles of treatment of patients in Kislovodsk resort. Stavropol publishing house. 1954. Dr. Pokrovsky O. M. Path, tour and trip type middle tourism and their application in Kislovodsk. C. 140-160; 337-339.

12. The practical guide to massage Century. And. Dubrovsky, N. M. Dubrovskaya.- M: Step, 1992, S. 66-84; 278-282; 370-374.

13. The massage. /Ed. by I. K. Cordes, P. Wibe, B. Cibil. M.: Medicine, 1983, S. 32-60; 144-153.

How non-surgical lengthening of the lower to the about are hypercorrection shortened limbs 2 mm, provide therapeutic dosed walking, classic, periosteal massage shortened limbs and vibratory germinative zones of short segments of the limb.


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