Method of treating myofascial pain accompanying spine osteochondrosis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, orthopaedics, reflexotherapy, physiotherapy exercises, recreation therapy and is applicable in integrated treatment of myofascial pain accompanying spine osteochondrosis. Pain management procedures are followed by a complex of exercises with using the HUBER apparatus consisting of seven staticodynamic exercises aimed at strengthening and activation of muscles of upper limb girdle, greater pectoral muscle, pelvic floor muscles and gluteal muscles. It is combined with loading and coordination improvement of left broadest muscle of back, left obliques, left lumbar quadrate muscle. Upper shoulder anchors, broadest muscle of back and rhomboid muscle are relaxed, and postural muscles are coordinated. Lumbar spine muscles are relaxed. Tone in upper extremity and back muscles is strengthened. It is followed by making exercises for activation of muscles of upper limb girdle, pectoral muscles, pelvic floor muscles, gluteal muscles. Then, the exercises for strengthening of lumbar muscles for the purpose of improving the body position coordination, relaxation of back ground of femoral and hip muscles, strengthening of abdominal wall muscles.

EFFECT: method improves support ability of feet, normalises position of the centre of gravity, forms an optimum motor conditions.

3 ex, 7 dwg

 

The invention relates to medicine, namely, neurology, orthopedics, acupuncture, physical therapy, rehabilitation, and can be used in the treatment of myofascial pain syndromes of spinal osteochondrosis

There is a method of treatment of myofascial pain syndromes with osteochondrosis of the spine by stretching using the measured tensile loads (patent RU №2163108, "a Method of treating degenerative disc disease in its clinical manifestations") or impact on the spine simultaneously in the transverse and longitudinal directions in the transverse direction affect the musculoskeletal apparatus in vibrate mode, and in a moment of forced stretching of the lumbar and thoracic spine - if you disable vibration (patent RU №2092148, "Method of stretching the patient's body").

The disadvantage of this method is uncontrolled stretching of the muscles and ligaments as a result of treatment and, as a consequence, the weakening of the muscular and Hyper-mobility of the vertebral motor segment. In no way active purposeful impact on the weakened muscles of the upper shoulder girdle, pectoral muscle, the pelvic floor muscles and gluteal muscles. After treatment saved violations movement patterns and postural balance.

There is a method of influence on possano the nick with Wellness chairs by creating multiple cycles of moderate stretching and compression of intervertebral discs, ensuring their internal massage (Patent RU №2069061, "Wellness chair").

The disadvantage of this method is the impossibility of dispensing the optimal load on the vertebral motor segment, which may be the cause of spondylolisthesis and the weakening of the muscular corset. In addition, there is no active purposeful impact on the weakened muscles and saved pathological motor stereotype.

Thus, these treatments do not contribute to the formation of an optimal movement pattern, the violation of which is the main cause of myofascial pain syndromes of spinal osteochondrosis and inevitably leads to relapse.

Closest to the claimed method is active physiotherapy technology "Huber" ("HUBER", LPG Systems, France) (Medical technology "Use hardware "HUBER" in clinical practice"; the registration certificate FS-2007/162, expiration date 07.08.2007-11.11.2014: OOO Esthetician). The peculiarity of the method used in this technology is the impact on all the muscular chains of the body from the feet to the hands at the same time with the active or passive isotonic and isometric muscle force. During therapeutic session is multisensory effect on the Whateley and nervous system, which leads to recovery of static and dynamic stereotypes, muscle tone, increase range of motion.

The apparatus HUBER equipped with a motorized platform with variable speed and amplitude of rotation, creating an unstable support for the patient, and dynamic vertical column, which is equipped with a system of horizontal handles with touch sensors corresponding to different zones of the body.

The patient has an effect on the handle of the column (pulled or pushed) with some force, at the same time adapting to the instability of support. Screen feedback in real-time shows the patient the magnitude of the impact, allowing them to coordinate their efforts and to regulate the activity of different muscle groups. Motorized platform makes consistently to work muscle groups that are responsible for the mobility of the spine and coordination.

Thus, the method allows for balanced strength and coordination of movement and postural control muscles for active posture correction and stabilization of the vertebral motor segment.

However, this method cannot be used in full in the treatment of patients with severe myofascial pain syndrome, because pathological pain impulses generated by three is gernamy points, formed in postural muscles, not allowing the patient to fully develop balanced strength and coordination of movement and forces him to "spare" the area of pain.

The objective of the invention is to develop a method for the treatment of myofascial pain syndrome in spinal osteochondrosis by affecting the pathogenesis of myofascial pain and active physiotherapy for the maximum possible recovery for optimal postural balance.

The problem is solved due to the fact that these medications stop pain syndrome simultaneous introduction to trigger points 1 ml reopoligliukina and 1 ml of 2% lidocaine solution for 30 minutes before performing exercises; conduct exercises, consisting of seven static-dynamic exercises, in the initial positions are presented in figure 1-7, aimed at strengthening and activation of the muscles of the shoulder girdle, the pectoralis major muscle, the pelvic floor muscles and muscles of the gluteal region, the load generation and better coordinate of the left latissimus, left obliques, the left square of the muscles of the waist; relaxed the top clamps of the scapula, the latissimus and rhomboid muscles, coordination, postural muscles, relaxation of the muscles of the lumbar spine, strengthening muscle tone top konechnosti and back; the exercises to activate the muscles of the shoulder girdle, chest muscles, pelvic floor muscles, gluteal muscles; next, perform exercises to strengthen the back muscles, to improve the coordination of body position in space, relaxation of the back muscles of the thigh and lower leg strengthening the muscles of the abdominal wall. Held 8-10 sessions, each of which consists of 7 exercises.

The solution of this problem allows to create an optimal motor pattern.

The technical result is achieved due to the impact on the pathogenetic mechanism of occurrence of myofascial pain - local hypertonus by inactivation of trigger points established in the field of hypertonus. Temporary inactivation of trigger points in the postural muscles is performed by the correction hypotonic space trigger zone introduction reopoligliukina and anesthesia in this zone. Thus, stops the generation of pain pulsation, and this allows the patient to repeatedly develop balanced strength and coordination, included in a specially designed set of static-dynamic exercise apparatus HUBER. The complex allows to improve the support ability of foot to normalize the position of the center of gravity and to shape the patient's optimal engine is the first stereotype, what prevents recurrence of the disease.

Figure 1 shows the position of the patient's body during exercise No. 1, aimed at strengthening and activation of the shoulder girdle, chest muscles, pelvic floor muscles and muscles of the gluteal region.

Figure 2 presents the position of the patient's body during exercise No. 2, aimed at creating a load on the left latissimus back, left obliques and left square muscle of the lower back and to improve coordination of the muscles.

Figure 3 presents the position of the patient's body during exercise No. 3, aimed at relaxation of the upper locking shoulder (trapezius muscle, muscles, levator scapulae), latissimus and rhomboid muscles and coordination mainly postural muscles.

4 shows the position of the patient's body during exercise No. 4, aimed at relaxation and relaxation of the muscles of the lumbar spine and strengthening the muscles of the upper extremities and back.

Figure 5 presents the position of the patient's body during exercise No. 5, aimed at the activation of the muscles of the shoulder girdle, chest muscles, pelvic floor muscles, gluteal muscles.

Figure 6 presents the position of the patient's body during exercise No. 6, aimed at strengthening ysz waist and to improve the coordination of body position in space.

Figure 7 presents the position of the patient's body during exercise No. 7, aimed at relaxation of the back muscles of the thigh and lower leg strengthening the muscles of the abdominal wall.

The method is as follows.

30 minutes prior to the procedure the patient identifies active trigger points in the postural muscles and muscle-tendon structures by palpation and manual muscle testing. Then a medical-pharmacological blockade for temporary inactivation of trigger points of the concerned muscles and muscle-tendon structures by simultaneous injection of 1 ml reopoligliukina and 1 ml of 2% solution of the local anesthetic lidocaine. During the next 20-40 minutes (depending on the state of the muscular corset of the patient and the number of sessions completed) is active kinesitherapy on the device "HUBER", including seven of physical exercises, allowing balanced in strength and coordination and control of muscles, for the formation of postural balance and optimal movement pattern.

Before the main exercise is a warm-up, representing a balance with open and closed eyes on a rotating platform with different position of the upper and lower extremities with the aim of passive-active expansion of the range of motion in all joints of the body and stimulation of the influence of natural gravity on the main axial joints. The exercises begins in limited amounts and gradually increase the load and amplitude. All movements of the patient with lumbar osteochondrosis performs while maintaining its vertical position, thus avoiding undue stress on the spine.

During exercise the rate and amplitude of rotation of the platform is determined individually and is maintained throughout the course of treatment. Information screen of the device reminds the patient the position of his arms and legs, the direction and the direction of movement of the platform. For each phase should pause for rest, which allows the patient to prepare for the next exercise.

Exercise # 1

1. The initial position of the patient (Figure 1). The patient is at the center of the platform, legs slightly bent at the knee joints, are shoulder-width apart, feet parallel, the position of the pelvis extensionnode. The type of abdominal breathing.

2. A description of the exercise. During inhalation, the hands carry downward and toward each other, thereby straining the pectoralis major muscle. During exhalation hands relax. This is simultaneously the static-dynamic tension of the pelvic floor muscles and gluteal muscles during inspiration and relaxation during exhalation. The angle of the platform is constantly changing.

Control the Addendum No. 2

1. The initial position of the patient (Figure 2). The patient carries out the transfer of the center of gravity of the body on the left leg. The right leg is delayed ago with the goal of keeping balance during operation of the platform. The left hand is located in the lower position of the rod, right at the top.

2. A description of the exercise. When the motion platform is barbell press seated left hand down to create a load on the left latissimus back, left obliques and left square muscle of the loin.

Exercise # 3

1. The initial position of the patient (Figure 3). The patient moves the center of gravity of the body on the right leg and carries out the focus on her. The left leg is set aside from the center of the platform in the opposite direction with the aim of preserving equilibrium. Hands fixed on the rod in the middle position at chest level.

2. A description of the exercise. Hand carry pressure on the principle of "push". This blade is maximally lowered into the lower position, which promotes relaxation of the upper locking shoulder (trapezius muscle, muscles, levator scapulae), latissimus and rhomboid muscles and coordination mainly postural muscles.

Exercise # 4

1. The initial position of the patient (Figure 4). The legs are mounted on the front surface of the platform. Feet parallel to each other, bent at the knees. The knees don't go out the front from the vertical fingertips. The pelvis is extensii. Hands fixed on the upper end of the rod is in the maximum position.

2. A description of the exercise. During the movement of the platform hand hold the top of the crossbar so that the load on the legs was minimal, which creates maximum relaxation of the lumbar spine during the exercise.

Exercise # 5

1. The initial position of the patient (Figure 5). The starting position is similar to exercise # 1 - the body centered, feet are parallel to the surface, pelvis extension, but the hands are placed on the lower crossbar of the rod. The type of abdominal breathing.

2. A description of the exercise. During inhalation, hand carry pressure down (towards the floor), followed by a voltage large pectoral muscles. During exhalation hands relax. When this exercise is also the tension of the pelvic floor muscles and gluteal muscles during inspiration and relaxation during exhalation.

Exercise # 6

1. The initial position of the patient (6). The right leg is in front of the platform, the left most removed; the right hand holds the lower left handle bar, left - to-right top.

2. A description of the exercise. The exercise is performed in two ways. In the first and second embodiment, the initial position of the patient in the same way. At the moment with the arsenia efforts, the patient takes a breath, during relaxation exhale.

In the first embodiment, the pressure of the hands is concentrically clockwise in the direction of inclination of the body. In the moment of effort, the patient takes a breath while relaxing exhale.

In the second embodiment, the pressure of the hands is concentrically counterclockwise.

Exercise # 7

1. The initial position of the patient (7). The patient is at the center of the platform. Feet parallel, legs are straight and are in the middle of the platform. Hands locked in the neutral position at the secondary level crossbar rod. During exercise, breathing free.

2. A description of the exercise. During the exercise the hands operate the type of "push". Legs are straight, are in the center of the platform - emphasis on heels. Feet maximum stretch for themselves. The body is maximally tilted back.

The treatment consists of 8-10 sessions. The course duration depends on the time of onset of stabilization of all parameters and termination of the positive dynamics. Clinical observations have shown that a clear positive trend observed in patients after the first session, however in the future it becomes less pronounced and after 8-10 session is terminated.

Examples of clinical application.

Patient Century, 42, housewife (outpatient map 032), nah who was born in outpatient treatment with a diagnosis of osteochondrosis L3-L4-L5, intradiscal dystrophy, chronically relapsing neprochitannoe for, aggravation, stationary phase syndrome lumbar ischialgia right, stage III, 3 the severity of clinical manifestations.

Objective: normostenik, moderate power, muscle growth moderate, heart sounds clear, rhythmic, the abdomen is soft, painless. The gentle gait. Hiperlans in the lumbar spine with the top of the L4-L5 - 1 tbsp. increase pain and megastorage period of L4-L5 motion in the vertebral motor segment L3-L4-L5 is limited in all directions: extension - 2 tbsp., inflexion - 2 tbsp., lateroflexion - 2 tbsp. right and left, tense and painful glutes, square arm to the right, the tensor fasciae latae hips. Stabilography revealed a deviation of the center of gravity of dorso-lateral to the left.

Treatment: before conducting each session was conducted palpation of muscle testing to identify trigger points. Therapeutic drug blockade simultaneous introduction 1 ml reopoligliukina and 1 ml of 2% lidocaine solution was carried out in megastate ligament at the level of L4-L5, L3-L4, trigger point, the square of the muscles on the right and lumbar-iliac ligament on the right. After 30 minutes, the patient started to perform complex designed exercise apparatus "HUBER". Performed all the exercises with the settlement of eponym increase session length by increasing the number of repetitions. Conducted 10 sessions.

Evaluation of treatment results: significant improvement, partial remission of type 1 level of rehabilitation. Stabilography after 5 and 10 sessions showed consistent improvement support ability of foot and normalization of the position of the center of gravity to the end of the treatment.

In follow-up after 6 months notes good health that can be measured as complete remission.

Patient S. 38 years, occupation - accountant, was in outpatient treatment with a diagnosis of osteochondrosis L4-L5. Spondylolisthesis, uncovertebral arthrosis, chronically relapsing, neprochitannoe for, aggravation, stationary phase syndrome papatowai ligament on the right, stage II syndrome, 3rd severity of clinical manifestations. Related: the syndrome of a vegetative dystonia on hypertonic type.

The gentle gait, scoliosis C-shaped, the top-level Th6-7 to the left, shorten the left leg 0.7 cm, the shortening of the superior oblique muscles of the head to the right. Marked tenderness in the projection of papatowai ligament on the right, pain in the projection L4-L5 on both sides. Weakened abdominal muscles, short flexor head, regional postural imbalance of the muscles of the upper Christianized syndrome. Stabilography revealed a sharp deviation of the center of gravity of ventro-lateral to the left.

Treatment: before provedennoego session was conducted palpation of muscle testing to identify trigger points. Therapeutic drug blockade simultaneous introduction 1 ml reopoligliukina and 1 ml of 2% lidocaine solution was carried out paravertebral at the level of L4-L5, trigger point, papatowai ligament on the right and in the lumbar-iliac ligament on the left. After 30 minutes, the patient started to perform complex designed exercise apparatus "HUBER". Performed full range of exercises, with a gradual increase in the duration of the session by increasing the number of repetitions. Conducted 10 sessions.

When carrying out a course of treatment of pain in the groin area were stopped completely, there is a slight limitation of motion in the lumbar spine in the direction of extensii, a slight restriction of the rotation of the neck to the right, lateroflexion left.

Stabilography after five and ten sessions showed consistent improvement support ability of foot and normalization of the position of the center of gravity to the end of the treatment.

Assessment results: a significant improvement, partial remission of type 1 level of rehabilitation.

In follow-up after 8 months of stable remission, occasionally during exercise is marked discomfort in the lumbar region. Periodically doing gymnastics.

Patient M., 54, teacher (outpatient map No. 074)were in outpatient treatment with a diagnosis of osteochondrosis L4-L5, inside disc degeneration, unco ertabyldy osteoarthritis, chronically relapsing, neprochitannoe for, aggravation, stationary phase syndrome, lumbalgia, stage II, 3-I degree of clinical manifestations. Accompanying diseases: polycystic breast cancer on the right, chronic gastritis.

The gentle gait, scoliosis S-shaped, the top-level Th6-7 to the right, the right limb shortening 0.6 cm, the shortening of the superior oblique muscles of the head to the right. Marked tenderness in the projection L4-L5, pain multifidus muscle on the left and the ilio-costal right. Weakened abdominal muscles, isochronally muscles, short flexor head. Stabilography revealed a deviation of the center of gravity of dorso-lateral to the right.

Treatment: before conducting each session was conducted palpation of muscle testing to identify trigger points. Therapeutic drug blockade simultaneous introduction 1 ml reopoligliukina and 1 ml of 2% lidocaine solution was carried out in megastate ligament at the level of L4-L5, trigger point, multifidus muscles on the left and lumbar-iliac ligament on the right. After 30 minutes, the patient started to perform complex designed exercise apparatus "HUBER". Performed full range of exercises, with a gradual increase in the duration of the session by increasing the number of repetitions. Conducted 10 sessions.

When carrying out the exchange rate L. the treatment of pain in the lumbar spine were stopped completely, there is a slight restriction of the rotation of the waist to the right, lateroflexion left and right. Stabilography - after five and ten sessions showed consistent improvement support ability of foot and normalization of the position of the center of gravity to the end of the treatment.

Assessment results: a significant improvement, partial remission of type 1 level of rehabilitation.

In follow-up through 12 months of stable remission, occasionally during exercise is marked discomfort in the lumbar region.

A method for the treatment of myofascial pain syndromes of lumbar degenerative disc disease through active kinesitherapy on hardware "HUBER", characterized by the fact that these medications stop pain syndrome simultaneous introduction to trigger points 1 ml reopoligliukina and 1 ml of 2%lidocaine solution for 30 minutes before performing exercises; conduct exercises consisting of seven static-dynamic exercises in the initial positions, shown in Fig.1-7 aimed at: strengthening and activation of the muscles of the shoulder girdle, the pectoralis major muscle, the pelvic floor muscles and muscles of the gluteal region; creating load and better coordination of work left the latissimus, left obliques, the left square of the muscles of the loins; relaxation of the upper tabs of the blades, the latissimus and rhomboid muscles, is ordinatio postural muscles; relaxation of the muscles of the lumbar spine, strengthening muscle tone in the upper limbs and back; conducting exercises to activate the muscles of the shoulder girdle, chest muscles, pelvic floor muscles, gluteal muscles; next, perform exercises to strengthen the back muscles, to improve the coordination of body position in space, relaxation of the back muscles of the thigh and lower leg strengthening the muscles of the abdominal wall.



 

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EFFECT: method provides reducing length of treatment in animals, promotes healing of deep ulcers and adherence of the detached hoof with hoof healing and growing.

3 cl, 6 dwg, 2 tbl

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to chemical-pharmaceutical industry, particularly a new antituberculous drug which contains as an active substance dicalcium salt heptahydrate of paraaminosalicylic acid in a therapeutically effective and safe amount, and also pharmaceutically acceptable excipients. Besides, the invention refers to a method of treating tuberculosis.

EFFECT: drug under the invention exhibits smaller toxic effects, and also increased spectrum of bacteriostatic activity.

3 cl, 6 tbl, 5 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to chemical-pharmaceutical industry, and concerns a composition and a technology of finished dosage forms of phospholipid nanoparticles of the size of 25 nm. The preparation is intended for oral administration for the purpose of therapy of lipid storage disease as a hypocholesterolemic agent. An infusion form is presented to be applied in injections in therapy of toxic and pre-comatose states. The phospholipid therapeutic composition for lipid storage disease and hepatic comatose and pre-comatose state in the form of the phospholipid nanoparticles of the size of 15-25 nm contains phosphatidyl choline, phosphatidyl ethanolamine and maltose. A method for making said phospholipid therapeutic composition consists in the fact that phospholipid, phosphatidyl ethanolamine and maltose are suspended in water, and the prepared suspension is exposed to a number of microfluidisation cycles at pressure 1700-1900+10% bar, temperature 40-55°C to be lyophilised.

EFFECT: preparations represent long stored lyophilised powders.

4 cl, 3 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and may be applied as an agent for prosthetic stomatitis accompanying a denture adaptation period. It involves mouth rinsing with 0.2% aqueous acetylsalicylic acid. The regimen is at least three times a day before meals. The length is at least five days.

EFFECT: method enables decreasing saliva viscosity and surface force, enhancing its wetting properties, providing a shorter denture adaptation period.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry and is intended for treatment of alveolar nerve trauma in dental implantation. Trapezoidal cut starting in retromolar region to medial part of canine is made. By means of apparatus "Piezosurgery" at angle 45° osteotomy in form of a rectangular window is made. Bone autotreansplant is formed. Through obtained bone window inferior alveolar nerve is taken on ligatures. Dental implant is removed. Bone wound is washed with 1% solution of dioxidine and processed through 0.05% miramistin solution for 5 minutes by waveguide from apparatus "Optodan". Bone defect is covered with autotransplant, resorbable membrane "Paradonkol" and muco-periosteal flap. Wound is sewn with interrupted sutures and isolated with film with metronidazole from oral cavity. Phonophoresis with 0.5% hydrocortisone solution, 10-12 procedures per course, amplipulse-phoresis with 2% nicotinic acid 10-12 procedures per course, acupuncture in Valle points - in places of entrance and exit of inferior alveolar nerve from lower jaw, 10-12 procedures per treatment course with measurement of indices of electroexcitability of skin of chin, cheek, mouth angle and pulp of teeth with application of apparatus PARKELL I time per day are performed.

EFFECT: method makes it possible to reduce operation trauma, reduce period of complete recovery of sensitivity in respective zones of face skin and pulp of teeth, innervated by inferior alveolar nerve due to carrying out complex therapy and constant control of indices of electroexcitability of respective face zones.

3 ex

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