Method for rehabilitation of patients suffering deforming arthrosis of knee joints

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to - arthrology, physiotherapy, balneology. The method involves physical methods of therapy, therapeutic exercises, massage, acupuncture and phytotherapy. The patients are trained to give a self-massage of the knee joints additionally during the resort therapy and after the termination of the rehabilitation. From the 1^st to 10^th day of the therapeutic course patient's knee joint is exposed to polychromatic polarised light at 20 cm for 6 minutes. The patients take 10 iodine-bromine baths at temperature 37°C for 10 minutes. From the 1^st to 5^th therapeutic days, the patients do combined therapeutic exercises; their lower extremities are massaged manually for 10 minutes. From the 6^th to 15^th days, the knee joints are exposed to sinusoid modulated currents (SMC) at modulation frequency 100 Hz, at a depth of 50 - 70%, current intensity to moderate vibration for 7 minutes. From the 6^th to 10^th days, the braking acupuncture follows by giving a 1-2-minute massage of the points 10RP, 9RP, 36E, 34E by introducing a needle for 30 seconds and by giving a point massage of cheng-fu, cuan, yang-lin-cuan, zu-sang-li, wei-yang, cheng-shan, chung-feng, hun-lun, nei-ting. The patients take a herbal infusion. From the 11^th to 15^th days, the knee joints are exposed to decimetric waves (DMW). That is followed by a hydro-massage of the lower extremities and lumbar region for 15 minutes up to 3 atm. Thereafter, the 10-minute post-isometric relaxation of the quadriceps muscle of thigh is applied. The patients do the complex of weight reduction exercises and take the herbal infusion. From the 16^th to 20^th day, the mud applications on the knee joints are prescribed at temperature 42°C for 30 minutes. If suffering gonarthrosis, the patients do the complex of therapeutic exercises. That is followed by the paravertebral vacuum therapy of the vertebral column. The 10-minute knee joint traction is applied. The patients take 20 g of the herbal infusion.

EFFECT: method recovers the joint mobility, improves the exercise tolerance of the lower extremities.

1 tbl, 2 ex

The invention relates to medicine and can be used in the rehabilitation of patients with deforming arthrosis of the knee joints in the conditions of the resort.

Osteoarthritis of the knee (OAKS) has recently attracted the attention of doctors of various specialties: it affects at least one third of the population over 60 years of age, the disease can occur in younger age groups.

Evaluation and management of patients with osteoarthritis of the knee (the OAKS) is a challenge for physicians of any specialty who face this disease. In recent years there has been a trend towards a significant increase in the number of persons suffering from osteoarthritis. The main reason leading the patient to the doctor, are pain, leading to muscle atrophy and dysfunction of the joint. Patients with lesions of the joints of the lower extremities become less active, which leads to deterioration of the musculoskeletal system. All this indicates the necessity of selection for patients OAKS rehabilitation programs.

In this regard, it is important to develop programs of rehabilitation treatment of patients with deforming arthrosis at the sanatorium stage.

With the decline of the popularity of "chemical" medicine continues to flourish medicine alternative or atradition who I am. Along with medicines, there are many health factors that play a significant role in the treatment of certain diseases.

To alternative medicine in our time are: physical therapy, physiotherapy, acupuncture, healing herbs, acupressure and some other types of massage, different therapies.

Non-pharmacological methods of treatment of osteoarthritis is one of the fundamental methods in the treatment of osteoarthritis. New techniques and modern equipment significantly increased the effectiveness of non-pharmacological therapy and made it the leading in the treatment and prevention of arthritis.

They can eliminate the harmful effects of drugs on the body and to get the maximum effect of the treatment.

The problem of rehabilitation of patients with deforming arthrosis of large joints of the lower extremities at the sanatorium stage is a very relevant and socially significant. OA of the knee (OAKS) has attracted special attention because of high prevalence, often progressive course and early disability and constancy of pain, significantly violate physical activity, quality of life and contributing to the development of depression.

The main goal of the treatment of osteoarthritis is to prevent the progression of degeneration of HRA is a and the maximum possible preservation of joint function. Therapy must be comprehensive, differentiated, long-term, systematic. You must consider a variety of factors that caused the disease, and stage peculiarities of the clinical course, the degree of dysfunction of the musculoskeletal system. Treatment should include both methods of influence on the local process in the joint, periarticular tissues, and effects on the body as a whole.

Extremely wrong are often recommendations are hard to develop a joint, “to disperse salt”, “feeling the pain” is often intensifies pain syndrome, provokes acute synovitis and worsens the course of osteoarthritis.

The well-known technique in the rehabilitation of patients V.M. Kovalenko, Opportunit. Osteoarthrosis. Practical guide. - K.: Morion, 2003. S. 230. From the first days of treatment the patient is prescribed medication (if necessary and intravenous drip medicine) in combination with electrophoregram and other non-pharmacological methods of treatment.

Basic principles for the treatment of osteoarthritis. Mechanical unloading of the joint is one of the most important aspects in the treatment of osteoarthritis. This includes recommendations for reducing body weight in obesity, excluding long stay in a fixed position, long standing, long walk, repeat the already stereotyped movements, moving large weights, which leads to mechanical overload of certain surfaces of the same joints.

High analgesic and anti-inflammatory effect has nonsteroidal anti-inflammatory drugs (NSAIDs). The most well established voltaren due to the good tolerability in the application. Brufen, ibuprofen, with a slightly lower therapeutic activity, is also well tolerated by patients, particularly in old age. Well tolerated and highly effective new NSAID - xefocam.

With success can be applied drugs other groups NSAIDs: flugeln, piroxicam, indomethacin.

The disadvantage of this method is the harmful effects of drugs on the body.

As therapeutic efficacy and tolerability of different NSAIDs in each patient individually, and when you assign them the necessary personal approach to assess both the efficiency and side effects of all drugs used.

The reduction of joint pain when taking NSAIDs may induce the patient to the disturbance regime, increased motor activity.

There is a method of treatment of osteoarthritis deformans in the conditions of sanatorium rainbow. http://www/sp-raduga.ru/Diseases/Diseases54/aspx. The use of pharmacotherapy in patients with osteoarthritis it is recommended that only the ineffectiveness of rehabilitation IU is opriate. In the conditions of the resort is the medication in combination with electrophoregram and other non-pharmacological methods of treatment. Physiotherapy is prescribed from the first days of treatment, even in case of aggravation of the disease. Treatment includes: various types of massages, baths, mud therapy, the impact of the shower, hirudotherapy, electrical stimulation, acupuncture, magnetoterapia, acupuncture, shock wave therapy, ultrasound, physical therapy, laser therapy, ozone therapy, ultraviolet blood irradiation.

In a way not reflected in the combination of therapeutic measures, the interaction and the sequence of their execution, which would comprehensively affect patients with deforming arthrosis of knee joints for better treatment of the disease.

Insufficiently developed a program of exercise therapy and its relationship to the program of physiotherapy, which may increase the effectiveness of treatment.

The objective of the invention - effective care to patients with deforming arthrosis in the form of a comprehensive program of non-pharmacological conservative treatment, including physical therapy combined with physical therapy in the conditions of the resort.

This object is achieved by a method of rehabilitation of patients with deforming arthrosis of the stake is different joints in the conditions of sanatorium, including physical therapies, physical therapy, massage, acupuncture, herbal medicine.

Patients are taught, and they additionally perform during treatment in sanatoria and after completion of the rehabilitation, self-massage of the knee. During the course of treatment from 1 to 10 day exercise impact on patient polychromatic polarised light from the stationary apparatus "Bioptron-1", containing various wavelengths ranging from 400 nm to 2000 nm at a power flux density of 40 mW/cm²the flux density of light energy per minute of 2.4 j/cm²the beam of light is directed to the region of the knee joint from a distance of 20 cm for 6 minutes Patients taking iodine-bromine bath at a temperature of 37°C 10 min No. 10. 1 through 5 day patients perform complex medical gymnastics with arthritis of the knee, get a manual massage of the muscles of the lower extremities 10 minutes From 6 to 15 day affect knee joints sinusoidal modulated currents (SMC) with a modulation frequency of 100 Hz, a modulation depth of 50-75%, duration parcels 2:3, rated current up to moderate vibration, the kind of work III-IV for 5 min each, mode 1, 7 min. From 6 to 10 day hold acupuncture on braking technique, conducting massage points 10RP, 9RP, E, E 1-2 min and introducing the needle for 30 min, hold acupressure points Cheng fu, Chuan, Yang-Ling-Chuan, zu-San is-Lee, Wei Yang, Cheng Shan, Zhong Feng, Huynh Harrier, nei ting, take an infusion of 15 g of the medicinal plants of the following composition: Linden flowers, calendula 3 pieces of root, elecampane root, yarrow herb 2 parts, mint, oregano, St. John's wort 1 part. From 11 to 15 day impact decimeter waves (UHF) on the area of the knee joint power of 15 W for 10-15 minutes, then conduct a hydro-massage of the lower extremities and lumbar region 15 min at pressures up to 3 atmospheres, then spend postisometric relaxation of the quadriceps femoris 10 min at the initial position of the patient lying on his stomach, leg bent at the knee, the initial position of the doctor is facing the head end of the couch, his hand locking rear foot, breath - patient extends the knee, and the doctor has a resistance, position fixed on 9-12 seconds on the exhale - the doctor increases the flexion passively stretching the muscle, the reception is repeated 3-4 times, patients perform exercises to reduce weight, take infusion of 20 g of the medicinal plants of the following composition: leaf bearberry, cranberry, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root 2 parts. From 16 to 20 day ill get mud laying mud applications on knee joints of sulfide mud at a temperature of 42°With a thin layer 3 is m for 30 min, perform complex medical gymnastics with arthritis of the knee joint to restore range of motion in the joint, hold the vacuum therapy lumbar region of the spine, paravertebral, perform traction of the knee joint methods of manual therapy or using a traction apparatus 10 min, take an infusion of 20 g of the medicinal plants of the following composition: leaf bearberry, cranberry, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root 2 parts.

The novelty of the invention:

1. Patients are taught, and they additionally perform during treatment in sanatoria and after completion of the rehabilitation, self-massage of the knee joints.

2. The first 10 days patients take treatment of polarised light from device "BIOPTRON-1", which gives good results in the treatment of acute and chronic pain. Iodine-bromine bath at a temperature of 37°C 10 min, which have a pronounced anti-inflammatory and antispasmodic effect, improves microcirculation and regeneration of cartilage tissue, trigger collagen synthesis, increase immunity. After physiotherapy from 1 to 5 day patients perform complex medical gymnastics with arthritis of the knee, get a manual massage of the muscles of the lower extremities.

3. From 6 to 10 days, patients continue to receive treatment polarized the first light and iodide-bromine baths, 6 through day 15 receive treatment on knee joints sinusoidal modulated currents (SMC), causing improved blood flow, lymphatic drainage, and reduce spasms of blood vessels, as well as suppression of transient activity conductors pain sensitivity and autonomic ganglia, reducing inflammation. Then from 6 to 10 day hold acupuncture - when expressed painful syndrome it is applied on the brake technique, perform acupressure. The treatment has an anaesthetising effect, relieve pain impulses, regulate vascular tone, improves blood circulation, mobilizes the immune system. The tincture of herbs.

4. From 11 to 15 day impact decimeter waves (UHF) on the area of the knee. As a result of heating of the tissue in the area of SCM, is expanding and increasing the number of functioning capillaries, increase in blood flow, increased vascular permeability, which leads to increase circulation, reduce swelling, inflammation and autoimmune reactions. Then conduct a hydro-massage of the lower extremities and lumbar region, which is equipped with water jets. The powerful jets stimulates and gives tone to the tissues and muscles; causes expansion of blood vessels of the skin and the whole body, which helps boost process is and circulation, metabolism, weight loss. Hot tub - a panacea for stress, tension, and the best armor from the adverse environment. Underwater massage promotes rapid resorption of hemorrhages and accelerates the recovery process. The following treatment - postisometric relaxation (PIR) of the quadriceps femoris. The effect of the feast is an example of direct increase and decrease the pain of passive and active movements in the joint, and to reduce the voltage of pain and increasing the length of the previously spazmaticly shortened muscles. Then the complex of exercises for weight loss that allows you to reduce the load on the joint. The tincture of herbs.

5. From 16 to 20 day ill get mud laying mud applications on knee joints of sulfide mud. Under the influence of mud recedes pain, increases joint mobility, increase muscle elasticity, improves skin elasticity. Then perform a set of therapeutic exercises with arthritis of the knee joint to restore range of motion in the joint. Spend vacuum-therapy lumbar region of the spine, paravertebral that allows you to quickly and safely stop pain syndromes. In places of special medical suction cans increases lymph and blood circulation in the skin, cloth the x and organs, improves tissue nutrition. Perform traction of the joint methods of manual therapy or using a traction device. Is the traction with the aim to dissolve the bones, increasing the distance between them and thus reducing the load on the joint. The tincture of herbs.

Our proposed method of rehabilitation treatment of patients with deforming arthrosis of the lower extremities has significant differences from analogs and prototypes, provides for the implementation of non-pharmacological methods of treatment of deforming arthrosis in combination with other treatments Spa treatment in the form of a comprehensive program for the entire course of stay at the resort. The method improves clinical symptoms: relieves pain in muscles and joints, muscle spasm, increases muscle strength and blood circulation at the level of microcirculation in the tissues of the diseased limb, restores mobility to the joints. We believe that the proposed method of treatment at the sanatorium stage will not only improve clinical symptoms, but also improve the social effectiveness.

One of the impacts that may alleviate the condition of the patient with osteoarthritis, is physiotherapy. Various methods of physical therapy effects, first of all, are used for their analgesic effect. At the same time the I they have a favorable effect on metabolic processes in the cartilage, microcirculation in bone, synovial membrane, periarticular tissues. Physiotherapy can improve the efficiency and quality of performance physical therapy, as by removing the pain and preparing the muscles of patients can actively and in large quantities to perform physical exercises that can increase the effectiveness of the treatment.

Objectives of exercise therapy in complex treatment of osteoarthritis can be represented in the form of a pyramid whose base is the restoration of mobility and the necessary range of motion in the joint; increase strength and muscle endurance; aerobic exercise. On this basis, in fact, are all other methods of rehabilitation treatment. The first task is therapeutic.

Regular, well-chosen exercises are provided at the joints healing effect.

Physical activity for a healthy person is prevention. When performing physical exercises applied force, the fluid containing nutrients, is squeezed out of the cartilage, as if it was a wet sponge. Then, when the pressure is removed, the fluid is re-absorbed by the cartilage, which thus receives nutrients and becomes wet. Continuous extrusion and the absorption liquid are important to ensuring the health of the cartilage. the ez this cartilage becomes thin, dry and more vulnerable.

The appropriate exercises not only support cartilage sponge" in a healthy state, they also strengthen the structures surrounding the joint, which reduces the load on the joint itself.

However, for those who are already sick, exercise useful and are an excellent tool for the treatment of osteoarthritis. They contribute to nutrient retention of fluid in the diseased joint and strengthening the surrounding structure, reduce the load on the joint itself. therapeutic effect of exercise programs with a predominant effect on the quadriceps muscle of the thigh is manifested a significant decrease in the intensity of pain and stiffness at rest, increase range of motion and improved functional performance of the knee in patients with gonarthrosis.

The second goal is weight control.

Numerous studies show that a favorable prognosis in the treatment of joints affected by the education of the patient and his level of intelligence. Understanding that patients with joint it is necessary to live, work, what with the disease must be considered, should lead to changes in the lifestyle of the patient, in which high locomotor activity should reasonably be combined with a strict regime of unloading of the joint. The awakening of motivation to physical activity, healthy lifestyle, train is their necessary motor skills, teaching the patient to physical therapy techniques for independent use, also is the most important task of exercise therapy in the treatment of arthritis.

Therapeutic exercise for this is gentle mechanical loads on the joints (sitting, lying) to reduce the pain of muscle spasm, improve the tone of the weakened muscle groups, strengthening the structure of the affected joints, improve the functional abilities of the patient. Similar objectives are pursued and the execution of therapeutic massage, which must also be gentle on the affected joints, to avoid mechanical irritation of the joint capsule, focuses on work with surrounding the joint muscles.

It is considered that the reduction of body weight by 1 kg reduces the load on the joint at 4 pounds. Therefore, in the treatment of osteoarthritis applied exercises for the lower body weight of the patient, including complexes of therapeutic exercises.

The method is as follows.

Treatment in the conditions of sanatorium "Procopius". Patients daily walks at a slow pace, stopping to explore the surrounding area and the lake in the warmer months physical therapy held in the open air. When it stops offer to listen to the sounds of nature, the silence, enjoy the smells of damp earth, forest, is Vijesti. This is recommended to feel that the body becomes healthier, feel better, comes a calm, the mood is improving.

Patients are taught, and they additionally perform during treatment in sanatoria and after completion of the rehabilitation, self-massage of the knee joints.

Self-massage of the knee joint:

Is held in position when massaged leg is slightly bent at the knee, lying on the couch and the other leg down. Used the following methods:

- stroking the palms of both hands.

- rubbing fingertips.

Patients receive treatment in stages in accordance with the objectives in the preparation of the complex of therapeutic measures, namely:

1. Pain;

2. The relief of the inflammatory process;

3. Improve the trophic joints and local blood flow;

4. Recovery of muscle strength;

5. Elimination of contractures in the joint.

In the first stage, relieve pain and muscle spasm.

From 1 to 10 day exercise impact on patient polychromatic polarised light from the stationary apparatus "Bioptron-1", containing various wavelengths ranging from 400 nm to 2000 nm at a power flux density of 40 mW/cm²the flux density of light energy per minute of 2.4 j/cm²the beam of light is directed to the area of the knee cost the VA from a distance of 20 cm for 6 minutes The treatment gives good results in the treatment of acute and chronic pain.

Patients taking iodine-bromine bath at a temperature of 37°C 10 min No. 10. 1 through 5 day patients perform complex medical gymnastics, get a manual massage of the muscles of the lower extremities 10 minutes

Iodine-bromine baths have a pronounced anti-inflammatory and antispasmodic effect, improves microcirculation and regeneration of the tissues.

1 through 5 day patients perform complex medical gymnastics with arthritis of the knee joint, get a manual massage of the muscles of the lower extremities 10 minutes

Complex therapeutic exercises with arthritis of the knee joints.

Each exercise to do at least 5 times.

1. Starting position: sitting on the couch. Sit up straight. Dangle your feet with moderate amplitude movements. This exercise to do as often as possible.

2. In the same position, raise one leg and hold for 3 seconds parallel to the floor. Stop with the right angle to the tibia. To change leg. When doing this exercise you should feel tension in the muscles of the femur and tibia.

3. "Small bike". Bend both legs at the knees, feet on the floor. The right leg to cause stomach with his knee, then straighten it and slowly lower to the floor and again to lead to the second leg. Stop always at the right angle. Legs to change.

Initial position (I.P.) lying to the back.

4. I.P. Legs stretched out. Bend the knee while the foot is slightly raised above the floor. Hold it there for 5 seconds. Legs to change.

5. "Big bike". Lying on the floor on your back to twist legs as if riding a Bicycle. To perform first slowly, then faster; slower is faster. All the time to pay attention to the tension in the muscles of the thigh.

6. Bend the leg at the knee, clasp thigh hand and pull to the belly. Pull the knee (foot at a right angle, to "stretch" heel). Feel the tension in the muscles. Hold it there for 5-8 seconds. Lower heel on the floor, then pull the leg. Feet to change one by one. The second leg, which lies on the floor, try not to bend.

7. Alternate flexion and extension stop, 10-15 times.

8. The circular motion of the feet by 4 laps in each direction 6 times.

9. Under the knees to place the platen.

Straighten one (both) legs, feet, to pull, to hold the drumstick on weight 5-7, bend and relax (pause) 3 to 10 times.

10. Straighten one (both) legs, feet expand outwards. To lift away from the roller, to hold the tibia weight 5-7, bend and relax (pause) 3, 8-10 times.

11. I.P. Legs straightened

Alternately bending and straightening the knees without lifting the heels from the floor 10 times.

12. To raise straightened and expanded outwards leg up to an angle of 30°, to keep her weight 5-7, lower and relax (PAH is a) 3, 10.

13. To raise straightened and expanded outwards leg up to an angle of 30°, hold on to weight, to make swinging movement of the bending - unbending foot, series 10 times.

14. To raise straightened and expanded outwards leg up to an angle of 30°and hold the weight of 4 laps in each direction, the amplitude of motion is small, 3 series 10 times.

I.P. Lying on his side.

15. Lying on the healthy side, one leg lying on his good leg.

Flexion and extension of both legs at the knees, don't bend their hip joints, 12-15 times.

16. Flexing the patient's legs at the knee, sliding the inner arch of her foot on the healthy leg (from ankle upwards), 12-15 times.

17. Lift the straight leg to the horizontal level, hold a weight of 5-7, lower and relax (pause) 3, 8-10 times.

18. Lift the straight leg to the horizontal level, to expand outwards, hold the weight with 5-7, lower and relax (pause) 3, 8-10 times.

19. Lift the straight leg up to the horizontal level, holding her weight, slowly bring to the front, and then back. The amplitude of motion is small, 3 series 10 times.

20. Lift the straight leg up to the horizontal level, holding her weight, to do 4 laps in each direction, 3 series 10 times.

21. Flexion at the knee with healthy feet, 2-15 times.

Ipia on his stomach.

22. One leg rests on a healthy, bending aching legs with healthy, painfully, 2-15 times.

23. Alternately bending the legs at the knees, twirling drumsticks inside 10 times.

24. Alternately bending the legs at the knees, turning the leg outwards, 10 times.

25. Alternate lifting straightened legs up, holding the 5-7 seconds each, 10 times.

Massage manual in deforming arthrosis of the knee joint.

The massage begins with the thigh muscles. Used massage techniques in the following sequence: combined stroke (3-4 times), squeezing the side of the hand (2-3 times), squeezing crests fists (3-4 times), shaking and stroking (2-3 times each)ordinary kneading (2-3 times), double ring (3-4 times) and double the ordinary (4-6 times) kneading, shaking (3-4 times), kneading double neck guitar (3-5 times), longitudinal kneading (3-5 times), stroking (3-4 times).

In the area of the joint use techniques concentric and circular strokes on the side plots: straight rubbing the base of the palms of both hands (6-8 times), forceps (3-5 times), rectilinear and circular rubbing (3-4 times each receive).

Then move to massaging the thigh, but the number of repetitions for each receiving reduced in two times. Then again massages joint: lateral teaching the TCI massaged circular rubbing phalanges, compressed in a fist (4-6 times), circular rubbing the base of the palms (3-6 times), concentric stroking (3-6 times). Then again massaged the muscles of the thigh squeeze (3-5 times), shaking (2-3 times), stroking (2-3 times).

Then, gently move to the active movements such as flexion and extension (5-7 times), rotation of the tibia on the inside and outside (5-7 times in each direction). Then proceed to massage the knee. After concentric strokes in painful places spend rubbing the base of the palm, fingertips, fingers, compressed in a fist (3-5 times). Finish the procedure by shaking and stroking (3-5 times).

Efforts massage therapist should be commensurate with the sensitivity of the tissues massaged. A good effect can be achieved by massage in warm water (37-39°C) or after a bath.

The next phase. The removal of the inflammatory process.

Patients continue to receive treatment with polarized light and iodide-bromine baths.

6 through day 15 affect knee joints sinusoidal modulated currents (SMC) with a modulation frequency of 100 Hz, a modulation depth of 50-75%, duration parcels 2:3, rated current up to moderate vibration, the kind of work III-IV for 5 min each, mode 1, for 7 minutes

6 to 10 day hold acupuncture on the brake methodology, conducting the massage is next 10RP, 9RP, E, E 1-2 min and introducing needle for 30 min, hold acupressure points Cheng fu, Chuan, Yang-Ling-Chuan, zu-San-Li, Wei Yang, Cheng Shan, Zhong Feng, Huynh Harrier, nei ting.

When expressed pain syndrome acupuncture is applied by the brake technique in local biologically active zones (BAZ). Select the most painful area (point), easy movements of the index finger hold the weak point massage for 1-2 minutes, then slow rotational translational movements of the needle. Depth - compliance with the topography DATABASES.

The location of the BASES of the knee. 10RP - on the inner side of the thigh, at a distance of 2 tuna from the upper edge of the patella. The depth of injection - 1-1 .5 CUN.

9RP - the intersection of a horizontal line drawn through the top of the tibial tuberosity, and the vertical through the middle of the inner thigh. The depth of injection of 0.5 CUN.

E - the gap between the peroneal and tibial bone to 1.5 cm distal from the top of the tibial tuberosity. The depth of injection - 0.6-1.0 CUN.

E - at a distance of 2 CUN above the upper outer corner of the patella, in the depression between the tendons of the lateral wide thigh and straight muscle of the thigh. The depth of injection - 0.6-.1.0 CUN.

U1. Acupressure massage (acupressure).

Has analgesic properties. Relieving pain impulses, normaliz what I vascular tone, it thereby improves everywhere blood flow to tissues, mobilizes the immune system.

For relieving pain in the joints of the lower limb massages points: Cheng fu, Chuan, Yang-Ling-Chuan, zu-San-Li, Wei Yang, Cheng Shan, Zhong Feng, Huynh Harrier, nei ting.

Herbal medicine.

Take an infusion of 15 g of the medicinal plants of the following composition: Linden flowers, calendula 3 pieces of root, elecampane root, yarrow herb 2 parts, mint, oregano, St. John's wort 1 part. 15 g of the mixture pour a glass of boiling water, insist 1 hour. Take 200 ml in the morning and evening before meals.

The next stage from 11 to 15 day. Improvement of blood circulation in the lower extremities and improve the trophic joints, weight loss (if indicated).

Continue sinusoidal modulated currents (SMC).

Impact decimeter waves (UHF) on the area of the knee joint power 15 W 10-15 minutes as a result of heating of the tissue in the area of SCM, is expanding and increasing the number of functioning capillaries, increase in blood flow, increased vascular permeability, which leads to increase circulation, reduce swelling, inflammation and autoimmune reactions.

Then conduct a hydro-massage of the lower extremities and lumbar region 15 min at pressures up to 3 atmospheres. The powerful jets stimulates and gives tone to the tissues and we the Indians; causes dilation of blood vessels of the skin and the whole body, which helps boost blood circulation, metabolism, and reduce weight. Hot tub - a panacea for stress, tension, and the best armor from the adverse environment. Underwater massage promotes rapid resorption of hemorrhages and accelerates the recovery process.

This is a quick way to lose weight by reducing body fat, restore proper water balance in the tissues. Warm water comes relaxation of tissue, which minimizes muscle tension during massage and increases its efficiency. Underwater massage reduces reflex excitability, reduces the tendency to spasm, gives analgesic effect. Hydro massage increases blood flow to the skin and hemodynamics in General, improves urine flow and metabolism, activates the trophic function, promotes rapid resorption of hemorrhages and edema fluid in the tissues. Water massage accelerates the recovery of motor functions, increases mobility in the joints of the extremities and spine.

Then spend postisometric relaxation (PIR) of the quadriceps femoris 10 min at the initial position of the patient lying on his stomach, leg bent at the knee, the initial position of the doctor - hundred the person to the head end of the couch, hand locking rear foot, breath - patient extends the knee, and the doctor has a resistance, position fixed on 9-12 seconds on the exhale - the doctor increases the flexion passively stretching the muscle, reception, repeat 3-4 times. The effect of the feast is an example of direct increase and decrease the pain of passive and active movements in the joint, and to reduce the voltage of pain and increasing the length of the previously spazmaticly shortened muscles. Feast restores length and elasticity not only shortened muscles, but wrinkled hand-ligamentous apparatus, mucous bags and is an effective method of relaxation adhesions.

Patients perform exercises for weight reduction.

Exercises for weight loss - bodyflex (breathing exercises).

Five stages of breathing bodyflex.

Exhale all the air from the lungs through the mouth.

Quickly inhale through the nose.

Of the diaphragm with the power exhale all the air through the mouth.

Hold your breath and do the retraction of the abdomen, eight to ten accounts.

Relax and breathe.

Step 1. The first thing to do is to exhale through your mouth the whole stagnated in light air. Collect lips into a tube, as if want to whistle, and slowly and evenly release of the entire air without a trace.

Step 2. Opostos is in the light, stop and squeeze the lips. Without opening your mouth, inhale through the nose as quickly and dramatically as soon as you can, fill your lungs to capacity. You gradually absorb one breath all the air in the room and the sound should be consistent with that. Imagine that you've stayed under water and, finally, came up for a breath of air, and now inhale through the nose as quickly and strongly as possible. Imagine how you tighten the air deep into your body as they are filled with light from top to bottom. Inhale aggressive. Breath is the most important part of this exercise, because it accelerates aerobic process. And in this case, the breath must be very noisy. If you make sounds, similar to a vacuum cleaner on the highest speed, most likely, you perform the exercise correctly.

Step 3. When your lungs are filled with air to failure, and you will feel that you are no longer able to breathe, slightly lift the head. Squeeze the lips, a plate of them, as if distributed to them lipstick. Now you will sharply exhale all the air, and as low as possible in the diaphragm. Now widely open mouth and begin to exhale. You should have something like the sound of "Bang!", but the sounds should come from the diaphragm and not from the lips or throat. To develop this deep exhale quite difficult, and you may need not one pop the TKA, in order to catch it. The first time you may even want to cough (from the lungs, not from the throat) and try to simulate the correct sound like he really comes from the depths of the lungs. You will understand when exhalation is done correctly, - "Bang!" will get a sibilant.

Step 4. Exhaling all the air, close your mouth and hold your breath. Continue to keep it during the whole stage, don't let yourself or molecules! Tilt your head, tighten your stomach and lift it up. Imagine how your stomach and other organs in the abdominal region literally zasovyvayut in the ribs. This is called "retraction of the abdomen, and is part of each bodyflex exercise that flat stomach. In addition, the retraction of the abdomen massages and stimulates the internal organs. Many people with irregular menstruation or poor bladder control reported significant improvements. If at this moment put on tummy hand, you will feel that it is hollow, as if the Cup under your ribs. This is because you have created inside the vacuum to do this, and exhaled all the air. If you tilt your head to the chest, you will simply be easier to pull the stomach up, because the abdominal muscles are often very weak. Keep the stomach involved, not breathing, for eight to ten accounts, counting "one thousand one, one thousand two, one thousand three...". It was during a retractable USB adapter cable is Denmark belly you will perform isotonic or isometric exercises, which will be mentioned below.

Step 5. Now relax, inhale and release your abdominal muscles. Breathing, you should feel as the air rushes into your lungs, and to hear some kind of sob. Remember the vacuum cleaner.

Exercise leads to weight loss, to reduce stress on the joints.

Take an infusion of 20 g of the medicinal plants of the following composition: leaf bearberry, cranberry, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root 2 parts.

20 g of the mixture infuse for 12 hours in 1 liter of water, boil 5 min, insist 30 minutes, wring out and take 100 ml 4 times a day.

From 16 to 20 day recovery phase range of motion in the joint, the elimination of contractures (if any), strengthening the muscles of the lower extremities.

Patients receive mud laying mud applications on knee joints of sulfide mud at a temperature of 42°With a thin layer of 3 cm for 30 minutes Under the influence of mud recedes pain, increases joint mobility, increase muscle elasticity, improves skin elasticity.

Perform complex medical gymnastics with arthritis of the knee joint to restore range of motion in the joint, which they performed in 1-5 day.

Spend vacuum-therapy lumbar region of the spine paravertebral is Ino. In the position of the patient on the couch on his stomach set on the surface of the back in the lumbar region of the spine special cupping. Due to the pressure drop in this region is the flow of blood to the biologically active zones. Allows you to quickly eliminate pain syndromes.

Perform traction of the knee joint methods of manual therapy or using a traction apparatus 10 minutes Is stretching with the aim to dissolve the bones, increasing the distance between them and reducing, thus, the load on the joint. Use traction table Anatomotor, which allows all kinds of traction, including: cervical, thoracic, lumbar spine, and the traction of limbs.

Traction device provides a comfortable safe and sensitive traction. Traction can be a constant or a variable angle of impact relative to the surface of the table. Load adjustable from 0 to 90 kg calibrated rotation of the handle.

Take an infusion of 20 g of the medicinal plants of the following composition: leaf bearberry, cranberry, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root 2 parts.

20 gsmes leave for 12 hours in 1 liter of water, boil 5 minutes, to insist 30 minutes, squeeze and take 100 ml 4 times a day. Herbal medicine is aimed at with irenie pain, providing anti-inflammatory action and improvement of the functional state of the joints. Infusions lekarstvennyh plants are well tolerated and do not usually have side effects.

METHODS.

The work was based on the analysis of rehabilitation treatment 44 - 32 women and 12 men with deforming arthrosis of the joints of the lower extremities, of which I severity was diagnosed in 26 patients, II in 16 patients, whose average age amounted to 48.5±4,1 years, aimed at rehabilitation treatment in the sanatorium "Procopius". The average duration of the disease and 12.4±2.1 years.

As an objective criteria for evaluating the effectiveness of rehabilitation treatment before treatment and at the end used:

1. Plomeria (bending angle).

2. The muscle soreness was studied on a 4-point scale:

- pain no - 4 points;

- palpation of the patient notices a faint soreness - 3 points;

- palpation is expressed pain - 2 points;

- palpation there is a sharp pain - 1 point.

3. BPH (dynamic gravimetric test).

This test was carried out with the objective quantification of muscle strength. The accident was carried out taking into account the amplitude of active pain-free movement in the study knee joint and made the camping as follows: the patient is offered, bending and straightening the leg, to raise the load (from 0.25 kg to 2 kg) to a certain height (usually from 0.1 m to 0.4 m) with a frequency of 20 strokes per minute, the sample is performed before the appearance of pain in the joint, muscle fatigue. Count the number of lifts cargo.

Then the calculated amount of work done by the formula:

A=13.1·m·h·n,

where: A - the amount of work done;

13.1 - coefficient taking into account the acceleration of free fall and the lowering of the goods;

m : load weight (kg);

h - height of the cargo; n - the number of executed UPS

4. Electrophysiological methods.

Blood flow studies were carried out by methods rheovasography and ultrasonic Doppler:

A. Rheovasography

Were recorded and were analyzed rheovasography lower extremities. Many quantitative indicators we used reovazograficheskie index (I), which reflects the intensity of the blood supply to the area being examined.

B. Ultrasonic dopplerography)

The research was carried out at rest, with the patient lying on his back under the Desk LDF femoral artery in cm for 1 second.

the results showed, what is the systematic application of the proposed method has a pronounced positive effect:

1. Range of motion (bend) the knee joint in the group with 1 degree increased by 25°, with the second degree - 20°.

2. Decreased muscle pain in patients with 1 degree in 1.8 times, with the second degree - in 1.3 times.

3. BPH in the study group before treatment - 12.6±10.8 hoists, end-of-course - 38.4±20.1 rises. In the control group was 13.1±40.3 rises at the beginning and 32.2±14.6 rises at the end of treatment.

4. The results rheovasography perfusion in the lower extremities in patients with 1 degree of the disease increased by 10±0.4 cm/s, with the second degree - 6±0.12 cm/S.

5. The results of the research method USDG showed acceleration of blood flow in the femoral artery in patients with 1 degree 9±0.1 cm/s, with the second level of 5±0.05 cm/S.

6. Evaluation of the effectiveness of rehabilitation treatment showed that a significant improvement was achieved in 75% of patients 1 degree of the disease and 45% in the second degree.

7. The obtained results confirm the effectiveness of the treatment and give reason to recommend it for the treatment of this pathology.

EXAMPLE 1.

The patient Century. Diagnosis upon admission to the sanatorium: deforming arthrosis of the right knee joint of degree 1: Works of THUNDER underground for 8 years. Ill the m considers himself 10 years.

At the beginning of treatment notes pain in the right knee, bending angle 95°, severe pain in the muscles of the right lower extremity, the indicator reovazograficheskie index equal to 1.7 cm/s, the velocity of the blood flow of the radial artery of the upper extremities average of 18.1 cm/sec. accident is 12 rises.

After the treatment the patient notes pain in the right knee joint, angle bending is equal to 70°, reovazograficheskie index increased by 8 cm/s, the velocity of the blood flow of the radial artery on the results USDG equal to 26.7 cm/sec accidents increased to 38 rises.

EXAMPLE 2

The patient Was Diagnosed upon admission to the sanatorium: departures left knee joint degree 2: Working as a miner in underground work for 16 years. Sick considers himself 11 years.

At the beginning of treatment marks a sharp pain in the right knee joint, angle bending 105°, severe pain in the muscles of the left lower extremity, the indicator reovazograficheskie index equal to 1.9 cm/s, the velocity of the blood flow of the radial artery of the upper extremities average of 12.1 cm/sec. accident value of 13 lifts.

After the treatment, the patient noted a slight pain in the left knee joint, angle bending equal to 80°, reovazograficheskie index increased by 6 cm/s, the velocity of the blood flow in the femoral artery on the results USDG R the VNA 18,7 cm/S. The accident grew to 32 rises.

Thus, the proposed method:

1. To reduce the pain.

2. To restore mobility to joints, improve blood circulation, improve functional status of the knee.

3. The method improves exercise tolerance in the lower limbs.

Method of rehabilitation of patients with deforming arthrosis of knee joints in the conditions of the resort, including physical methods of treatment, physical therapy, massage, acupuncture, herbal medicine, characterized in that the patients are taught and they additionally perform during treatment in sanatoria and after completion of the rehabilitation, self-massage of the knee, during the course of treatment from 1 to 10 day exercise impact on patient polychromatic polarised light from the stationary apparatus "Bioptron-1", containing various wavelengths ranging from 400 nm to 2000 nm at a power flux density of 40 mW/cm²the flux density of light energy per minute of 2.4 j/cm²the beam of light is directed to the region of the knee joint from a distance of 20 cm for 6 min, patients taking iodine-bromine bath at a temperature of 37°C 10 min No. 10, 1 to 5 day patients perform complex medical gymnastics with arthritis of the knee, get a manual massage of the muscles of the lower extremities 10 min; from 6 to 15 day impact the comfort of the knee joints sinusoidal modulated currents (SMC) with a modulation frequency of 100 Hz, a modulation depth of 50-75%, duration parcels 2:3, rated current up to moderate vibration, the kind of work III-IV for 5 min each, mode 1, 7 min, from 6 to 10 day hold acupuncture on braking technique, conducting massage points 10RP, 9RP, E, E 1-2 min and introducing needle for 30 min, hold acupressure points Cheng fu, Chuan, Yang-Ling-Chuan, zu-San-Li, Wei Yang, Cheng Shan, Zhong Feng, Huynh Harrier, nei tin, take infusion of 15 g of the medicinal plants of the following composition: Linden flowers, calendula 3 pieces of root, elecampane root, yarrow herb 2 parts, mint, oregano, St. John's wort 1 part; from 11 to 15 day impact decimeter waves (UHF) on the area of the knee joint power of 15 W for 10-15 minutes, then conduct a hydro-massage of the lower extremities and lumbar region 15 min at pressures up to 3 atmospheres, then spend postisometric relaxation of the quadriceps femoris 10 min at the initial position of the patient lying on his stomach, leg bent at the knee, the original the position of the doctor is facing the head end of the couch, his hand locking rear foot on the breath - patient extends the knee, and the doctor has a resistance, position fixed on 9-12 seconds on the exhale - the doctor increases the flexion passively stretching the muscle, the reception is repeated 3-4 times, patients perform exercises to reduce weight, take infusion of 20 g sat the RA medicinal plants of the following composition: leaf bearberry, cranberries, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root, 2 parts; from the 16th to the 20th day ill get mud laying mud applications on knee joints of sulfide mud at a temperature of 42°With a thin layer of 3 cm for 30 min, perform complex medical gymnastics with arthritis of the knee joint to restore range of motion in the joint, hold the vacuum therapy lumbar region of the spine, paravertebral, perform traction of the knee joint methods of manual therapy or using a traction apparatus 10 min, take an infusion of 20 g of collection of medicinal plants next composition: the leaves of bearberry, cranberry, corn silk, fruit leaf beans 3 pieces of grass knotweed, horsetail root, elecampane root 2 parts.