FIELD: medicine, manual therapy.
SUBSTANCE: the present innovation deals with treating patients with neurological manifestations of hernias and protrusions of lumbar intervertebral disks in acute, subacute periods and as prophylaxis in the period of remission. The innovation could be applied both as independent method and in combination with other therapeutic methods (application of lumbo-sacral corset, different variants of medicinal therapy). The impact should be fulfilled by taking into account pathological mechanisms as the foundation of the disease. The main point is the reconstruction of regional outflow of venous blood out of lumbo-sacral segments and spinal radicles, internal and external vertebral venous plexuses, lymph out of lymphatic vessels of epidural space and perivertebral lymphatic plexuses, and, also, out of osseous and muscular-ligamentous structures of vertebral column, inferior limbs and reconstruction of arterial blood inflow to lumbo-sacral segments and spinal radicles, and, also, to osseous and muscular-ligamentous structures of vertebral column, inferior limbs. The innovation enables to shorten terms of therapy up to 1-1.5 mo, prevent the relapses during remission period and, also, prevent the lesions of motor apparatus of manual therapeutist and decrease physical loading upon it during a seance. Thus, on both sides of patient's body it is necessary to carry out postactivation strain (PAS) of muscular-ligamentous apparatus of vertebral column at tension and fluctuating shift of dural sac in epidural space, along with simultaneous dynamic vascular compression of internal and external vertebral venous plexuses, lymph vessels of epidural space and perivertebral lymph plexuses, along with the strain of cicatrices and adhesions of epidural space, PAS of muscular-ligamentous apparatus of inferior limbs, pelvis at homogeneous dynamic compression of intramuscular and main venous, lymph vessels to conduct manipulations at spinal motor segment (SMS) by taking into account the evolution of myofixation of patient's motor apparatus from generalized myofixation till local one, moreover, PAS should be fulfilled at amplitude of 15-90°, due to applying patient's self-resistance and sport weighting compounds and means starting from patient's peripheral departments of the body and finishing with lumbar department of vertebral column, firstly, it is necessary to fulfill PAS of muscular-ligamentous apparatus of cervical, the upper thoracic departments of vertebral column, suprabrachii at tension and fluctuating shift of dural sac in flexion, lateroflexion and rotation; then - anterior groups of muscular-ligamentous apparatus of shin, femur, talocrural and knee joints in flexion and activation and paravertebral muscles at tension and fluctuating shift of dural sac in extension, and, also, piriform muscles and muscular-ligamentous apparatus of gluteal areas, hip and knee joints in abduction and activation of paravertebral muscles at tension and fluctuating shift of dural sac in extension, after that - posterior groups of muscular-ligamentous apparatus of shin and talocrural joints in extension, then - sacro-tuberal ligaments and muscular-ligamentous apparatus of gluteal areas and hip joints in flexion, and also, sacro-osseous, sacro-iliac ligaments and muscular-ligamentous apparatus of gluteal areas and hip joints in adduction, after that - internal groups of muscular-ligamentous apparatus of femur and hip joints in abduction, then - posterior groups of muscular-ligamentous apparatus of shin and talocrural joints in extension, thigh, gluteal areas, knee and hip joints in flexion, after that - iliac-lumbar muscles, anterior groups of muscular-ligamentous apparatus of thigh and hip joints in extension and at last - muscular-ligamentous apparatus of thoracic, lumbar departments of vertebral column, pelvis and iliac-lumbar ligaments at tension and fluctuating shift of dural sac in rotation in bending and neutral vertebral positions, the impact upon cervical and thoracic departments of vertebral column should be finished with manipulations, upon pelvis - due to mobilizations or manipulations upon sacro-iliac joints, followed by pressing myofascial trigger points of loins, pelvis and inferior limbs, at the end of therapeutic course while passing into inferior restricted vertebral myofixation should be carried out target manipulations upon healthy lumbar SMS from both sides, therapeutic course lasts from 5 to 15 seances depending upon manifestation picture of clinical manifestations and against the tempo of myofixation evolution in patient's motor apparatus carried out at 1-3-d-long intervals depending upon the ability of muscular-ligamentous apparatus to be recovered after physical loading.
EFFECT: higher efficiency of complex therapy.
24 dwg, 3 ex
