The problem of lumbar osteochondrosis is now far from being resolved, as the disease is increasingly occurring in young people and leads to the loss of working capacity, and in 10% of cases it becomes cause of disability. Sanatorium-and-spa treatment (SKL) occupies an important place in the restoration of workability of these patients and contributes to their return to normal life. The purpose of this work was to study the influence of Detensor-therapy on the indices of individual health of patients with lumbar osteochondrosis.
According to the results of the tests it was reliably confirmed that the course of Detensor therapy leads to an improvement in the Individual health indicators in patients with lumbar osteochondrosis.
Osteochondrosis of the spine is the most common nosology in clinical practice in persons working the age of 25-50 years, and is the main loss of temporary work capacity, often becoming the cause of disability. After 30 years already Every fifth person in the world suffers from manifestations osteochondrosis, and more than half of patients with osteo larynx is affected by lumbar spine injury the spine. In the structure of patients at the medical office level, it accounts for up to 70%.
In the clinical picture, in most patients, pre-have pain and muscle-tonic syndromes, but along with them autonomic disturbances are revealed and changes in the psychological sphere. To the solution this problem can contribute to the indicators of the functional reserves of the body (FRO) as indicators of individual health, reflecting the state of autonomic homeostasis, adaptive potential of the body and psychometrics patient status of the patient.
In recent years, in clinical practice, all greater place in SCL patients with lumbar osteochondrosis (PO) is winning child-care therapy – original method of gentle stretching and unloading spine using therapeutic mat Dr. K. Kienlein (FRG). Little studied is the influence of Detensor therapy on individual health of this category of patients. Modern SCL technology provides for a comprehensive quantification of the results,
based on the integration of nosological and adaptational approaches. Previously, we had scientifically substantiated and successfully used in practice, the methodology for assessing the effectiveness of SCR,
including analysis of the dynamics of the three components: clinical symptoms, data and FBI indices
Recovery FPOs, reduced because of disease and / or adverse environmental effects, are currently considered one of the main tasks of SCL [1, 7]. For rate the results of treatment exactly the dynamics of FRO indices is often of decisive importance relating to the absence in many cases of significant clinical abnormalities in patients entering treatment. In a patient, the dynamics of various parameters against the background of SCL, as a rule, is expressed in different degrees, and in some cases even is multidirectional, so it is methodologically expedient integrate changes in several indicators to make an unambiguous decision on the outcome of treatment. The purpose of this work was to study the effect of the course of Detensor therapy in complex rehabilitation treatment on the indices of individual health of patients with lumbar osteochondrosis.
The work is based on the results of a survey of 120 patients with PO without significant concomitant pathology undergoing rehabilitative treatment in our clinic. They are 80 men, 40 women aged 18 to 44 years (an average of 33.5 ± 0.6 years). All patients entered the sanatorium with the established diagnosis of “osteochondrosis of the lumbar spine”. In the referral documentation, all had an MRI report. All patients underwent a comprehensive examination, including a clinical examination of a neurologist, physiotherapist, physiotherapist, gynecologist (in women), electrocardiography, kidney ultrasound, FRO study.
To quantify the intensity of the pain syndrome, a 10-point visual-analogue scale of the Borg (HSB) was used. The testing was conducted three times: on admission, on the 7th and 14th days of treatment. The state of muscle tone in the back and lower limbs was assessed in three degrees in accordance with the standard scheme of vertebra-neurological examination.
The FRO study was carried out with the help of the software-hardware complex “Integral health indicator” and included the implementation of a set of tests that determine the functional state of the somatic sphere and the adaptive ability: assessing the initial vegetative status (IN) and the activity of the body’s regulatory systems (PARS), the level of physical abilities of the organism UVB), the functional state of the central nervous system (FRNC), levels of personal anxiety (UT), emotional stability (ES), stress resistance (SS).
Based on the results of testing, the integral index of the IGF was calculated, reflecting the general state of the body’s functional reserves, having the following scale of assessment: 75-100% – high, 50-74% – medium, 25-49% and 0-24% is low. Quantitative evaluation of pain and muscle-tonic syndromes and FRO investigation were carried out twice – upon admission and at discharge.
During the work, all subjects surveyed by random sampling were divided into two equal groups, comparable by sex, age and clinical manifestations: the primary and control. All patients underwent a 14-day course of rehabilitation treatment in accordance with the Federal Standard for the Treatment of Patients with Diseases of the Musculoskeletal System and Connective Tissue, which included: physiotherapy in the gym, gymnastics in the pool, manual massage lumbar region, sedative aerophytotherapy and phyto-tea, magnetotherapy with a running pulse magnetic field, optimal nutrition.
Patients of the main group along with these methods used Detensor therapy, which is considered a promising method of treatment. The procedures were carried out in accordance with the standard procedure: the patient’s position – lying on his back on the therapeutic mat “Detensor” with functional supports in the shin and neck area, duration – 60 minutes, daily, No. 10. The procedures were accompanied by relaxation musical therapy. To evaluate the results of treatment, an algorithm developed by us was used, considering existing criteria of effectiveness and own experience of practical work.
Upon admission to the clinic, 74 subjects (61.7%) complained of low back pain arising from a static-dynamic load. The intensity of pain was in the range from mild to moderate, the HBB index was from 0 to 5, in
average 2.74 ± 0.07 points. 87 patients (72.5%) complained of stiffness and restriction of mobility in the spine, 81 (67.5%) noted irritability, 58 (48.3%) – a feeling of anxiety or anxiety, 22 (18.3%) – sleep disturbance.
Neurological examination revealed an increase in the tone of long muscles of the back in most patients (107 people – 89.2%), of them I degree – in 82 (76.6%), II degree – in 25 (23.4%). Soreness in palpation of paravertebral lumbar points
of the spine department was defined in 77 people (64.2%), the presence of trigger zones in the lumbar region – in 44 people (36.7%).
According to the results of the primary FRO study, a decrease in total functional reserves (IGFR <50%) was determined in 46 patients (38.3%), including a significant decrease (11% (9.2%) in IGFR <25%).
The average value of IPFR was 50.1 ± 1.4%. At the end of the course of SKL, pain in the lumbar region was preserved in 52 patients (43.3%), but their average intensity for HBB significantly decreased to 0.98 ± 0.09 points (p <0.01), ranging from 0 up to 4 points. Feeling of stiffness in the spine remained in 38 patients (31.7%), but everyone marked it reduction. Significantly reduced the number of nonspecific complaints. Regression of myotonic disorders after treatment registered in 101 (94.4%) of 107 patients who had them on admission. At discharge, the increase in muscle tone was not higher than I degree and was determined only in 30 people (25.0%). Soreness of the paravertebral points was preserved in 9 (7.5%), trigger zones – in 3 (2.5%) patients.
In the general group, positive dynamics (improvement and significant improvement) in the state of health was achieved in 112 patients (93.3%). The proposed algorithm is applied to the comparative analysis of the effectiveness of SCR in patients with PO, in addition to the curative standard of the course of detensor therapy (the main group) and received only a standard treatment program (control group). As can be seen from the table, positive dynamics of the health status in the main group was found in 96.7% of patients, in the control group – in 90%. But the difference in gradation “significant improvement” is especially significant – 25% in the main group versus 6.7% in the control group.
The indicator of the effectiveness of treatment in points was significantly higher in patients receiving detensor therapy, on average 3.15 ± 0.11, while in the control group it was 2.52 ± 0.10 points (p <0.01) . The number of patients with reduced general functional reserves (IGFR <50%) decreased 2-fold – up to 23 people (19.2%), including very low (IGFR <25%) to 4 (3.3%). The dynamics of IPFR was estimated by the difference between the final and initial values. A significant increase in IPFR (5% or more) was observed in 93 people (77.5%), including a significant (20% or more) – in 19 (15.8%). In 23 cases (19,2%) there was no significant dynamics (the change of IGFR was less than 5%), and in 4 patients IPFR decreased by
5% or more. The average value of IGFR in the general group increased by 10.3 ± 0.9% and was 60.4 ± 1.3% after treatment. The course of detensor therapy leads to an improvement in individual health indicators, which is manifested by a significant improvement in the results of SCL.
The use of the detrusor system in the complex rehabilitation treatment of patients with lumbar osteochondrosis makes it possible to improve its results, in particular, to achieve a more rapid regression of pain and muscular-tonic syndromes, a more pronounced growth of FRO.
After the course of rehabilitation treatment in patients with lumbar osteochondrosis, there is a decrease in the severity of pain and muscle-tonic syndromes, as well as an increase in the total functional reserves of the body. For complex objective evaluation of the results of treatment of patients with PO it is expedient to use an algorithm that includes a quantitative analysis of the dynamics:
The application of this algorithm showed that the inclusion of detensor therapy in the complex program of sanatorium treatment for patients with PO allows to significantly increase its effectiveness and thereby improve individual health indicators.