Exercise therapy contraindications are absolute and relative. Forms and means of exercise therapy
Ministry of Education and Science of the Russian Federation
Federal State Budgetary Educational Institution
higher education "Mordovia State
Pedagogical Institute named after M.E. Evsevyeva"
Faculty of Physical Education
Department of Theory and Methods of Physical Culture and Sports
ABSTRACT
INDICATIONS AND CONTRAINDICATIONS TO
Direction of training Pedagogical education
Profile Physical culture
checked
cand. honey. Sciences, Associate Professor ________________________________ Е. E. Elaeva
Saransk 2016
Introduction………………………………………………………..……………………3
1 Indications and contraindications for exercise therapy ………………………..………….5
2 Indications and contraindications of massage………………………..………...8
Conclusion……………………………………………………………….…………12
List of sources used………………………………….…...……..14
Introduction
Exercise therapy and massage in the complex of rehabilitation measures are widely used in any medical specialty.
Indications for exercise therapy and massage are very extensive. They are used as a method of functional treatment for injuries in order to stimulate the functions of damaged limbs and accelerate wound healing, for spinal fractures, for the treatment of contractures, diseases of the musculoskeletal system and joints. In surgical practice, exercise therapy is prescribed before and after operations in order to prevent postoperative complications and accelerate the healing of the surgical wound. Classes contribute to a more rapid recovery of impaired functions of the affected organ and the body as a whole. In the clinic of internal diseases, this method is widely used in diseases of the cardiovascular system, especially in coronary heart disease. With myocardial infarction, exercise therapy is an indispensable element in the system of complex restoration of the patient's health at all stages of treatment - in a hospital, sanatorium, clinic. Exercise therapy techniques have been developed for hypotension and hypertension, chronic coronary insufficiency, heart defects and other diseases of the cardiovascular system.
With the help of physical exercises, it is possible to directly influence the functions of the respiratory system disturbed by the disease, to strengthen the respiratory muscles. In this regard, exercise therapy is used for acute and chronic pneumonia, emphysema, bronchial asthma and other respiratory diseases. It is of no less importance in metabolic diseases: obesity, gout, diabetes mellitus, etc. Exercise therapy is used as a method of rehabilitation therapy for complete and incomplete paralysis, neurosis, and the consequences of infectious diseases with damage to the central and peripheral nervous system. In obstetrics, physical exercises are prescribed during pregnancy and the postpartum period, they are an indispensable element of almost all chronic gynecological diseases. Experience has been gained in the successful use of physiotherapy exercises in a number of diseases of the gastrointestinal tract, mainly in the chronic stage of diseases. Exercise therapy is especially indicated in childhood. The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and development of the child's body. Therefore, exercise therapy is an important element in the treatment of almost all childhood diseases. In the elderly, it maintains and develops the function of the main body systems and prevents premature aging.
On the basis of modern physiological and clinical concepts, the theoretical foundations of exercise therapy and massage have been developed, physical exercises have been systematized and methodological provisions for their use have been determined. Various private methods of exercise therapy and massage have been substantiated and applied for many diseases and injuries.
1 Indications and contraindications for therapeutic physical culture
Therapeutic physical culture is an independent medical discipline that uses the means of physical culture for the prevention of exacerbations and the treatment of many diseases and injuries and rehabilitation. The specificity of therapeutic physical culture in comparison with other methods of treatment lies in the fact that it uses physical exercise as the main therapeutic agent, which is a significant stimulator of the vital functions of the human body.
Therapeutic physical culture should be considered as one of the elements of modern complex treatment. Complex treatment is understood as individually selected therapeutic methods and means that ensure a change in the body's reactivity in a positive direction, improvement and restoration of the functions of an organ or system affected by the disease. Complex treatment affects not only pathologically altered tissues, organs or organ systems, but also the whole organism as a whole. The proportion of various elements of complex treatment depends on the period and clinical course of the disease. In the process of clinical recovery and the need to restore the ability to work of a person who has undergone a particular disease or injury, an essential role in complex treatment belongs to therapeutic physical culture, as a method of functional therapy. Physical exercises, regardless of the place of their application, affect the reactivity of the whole organism and involve the mechanisms that participated in the pathological process in the overall reaction. In this regard, therapeutic physical culture can be called a method of pathogenetic therapy.
Therapeutic physical culture provides for the conscious and active performance of appropriate physical exercises by patients. In the process of practicing them, the patient acquires the skill of using natural factors of nature for the purpose of hardening, is accustomed to observing the regime of movements, the use of physical exercises for therapeutic and prophylactic purposes. This allows us to consider the use of physical exercises for therapeutic purposes as a therapeutic and pedagogical process.
Therapeutic physical culture uses the same means and principles of application as physical education for a healthy person. It is based on the principles of the Soviet system of physical education, namely the principles of comprehensive impact, application and health-improving orientation. Thus, in terms of its content, therapeutic physical culture is an integral part of the Soviet system of physical education.
Indications for exercise therapy
Physiotherapy exercises are used for almost any ailments and injuries and have no age or gender restrictions. The main indications for its use are considered to be the absence, weakening or perversion of a function established as a result of a disease, injury, injury or their complications when the condition of positive dynamics in the physical condition and well-being of the patient is met. It is worth emphasizing that the effect of physiotherapy exercises is greatly increased with its earlier and systematic use in complex comprehensive treatment and rehabilitation.
Contraindications to exercise therapy
There are, frankly, few contraindications for physiotherapy exercises, and in most of their cases all of them are temporary, short-lived and relative. General contraindications include:
lack of contact with the patient due to mental disorders;
acute infectious and inflammatory diseases;
intoxication;
high body temperature;
elevated ESR of unknown origin;
arterial hypertension (with indicators over 200/120 mm Hg);
malignant neoplasms, tumors (in the phase before radical methods of treatment);
metastases;
irreversible progressive diseases;
the presence of a foreign body near large vessels or nerve trunks.
pronounced pain syndrome;
external or internal bleeding or the threat of its occurrence;
thrombosis;
When prescribing exercise therapy to patients, it is necessary to take into account limiting, restricting, limiting indicators and risk factors. Their statement makes it possible to clarify the methodology and dosage of physical activity during physiotherapy exercises. Such limiting factors include deviations in physical development and mental state, comorbidities and complications that affect the choice of physical exercises for the underlying disease. Risk factors are such conditions in which the patient may be injured or damaged at the time of performing the prescribed physical exercises (osteoporosis, fragile callus, aneurysm of the heart or aorta, etc.).
As you can see, indications and contraindications for exercise therapy are an important point in choosing a strategy for complex treatment of a patient. That is why physiotherapy exercises should be prescribed and supervised by a properly qualified specialist in any appropriate medical, sanatorium or rehabilitation institution.
2 Indications and contraindications of massage
Massage has long been valued for its healing, preventive, therapeutic properties. It can be carried out for all healthy people, as well as for healing the body and treating various diseases.
Practicing massage therapists say that there are no contraindications to massage at all, you just need to be able to select the type of massage specifically, the effect on the nervous system, lubricants, massage techniques, session time, and so on. But still, it should be borne in mind that it will not be easy for a non-professional to do this, and therefore the massage procedure can bring not benefit, but harm to the body.
To prevent this from happening, consider the indications and contraindications for massage (self-massage).
Indications for massage:
Diseases of the cardiovascular system: hypertension, coronary heart disease, heart defects, myocardial infarction (including in the postoperative period), disease of the veins and arteries.
Respiratory diseases: pharyngitis, tonsillitis, bronchial asthma (not in the acute stage), laryngitis, pleurisy, rhinitis, chronic pneumonia and bronchitis.
Diseases of the musculoskeletal system: osteochondrosis (of all parts of the spine), rheumatoid arthritis, dislocations, sprains, bruises, fractures at all stages of healing, curvature of the spine, impaired posture, flat feet.
Diseases and disorders of the nervous system: radiculitis, trauma of the nervous system, cerebrovascular accident (consequences), neuritis, cerebral palsy, neuralgia.
Diseases of the digestive system (not in the acute stage): gastritis, colitis, peptic ulcer (if there is no predisposition to bleeding), liver and gallbladder diseases.
Inflammatory diseases of the male and female genital organs: prostatitis, chronic urethritis, abnormal positions and displacements of the uterus and vagina, anatomical inferiority of the uterus, pain in the sacrum, tailbone, and the area of the uterus and ovaries in the intermenstrual period.
Massage is also used for: skin diseases (acne, hair loss), diseases of the ear, throat, nose, eyes, various back pains, headaches, sleep disturbance and increased irritability, sexual weakness, toothache, as well as in case of violation metabolism (cellulite, overweight, gout, diabetes).
Massage contraindications
Contraindications to massage (self-massage) can be divided into three groups: temporary, local and absolute.
Temporary contraindications are temporary, and after the inflammatory processes subside and pathological signs disappear, massage sessions can be performed. These contraindications include:
Diseases of the skin, nails and scalp with an infectious, fungal or unexplained etiology (causes and conditions for the onset of diseases), various skin rashes, skin lesions in the acute stage of inflammation;
Purulent processes, inflammation of the lymph nodes and blood vessels;
Hemorrhage, bleeding (nasal, intestinal, uterine);
Acute febrile conditions, high body temperature, acute inflammatory processes;
Acute hypertensive or hypotensive crisis;
Pain in the region of the heart;
Acute respiratory diseases (within 2-5 days after them);
General severe conditions in various diseases and injuries;
Alcohol intoxication.
Local- these are contraindications related to certain parts of the body. These include:
Warts, skin lesions or irritations, abrasions and cracks;
Psoriasis, neurodermatitis, eczema;
Local increase and soreness of the lymph nodes;
Significant varicose veins with trophic disorders;
Disease of the mammary glands (mastopathy);
Lumbar area and abdomen with a diagnosed ovarian cyst;
Pain on palpation (palpation) of the abdomen, disease of the abdominal organs with a tendency to bleeding, after bleeding due to peptic ulcer, as well as caused by diseases of the female reproductive system, menstruation, pregnancy;
In women - 2 months during the postpartum and post-abortion period.
Absolute- these are contraindications in which massage is not prescribed due to the high probability of deterioration in human health:
Benign and malignant tumors of various localization;
Gangrene, osteommelitis, trophic ulcer;
Blood diseases, atherosclerosis of peripheral vessels, thrombosis;
Thrombophlebitis;
Mental diseases with excessive excitement, significantly altered psyche;
Renal and liver failure;
Active forms of tuberculosis;
Venereal diseases.
It should be remembered that the main property of massage is to stimulate blood flow, and therefore if the body is affected by an infectious or viral disease (even such as acute respiratory infections), we risk, through massage manipulations and “blood dispersal”, to contribute to the accelerated spread of viruses throughout the body, and as well as their increased reproduction.
Conclusion
Therapeutic physical culture and massage for scoliotic disease are only part of the means of complex therapy, so they must be combined with treatment with position, the correct mode of movement and static loads, with the necessary drug therapy, special methods of orthopedic treatment, etc.
In the introductory part of a special lesson in physical therapy, walking, exercises in constructions and rearrangements, exercises for educating and consolidating the skill of correct posture, breathing exercises are used.
In the main part of the lesson, most of the means aimed at solving the main tasks of this period of treatment are used. In this part of the lesson, exercises are used that train the general and strength endurance of the muscles of the back, abdominals and chest to strengthen the muscle corset, corrective exercises in combination with general developmental and respiratory exercises. Preferential starting positions lying and kneeling emphasis. At the end of the main part of the lesson, it usually includes an outdoor game, the rules of which provide for maintaining the correct posture.
In the final part of the lesson, running, walking, coordination exercises, breathing exercises are used. In some cases, it is advisable to include in this part of the game for attention while maintaining the correct posture.
Exercise therapy is used in all stages of the disease, providing a complete solution to the therapeutic problems of complex therapy; these tasks include the reduction and elimination of pathological changes in the spine, stimulation of regeneration processes, activation of trophic processes in the spine, prevention of muscle atrophy, development of compensatory adaptive reactions aimed at stabilizing the spine and preventing its deformation, providing conditions for the normal functioning of the cardiovascular and respiratory systems, increasing the nonspecific resistance of the child's body. When treatment is carried out in an orthopedic hospital (sanatorium), physiotherapy exercises are carried out in the initial lying position with the inclusion of general developmental exercises for most muscle groups while maintaining the straightened position of the thoracic spine, static and dynamic breathing exercises, exercises for coordination of movements. Special exercises for the muscles of the back, trunk, and spine provide a compensatory effect, and also create the necessary prerequisites for restoring and improving the trophism of the affected vertebrae, and stimulating regeneration processes. With their help, a sufficiently powerful muscle corset is created with a predominant strengthening of the back extensors. Exercises for the abdominal muscles are carried out from the starting positions, excluding forward bending and increasing pressure on the anterior sections of the thoracic vertebral bodies.
In combination with exercise therapy exercises, a massage of the back area is used, which includes all the techniques and provides a significant improvement in the nutrition of the muscles of a sick child; teaching the latter some types of special exercises used in the early postoperative period.
Swimming is contraindicated in progressive forms of scoliosis. Swimming should be prescribed very carefully to patients with dysplastic scoliosis.
General contraindications include acute and chronic skin diseases (fungal, infectious skin diseases); diseases of ENT organs (otitis media, sinusitis, decompensated tonsillitis); eye diseases (conjunctivitis, blepharitis), high fever, general serious condition.
List of sources used
Amosov, N. M., Human health / N. M. Amosov, Ya. A. Bendet. – M.: 1984. – 58 p.
Biryukov, A. A. Massage / A. A. Biryukov. – M. : F i S, 2005. – 134 p.
Belaya, N. A. Guide to therapeutic massage / N. A. Belaya. - M. : Medicine, 1983. - 128 p.
Vasichkin, V. I. Handbook of massage / V. I. Vasichkin. - St. Petersburg, 2005. - 205 p.
Verbov, A.F. Fundamentals of therapeutic massage / A.F. Verbov. - M. : Polygon, 2008. - 34 p.
Vydrin, V. M. Physical culture of university students / V. M. Vydrin, B. K. Zykov, A. V. Lotonenko. - M. : 1996. - 241 p.
Demin, D.F. Medical control during physical education classes / D. F. Demin. - St. Petersburg, 1999. - 31 p.
Epifanov, V.A. The role and place of physical therapy in medical rehabilitation / V. A. Epifanov, T. G. Kuzbasheva. - M. : 2004. - 35 p.
Physiotherapy applied practically for any illness or injury and has no age or gender restrictions. The main indications for its use are considered to be the absence, weakening or perversion of a function established as a result of a disease, injury, injury or their complications when the condition of positive dynamics in the physical condition and well-being of the patient is met. It is worth emphasizing that effect of physical therapy significantly increases with its earlier and systematic use in a comprehensive comprehensive treatment and rehabilitation.
Contraindications to exercise therapy
There are, frankly, few contraindications for physiotherapy exercises, and in most of their cases they all wear temporary, short and relative character. General contraindications include:
- lack of contact with the patient due to mental disorders;
- acute infectious and inflammatory diseases;
- intoxication;
- pronounced pain syndrome;
- external or internal bleeding or the threat of its occurrence;
- thrombosis;
- embolism;
- high body temperature;
- elevated ESR of unknown origin;
- arterial hypertension (with indicators over 200/120 mm Hg);
- malignant neoplasms, tumors (in the phase before radical methods of treatment);
- metastases;
- irreversible progressive diseases;
- the presence of a foreign body near large vessels or nerve trunks.
When prescribing exercise therapy to patients, it is necessary to take into account limiting, restraining, limiting indicators and risk factors. Their statement makes it possible to clarify the methodology and dosage of physical activity during physiotherapy exercises. Such limiting factors include deviations in physical development and mental state, comorbidities and complications that affect the choice of physical exercises for the underlying disease. Risk factors are those conditions in which the patient may be injured or damaged at the time of performing the prescribed physical exercises (osteoporosis, fragile callus, aneurysm of the heart or aorta, etc.).
Mechanisms of the therapeutic effect of physical exercises in CV diseases
The therapeutic effect of physical exercises is based on the positive effect of muscle activity on the function of the heart and blood vessels. When the muscles work, the CCC increases their blood supply and thus makes it possible to continue working. Therefore, with the help of physical exercises, it is possible to have a targeted effect on many functions of the cardiovascular system. In diseases of the heart and blood vessels, physical exercises improve the adaptive processes of the cardiovascular system, which consist in strengthening the energy and regenerative mechanisms that restore impaired functions and structures.
Physical exercise improves trophic processes. They increase the blood supply to the heart by increasing coronary blood flow, opening reserve capillaries and developing collaterals, and activate metabolism. All this stimulates the recovery processes in the myocardium, increases its contractility. Physical exercise improve overall metabolism in the body, reduce the content of cholesterol in the blood, delaying the development of atherosclerosis.
Systematic physical exercises have an impact on blood pressure through many parts of the long-term regulatory systems. So, gradual, dosed training increases the tone of the vagus nerve and the production of hormones (for example, prostaglandins) that reduce blood pressure. As a result, heart rate and blood pressure decrease at rest.
Particular attention should be paid to special exercises, which, having an effect mainly through neuro-reflex mechanisms, reduce blood pressure. So, breathing exercises with an extended exhalation and slower breathing reduce heart rate. Exercises in muscle relaxation and exercises for small muscle groups lower the tone of arterioles and reduce peripheral resistance to blood flow.
In many diseases of the cardiovascular system, the patient's motor mode is limited. In this case, exercise becomes especially important. They render general tonic impact, improve the functions of all organs and systems and thus prevent complications, activate the body's defenses and accelerate recovery.
In a serious condition of the patient, physical exercises are used that have an effect through extracardiac (extracardiac) circulatory factors. Thus, exercises for small muscle groups promote the movement of blood through the veins, acting as a muscle pump, and, causing the expansion of arterioles, reduce peripheral resistance to arterial blood flow. Breathing exercises contribute to the flow of venous blood to the heart due to the rhythmic change in intra-abdominal and intrathoracic pressure. During inhalation, the negative pressure in the chest cavity has a suction effect, and the rising intra-abdominal pressure, as it were, squeezes blood from the abdominal cavity into the chest cavity. During expiration, intra-abdominal pressure decreases, which facilitates the movement of venous blood from the lower extremities.
Normalization of functions is achieved by gradual and careful training, which strengthens the myocardium and improves its contractility, restores vascular responses to muscle work and changes in body position. Physical exercise improves the function of regulatory organs, their ability to coordinate the work of the cardiovascular, respiratory and other body systems during physical exertion. Thus, its ability to perform more work is increased.
Physical culture is of great importance for the prevention of diseases of the cardiovascular system, as it compensates for the lack of physical activity of a modern person. Physical exercises increase the general adaptive capabilities of the body, its resistance to various stressful influences, improving the emotional state. Activation of the motor mode with the help of various physical exercises improves the functions of systems that regulate blood circulation, improves myocardial contractility, reduces the content of lipids and cholesterol in the blood, increases the activity of the anticoagulant blood system, promotes the development of collateral vessels, reduces hypoxia, i.e., prevents and eliminates the manifestation most risk factors for major cardiovascular diseases.
Thus, physical culture is shown to all people not only as a health-improving, but also as a prophylactic. It is especially necessary for those who are healthy, but have any risk factors for cardiovascular diseases, as well as for those who have had a CCC disease, as a prevention of its recurrence or exacerbation of a chronic disease.
Indications and contraindications for the use of therapeutic physical culture
Therapeutic physical culture is indicated for all diseases of the cardiovascular system. Contraindications are temporary. Therapeutic physical culture is contraindicated in the acute stage of the disease (myocarditis, endocarditis, angina pectoris and myocardial infarction during the period of frequent and intense attacks of pain in the heart area, severe cardiac arrhythmias), with an increase in heart failure, with severe complications from other organs.
With the subsiding of acute phenomena and the cessation of the increase in heart failure, the improvement of the general condition should begin to engage in therapeutic physical culture.
Therapeutic physical culture is also indicated in the initial stages and in the compensated state of blood circulation in the following diseases: myocardial dystrophy, myocarditis, endocarditis, heart defects, atherosclerosis, coronary heart disease, vegetative-vascular dystonia, hypertension and hypotension, obliterating diseases of the arteries.
Fundamentals of exercise therapy methodology
In therapeutic physical training with patients with cardiovascular diseases, it is necessary to adhere to a number of general methodological rules. Particular attention should be paid to strict adherence to the basic didactic principles, as well as to the use of methodological techniques for dissipating and alternating loads, when an exercise for one muscle group is replaced by an exercise for another group, and exercises with a large load alternate with exercises that require little muscle effort, and with breathing exercises.
The method of therapeutic physical culture depends on the disease and the nature of the pathological changes caused by it, the stage of the disease, the degree of circulatory insufficiency, the state of the coronary blood supply, the functional state of the patient.
In severe manifestations of the disease, severe heart failure or coronary circulation, classes are structured in such a way as to primarily have a therapeutic effect: prevent complications by improving peripheral circulation and respiration, help compensate for weakened heart function by activating non-cardiac circulatory factors, improve trophic processes by due to the normalization of myocardial blood supply. For this, low-intensity physical exercises performed at a slow pace for small muscle groups, breathing exercises and muscle relaxation exercises are used.
When the patient's condition improves, therapeutic physical culture is used in a complex of rehabilitation measures to restore working capacity. Although physical exercises continue to be used to implement therapeutic tasks, the main direction is systematic training, a gradual increase in physical activity. At first, this is achieved through a greater number of repetitions, then by increasing the amplitude and pace of movements, more difficult physical exercises and starting positions. So, from low-intensity exercises, they move on to exercises of medium, then high intensity, from the initial positions lying and sitting to the initial standing position. In the future, dynamic loads of a cyclic nature are used: walking, working on a bicycle ergometer, running.
After the end of rehabilitation treatment and in chronic diseases, physiotherapy exercises are used to maintain the achieved results of treatment to improve blood circulation and stimulate the functions of other organs and systems. Physical exercises and their dosage are selected depending on the residual manifestations of the disease and the functional state of the patient. A variety of physical exercises are used (gymnastics, elements of sports, games), which are periodically replaced, physical activity is familiar, but from time to time it either increases or decreases.
To determine physical activity, it is necessary to take into account many factors: manifestations of the underlying disease and the degree of coronary insufficiency, the level of physical performance, the state of hemodynamics, the ability to perform household physical activity. Taking into account these factors, 4 functional classes of patients with coronary heart disease are distinguished. For each functional class, motor activity and programs of therapeutic physical training are regulated. This regulation also applies to patients with other diseases of the cardiovascular system.
2.1. GENERAL CHARACTERISTICS OF THE METHOD OF THERAPEUTIC PHYSICAL CULTURE
Therapeutic physical culture (LFK) is understood as the use of physical culture means to a sick person with a therapeutic and prophylactic purpose for a faster and more complete restoration of health and working capacity and prevention of the consequences of a pathological process (V.N. Moshkov). Exercise therapy studies the changes that occur in the patient's body under the influence of various physical exercises, which, in turn, allows you to create methods of exercise therapy that are clinically and physiologically sound in various pathological conditions.
Exercise therapy as an integral part of the system of physical education and physical culture is a medical and pedagogical process and solves special problems. It is designed to restore impaired health, eliminate the formed inferiority of physical development, moral and volitional qualities of the sick, to help restore their ability to work, in other words, their comprehensive biological and social rehabilitation.
Exercise therapy is also a treatment and educational process, since it educates the patient with a conscious attitude to the use of physical exercises and massage, instills in him hygienic skills, provides for his participation in the regulation of the motor regimen, and educates the correct attitude to hardening by natural factors.
The exercise therapy method uses the principle of exercise. The training of a sick person is provided by the systematic and dosed use of physical exercises for the purpose of general improvement of the body, improvement of functions disturbed by the pathological process, development, education and consolidation of motor skills and volitional qualities.
Distinguish between general and special training.
General training pursues the goal of healing, strengthening and general development of the patient's body; she uses a variety of types of restorative and developing physical exercises and massage techniques.
Special training aims to develop functions that are impaired due to illness or injury. It uses types of physical exercises that directly affect the affected area or functional disorder.
Based on the data of the physiology of muscular activity and clinical and functional studies, the following basic principles for achieving fitness have been formulated:
Systematicity, which means a certain selection and distribution of exercises, their dosage, sequence; the system of classes is dictated by the objectives of the training;
The regularity of classes involves their rhythmic repetition and, accordingly, the alternation of loads and rest. In exercise therapy, regularity is usually understood as daily classes;
duration. The effectiveness of physical exercises directly depends on the duration of the classes. In exercise therapy, "course" classes are unacceptable (by analogy with the courses of resort, physiotherapy and drug treatment). Having started physical exercises under the guidance of specialists in a medical institution, the patient must necessarily continue these exercises on his own at home;
Gradual increase in physical activity. In the process of training, the functional capabilities and abilities of the body increase, so physical activity should increase. This is one of the ways of physical improvement of the organism;
Individualization. It is necessary to take into account the individual physiological and psychological characteristics of each student, the strengths and weaknesses of his body, the type of higher nervous activity, the age and fitness of the patient, the characteristics of the underlying disease, etc.;
Variety of funds. In exercise therapy, gymnastic, sports, game, applied and other types of exercises are rationally combined, complementing each other, for a versatile effect on the body.
The development of fitness is based on the improvement of nervous control. As a result of training, the strength, balance and mobility of nervous processes increase, which leads to an improvement in the regulation of functions. At the same time, the interaction of motor and vegetative functions is improved and coordinated. Physical exercise affects primarily the function of the respiratory and cardiovascular systems. A trained organism is capable of a more complete mobilization of functions, which is associated with a significant range of shifts in the internal and throughout the vegetative sphere. A trained organism can withstand large deviations of homeostatic constants without damage to itself (Scheme 2.1)
Scheme 2.1.Therapeutic and preventive effect of physical training (Zhuravleva A.I. 1993)
The main positive aspects of the exercise therapy method include:
Deep physiology and adequacy;
Universality, which means a wide range of actions - there is not a single organ that would not react to movements. A wide range of influence of exercise therapy is provided by the involvement of all levels of the central nervous system, endocrine and humoral factors;
Absence of negative side effects (with the correct dosage of physical activity and rational methods of training);
The possibility of long-term use, which has no restrictions, moving from therapeutic to preventive and general health (I.B. Temkin);
Formation of a new dynamic stereotype that reactively eliminates or weakens the pathological stereotype. In a normal stereotype, motor skills predominate; its restoration is the general task of exercise therapy;
Transfer of all physiological systems of an aging (and not only aging) organism to a new, higher level, which ensures an increase in vitality and energy accumulation. Optimal motor mode delays aging.
2.2. MECHANISMS OF ACTION OF PHYSICAL
EXERCISES
Physical exercises have a tonic (stimulating), trophic, compensatory and normalizing effect on the body.
Tonic (stimulating) effect of physical exercises.
In case of a disease, the body is in especially unfavorable conditions, both due to dysfunction caused by the pathological process, and due to forced hypokinesia, which worsens the patient's condition and contributes to the progression of the disease. The tonic effect of physical exercises is expressed primarily in the stimulation of motor-visceral reflexes. An increase in the afferent impulse of proprioceptors stimulates cellular metabolism in the neurons of the central link of the motor analyzer, as a result of which trophic
the effect of the central nervous system on skeletal muscles and internal organs, i.e. for the whole organism.
Physical exercises have certain advantages, consisting in their physiology and adequacy, versatility (a wide range of effects of physical exercises), the absence of negative side effects (with the correct dosage of the load and rational methods of training), the possibility of long-term use, which has practically no restrictions, passing from curative to preventive and health-improving.
Trophic effect of physical exercises. One of the mechanisms of physiological regulation of tissue metabolism is trophic reflexes. The trophic function is performed by various parts of the central nervous system, including the cerebral cortex and the hypothalamus. It is known that the implementation of any type of nervous activity - from a simple reflex act to complex forms of behavior - is associated with a change in the level of metabolic processes, especially in cases where the musculoskeletal system acts as an executive effector mechanism. The information coming from the proprioceptors of the latter has a high level of trophic influence on all organs, including the cells of the nervous system.
The trophic effect of physical exercises in the phase of formation of a regenerate that replaces a defect is well known. It is based on the activation of plastic processes with increased protein delivery, which provides compensation for energy costs for muscle work. The therapeutic use of physical exercises not only stimulates trophic processes, but also, directing it along the functional channel, contributes to the formation of the most complete structure of the regenerate.
The trophic effect of physical exercises can manifest itself in the form of regenerative or compensatory hypertrophy. Regeneration hypertrophy proceeds in the form of a more intense physiological reaction of tissue elements. For example, active muscle loads in patients with traumatic injuries of the lower extremities lead to an increase in the neurotrophic effect on a certain muscle group, activation of the RNA-protein system, increased protein synthesis and a decrease in decay (especially myofibrillar proteins), an increase in the power of the enzymatic systems of anaerobic and especially aerobic synthesis of macroergs due to
enhancing the utilization of lipids and carbohydrates. An increase in the functional load (along the axis of the long bone) enhances the hydrodynamic effect of elastic bone deformations on microcirculation and tissue trophism and leads to the predominance of bone formation processes over resorption ones.
In diseases and injuries of the central and peripheral nervous system, muscle dysfunction (paresis, paralysis) can cause the development of stiffness in the joints, contractures. With a prolonged absence of active movements in the joints, secondary changes develop in them, which in turn reduce the amplitude of movements. In the process of performing special physical exercises, blood and lymph circulation in the periarticular tissues improves, mobility increases, which in turn leads to a more complete functional restoration of the entire limb. Using thus viscero-visceral and motor-visceral relationships, it is possible to choose physical exercises in such a way that their trophic effect is localized precisely in a particular area or organ.
Formation of compensation. Compensation is a temporary or permanent replacement of impaired functions. Compensatory processes have two stages: urgent and long-term compensation. So, for example, with a traumatic injury to the right hand, the patient immediately begins to use the left hand in various household operations. This urgent compensation is important in extreme situations, but it is obviously inferior. Subsequently, as a result of training with physical exercises and the formation of a system of new structurally fixed connections in the brain, skills are developed that provide long-term compensation - relatively perfect performance of household manipulations with the left hand, usually performed by the right.
As a result of the study of compensatory processes in violation of motor functions and functions of internal organs, Academician Anokhin P.K. formulated several general principles that characterize the process of formation of functional systems that compensate for the defect. These principles can be applied to compensatory processes in case of damage to various organs. For example, damage to the lower limb causes impaired balance and walking. This entails a change in signaling from the receptors of the vestibular apparatus, muscle proprioceptors,
skin receptors of the extremities and torso, as well as visual receptors (the principle of signaling a defect). As a result of the processing of this information in the central nervous system, the function of certain motor centers and muscle groups changes in such a way as to restore balance to some extent and maintain the possibility of movement, albeit in an altered form. As the degree of damage increases, the signaling of a defect can increase, and then new areas of the CNS and their corresponding muscle groups are involved in compensatory processes (the principle of progressive mobilization of spare compensatory mechanisms). In the future, as effective compensation or elimination of the damage itself, the composition of the afferent impulse flow entering the higher parts of the nervous system will change. Accordingly, certain departments of the functional system that were previously involved in the implementation of compensatory activity will be switched off, or new components will be switched on (the principle of reverse afferentation of the stages of restoration of impaired functions). Preservation of a sufficiently stable anatomical defect after regular physical exercises will make itself felt by a certain combination of afferentations entering the higher parts of the nervous system, which, on this basis, will ensure the formation of stable compensation for temporary connections and optimal compensation, i.e. minimal lameness with a given injury (principle of sanctioned afferentation). Long-term training of compensatory mechanisms (walking on crutches, with a stick, on your own) can provide sufficient compensation for impaired or lost functions, however, at a certain stage, further improvement of complex reflex mechanisms does not lead to a significant change, i.e. compensation stabilization occurs (the principle of relative stability of compensatory devices). In this period, a dynamically stable balancing of the patient's body with a certain structural and functional defect in the external environment is established.
The role of the cerebral cortex in compensatory processes in case of damage to the underlying parts of the nervous system is determined by the fact that the cortical parts of the analyzers are sensitive to any change in the relationship of the body with the environment. This explains the decisive role of the cortex in compensating for movement disorders.
after trauma and reconstructive surgery. For example, after the operation of splitting the forearm (the creation of the Krukenberg arm), there are only anatomical prerequisites for compensating for the missing hand. In order for the newly formed branches of the hand to take over the function of the missing hand to some extent, profound changes in the functions of the shoulder and forearm are necessary, due to the restructuring of the corresponding nerve centers. Without training based on a verbal explanation of the training of certain muscle groups, showing the pattern of the movement itself and fixing it in the process of training, such a restructuring is impossible even for a number of years. For the development of compensation in this case, the active activity of the cortical mechanisms, in particular the mechanisms of the second signaling system, and the training by physical exercises of certain muscle groups of the shoulder and forearm are necessary (Epifanov V.A., 1997).
The process of compensating for impaired functions is active, since the patient's body uses a rather complex set of different reactions that are most appropriate in a particular situation to ensure the greatest degree of controllability of body segments in order to achieve optimal strategy and tactics in relations with the environment.
Normalization of pathologically altered functions and integral activity of the body. Physical therapy is primarily a therapy that uses the most adequate biological ways to mobilize the body's own adaptive, protective and compensatory reserves to eliminate the pathological process. Together with motor function, health is restored and maintained. The most important way to normalize functional disorders is the impact through proprioceptors, the impulse from which has both a general tonic effect on the central nervous system and a specific effect on the nerve centers for the regulation of physiological functions (in particular, on the vasomotor centers).
Physical exercise in some cases has a symptomatic effect on physiological functions. For example, special breathing exercises can, according to the mechanism of motor-pulmonary reflexes, activate the drainage function of the bronchi and provide increased sputum secretion. With the phenomena of flatulence, special exercises can affect intestinal motility and normalize its function.
Thus, the therapeutic effect of physical exercises is diverse. It can manifest itself in a complex way, for example, in the form of a simultaneous trophic and compensatory influence. Depending on the specific pathology, the localization of the process, the stage of the disease, the age and fitness of the patient, it is possible to select certain physical exercises, the dosage of muscle load, which will ensure the predominant action of a certain mechanism necessary for restorative treatment in a given period of the disease.
2.3. MEANS OF THERAPEUTIC
PHYSICAL CULTURE
The main means of exercise therapy are physical exercises used for therapeutic purposes, and natural factors of nature, additional - mechanotherapy (training on simulators, block installations), massage and ergotherapy (occupational therapy).
2.3.1. Physical exercise
Physical exercises affect not only various systems of the body as a whole, but also individual muscle groups, joints, spine, allowing you to restore strength, speed, coordination, endurance, etc. In this regard, exercises are divided into general developmental (general tonic, general strengthening) and special.
General developmental exercises are aimed at improving and strengthening the whole body.
The task of special exercises is a selective effect on one or another part (segment, region) of the musculoskeletal system, for example, on the foot with flat feet, on the spine with its deformation, on one or another joint with restriction of movement.
Exercises for the muscles of the body have a general strengthening effect on a healthy person. For a patient, for example, with a disease of the spine (scoliosis, osteochondrosis, etc.), they constitute a group of special exercises, as they contribute to the correction of the spine, increase the mobility of the spine as a whole or in any department, strengthen the surrounding muscles, etc.
Thus, the same exercises for one person can be general strengthening, for another - special. In addition, the same exercises, depending on the method of application, can contribute to the solution of various problems. For example, extension or flexion in the knee joint in one patient can be used to develop mobility in the joint, in another - to strengthen the muscles surrounding the joint, in the third - to develop muscle-articular feeling (accuracy in reproducing a given range of motion without visual control).
The classification of physical exercises is based on several features.
Anatomical sign. There are exercises for small (hand, foot, face), medium (neck, forearm, lower leg, thigh), large (limbs, torso) muscle groups.
The nature of muscle contraction. Physical exercises are divided into dynamic (isotonic) and static (isometric).
Dynamic exercises - exercises in which the muscle works in isotonic mode; in this case, periods of contraction alternate with periods of relaxation, i.e., the joints of the limbs and trunk are set in motion. Muscle tension during isotonic exercises can be dosed by using a lever, changing the speed of movement of a moved body segment and using additional weights, resistances, gymnastic equipment, etc. An example of a dynamic exercise can be flexion and extension of the arm in the elbow joint, abduction of the arm in the shoulder joint, torso tilt forward, to the side, etc.
The contraction of a muscle, in which it develops tension, but does not change its length, is called isometric. This is a static form of reduction. For example, if a patient from I.P. lying on his back lifts his straight leg up and holds it for some time, then he performs first dynamic work (lifting), and then static work, when the hip flexor muscles produce isometric tension. Muscle tension under a plaster cast in traumatic injuries of the limbs is widely used to prevent muscle hypotension.
The degree of activity. Physical exercises can be active and passive depending on the task, the condition of the patient, the nature of the disease or injury, and also
to create a strictly adequate load. Active exercises can be performed in light conditions, i.e. with the elimination of friction, gravity, reactive muscle forces (for example, flexion at the elbow joint with support on the horizontal plane of the table or abduction of the lower limb, sliding the foot along the plane of the couch / bed, and etc.). To facilitate the execution of movements, special sliding planes (horizontal and inclined), roller carts, as well as various suspensions that eliminate the friction force at the moment of active movement are proposed. To impede muscle contraction, you can use movements with a shock absorber or resistance provided by a methodologist, resistance can be created at different stages of the movement: at the beginning, in the middle and at the end. Passive-active exercises they call those in which the patient helps the methodologist to make passive movements, and active-passive exercises are those in which the methodologist resists the movement actively performed by the patient. Exercises in passive movements are used in the form of moving individual segments of the body. They can be performed by an exercise therapy methodologist or the patient himself (with the help of healthy limbs or under the influence of gravity), passive movements are used to stimulate the restoration of movements and prevent contractures and stiffness in the joints (with paresis and paralysis, in the post-immobilization period, etc.).
Exercises using reflex movements are used when the patient cannot voluntarily contract certain muscles. With paralysis and paresis of central origin, as well as in children of the 1st year of life, both physiological and pathological reflexes can be used. Reflex can be, for example, leg extension in the knee and hip joints with pressure exerted on the plantar surface of the foot.
Stretching exercises are used in the form of various movements that cause a slight excess of their inherent passive mobility in the joints. The therapeutic effect of these exercises is used for contractures and stiffness of the joints, deterioration of the elastic properties of the tissues of the musculoskeletal system and skin, excessive increase in muscle tone (spastic paresis and paralysis), to restore mobility lost during diseases, etc.
Attention!When stretching atrophic, degeneratively altered and denervated muscles, their overextension easily occurs, followed by a deterioration in function (in particular, a decrease in strength) and a slowdown in the normalization of activity.
Exercises in active relaxation of various muscle groups can be applied to individual segments of the body (hand, foot), limbs as a whole, limbs and torso at the same time. They contribute to the normalization of increased tone in various manifestations of pathology (pain contractures, spastic paresis, etc.) and improve overall coordination of movements. Relaxation exercises are divided into:
Exercises in relaxation of individual muscle groups at rest in I.P. standing, sitting and lying;
Exercises in relaxation of individual muscle groups or muscles of individual segments of the body after their isometric tension or after performing isotonic work;
Exercises in relaxation of individual muscle groups or muscles of individual segments of the body in combination with active movements carried out by other muscles;
Exercises in relaxing the muscles of individual segments of the body, combined with passive movements in the same segments;
Exercises in relaxing the entire musculature at rest in the I.P. lying down (muscle relaxation exercises).
Corrective (corrective) exercises are called physical exercises in which the movements of the limbs and torso or individual segments of the body are aimed at correcting various deformities (neck, chest, spine, feet, etc.). In these exercises, the most important is the starting position, which determines their strictly localized impact, the optimal combination of force tension and stretching, and the formation of a slight overcorrection of a strong position in all possible cases.
The overall impact of corrective exercise is consistent with that of low- or moderate-intensity exercise.
Coordination exercises involve unusual or complex combinations of different movements. The proportionality of muscular efforts and the compliance of the performed movement with the given one in direction, speed and
amplitude. Coordination exercises are widely used for violations of coordination movements as the main manifestation of a disease of the central nervous system (spastic paresis, hyperkinesis, ataxia, etc.). Disturbance of coordination to one degree or another is observed in most diseases, especially in bed rest.
Balance exercises are characterized by:
Movements of the vestibular apparatus in different planes during movements of the head and torso;
Changes in the area of support (for example, the transition from the main stance to the stance on one leg) at the time of the exercise;
By moving the height of the common center of gravity in relation to the support (for example, when moving from ip sitting to ip standing on toes with arms raised up).
Exercises in balance activate not only vestibular, but also tonic and statokinetic reflexes.
In terms of the overall effect of exercises in balance, they are similar in intensity to exercises with dosed power stress.
Breathing exercises include exercises in which the components of the respiratory act are regulated arbitrarily (by verbal instructions or by command).
The use of breathing exercises for therapeutic purposes can provide:
Normalization and improvement of the breathing mechanism and mutual coordination of breathing and movements;
Strengthening the respiratory muscles (main and auxiliary);
Improving the mobility of the chest and diaphragm; prevention and correction of chest deformities;
Stretching moorings and adhesions in the pleural cavity;
Prevention and elimination of congestion in the lungs; removal of sputum.
Respiratory exercises also have an inhibitory and less often activating effect on cortical processes, promote blood circulation, and reduce increased (after other physical exercises) vegetative functions.
Breathing exercises are divided into static and dynamic.
TO static include exercises that are not combined with movements of the limbs and torso, namely exercises:
In even rhythmic breathing, in slowing down breathing;
In changing the type (mechanism) of breathing (thoracic, diaphragmatic, full and their various combinations);
In changing the phases of the respiratory cycle (various changes in the ratios of inhalation and exhalation time, the inclusion of short-term pauses and breath holdings due to “blowing out” and other methods, a combination of breathing with pronouncing sounds, etc.).
Static breathing exercises also include exercises with metered resistance:
Diaphragmatic breathing with resistance by the hands of the methodologist in the region of the edge of the costal arch closer to the middle of the chest;
Diaphragmatic breathing with a bag of sand of various weights (0.5-1 kg) placed on the upper quadrant of the abdomen;
Upper thoracic bilateral breathing with overcoming resistance under pressure by the hands of a methodologist in the subclavian region;
Lower thoracic breathing with the participation of the diaphragm with resistance to pressure by the hands of the methodologist in the region of the lower ribs;
Upper thoracic breathing on the right with resistance when pressing with the hands of the methodologist in the upper part of the chest;
The use of inflatable toys, balls, various devices. dynamic called exercises in which breathing
combined with various movements:
Exercises in which movements facilitate the implementation of individual phases or the entire respiratory cycle;
Exercises that provide a selective increase in mobility and ventilation of individual parts or in general of one or both lungs;
Exercises that help restore or increase the mobility of the ribs and diaphragm;
Exercises that help stretch adhesions in the pleural cavity;
Exercises that form the skills of a rational combination of breathing and movements.
drainagebreathing exercises are called exercises that promote the outflow of discharge from the bronchi into the trachea, from where sputum is evacuated during coughing. When performing special physical exercises, the affected area
should be located above the bifurcation of the trachea, which creates optimal conditions for the outflow of discharge from the affected bronchi and cavities.
To create a better outflow of discharge from the affected area, use: a) static and b) dynamic drainage exercises.
Exercises in sending impulses to movement (ideomotor exercises) are expressed in the active sending of impulses to contract individual muscle groups without changing the position of limb segments. Such exercises, causing muscle contractions, affect their strengthening and increase efficiency. Exercises are recommended for patients on bed rest, with immobilization, paralysis and paresis.
Rhythmoplastic exercises are more often used after the patient is discharged from the hospital at the stage of rehabilitation treatment (polyclinic - sanatorium aftercare) in order to completely correct the functions of the musculoskeletal system (for example, with diseases of the joints, after injuries or surgical interventions), as well as in neurological practice (for example, with neuroses). Exercises are performed with musical accompaniment in a given rhythm and tone, depending on the functional state of the patient, the type of higher nervous activity, age and exercise tolerance.
Exercises with the use of gymnastic objects and apparatus. Depending on the specific conditions, exercises are performed without objects; with objects and equipment (gymnastic sticks, balls, dumbbells, maces, etc.); on shells (mechanotherapeutic shells can also be included here).
In accordance with the general kinematic characteristics, exercises are divided into cyclic and acyclic (Scheme 2.2).
Locomotive (displacement) cyclic exercises include running and walking, skating and skiing, swimming, cycling, etc. These exercises include repeated repetition of stereotypical cycles of movements.
Acyclic exercises include exercises with a sharp change in motor activity (games, jumps, gymnastic exercises, etc.). With acyclic exercises, power changes dramatically.
All cyclic exercises can be divided into anaerobic and aerobic. When performing anaerobic exercises, the leading quality is power, while performing aerobic exercises - endurance.
Physical exercises used to treat various diseases can be low, moderate, high, and (rarely) maximum intensity.
With low-intensity exercises in the form of, for example, slow rhythmic movements of the feet or squeezing and unclenching the fingers of the hand, as well as isometric tensions of small muscle groups (for example, the flexor muscles of the forearm during plaster immobilization), the overall physiological changes are insignificant.
Scheme 2.2.Kinematic characteristics of exercises
Changes in the activity of the cardiovascular system are favorable and consist of a combination of a slight increase in the stroke volume of the heart of the total blood flow velocity, a slight increase in systolic and a decrease in diastolic and venous pressure. There is a slight decrease and deepening of breathing.
Exercises of moderate intensity are accompanied by muscle tension and medium strength with an average speed of stretch contraction, isometric tension and relaxation of a relatively large number of muscle groups or muscles. Examples can be movements performed at a slow and medium pace with the limbs and torso, movements similar to those used in self-service, walking at a slow and medium pace, etc. The activation of cortical processes in them is moderate. Pulse and systolic blood pressure in most cases slightly increase, diastolic decreases. Moderately frequent and deep respiratory movements and increased pulmonary ventilation. The recovery period is short.
High-intensity exercises involve large muscle groups with moderate or high strength and sometimes with a significant speed of their contractions, pronounced static tensions of synergistic muscles, intense changes in vegetative-trophic processes under the influence of postural-tonic reflexes (for example, fast "streaming" of medicine balls, fast walking, exercises on gymnastic apparatus, accompanied by the transfer of body weight to the upper limbs, skiing, etc.). These exercises significantly increase the excitability and mobility of cortical processes. The pulse rate increases markedly, systolic blood pressure increases and diastolic blood pressure decreases. Unsharply quickens and deepens breathing; pulmonary ventilation often delivers more oxygen than is absorbed by the body. The recovery period is quite long.
Exercises of submaximal and maximum intensity include the movement of a large number of muscles with maximum intensity and high speed of their contractions, pronounced postural-tonic reactions (for example, speed running). Patients with high power of work performed
can maintain no more than 10-12 seconds, so the activity of the vegetative organs and metabolism do not have time to increase to the maximum limits. Oxygen debt is growing rapidly. The activity of the cardiovascular and respiratory systems is maximally enhanced at the end of classes; a high heart rate is combined with a slightly changing stroke volume of the heart and a marginal increase in respiratory function.
Applied sports exercises are walking, running, crawling and climbing, and much more. In exercise therapy, those elements of applied and sports movements that are necessary for domestic and industrial motor acts are used: grasping, squeezing, shifting various objects; fastening and unbuttoning buttons; opening and closing lids, etc.
Physical exercises in water, underwater massage, traction treatment and correction of position in the aquatic environment, therapeutic swimming have various therapeutic effects on the patient's body. Use for therapeutic purposes in diseases of internal organs and damage to the locomotor apparatus of physical exercises in the aquatic environment is based on reducing body weight in water; hydrostatic effect on the body; the influence of the thermal factor and the positive impact on the emotional sphere of the patient.
The pressure of a column of warm water during exercise has a positive effect on peripheral circulation. Active movements in the water, especially in the peripheral segments of the limbs, help venous outflow, lymph circulation, and reduce swelling in the joints. The physiological effect depends on the temperature of the water: warm water improves arterial circulation and venous blood outflow, helps to reduce pain and relax muscles. In the process of performing physical exercises, swimming, the respiratory function is activated (the depth of breathing, VC increases). This is facilitated by exhalation into the water: the resistance of the water column at the time of active (forced) exhalation leads to the strengthening of the respiratory muscles. The stay of a person in water approaches the state of weightlessness. Active movement in the aquatic environment can be performed with minimal muscle effort, since the inhibitory effect of the weight of limb segments on movement is sharply reduced. In water
the amplitude of movements in the joints increases, the movements are performed with less muscle tension, and with additional effort, the resistance of rigid soft tissues is more easily overcome (A.F. Kaptelin). To increase the load on the muscular system, increase muscle strength, exercises are used at a fast pace and with a change in direction, creating eddy currents of water. The compaction of the water column during movements counteracts them. The force of counteraction of the mass of water to movements (physical exercises, swimming, etc.) also depends on the volume of the immersed part of the body. For example, an increase in the surface of a segment of a limb or torso immersed in water leads to an increase in the load on the working muscle groups. The contrast of the force load on the muscles at the moment of transferring the limb from the water to the air environment contributes to strengthening. The water environment facilitates not only movements in the joints, but also some locomotor functions - moving the body and walking. As a result of a decrease in body weight in water, movement (especially in patients with paresis of the muscles of the lower extremities) is facilitated.
The main contraindications to exercise in the pool and swimming; mental illness, skin and venereal diseases, acute inflammatory processes, open wounds and ulcers, infectious diseases, general serious condition, impaired function of the cardiovascular system, tumor processes, tendency to bleeding, after intra-articular fractures (early after injury), trophoneurotic disorders , instability of the affected PDS of the spine.
2.3.2 Games in exercise therapy
Games in exercise therapy are divided into 4 types increasing in load: games on the spot; sedentary; mobile and sports games. From a physiological point of view, games are complex forms of acyclic muscular activity, which significantly complicates the dosage of general and special loads. However, this lack of games is compensated by their high emotionality. Positive emotions that arise during gaming activities stimulate the functions of all major body systems, arouse enthusiasm and interest in such activities. This applies to the use of games for general physical fitness and training games in sports.
Games are used as one of the means of exercise therapy and are one of the components of the active motor mode. In a number of conditions, when exercise therapy pursues the goal of a general impact, increasing the functionality of the circulatory and respiratory organs without a differentiated effect on their individual links, games can be the main training tool. In this regard, they should become part of the motor regimen of patients not only in medical institutions, but also in everyday life.
2.3.3. motor mode.
The effectiveness of the treatment and recovery process depends on the rational construction of the motor regime, which provides for the use and rational distribution of various types of the patient's motor activity throughout the day in a certain sequence in relation to other means of complex therapy. Correct and timely appointment and use of the appropriate mode of movement contribute to the mobilization and stimulation of the protective and adaptive mechanisms of the patient's body and its readaptation to increasing physical stress.
A rational mode of movement is based on: a) stimulation of recovery processes through active recreation and targeted training of the functions of various organs and systems; b) promoting the restructuring and formation of an optimal dynamic stereotype in the central nervous system; c) the adequacy of physical activity to the age of the patient, his physical fitness, the clinical course of the disease and the functional capabilities of the body; d) gradual adaptation of the patient's body to an increasing load; e) rational combination and expedient consistent use of exercise therapy with other therapeutic factors used in the complex therapy of patients at the stages of treatment: clinic - hospital - spa treatment.
In medical institutions, the following motor modes are distinguished:
In the hospital - bed (strict and lightweight); semi-bed (ward) and free;
In outpatient clinics, sanatoriums, rest homes and dispensaries - sparing, sparing training and training.
2.3.4. Indications and contraindications for the appointment of exercise therapy
The main indications for the appointment of exercise therapy: the absence, weakening or perversion of the function that occurred as a result of the disease or its complications; positive dynamics in the patient's condition according to the totality of clinical and functional data - improvement in well-being, reduction in the frequency and intensity of pain attacks, improvement in functional and clinical and laboratory examination data. Indications for the appointment of exercise therapy are essentially its tasks.
Contraindications to the appointment of exercise therapy: lack of contact with the patient due to his serious condition or mental disorders; acute period of the disease and its progressive course; increase in cardiovascular insufficiency; sinus tachycardia (more than 100 per minute) and bradycardia (less than 50 per minute); frequent bouts of paroxysmal or atrial tachycardia; extrasystoles with a frequency of more than 1:10; negative dynamics of the ECG, indicating a deterioration in coronary circulation; atrioventricular block II-III degree; hypertension (BP above 220/120 mm Hg) against the background of a satisfactory condition of the patient; hypotension (BP below 90/50 mm Hg); frequent hyperor hypotonic crises; the threat of bleeding and thromboembolism: anemia with a decrease in the number of erythrocytes to 2.5-3 million, ESR more than 20-25 mm / h, leukocytosis.
2.3.5. Natural factors of nature
Natural factors of nature (sun, air and water) occupy a relatively smaller place in exercise therapy than physical exercise. They are used as a means of healing and hardening the body.
Hardening is a set of methods for purposefully increasing the functional reserves of the body and its resistance to the adverse effects of physical environmental factors (low or high air temperature, water, low atmospheric pressure, etc.) through systematic training dosed exposure to these factors.
Hardening is one of the most important areas of prevention, an integral part of health promotion measures at home, sanatoriums and rest homes, boarding houses. Hardening is carried out in the following forms: a) hardening by the sun; b) hardening with air and c) hardening with water (wiping the body, a contrast shower, swimming in open water).
2.4. FORMS AND METHODS OF MEDICAL
PHYSICAL CULTURE
The main forms of exercise therapy include: a) morning hygienic gymnastics (UGG); b) procedure (occupation) LG; c) dosed ascents (terrenkur); d) walks, excursions and nearby tourism (Scheme 2.3)
Scheme 2.3. Forms of exercise therapy
2.4.1. Morning hygienic gymnastics
Morning hygienic gymnastics at home is carried out in the morning and is a good means of transition from sleep to wakefulness, to the active work of the body
The physical exercises used in hygienic gymnastics should be easy. Static exercises that cause strong tension and breath holding are unacceptable here. Selected exercises that affect different groups
muscles and internal organs. In this case, it is necessary to take into account the state of health, physical development and the degree of workload.
The duration of gymnastic exercises should be no more than 10-30 minutes, the complex includes 9-16 exercises. These can be general developmental exercises for individual muscle groups, breathing exercises, exercises for the body, for relaxation, for the abdominal muscles.
All gymnastic exercises should be performed freely, at a calm pace, with a gradually increasing amplitude, with the involvement of small muscles first, and then larger muscle groups.
2.4.2. Occupation (procedure) in therapeutic gymnastics
LH is the main form of exercise therapy. Each procedure consists of three sections: introductory, main and final.
The introductory section of the procedure allows you to gradually prepare the patient's body for increasing physical activity. They use breathing exercises and exercises for small and medium muscle groups and joints.
During the main section, a training (general and special) effect on the patient's body is carried out.
In the final period, through breathing exercises and movements covering small and medium muscle groups and joints, the overall physical stress is reduced.
Technique of the LH procedure. During the procedure, the following rules must be observed.
1. The nature of the exercises, physiological load, dosage and initial positions should be adequate to the general condition of the patient, his age characteristics and fitness status.
2. Physical exercise should affect the entire body of the patient.
3. The procedure should combine general and special effects on the patient's body, so it is necessary to use both general strengthening and special exercises.
4. When drawing up the procedure, one should observe the principle of gradual and consistent increase and decrease in physical activity, maintaining the optimal physiological load curve.
5. When selecting and conducting exercises, it is necessary to alternate the muscle groups involved in the performance of physical activity.
6. In the treatment course, it is necessary to update and complicate the exercises used daily. 10-15% of the previous exercises should be introduced into the LH procedure to ensure the consolidation of motor skills. However, it is necessary to consistently diversify and complicate the methodology.
7. The last 3-4 days of the course of treatment should be devoted to teaching patients the gymnastic exercises recommended for subsequent homework.
8. The amount of methodological material in the procedure should correspond to the mode of movement of patients.
The correct use of physical exercises provides for the distribution of physical activity, taking into account its optimal physiological curve. The latter is usually understood as the dynamics of the body's reactions to physical exercises throughout the procedure. The distribution of physical activity in the procedures of LH is carried out according to the principle of a multi-vertex curve (Fig. 2.1)
Starting positions. In LG, there are three main positions: lying (on the back, on the stomach, on the side), sitting (in bed, on a chair, on the couch, etc.) and standing (on all fours, relying on crutches, bars, the back of a chair, etc. .). For example, in diseases of the respiratory system, you can perform exercises in the initial position lying down, reclining, with a raised head end, sitting and standing. If the tubular bones of the lower extremities are damaged (skeletal traction is applied), the exercises are performed in the initial position lying on the back.
The LG technique is based on:
Didactic principles (visibility, accessibility, systematic, gradual and consistent execution of exercises, individual approach); correct selection and determination of the duration of physical exercises;
The optimal number of repetitions of each exercise;
The physiological pace of the movements;
The adequacy of the power voltage to the capabilities of the patient;
Degrees of complexity and rhythm of movements.
Rice. 2.1.Curve of the physiological load of the LH procedure (V.N. Moshkov): a) the first half of the treatment course; b) the second half of the treatment course
Therapeutic taskcan be defined as the goal of restorative measures at a given stage in the development of a pathological condition. The objectives of treatment (including exercise therapy) are determined by ideas about the etiology and pathogenesis of a disease or injury. For example, with the development of respiratory failure in a patient with pneumonia in the acute period, the leading therapeutic task is to compensate for respiratory failure. In bronchial asthma, changes in external respiration highlight the need to improve bronchial patency, relieve bronchospasm, and evacuate the pathological contents of the bronchi. In some cases, treatment tasks are determined not by pathological changes inherent in the main process, but by the individual picture of the disease and measurements of other organs and systems (for example, prevention of deformities of the musculoskeletal system in diseases of the spine). In complex therapy, the tasks of normalizing autonomic disorders, restoring lost or impaired motor skills or a normal movement structure after an injury (reconstructive surgery), etc. may appear.
Selection of means of exercise therapy in accordance with the tasks.
By direction, they distinguish:
Special tasks, characteristic only for this form of pathology, and combinations of morphofunctional changes;
General tasks associated with changes in the protective forces, reactivity, growth and development of the patient, the emotional sphere, etc., which, as a rule, occur in many diseases.
To solve special problems, the means of exercise therapy are selected taking into account the mechanisms of trophic and compensatory action. Such is the specific effect of specially selected breathing exercises on the functional respiratory system or selective massage on the tissue of the massaged area of the body and the corresponding internal organ associated with the irritated zone of segmental innervation.
To solve general therapeutic problems, the stimulating and normalizing effect is of primary importance, and the therapeutic effect is manifested throughout the body. More often they use general developmental physical exercises, general massage, outdoor games that are adequate to the therapeutic and protective regimen, and means of hardening.
Dosage of exercise in the classes of LH is important, since the therapeutic effect of physical exercises and massage largely depends on it. An overdose can cause deterioration of the condition, and an insufficient dosage does not give the desired effect. Only if the patient's condition corresponds to his capabilities, physical activity can optimally change the functions of various body systems and have a therapeutic effect.
Physical activity is dosed depending on the tasks of a particular period of treatment, manifestations of the disease, functionality, age of the patient and his tolerance to physical activity.
You can change the physical load by various methodological methods, since it depends on many factors (Scheme 2.4).
Scheme 2.4.Dosing of physical activity
Of great importance for the dosage of physical activity is the density of classes. It is determined by the ratio of the duration of the actual exercise to the duration of the entire exercise session. In exercise therapy, the load density reaches 25-30%. Basically, it depends on the duration of the breaks between individual exercises. In therapeutic physical education, the density of the load increases significantly.
Depending on the tasks in different periods of treatment, therapeutic, tonic (supportive) and training dosages of loads are distinguished.
Therapeutic dosage is used when it is necessary, first of all, to have a therapeutic effect on the affected system or organ, form compensation, and prevent complications. At the same time, the total physical load in classes is usually small and increases slightly from lesson to lesson. When the condition worsens, it is reduced.
A tonic (maintenance) dosage is used in a satisfactory condition of the patient with prolonged mobilization, chronic diseases with an undulating course, after the end of rehabilitation treatment with the maximum possible therapeutic effect. General and local physical activity depends on the functionality of the body as a whole and the individual affected organ or system. They should stimulate the functions of the main systems, i.e. have a tonic effect and maintain the results achieved. Physical exercise of moderate or high intensity is used.
The training dosage is used during the recovery period and during the period of rehabilitation treatment, when it is necessary to normalize all body functions, increase efficiency or achieve high compensation. To determine the amount of physical activity that has a training effect, various tests are carried out. So, in diseases of the cardiovascular system, the maximum allowable physical activity is determined using a tolerance test; the value of the axial load in diaphyseal fractures - using the pressure of the injured immobilized leg on the scales until the onset of pain (the optimal load is 80% of the value obtained); training effect to increase muscle strength has a load of 50% of the maximum.
Particular systematization of physical exercises is the basis for the construction of differentiated methods of exercise therapy.
The correct choice of physical exercises to a certain extent determines the effectiveness of the exercise therapy technique. Frequent systematization of physical exercises, taking into account their directed influence on the affected system or organ, depending on the etiology, remains a necessary element of the reasonable construction of any differentiated and effective methodology.
Methods for carrying out LG procedures. The LH procedure can be carried out: a) by an individual and b) by a group method.
An individual method is used in patients with limited motor activity due to a serious condition. A variant of the individual method is an independent method, prescribed to the patient when it is difficult for him to regularly visit a medical institution or when he is discharged for aftercare in an outpatient or home setting.
The group method is most common in medical institutions (clinic, hospital, spa treatment). Groups are formed with a focus on the underlying disease and the functional state of patients.
2.4.3. simulators
Simulators of various designs are widely used in the rehabilitation treatment of patients at various stages of rehabilitation. With their help, motor qualities are purposefully formed (general, speed and speed-strength endurance, speed and coordination of movements, strength and mobility in the joints and spine), which are one of the indicators of health. The use of simulators in medical institutions can significantly expand the range of means and methods of physical therapy, increase not only the health-improving, but also the therapeutic effectiveness of exercises.
Pulitotherapy - classes on block devices. The block changes the direction of the force without changing its magnitude. This property is used to resist individual muscle groups through a certain mass.
Block therapy is recommended for all injuries and diseases of the musculoskeletal system and the nervous system, if it is necessary to selectively work on a certain joint or muscle group in order to increase the range of motion.
2.4.4. Traction therapy
Traction therapy is one of the methods of restorative treatment of injuries and diseases of the musculoskeletal system and their consequences (deformities, contractures, degenerative-dystrophic processes in the spine and joints, etc.). There are: a) underwater traction (vertical and horizontal) and b) dry traction.
After the procedure, wearing unloading orthopedic corsets (in case of damage to the spine), orthoses (in case of damage to the joints) is indicated.
2.4.5. Ergotherapy
Ergotherapy (occupational therapy) is an active method of restoring impaired functions with the help of household or elements of labor operations.
From a physical point of view, the method restores or improves muscle strength and mobility in the joints, normalizes blood circulation and trophism, adapts and trains the patient for optimal use of residual functions.
From a psychological point of view, the method develops the patient's attention, inspires hope for recovery, maintains physical activity and reduces the level of disability.
From a social point of view, the method provides the patient with the opportunity to work in a team.
Three types of ergotherapy are mainly used in medical institutions: a) general strengthening; b) restorative and c) professional.
The labor regime is set individually for each patient. There are five main modes:
0 - the mode of temporary non-attendance by the patient of the ergotherapy room;
1 - ward mode (the patient is engaged in the ward);
2 - student mode (the period of mastering the recommended type
work); transfer to other types of operations (for example, modeling from plasticine, knitting, etc.).
3 - shortened working hours
4 - full-time mode with limited use
types of operations (stability of the labor installation). It is prescribed when the patient is unable to switch from a simple stereotyped labor operation to other types of labor
THERAPEUTIC PHYSICAL CULTURE (LFK) as a method of treatment - the use of a complex of physical education tools for preventive, therapeutic and rehabilitation purposes. Exercise therapy is widely used in the system of complex treatment in hospitals, clinics, sanatoriums. LFK should be considered as rather effective additional to lay down. event to the main methods - surgical, medical, etc., it is one of the methods of medical rehabilitation (see).
In addition to lay down. - the professional, tasks, LFK pursues also the educational purposes. Regular use of exercise therapy in the b-tse, clinic, at home develops a patient's conscious attitude to the use of physical. exercises, instills a gigabyte. skills, the right attitude to hardening the body.
The main means of exercise therapy is physical. exercises have long been known to practical medicine. So, in ancient Chinese medicine in the 3rd millennium BC. e. honey was described and applied. gymnastics, in which the main attention was paid to breathing exercises. In ancient Greece, Hippocrates considered exercises to be a means of stimulating physiological processes, pointing to their healing and restorative significance. K. Galen recommended gymnastics and certain types of labor for obesity, general weakness, movement disorders in the joints, etc.
The respiratory exercises applied in to lay down. gymnastics in order to improve the function of external respiration, are divided into two types: static, performed without movement of the arms and muscles of the shoulder girdle, and dynamic, when the phases of breathing are combined with the movement of the arms, shoulder girdle and body. When performing exercises of a dynamic nature in the act of breathing, in addition to the main respiratory muscles (diaphragm, external and internal intercostal muscles), auxiliary respiratory muscles are involved (the latissimus dorsi, upper posterior serratus muscles, large and small pectoral, etc.). Due to this, breathing becomes fuller and deeper and more oxygen enters the lungs with the inhaled air. Breathing exercises of a dynamic nature also prevent the occurrence of congestion in the liver, improve the activity of the intestines. tract, respiratory system. As well as static, they are widely used for various diseases and after intense exercise in order to reduce physical. load on the body. Respiratory exercises in to lay down. gymnastics is not used in isolation, but in combination with other gymnastic exercises. In addition, there are physical exercises performed in combination with breathing phases. Exercises concern them, in to-rykh muscles of an abdominal press, the lower extremities and the body participate (for example, inclinations of the case forward, pressing of the legs bent in knees to a stomach are carried out on an exhalation).
A special place in exercise therapy is occupied by physical. exercises in water (bath, pool or open water) - the so-called. kinesihydrotherapy. Performing exercises in water (Fig. 5) is facilitated by the mechanical and thermal influence of the aquatic environment, as a result of which many movements, the implementation of which is difficult in bed, on the couch, in the exercise therapy room, in water are performed without significant effort or freely due to lightening the weight of the limb and reduction of pain or spastic phenomena in the muscles. With the vertical position of the body in the water, learning to walk is facilitated, stability in standing and walking increases. Phys. exercises in water can be used both with full immersion of the body in it, and with partial (hand, forearm, feet, etc.) * Phys. exercises in the morning gig. gymnastics (see Charging) for the purposes of exercise therapy wear a special to lay down. character. More often use restorative and breathing exercises in accordance with the condition of patients, their physical. readiness.
Dosed walks, walking in the fresh air have a particularly favorable effect on the neuropsychic sphere of the patient. They are carried out on flat terrain, starting from a route with a length of 1000 to 3000 m with a moderate physical load.
During the Great Patriotic War, the methods developed by exercise therapy were widely and with great success used to restore the health of the wounded and sick. In the post-war period, departments and exercise therapy rooms are organized in all large-tsah and clinics for adults and children. In 1950, the Regulations on medical and physical education dispensaries were approved, in the structure of which departments of exercise therapy are provided; dispensaries are the organizational and methodical centers on LFK for all to lay down. - prof, establishments.
In 1966, a resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures for the further development of physical culture and sports" was issued, which played an important role in expanding the use of exercise therapy. In this resolution M3 of the USSR it is offered to expand use of physical culture in to lay down. - prof, work honey. institutions, to increase the network of exercise therapy rooms at polyclinics, to improve the training of students of medical universities and doctors on the use of physical education in medical and professional purposes.
Research work in the field of exercise therapy is concentrated Ch. arr. in branch a wedge, research in-ta, at departments of medical and physical culture in-t and in large medical and physical culture dispensaries. In 1970 in Kyiv the Research in-t of medical problems of physical education M3 of the Ukrainian SSR was opened in the health care system. In in-those the big department of exercise therapy functions; the specialized council of in-that is given the right to defend and receive cand. dissertations. Since 1973, the department of exercise therapy and medical supervision has been organized in the Central Research Institute of Balneology and Physiotherapy M3 of the USSR. The Academic Council of this in-that is a specialized council for the admission and protection of candidates. and doctoral dissertations in the discipline "Therapeutic exercise and sports medicine".
Exercise therapy is considered as one of the leading components in the medical system. rehabilitation of patients of different profiles. At the Academy of Medical Sciences of the USSR, as part of the Scientific Council for Physical Education and Sports, the All-Union Problematic Commission for Exercise and Physical Therapy operates in the medical system. rehabilitation, which plans and coordinates all research work in the country in the field of exercise therapy. The All-Union scientific and medical society for medical control and exercise therapy, organized in 1968, plays a large role in disseminating scientific achievements in exercise therapy, which unites not only medical specialists in exercise therapy, but also exercise therapy instructors. The All-Union Congress of the Society took place in 1975 in Kyiv. Scientific medical about-va on medical control and LFK are organized in all union republics and many large cities. The journal "Resortology, physiotherapy and physiotherapy exercises" is published, where scientific works in the field of exercise therapy are published.
In the socialist countries (NRB, Hungary, GDR, Czechoslovakia) there are in-you sports medicine developing also questions of use of physical culture and sports as means of treatment and prevention.
Bibliography: Vinokurov D. A. Private methods of physical therapy, L., 1970; Hubert K. D. and Ryss M. G. Gymnastics and massage at an early age, M., 1972; Danko Yu. I. Sketches of physiology of physical exercises, M., 1974, bibliogr.; Ivanov S. M. Physiotherapy exercises for bronchial asthma in children, M., 1965, bibliogr.; it, Physiotherapy exercises at chronic pneumonia at children, M., 1968, bibliogr.; about N e, Medical control and exercise therapy, M., 1970; K Aptelin A.F. Restorative treatment (physiotherapy exercises, massage and occupational therapy) for injuries and deformities of the musculoskeletal system, M., 1969; Leporsky A. A. Physiotherapy exercises for metabolic diseases and diseases of the joints, M., 1960, bibliogr.; Therapeutic physical culture, ed. V. E. Vasilyeva. Moscow, 1970. Therapeutic physical culture, ed. Edited by S. N. Popova. Moscow, 1978. Therapeutic physical culture, ed. I. M. Sarki-zova-Serazini. Moscow, 1960. Therapeutic physical culture in diseases in childhood, ed. S. M. Ivanova, M., 1975, bibliogr.; Mogendovich M. R. and T e m to and I. B. N. Physiological bases of medical physical culture, Izhevsk, 1975, bibliogr.; Moshkov V. N. General principles of physical therapy, M., 1963, bibliogr.; he, Therapeutic physical culture at health resorts and sanatoriums, M., 1968, bibliogr.; about N e, Therapeutic physical culture in the clinic of nervous diseases, M., 1972, bibliogr.; he, Therapeutic physical culture in the clinic of internal diseases, M., 1977, bibliogr.; Postnikova V.M. The general technique of application of physical exercises in physiotherapy exercises, M., 1967, bibliogr.; Sarkizov-Serazin and I.M. The role and importance of Russian science in the development of physical therapy, in the book: Essays on the history of physical. culture, ed. N. I. Toropova, v. 4, p. 20, M. - L., 1949; Sokolov A. A. and Zausaev V. I. Use of medical physical culture in maxillofacial surgery, M., 1970, bibliogr.; Stolyarova A. G. and Tkacheva G. R. Rehabilitation of patients with post-stroke motor disorders, M., 1978; Fonarev M. I. Therapeutic physical culture in diseases of young children, L., 1973, bibliogr.; Khrushchev S. V. Physiotherapy exercises for rheumatism in children, M., 1966, bibliogr.; Kraus H.a. R a a b W. Hypokinetic disease, diseases produced by lack of exercise, Springfield, 1961.
V.N. Moshkov; S. M. Ivanov (ped.).