Combination of LFK with other methods of treatment. The combination of therapeutic physical culture with resort factors

Treatment methods used in modern medicine are widely combined with therapeutic use of physical exercises.

Therapeutic physical culture is an integral part of all motor modes.Selection of physical exercises, forms of their conduct and load in classes in each individual case should correspond to the motor activity allowed by individual modes.

With strict bed Therapeutic gymnastics is used - as a means of preventing adverse effects of adamisia (stagnant phenomena in lungs, vessel thrombosis, violations of the gastrointestinal tract, etc.). Special exercises, predominantly respiratory, are included in some cases in a complex of the methods of so-called intensive therapy or resuscitation measures (for example, after severe injuries, after operations, on the heart, lungs and abdominal organs, during damage to the central nervous system and blood hemorrhages in the brain, Extensive myocardial infarction).

Therapeutic gymnastics provides preparation for the expansion of a strict bed mode: to change (self-independent or with the help of medical personnel) position in bed, it is not dropped to the seat in bed, to take food, wash, and the like.

With a chamber mode During the study of therapeutic and hygienic gymnastics, providing general connivorous, trophysical and formative compensation for influence, the patient is prepared for the transition to the position sitting in bed to lower the legs, to the transition to the chair or chair, to getting up and slow walking within the chamber.

With free mode Based on the observations of the patient's reactions in the study of therapeutic and hygienic gym and therapeutic walking, its motor activity is dosed: length and pace of walking, lifts and descents on the stairs, the total duration of stay in motion, etc. In some cases, the question of the participation of the patient in some types of simple sports games and entertainment may be resolved (table tennis, crocketh, etc.).

With gentle engine mode in sanatorium and outpatient polyclinic conditions Loads in the classification of therapeutic physical culture should not exceed the reduced adaptability of the patient to muscle activities and, at the same time, should counteract adverse manifestations of hypodynamics. In case of toning mode, during exercise, the motor activity of the patient is gradually expanding. The loads that contribute to the subsequent supercompensation of the energy costs and the improvement of the functions and the morphological structures of the body are used. With the training mode, the study of therapeutic physical culture should ensure the restoration of performance and serve as one of the main means of rehabilitation.

Therapeutic physical culture must be combined with the care of the patient.There are various paths for this. Must be produced carrying Chambers and Cabinets of therapeutic physical culture before classes.

Most patients have a violated adaptation to the joint effect of muscle loads and climatic factors. Simultan use of exercise and tempering physical factorsit is better restores both adaptation to muscle loads and the harness of the body. Claims under appropriate climatic conditions and testimony are carried out with open veranes, windows or on verandas and sites. In the cases shown, patients are engaged in light sports costumes or naked to the belt.

Under the beddown conditions need prepare a sick bed to conduct: Throw off the blanket, fix the sheet, properly place or remove extra pillows, etc. With appropriate clinical data at the end of occupations the patient should give a position having the treatment: To wear straps for stretching when the spine turning, to feed the temporarily removed Longhet when the bone of the forearm, translate the patient who had a myocardial infarction, to sit on the chair (stool), help move to the lying position (for example, after walking the ballroom with a fracture of the thigh high gypsum bandage), etc. Need to be kept observation of the state and well-being Each of those engaged before classes in the process of them and after completion. With adverse reactions, the load should be reduced, the time of conducting classes is reduced (if possible, imperceptibly for the patient). On the observations and activities carried out, the instructor on therapeutic physical culture should inform the doctor in these cases on the same day of the attending physician.

Combination of exercise with physical and balneological medicationsit should ensure an increase in their total efficiency. For example, with paralymps and paresis, a combination of physical exercises with electrical stimulation of muscles and with electrical behavior is of particular importance; Exercises in water, and especially swimming, increase energyrators and metabolism is larger than the amount of applied water baths of the same temperature and gymnastic exercises similar to the muscular load with swimming movements. The correct sequence or one-time use of physiotherapeutic procedures and medical gymnastics are essential. For example, thermal procedures (paraffin or mud applications, solux, etc.), used in contractures, must precede therapeutic gymnastics. The ionophoresis of most medicinal substances should be applied with some break after the study of the medical gymnastics. In some cases, it is advisable to apply therapeutic gymnastics during a physiotherapeutic or balneological procedure (for example, in a mineral bath with a polyarthritis; in a local thermal bath for brushes and fingers with a sharp limitation of movements in them).

With a combination of therapeutic physical culture with therapeutic nutrition under the influence of exercises, the efficiency of reinforced protein food during dystrophy is increased; The processes of tissue regeneration processes are more accelerated with a rich full-fledged food diet; increasing the effectiveness of enhanced vitaminization; The activity of the glycogen-formational function of the muscles in the food soldering is rising, rich in carbohydrates. Determining the time of the treatment of therapeutic physical culture, it should be taken into account that a significant muscular load, directly preceding the feeding of food, can have an inhibitory effect on a stomach and intestine; Currently, even with moderate load, spent shortly after meals, can sharply accelerate its evacuation from the stomach and strengthen the intestinal peristalsis.

The effectiveness of therapeutic influence of physical exercises is significantly increased. fortheir combined with psychotherapeutic effects.

With a comprehensive use of suggestion and physical exercise (potentiation), the patient in the previous conversation should be set forth the essence of therapeutic effects of physical exercises, and during the subsequent exercise and at the end of the classes - repeatedly confirm the individual aspects of their favorable effects.

According to special testimony you can apply physical exercises in hypnotic state. This eliminates or dramatically decreases the effect of exercises on the cortical department of the central nervous system and motor-visceral reflexes are activated.

Medical the use of exercise must be combined with work therapy.For example, when restoring the normal amplitude of movements in separate joints, you can combine therapeutic gymnastics with the implementation of individual labor operations. It is advisable to combine the studies of therapeutic physical culture with various types of work, the completion of the manufacture of certain products of labor or the implementation of specific tasks.

The total muscular load with a combination of therapeutic physical culture and work therapy should not exceed the level of motor activity corresponding to the motor regime assigned to the patient. Successes in the restoration of functions and the formation of motor and vegetative compensation; The exercise achieved during classes is expanded and secured in the process of employment and contribute to the rehabilitation of patients.

Full the combination of medicinal therapy with exerciseprovides improving the effectiveness of therapeutic action of the latter. Various options for such a combination are possible. The course of drug therapy after receiving some effect is complemented by therapeutic use of physical exercises. For example, after use, for some time of heart rate, the treatment gymnastics is appointed for insufficiency of the blood circulation of the I-II stage. As a result, the degree of insufficiency of blood circulation decreases in most cases faster than in the isolated use of these funds. If blood circulation is significantly improved, the drug therapy is canceled with the continuing use of therapeutic physical culture.

Exercise can be carried out shortly after receiving medicinal substances. For example, in a patient with spastic paresium after a decrease in the muscle tone, which occurred under the influence of appropriate drugs, special exercises, activating intestinal peristalsis, are carried out after 1 1/2 -2 hours after receiving a saline laxative (they enhance its effect); Classes of medical gymnastics are held shortly after the manifestation of the anesthetic effect of the adopted medication in a patient with neuritis.

With the appropriate method of occupations, the action of the drug substance is preserved and at the same time the corresponding effect on therapeutic use of physical exercises. For example, when using sleeping pills and painkillers with a patient who has undergone heavy operation on the stomach, the simplest respiratory and other gymnastic exercises can be appointed. In this case, respiration is activated, intestinal peristalsis and blood circulation while maintaining developing under the influence of gestures of protective braking.

Wide combined therapeutic use of physical exercises with surgical interventions.The preoperative period is carried out by therapeutic gymnastics, preparing for the use of postoperative gymnastics and contributing to obtaining the best effect from surgical intervention. In the early postoperative period, directly following the operation, therapeutic gymnastics under a number of interventions can be one of the means of special impacts that are resuscitation (operations on the heart, operations on the lungs, etc.). Postoperative gymnastics is very important for the prevention of various complications, especially in the elderly. In the previous postoperative period, therapeutic physical culture activates the processes of healing, restoring disturbed functions or the formation of compensation and contributes to the fastest rehabilitation of patients.

Manual therapy includes antigravitational, mobilization, postisometric and other muscle relaxation methods. These methods can be used in patients with diseases of the spine and joints in any stage of the disease, combine them with the reception of any medication and carrying out any physiotherapeutic procedures.

Methods of mobilization and articular manual techniques are used after removing pronounced pain syndrome. This is achieved by applying analgesizing treatment, which can be combined with the reception of small tranquilizers, sedative and antihistamine. If a sympathegal component prevails in the symptoms of the disease, gangliplockers and neurotropic agents are prescribed. To improve microcirculation, in the absence of hernial protrusion, the solution of nicotinic acid is introduced patients according to the scheme. Dehydration preparations are used to remove the edema and swelling of the tissue.

In some cases, it is effective inside the skin, subcutaneous, paravertebral, epidural blockade, sometimes blockade of sympathetic nodes, nervous trunks, individual muscles.

Training therapy should be appointed differentiated, as it can be contraindicated with severe pain, with a sharply expressed deforming spondylise, spondyltarrosis, a stepped multi-segment of the spinal sponilla with spondylolistrisomes, when they appear during the expression of sharp pains, along the roots. After tracting therapy, the patient is recommended to relax for 40-60 minutes. Massage in patients with vertebral diseases of the spine must be prescribed strictly differentiated, taking into account physiological bends. It is impossible to use testers of manual therapy for bending with hyperlordosis in the lumbar and cervical spine and to extend when the kyphosis is smooth in the thoracic spine.

The combination of manual therapy with therapeutic physical education is effective in patients with vertebral osteochondrosis syndromes in the event that it is appointed purposefully and strictly differentiated, depending on the disorders of the dynamic posture and the pathological motor stereotype.

With the smoothness of physiological bends, therapeutic physical culture should be directed to their increase, with an increase - on their decrease. Unfortunately, few of the doctors on therapeutic physical culture are prescribed to therapeutic gymnastics, taking into account physiological bends. Under our observation was the patient K. 18 years, applied after inpatient treatment about the vertebrid-basilar insufficiency. From the age of 6 at the sport and played in a hockey team. The appearance of symptoms of vertebral-basilar insufficiency arose during the rod of the rod. Treatment in hospital without effect. With objective inspection, special attention is drawn to the straightened vertebral pillars with two longitudinal muscle heavy tonic tensions of muscles - rectifiers of the back from the nape to the sacrum on both sides .. after 8 procedures of manual therapy, the clinical symptoms of vertebral-compasses failure managed to stop. The patient is a professional hockey player athlete. It was allowed to engage in professional activities under the condition of exception during exercise exercises for extension in the thoracic spine, in the cervical and lumbar - for bending. According to 9-year-old Katimnosis, the patient is healthy, continues to play hockey.

In patients with vertebral osteochondrosis syndromes, the peripheral affamentation, which comes from the spine as a result of the formation of functional blockade, constantly enhances the pathological motor stereotype. As a result of compensatory processes occurring in the body, clinical manifestations of the osteochondrosis of the spine. The pathological motor stereotype adapts and makes a patient as if more resistant to the disease. During the treatment of therapeutic physical education, the patient replaces the muscles that we want to strengthen, others - the substitution. As a result, the patient exercises its non-coordination instead of eliminating it and thereby fixes the pathological motor stereotype.

The prescription of therapeutic gymnastics is absolutely contraindicated patients with clinical manifestations of the osteochondrosis of the spine. Functional blockages that are not immediately eliminated by special targeted techniques of manual therapy and maintain a steady pathological motor stereotype of peripheral affamentation, cannot be removed by therapeutic gymnastics. With peripheral afferentation, all the movements of the patient and its posture are distorted, so it is impossible to determine even the true power of the muscles and establish which symptoms are a consequence of the vertebrogenic disease, and which are related to central regulation disorders.

We recommend patients with vertebral syndromes of the osteochondrosis of the spine Therapeutic gymnastics for 2 months after manual therapy to carry out in the initial position lying, without movements in the spine. Special exercises on the spine, which performs the patient itself, is an automotation - only a doctor who owns the methods of manual therapy can be prescribed.

The restructuring of the pathological engine "Stereotype in humans is a multi-stage and difficult process, therefore, it is promising to engage in therapeutic physical education with patients of younger age with another plastic nervous system. In the future, the testimony for active targeted preventive medical gymnastics in children and young people will have ever increasing importance. .

Thus, with pronounced pain syndromes of the spine and joints in the acute stages of the disease, treatment should be started with articular technology on distant lesions of positions and from other, less specific methods to which immobilization include manual muscle relaxation, medication therapy, blockades, massage, reflexology.

In the acute period of the disease in patients with vertebral syndromes of the spine, the purpose of massage, therapeutic physical education, physiotherapy, especially in thermal dosages, can lead to an increase in edema in the surrounding spinal roofs of the tissues and to the exacerbation of the disease.

In the chronic course of the disease, manual therapy can be carried out in combination with courses of radon, carbonate, chloride, sodium, sulfide, turpentine baths, with naphthalase, mud (dirt with low temperatures), massage, leaf.

Reflexotherapy is recommended for patients with neurological syndromes of spinal osteochondrosis, starting with an acute period. The choice of a method of therapeutic effect depends on the clinical form of the disease, its stage, the presence of concomitant diseases.

Treatment with the simultaneous use of various means and treatment methods is called complex treatment. The complex of funds and methods used by modern medicine includes healing Fitnesswhich should be skillfully combined with other types of therapy (diet, motor regime, reflexology, medicines, psychotherapy , physiotherapy, etc.) so that some of them complemented and strengthened the effect of others.

In order to normalize the functions and increasing the reactivity of the body, as well as for curing malignant formations, X-ray therapy (treatment by X-ray) and radiation therapy (the use of all types of ionizing radiation of various energy) is successfully used.

Lessons LFK May increase the action of diet food. For example, with diabetes mellitus, when the blood sugar in the patient is picologically elevated, the healing nutrition with a reduced carbohydrate content is combined with such physical exercises that increase sugar consumption; In atony's constipation, a special diet and exercise enhance the intestinal peristalsis; When avitaminosis with increases the number of vegetables and fruits rich in vitamin C, and generalizing physical exercises contribute to his assimilation.

Combination medicinal treatment With the studies of therapeutic physical culture, in many cases increases the effectiveness of their action. For example, during spastic paralims, when the patient fails to perform the extension of the arms due to the increased tone of the muscles, the introduction of the strip-like substances reduce muscle tone. The execution of this exercise strengthens the extensors of the hand, and in the future movement becomes available and without the introduction of drugs.

In some diseases, medicines and exercise should be opposite. In these cases, the reception of drugs and classification of therapeutic physical culture should not coincide in time. For example, at first, exercise should be performed, and then enter medications.

Often, the exercise is used in a complex with physiotherapy. As a rule, classes are carried out to physiotherapy procedures, but in some cases the best action is achieved at reverse order. For example, when limiting mobility in the joints, a good therapeutic effect gives a combination of thermal procedures (paraffin, dirt) with special exercise, especially when they are directly followed by thermal procedures. However, it is necessary to take into account that dirt and paraffin have a significant effect on the cardiovascular system, so the load when performing physical exercises should be small. A good effect is achieved in the study of therapeutic physical culture after physiotherapeutic procedures that reduce pain.

During classes, therapeutic massage is often used. Some massage techniques are used between exercise (for example, under paralysis). Massage is widely used during classes with infants. But in medical practice, massage as an independent procedure is more widely used. Nevertheless, the best results are obtained by combining it with physical exercises.

Mehanotherapy increases the effectiveness of medical gymnastics in cases where it is necessary to obtain a pronounced local impact, for example, increase the mobility in the joint or strengthen any muscle group. Working on special devices is achieved enhanced local impact, and in the study of therapeutic gymnastics, you can get more time to solve other tasks. Mechanotherapy can be carried out in the form of a separate procedure or are included in the medical gymnastics (usually at the end of the main part of the lesson).

Occupational therapy It is also successfully combined with therapeutic physical culture. With this combination, the recovery of the disturbed functions of the patient contributes to the movement associated with the production of products of labor or the implementation of certain tasks (cleaning the territory, etc.). Therapeutic physical culture prepares the patient to work therapy, allows you to choose the most appropriate labor processes and properly dispense the physical exertion. Empty therapy helps restore adaptation to physical exertion.

The beneficial effect calls resort treatment . This is due to the impact on the patient the combination of therapeutic means of this resort with rest, the alternation of the treatment of therapeutic nutrition, motor regime.

The combination of various therapeutic agents requires the purpose of the rational time of their conduct and the sequence. Morning hygienic gymnastics is carried out after sleep. The time between breakfast and lunch is most favorable for the treatment of medical gymnastics, and the second half of the day is for other forms of therapeutic physical culture (dosage walking, sports exercises and games). Claims of therapeutic physical culture should not be carried out immediately after meals and such physiotherapy procedures that cause significant shifts in the body.

Physiotherapy and LFC are relatively frequently used in the complex therapy of patients with therapeutic agents. LFC is an important method of rehabilitation and treatment for various diseases. Its effectiveness depends not only on stage and characteristics of the clinical course of the disease, but also from the correctness of the combination of physical exercises with other medical measures, incl. with physiotherapy. With the last leaf, it is organically combined and can significantly increase the effectiveness of therapeutic complex.
Therapeutic gymnastics in one day can be used with almost all kinds of physical therapy - with galvanization and drug electrophoresis, electrical stimulation, high-frequency and impulse therapy, heat and balneotherapy. In medical practice, the most often in the complex includes a triad of physical impacts: physiotherapy, leaf and massage. The most rational for most patients with two types of combining these therapeutic agents: a) the physiotherapy procedure is first carried out at the beginning, then a massage and after 30-90 minutes; b) the first is prescribed a physiotherapeutic procedure, after 2-3 h - Flamm and then massage. The reduction of these time intervals may cause an overload of the body and adverse reactions, so they should not be broken.
Somewhat differently, these therapeutic factors are combined only in certain diseases. In terms of muscle contractures, therapeutic gymnastics is carried out after thermal procedures and massages. If painful syndrome is expressed, in order to reduce its reduction, it is advisable to appoint a massage after the exercise. In patients with cardiovascular diseases, the next option is considered to be the following procedure for the purpose: massage, after 30-60 min - therapeutic gymnastics, after 60-90 min - the balneophysiotherapy procedure (most often therapeutic baths).
In paralytic diseases in children and adolescents, it is recommended to use the leaf in a complex with pulsed therapy and a gasolution. LFC is usually carried out 10-15 minutes after treatment with pulse currents according to the method of K.A. Semenova. When combining with a heat carriage, the leaf is carried out before and after the mud, and the filler procedures are prescribed before and after therapeutic gymnastics.
Gymnastic exercises are often combined with a massage. At the same time, gymnastic exercises are usually performed in the form of active movements, i.e. The patient itself at the massage therapist team. Active movements can be used before, in the process and after massage. More often they are performed in the process of massage, and when the joints of the joints - after it. The simultaneous use of massage and active movements increases the performance of muscle tissue, accelerates the inclination of fractures and warns muscle atrophy.
Of course, the recommendations given are far from being exhausted possible options for combining physiotherapy with LFK and massage. It is impossible to do this, and most importantly - there is no need for this. Only a thoughtful attitude of the doctor to each patient and the accounting of fundamental principles of combination in physiotherapy can provide high efficiency of treatment and rehabilitation of patients of various profiles.

Massage is effective, not a medical method of functional therapy, which is widely used in various fields of treatment and restoration of the body.
Massage is used at all stages of medical rehabilitation of patients. It is used in the complex restoration treatment of subacute and chronic diseases of the blood circulation organs, the nervous system, the musculoskeletal system, internal organs, as well as in the manifestation of certain skin diseases.

The massage has proven itself as an excellent means of prevention and recovery of mental and physical activity. A special place occupies a massage in sports and recreation practices, standing out in a separate view of "sports massage". The widespread use of various massage techniques in cosmetology gives striking results in rehabilitation and rejuvenation.

In the use of complex therapy for various diseases, in addition to the massage, various types of physioprocessed are included, while it is necessary to take into account their compatibility.

Massage can be combined with various physiothereders, apply "simultaneously" or "combined" to be applied consistently, depending on which the impact must have a massage: relaxing, toning, etc. The purpose of the sequence or a combination of physioprocessed, depends not only on the signs of similarity on their physiological action. It is necessary to take into account the depth and intensity of the impact of procedures, the nature of the pathological process, and the main reaction of the patient himself on this procedure and its condition at the time of its purpose. When applying various massage techniques, as well as aligning them with other physiotics, the health, age and reactivity of the nervous system is necessarily taken into account.

It is not recommended to apply such powerful stimuli in one day such as a common massage and a common light bath, due to the fact that both physical factors have a very energetic effect on the patient's body.

When prescribing a course of treatment with massage and electrophoresis, it is not recommended to massage the skin areas to which the electrodes imposed, but if necessary, massage should be carried out 30-60 minutes to electrophoresis or assign procedures every other day.

A number of physiotherapeutic procedures are incompatible by the nature of those reactions that these procedures cause, for example, common ultraviolet irradiation and massage, Sharcot shower and a common massage.

• It is impossible to massage the bodies subjected to a quartz lamp.

Physiotherapeutic procedures that do not cause a long-term consequence and are not a heavy load on the cardiovascular and nervous systems, can be assigned to the same day, but at different times of the day:

• water bath (short and low temperature) and massage;

• steam bath and massage, mud (local applique) and massage, paraffin appliqué and massage.

Low pressure shower (fan, circular, rain) can be prescribed every other day.

Sharing massage and other physiotherapy.

• one day you can spend massage and inhalation, quartz tube. The sequence of these procedures does not matter.

• with hypertension, massage is prescribed to therapeutic gymnastics.

• effectively combine daily massage with medicinal gymnastics and every other day with ultrasound and coniferous baths.

• the use of preliminary massage in the areas of the body exposed to reflexotherapy (acupuncture) increases its efficiency.

• it is recommended to perform a massage before and after the cold procedure. After challenge measures, the massage should be more intense. Segmental and reflex massage reduces meteo-sensitivity.

• massage with the consequences of injuries of the musculoskeletal system, bruises, stretching, fractures, contractures need to be produced after paraffin and mud appliqués, mud or bath, it contributes to rapid and efficient recovery.

It is believed that mud, leaf and massage are synergistic procedures that must follow each other with minimal intervals.

Massage can be combined with other physical factors in different sequences. N. A. Belaya * recommends with ischemic heart disease alternate massage with baths in different days or perform it before receiving the bath.

• with asthenic syndrome and atony of Vessels O. F. Kuznetsov recommends massage, then the healing gymnastics, after it is an oxygen bath, and when the vessel spasme is first an oxygen bath, then therapeutic gymnastics and massage.

• with dermatogenic, desogenous and myogenic batch contractures, L. A. Kutubyov advises first to prescribe a physiotherapeutic procedure (diathermy, paraffin and mud and therapy), and then therapeutic gymnastics, after which massage is carried out.

• it is considered advisable in injuries of peripheral nerves to prescribe a massage after therapeutic gymnastics, as it removes fatigue, or in front of the physiotherapeutic procedure as preparation (extension of vessels) to it.

• the sequence of appointment of procedures with radiculitis (shain-breast, lumbar-sacrive) depends on the severity of pain syndrome: with severe pain, the massage is made before LG, when the pain is sacred - before and after LH.

• massage is useful before applying an orthopedic product. Pre-massage of the limb and light stroking of the palm surface II or II and III fingers of the muscle, which is reduced when the limb is moving in the movable tire, increases the efficiency of orthopedic measures.

It should be noted that the complex of physiotherapy (treatment with heat, massage, electric trains, photology, reflexology, etc.) is assigned and recommended only by the attending physician. Therapist examining the patient's treatment, applies certain methods of influence based on the pathology of the disease, the susceptibility of the patient to this procedure, and in the patient's condition at the time of the treatment.

* N. A. Belaya - Dr. Med. Nauk, Professor, Consultant of the 4th Moscow Medical Physical Cultural Dispensary.