Physical therapy and osteochondrosis of the spine

Therapeutic physical training in our country is rightfully taking an increasing place not only with diseases of the musculoskeletal system, but also in the therapy of internal, nervous and other diseases. Targeted and dosed, structured movements are a very effective means of rehabilitation and rehabilitation for various diseases.

The achievements of biology, dynamic anatomy, physiology, biophysics, biomechanics on the one hand, and clinical medicine, on the other, are the basis of the theoretical positions of modern curative physical education. They allowed us to approach a deep understanding of the therapeutic value of exercise therapy (physical exercises, massage, etc.) and theoretically justify their use in various diseases, and in particular, in diseases of the spine. On the basis of modern physiological, biomechanical and clinical concepts, the theoretical foundations of exercise therapy have been established, physical exercises have been systematized and methodological provisions have been defined for their application. Thus, the necessary prerequisites have been created for methodical development of particular issues in the field of practical application of therapeutic physical training. All this taken together contributed to the formation of the Russian school of curative physical culture.

Physiotherapy is one of the most biologically based treatment methods, based on:

• adequacy;
• universality (this means a wide range of actions - there is not a single body that does not react to movements);
• a wide range of effects, which is provided by the multifaceted mechanisms of action, including all levels of the central nervous system, endocrine and humoral factors;
• 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 no limitations, moving from medical to prophylactic and general health.

Practically LFK is, first of all, therapy of regulatory mechanisms, using the most adequate biological ways of mobilizing its own adaptive, protective and compensatory properties of the organism for the elimination of the pathological process. Together with the motor dominant, health is restored and maintained (IB Temkin, VNMoshkov).

A wide range of the use of drugs is determined by the driving value of the locomotor apparatus in all human activities. Motor activity is a necessary condition for the normal functioning and improvement of all the most important body systems.

The motor analyzer is structurally connected with higher vegetative centers through various pathways and levels of the nervous system (pyramidal, extrapyramidal pathways, reticular formation, etc.). The disabling of these links - functional or morphological - leads to a deregulation of motor-visceral relationships and the emergence of pathology in both the motor and the vegetative spheres of the body.

The role of proprioceptors and interoceptors in controlling vegetative functions is not uniform (AA Ukhtomsky). It is no accident that reflex therapy comes with proprioceptors (therapeutic physical culture), but not with interoceptors, so it is possible to change the functional state of the motor analyzer and its locomotor apparatus purposefully to influence the activity of internal organs. In accordance with the leading role of motor activity, proprioception through the central nervous system (mainly its supra-segmental, i.e., higher levels) adapts the vegetative sphere to the current needs of the skeletal musculature, while interoception only restores homeostasis.

The pathology of the neuro-regulatory mechanisms begins with a disruption of the feedback. In pathological states, the type of feedback can change, be distorted, which leads to a sharp disharmony of physiological functions. The task of physiotherapy exercises in these cases is to restore the primacy of motility, which subordinates all the vegetative systems of the organism. Normalization of autonomic functions in the therapeutic use of physical exercises is provided by the use of motor-visceral reflexes, which suppress the altered inter-active impulses. This is achieved by a functional reorganization of the reactivity of the entire nervous system from the cerebral cortex to the peripheral vegetative nodes according to the dominant principle.

Pain in the spine leads to muscle tension, restriction of mobility, stiffness in the affected area and ultimately to hypokinesia. The latter aggravates the disease and leads to the pathology of the entire neuromuscular system, the violation of the nervous trophism of the body. In the pathogenesis of this condition lies the deficit of proprioception, or "motor hunger" as the result of the loss of the most powerful natural reflex stimulator of all the physiological functions of the body and the neuropsychological tone. Hence the mechanism of the therapeutic effect of curative physical education is clear: it is necessary to fill the deficit of proprioception by activating the motility and thereby restore to it the role of the leading regulator of life activity.

Proprioceptors, i.e. Motor analyzer in general, have a trophic significance. This is proved both by a negative method - the fact of the appearance of a hypokinetic syndrome when the proprioceptive afferentation is turned off, and positive - the appearance of proprioceptive influences promotes the restoration of normal physiological functions. This is the preventive role of the optimal motor regime, and the mechanism of the influence of the remedies of physiotherapy with many nervous diseases.

The position of ADSperansky that "the nervous system innervates the tissue to which the tissue" innervates the nervous system "is the most relevant to the muscles and their reception. Proprioception stimulates, first of all, the metabolism in the neurons of the motor analyzer, adapting appropriately and vascularizing them. Through them proprioception has a trophic effect on the musculature of the body and on the internal organs, i.e. Ultimately on the whole body. Without sufficient afferent stimulation of the processes of nutrition and metabolism in the central neurons themselves, there can be no reliable reflex-trophic regulation of all organs of the body.

It is of fundamental importance that physical exercises can naturally change (strengthen or weaken) the central processes of excitation and inhibition. At present, scientific data on the effect of physical exercises on neurodynamics are accumulated, and specialists in therapeutic physical training have practical material on this issue. So, it is known that active exercises performed with sufficient muscle tension increase the process of stimulation; breathing exercises and exercises in voluntary relaxation of skeletal muscles, on the contrary, contribute to the enhancement of the inhibitory process. Recently, it has become possible to evaluate the role of excitation and inhibition from fundamentally new positions and formulate the principle of protective excitation, which is of great importance in the problem of the essence of biological stability of an organism (MRMogendovich). Active motor mode and positive emotions serve as a source of energy for self-defense of the organism at all levels of its vital activity.

The successes of the clinical and physiological doctrine of motor-visceral regulation completely reinforce the practical value of therapeutic physical training as a biological factor of reflex therapy in neuro-orthopedic diseases, and also for the prevention of hypokinetic disease.

The basic concepts of the essence of the influence of therapeutic physical culture on the visceral-vegetative sphere are based on the following provisions:

• The stimulating effect of therapeutic physical education on the patient is carried out by the reflex mechanism as the main one. This influence consists of a training and trophic;
• any reflex reaction begins with irritation of the receptor. The main regulator in performing physical exercises is proprioception (kinesthesia);
• The motor-visceral reflexes caused by it have both unconditional and conditioned reflex nature;
• in the process of exercise exercise forms a new dynamic stereotype, reactively eliminating or weakening the pathological stereotype.

A normal stereotype is characterized by the dominance of motility; in the restoration of it and the general task of exercise therapy lies.

Physical exercises enhance the functional "reorganization" of all parts of the nervous system, providing a stimulating effect on both efferent and afferent systems. In connection with the fact that the process of exercise is the basis of the mechanism of the influence of physical exercises, the dynamic "reorganization" of the nervous system covers both cells of the cerebral cortex and peripheral nerve fibers.

When performing physical exercises, various reflex connections (cortico-muscular, cortico-vascular and cortico-visceral, and also muscular and muscular-cortical) intensify, which contributes to a more coordinated functioning of the basic systems of the body. Active involvement of the patient in the process of conscious and dosed exercise serves as a powerful stimulus for subordinate influences.

During the exercise of physical exercises, a large amount of blood flows into the working muscles, and, consequently, more nutrients and oxygen. With the systematic application of physical exercises, muscles are strengthened, their capacity and efficiency increase. In connection with the fact that the mechanism of the influence of physical exercises is based on the action of movements on all parts of the nervous system, exercise therapy is indicated for diseases of the central nervous system and peripheral nerves. The use of the movement function in the process of training the affected system makes it possible to develop neuromuscular mechanisms in motor function disorders, i.e. To carry out the tasks of regenerative therapy in the defeat of the nervous system.

Motion control is the result of the interaction of the CNS and the executive apparatus, carried out on the basis of mutual information exchange between the starting and efferent parts of the motor analyzer.

The leading principle of controlling voluntary motor activity is the principle of sensory corrections. The change in the functional state of the proprio-receptors of muscles during the performance of movements serves as a signal for the formation of corrective pulses in the central apparatus of motion control (feedback, according to NA Bernshtein).

In the ring scheme of motion control there is no ring nervous process, i.e. Reflex ring. There is no morphological connection between the end of the motor nerve in the muscle and the device of pro-conception, but there is a strong functional connection.

In the management of voluntary movements included different levels of the central nervous system, from the spinal cord to the higher cortical projections of the motor analyzer. A complex hierarchy of subordination between the lower and higher divisions of the central nervous system is one of the prerequisites for motor coordination. Coordination of physiological functions of different levels of complexity is an internal content of the motion control process.

The essence of coordination is the coordination of certain types of the body's activities when performing a holistic motor act. With a certain conventionality, there are three types of coordination: 1) nervous; 2) Muscular; 3) motor.

Nervous coordination carries out a combination of nervous processes leading to the solution of the motor problem.

Muscular coordination realizes the coordinated tension (contraction) and relaxation of the muscles, as a result of which motion becomes possible.

Motor coordination is an agreed combination of movements of individual parts of the body in space and in time, corresponding to the motor task, the current situation and the functional state of the organism.

The correctness and accuracy of arbitrary movements are provided by the motor analyzer. The abundance of associative connections of the motor analyzer to the cortical centers of other analyzers makes it possible to analyze and control the movement from the visual, auditory, dermal analyzers, the vestibular apparatus. Execution of movements involves stretching the skin and pressure on certain areas of them. Tactile receptors on the mechanism of conditional temporary connection are included in the analysis of movements. This functional relationship is the physiological basis of the complex kinesthetic analysis of movements, in which impulses from the tactile receptors complement proprioceptive sensitivity.

Coordination is considered by NA Bernshteyn as overcoming excessive degrees of freedom of movement. The action of internal reactive forces introduces an element of disturbance into the initial character of the motion. The organism copes with the reactive forces arising during the movement in two ways:

• their braking;
• inclusion in the main motor act.

When doing physical exercises in LH sessions, both these paths are used in close unity. The inhibition of reactive forces arising in one motor link ensures their transmission through the rigid system of the bone levers of the locomotor apparatus to the other links of the body.

A sudden change in the motor situation is an external cause requiring immediate correction of movement. Change in frictional forces, viscosity, elasticity of muscles, their initial length - internal conditions that require correction in the motor structure of the action.

The quality of execution of arbitrary movement and its correspondence to the target installation are controlled by the CNS due to the back afferentation from the muscular apparatus.

In determining the leading mechanisms of coordination, it is necessary to take into account the complex physiological and biomechanical regularities that form the basis of arbitrary movements. The general trend in coordination of movements is the most expedient use of biomechanical properties of the musculoskeletal system.

[1], [2], [3]