Physical therapy and osteochondrosis of the spine

Therapeutic exercise in our country rightfully occupies an increasingly important place not only in diseases of the musculoskeletal system, but also in the therapy of internal, nervous and other diseases. Targeted and dosed, structurally designed movements serve as a very effective means of rehabilitation and readaptation in various diseases.

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

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

• adequacy;
• universality (this means a wide range of action - there is not a single organ that does not respond to movement);
• a wide range of influence, which is ensured by the versatility of the mechanisms of action, including all levels of the central nervous system, endocrine and humoral factors;
• absence of negative side effects (with the correct dosage of the load and rational training methods);
• the possibility of long-term use, which has no limitations, moving from therapeutic to preventive and general health-improving.

In practice, exercise therapy is, first of all, a therapy of regulatory mechanisms, using the most adequate biological ways of mobilizing the body's own adaptive, protective and compensatory properties to eliminate the pathological process. Together with the motor dominant, health is restored and maintained (I.B. Temkin, V.N. Moshkov).

The wide range of application of exercise therapy is determined by the leading role of the locomotor system in all human activities. Motor activity is a necessary condition for the normal functioning and improvement of all the most important systems of the body.

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

The role of proprioceptors and interoceptors in the control of vegetative functions is not equal (A.A. Ukhtomsky). It is no coincidence that reflex therapy comes from proprioceptors (therapeutic exercise), but not from interoceptors, therefore it is possible to purposefully influence the activity of internal organs by changing the functional state of the motor analyzer and its locomotor apparatus. In accordance with the leading role of motor skills, proprioception, through the central nervous system (mainly its suprasegmental, i.e. higher levels), adapts the vegetative sphere to the current needs of the skeletal muscles, while interoception only restores homeostasis.

Pathology of neuroregulatory mechanisms begins with a violation of feedback. In pathological conditions, the type of feedback can change, be distorted, which leads to a sharp disharmony of physiological functions. The task of therapeutic physical training in these cases is to restore the primacy of motor skills, which subordinates all vegetative systems of the body. Normalization of vegetative functions in the therapeutic use of physical exercises is ensured by the use of motor-visceral reflexes that suppress altered interactive impulses. This is achieved by functional restructuring 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, limited mobility, stiffness in the affected area and, ultimately, to hypokinesia. The latter aggravates the disease and leads to pathology of the entire neuromuscular apparatus, disruption of the nervous trophism of the body. The pathogenesis of this condition is due to a deficit of proprioception, or "motor hunger" as a result of the loss of the most powerful natural reflex stimulator of all physiological functions of the body and neuropsychological tone. Hence, the mechanism of the therapeutic effect of exercise therapy is clear: it is necessary to compensate for the deficit of proprioception by activating motor skills and thereby return it to the role of the leading regulator of life.

Proprioceptors, i.e. the motor analyzer as a whole, have a trophic significance. This is proven both by a negative method - the fact of the occurrence of hypokinetic syndrome when turning off proprioceptive afferentation, and by a positive method - the occurrence of proprioceptive influences contributes to the restoration of normal physiological functions. This is the preventive role of the optimal motor regime, and the mechanism of the influence of therapeutic physical training in many nervous diseases.

A.D. Speransky's position that "the nervous system innervates tissue to the same extent that tissue "innervates the nervous system" - applies most of all to muscles and their reception. Proprioception stimulates primarily the metabolism in the neurons of the motor analyzer, adapting their vascularization accordingly. Through them, proprioception has a trophic effect on the body's muscles and internal organs, i.e., ultimately, on the entire organism. 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 fundamentally important that physical exercises are able to change (strengthen or weaken) the central processes of excitation and inhibition in a regular manner. At present, sufficient scientific data on the influence of physical exercises on neurodynamics has been accumulated, and specialists in therapeutic exercise have practical material on this issue. Thus, it is known that active exercises performed with sufficient muscle tension enhance the excitation process; breathing exercises and exercises in voluntary relaxation of skeletal muscles, on the contrary, contribute to the strengthening of the inhibition process. Recently, it has become possible to evaluate the role of excitation and inhibition from fundamentally new positions and to formulate the principle of protective excitation, which is of great importance in the problem of the essence of the biological stability of the organism (M.R.Mogendovich). An active motor regime and positive emotions serve as a source of energy for the self-defense of the organism at all levels of its life.

The successes of the clinical and physiological doctrine of motor-visceral regulation are fully supported by the practical value of therapeutic exercise as a biological factor in reflex therapy for neuroorthopedic diseases, as well as for the prevention of hypokinetic disease.

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

• the stimulating effect of therapeutic physical training on the patient is carried out by the reflex mechanism as the main one. This effect consists of training and trophic;
• any reflex reaction begins with the stimulation of a receptor. The main regulator when performing physical exercises is proprioception (kinesthesia);
• the motor-visceral reflexes it causes are of both unconditioned and conditioned-reflex nature;
• In the process of exercise therapy, a new dynamic stereotype is formed, which reactively eliminates or weakens the pathological stereotype.

The normal stereotype is characterized by the dominance of motor skills; its restoration is the general goal of exercise therapy.

Physical exercises enhance the functional "restructuring" of all links of the nervous system, exerting a stimulating effect on both the efferent and afferent systems. Due to the fact that the mechanism of influence of physical exercises is based on the process of exerciseability, the dynamic "restructuring" of the nervous system covers both the cells of the cerebral cortex and the peripheral nerve fibers.

When performing physical exercises, various reflex connections are strengthened (cortico-muscular, cortico-vascular and cortico-visceral, as well as muscular and muscular-cortical), which contributes to a more coordinated functioning of the main systems of the body. The active involvement of the patient in the process of conscious and dosed exercise serves as a powerful stimulus for subordination influences.

During physical exercises, a large amount of blood flows to the working muscles, and therefore, more nutrients and oxygen. With systematic use of physical exercises, the muscles are strengthened, their power and performance increase. Due to the fact that the mechanism of influence of physical exercises is based on the action of movements on all links of the nervous system, exercise therapy is indicated for diseases of the central nervous system and peripheral nerves. Using the function of movement in the process of training the affected system allows developing neuromuscular mechanisms in disorders of the motor function, i.e. to carry out the tasks of restorative therapy in lesions of the nervous system.

Movement control is the result of the interaction of the central nervous system and the executive apparatus, carried out on the basis of mutual exchange of information between the trigger and efferent parts of the motor analyzer.

The leading principle of control of voluntary motor activity is the principle of sensory corrections. Changes in the functional state of muscle proprioceptors during movement execution serve as a signal for the formation of corrective impulses in the central apparatus of movement control (feedback, according to N.A. Bernstein).

In the ring circuit of movement control there is no ring nerve process, i.e. reflex ring. There is no morphological connection between the end of the motor nerve in the muscle and the proprioception apparatus, but there is a strong functional connection.

Various levels of the central nervous system are involved in the control of voluntary movements, from the spinal cord to the higher cortical projections of the motor analyzer. A complex hierarchy of subordination between the lower and higher parts of the central nervous system serves as one of the necessary prerequisites for motor coordination. Coordination of physiological functions of varying levels of complexity is the internal content of the process of movement control.

The essence of coordination lies in the coordination of individual types of activity of the organism during the performance of a complete motor act. With a certain conventionality, three types of coordination can be distinguished: 1) nervous; 2) muscular; 3) motor.

Nervous coordination carries out a combination of neural processes that lead to the solution of a motor task.

Muscle coordination involves the coordinated tension (contraction) and relaxation of muscles, which makes movement possible.

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

The correctness and accuracy of voluntary movements are ensured by the motor analyzer. The abundance of associative connections of the motor analyzer with the cortical centers of other analyzers allows for the analysis and control of movement by the visual, auditory, cutaneous analyzers, and vestibular apparatus. Movement is associated with stretching of the skin and pressure on individual areas. Tactile receptors are included in the analysis of movements by the mechanism of conditional temporary connection. This functional connection is the physiological basis for complex kinesthetic analysis of movements, in which impulses from tactile receptors supplement proprioceptive sensitivity.

Coordination is considered by N.A. Bernstein as overcoming excess degrees of freedom of movement. The action of internal reactive forces introduces an element of disturbance into the initial nature of the movement. The organism copes with the reactive forces that arise during the movement in two ways:

• their inhibition;
• inclusion in the basic motor act.

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

A sudden change in the motor situation is an external cause requiring immediate correction of the movement. Changes in the forces of friction, viscosity, elasticity of muscles, their initial length are internal conditions requiring correction in the motor structure of the action.

The quality of execution of a voluntary movement and its compliance with the target setting are controlled by the central nervous system due to feedback from the muscular apparatus.

When determining the leading mechanisms of coordination, one should take into account the complex physiological and biomechanical patterns that form the basis of voluntary movements. The general tendency in the coordination of movements is the most appropriate use of the biomechanical properties of the musculoskeletal system.

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