Stretching of muscles with osteochondrosis of the lumbosacral spine

This methodical technique is recommended to be introduced into the massage procedure immediately after the preparation of the appropriate muscle with massage techniques (stroking, rubbing, kneading and vibration).

Stretching techniques are used when the elastic properties of the tissues of the locomotor apparatus and skin deteriorate, and the muscle tone is increased excessively. Their intensity is measured by the degree of active tension of the muscles that produce the stretching, by special starting positions. Increase the stretching effect can be due to the additional efforts of the doctor (masseur). With the systematic application of stretches, morphological rearrangement and improvement of the elastic properties of pathologically altered tissues causing deformation occur.

ATTENTION! Under the influence of stretching on atrophic (weakened), degenerate changed and denervated muscles, there can easily be a danger of their overextension, subsequent deterioration of function (in particular, a reduction in strength) and a slowdown in the processes of normalization of activity.

[1], [2], [3]

Method of stretching the muscles

Abdominal muscles ("pseudovisceral pain")

Trigger points of the abdominal muscles cause suffering not only from reflected pain, but also from induced visceral disorders. Symptoms of damage to internal organs caused by myo-fascial TT often make diagnosis difficult. Unilateral TT often causes pain on both sides. In this case, patients usually complain of "burning" in the abdomen, "overflow", "swelling", "swelling", "gases", etc.

1. Slanting abdominal muscles. Active TT of the upper portion of the external oblique abdominal muscle, located in front of the ribs, causes heartburn and other symptoms, usually characteristic of a hernia of the esophageal opening of the diaphragm. TT, localized in one of the three muscle layers of the lower aboral wall of the abdominal wall, reflect pain in the inguinal region. Active TT, causing pain along the upper edge of the pubic bone and in the lateral half of the inguinal ligament can be the cause of increased excitability of detrusor and spasm of the sphincter of the bladder, which is manifested by increased urination or urinary retention.
2. Straight abdominal muscle. In the upper part of the TT, located at this level, both to the right and to the left, reflect girdle pain. When CT is localized in the periapical region, cramping intestinal colic is not uncommon (Kellgrent J., 1977, Murray J., 1975). Lateral CT can provoke a diffuse pain in the abdomen, which is strengthened by movements of the TT, located in the lowest parts of the muscle, reflect pain bilaterally in the sacroiliac lumbar region (Figure 6.31, b).

The technique of stretching the rectus abdominis

I.p. Patient - lying on his back (under the waist is put a cotton-gauze roll), hands are put under the head, legs are lowered down, feet - on a stool. The difference between the levels of the table and the stool should be approximately 60 cm. The patient, bending his back, takes a deep breath. At this time, there is a stretching of the muscle.

Technique of stretching the external oblique abdominal muscle

I.p. Patient - lying on a healthy side, the shoulder is pulled back, to the plane of the couch. In this case, the thoracolumbar spine is rotated, as when the anterior dentate muscle is stretched.

For inactivation of myofascial TT, it is advisable to include the following exercises in LH exercises:

• abdominal breathing, as it is useful for stretching the oblique abdominal muscles;
• lifting the pelvis. Exercise is aimed at stretching the lumbar muscles and training the peritoneal muscles.

I.p. The patient - lying on his back, one hand is located in the area of the pubic articulation, the other - in the epigastric region, the legs are bent in the knee and hip joints. The patient "presses" the lumbar region on the surface of the couch, with the abdominal muscles contracting, aligning the spine (hands are thus approaching). Subsequent movement: lifting the pelvis with a straight back (hands touch each other). Then the patient returns to the hospital; Exercise is supplemented by respiratory and relaxing exercises.

• Exercise "sit-lie" provides for the tension of the elongated rectus abdominis muscle, rather than the shortened one. Stages of the exercise:

1. Initially, the patient from the p. Sitting slowly on his back (legs bent at the knee and hip joints). Pauses between the phases of movement should be within 15-30 seconds (isometric muscle tension);
2. bending of the trunk from the ips. Patient - lying on his back. The patient from the plane of the couch lifts the head first, then the shoulder belt, scapula, without tearing the lower back;
3. transition from the i.p. Patient - lying in the p. - sitting. To increase tension, hands must first be placed on the hips, then on the abdomen, on the chest and, finally, put behind the head. 

Technique of stretching.

• I.p. Patient sitting on a chair. The physician helps the patient to perform the torso inclination forward with simultaneous rotation; the patient turns his face in the same direction.
• Corrective exercises that promote muscle stretching:

1. stretching of the invertebral muscles of the lower back;
2. stretching of thoracic and lumbar psoaspozvonkovyh muscles in the aquatic environment.

[4], [5], [6], [7]

Muscles of the back

1. Superficial cortical muscles. The most common active TTs appear in the longest and ileal-rib muscle of the breast. The latter reflects pain predominantly upward, and the ileal-rib waist and the longest muscle of the breast - mostly downwards.

Symptoms of a lesion of the left ileal-rib muscle of the breast simulate the signs of the angina pectoris, and the right or both - a picture of pleurisy (Yann C. Et al., 1978). Lange M. (1931) described the defeat of the muscle, straightening the spine, at the level of the waist, as a frequent cause of "lumbago" and sacral pain. In the future, many patients with reflected pain emanating from myalgic areas or painful points in a muscle that straightens the spine were reported for muscle rheumatism.

Method of stretching the muscle.

• I.p. Patient - sitting on a chair, feet shoulder width apart, arms lowered, body tilted forward.
• I.p. Patient - sitting on the couch, legs straightened. The patient should touch the toes with his hands.

When performing the stretching procedure, the physician hand helps the patient to perform the exercise, while strengthening the tilt movement.

2. Deep proximal muscle. Deep muscles more often than, superficial, reflect pain in the anterior abdominal wall. Involvement in the process of the deepest of the invertebral muscles-rotators causes pain along the middle line of the back and reflected soreness with percussion along neighboring spinous processes. And only deep palpation allows to reveal, from which side pain comes. 

ATTENTION! It is advisable to carry out the movement on a prolonged exhalation.

Muscles of hip

1. Muscles - hip flexors

• The muscle that strains the fascia of the thigh is active TT located in the upper third of the thigh. The pattern of reflected pain is revealed on the lateral surface of the thigh.
• Scallop muscle - active TT is projected in the inguinal region. Pattern of reflected pain - the medial surface of the upper third of the thigh.
• The quadriceps muscle of the hip (rectus muscle) - active TT is diagnosed at the sites of attachment of the muscle. The pattern of reflected pain is projected along the muscle and concentrates in the region of the knee joint.
• The lumbosacral muscle - active TT is located in the groin, the navel and the upper third of the quadriceps muscle.

Technique of stretching the muscles - hip flexors.

• I.p. Patient - lying on his stomach. The alternating lifting of straight legs. The affected limb rises with the help of a doctor.
• I.p. Patient - kneeling at the gymnastic wall, holding hands with the rail. The maximum extension of the affected leg in the hip joint, without tearing the sock from the floor plane.
• I.p. The patient - standing on all fours, the struck leg is maximally unbent with an emphasis on the toe (the leg and trunk form one straight line at the same time). Bending of a healthy leg to the limit in the hip and knee joints while sliding the affected leg backwards.

2. Thigh extensor muscles

• Gluteus maximusus.
• Middle gluteus muscle.

A) Methods of stretching the gluteus muscles.

The biceps femoris, semimembranous and semitendinous muscles of the thigh - active TT are located in the middle third of the posterior surface of the thigh. The pattern of reflected pain is projected in the upper third of the thigh.

• I.p. Patient - lying on his back, legs straightened, hands along the trunk. Slowly bend the leg in the hip and knee joints, then bend the other leg and with the help of hands pull them to the chest (hands are placed in the "lock");
• I.p. The patient is the same, but with one hand the doctor flexes the head and shoulders of the patient forward, while simultaneously with the other hand exerting slight pressure on the legs.

B) For passive stretching of the muscle fibers of the middle gluteus muscle in and. Etc. Patient - lying on a healthy side, you need to bring a hip bent in the hip joint.

• I.p. The patient - lying on his stomach, the leg is bent in the hip and knee joints. The doctor fixes the patient's pelvis with one hand, the other - rotates the leg outwards.

Technique of stretching the posterior group of hip muscles.

• I.p. Patient - lying on his back. Bend the leg in the hip and knee joints, then with the help of hands slowly straighten it, increasing the angle of ascent.

3. Adductor muscles of the hip. Active TT is localized in the middle third of the inner surface of the thigh.

Technique of stretching the leading muscles of the thigh.

• I.p. Patient - lying on his back. Raising the legs to the sides;
• i.p. Patient - standing sideways to the gymnastic wall on a healthy leg, the struck leg is set aside, stop on the 3rd - 4th rake - squat, bending a healthy leg;
• i.p. Patient - sitting on the bed, holding his hands on the crossbar of the back - simultaneous raising of the legs to the sides, gradually lowering them from the bed the patient as if sits astride a bed;
• i.p. Patient - lying on his back, legs straight. The doctor fixes a healthy leg with one hand in the lower third of the thigh, with the other hand taking away the affected leg.

Muscles of lower leg

Calf muscle. Active TT is located in the upper third of the shin. The pattern of reflected pain covers the entire muscle mass and part of the plantar surface of the foot.

Technique of stretching the leg muscles.

• I.p. Patient - lying on his back, legs straightened. The doctor, grasping his arm in the lower third with his hand, performs the back flexion of the foot with the other hand, first with the bent leg in the knee and hip joints, then with the straightened leg.