Treatment of coccylogeny: physical rehabilitation

The complex of conservative treatment of cocciogeny includes, first of all, a large volume of physiotherapeutic procedures: darsonvalization by the introduction of an electrode into the rectum; ultrasound with an analgesic mixture or hydrocortisone, paraffin applications, therapeutic mud, ozocerite.

The leading role in the rehabilitation of patients with cocciage belongs to the means of exercise therapy, which must solve the following problems:

1. Improve trophic processes of the pelvic organs.
2. Strengthen the musculoskeletal apparatus of the pelvic floor, pelvic girdle, abdominal muscles and back.
3. To promote the restoration of anatomical and topographic relationships of the pelvic organs.
4. Assist in the removal of the pathological dominant in the cerebral cortex.
5. Provide a general strengthening effect on the patient's body. When including exercise therapy in complex therapy of the disease, along with the general principles of physical training, the following guidelines should be considered:
   • Differentiate the technique of application of the drugs of exercise depending on the severity (light, medium, heavy), age and tolerance to the physical load of the patient.
     
   • To use different initial positions when performing physical exercises: a) with mild degree - lying, standing, and only from the second half of the course of treatment - sitting; b) with an average degree - the same, excluding the IP. - sitting; c) when heavy - standing on all fours, antiortostatic (lying on the back on an inclined plane with an elevated foot end, the angle of which can be changed to 30 ° depending on the tolerance of the negative gravitational load) lying on its side.
   • Use special isotonic exercises and isometric (static) stresses in the exercises to maximize the musculoskeletal apparatus of the pelvic floor, pelvic girdle, back muscles and abdominal pressure.

An approximate set of physical exercises

1. I.p. - standing, legs together, hands are lowered. Slowly raise your hands up, take your foot back, bend over - inhale, return to the i.p. - Exhalation. Repeat with each foot 2-3 times.
2. I.p. - also. Raising his bent leg, pull his knee three times with his hands to his chest, tilt his head - exhale, return to the i.p. - Inhalation. Try not to bend the supporting leg. Repeat each leg 4-6 times.
3. I.p. Standing, legs apart, hands on the waist. Circular movements of the pelvis. Repeat 8-12 times in each direction.
4. I.p. - standing, legs together, hands are lowered. Spring squats with simultaneous raising of hands through the sides upwards. Repeat 12-16 times.
5. I.p. Standing, legs apart, arms outstretched. Rotate hands with hands up, head back, bend - inhale, count to three, then return to the i.p. Repeat 8 12 times.
6. I.p. - sitting, legs bent, knees hands are pulled to the chest, the head is lowered, the back is round. Rolling on his back, touch the head of the floor, return to the i.p. Repeat 8-12 times.
7. I.p. - lying on his back, legs bent and divorced, hands along the trunk. Raise the pelvis, knees to spread apart, strain the muscles of the buttocks, keep this position for 3-5 seconds. Repeat with small intervals 8-12 times.
8. I.p. - the same, but the legs are widely divorced. Tilt one leg to the limit inside, the other - to the limit outward. Then - on the contrary. Repeat 4-6 times.
9. I.p. - also. For 5-7 seconds with the effort to connect the knees, repeat 8-12 times with 7-10-second intervals for rest.
10. I.p. - lying on his back, bent legs slightly raised. Perform the exercise "bike" for 10-15 seconds. Repeat 4-6 times with 10-15-second intervals for rest.
11. I.p. - lying on his back, hands along the trunk. Sit down without the help of hands and perform three springy leans forward, trying to touch the forehead with your knees. Repeat 12 to 16 times.
12. I.p. - lying on his back, bent legs slightly raised. Turn both feet to the left, trying to touch the floor with your left knee. The same in the other direction. Repeat 12-16 times.
13. I.p. - lying on his back, along the trunk. Raise, blind, bent legs and try to socks touch the floor behind your head. Repeat 8-12 times.
14. I.p. - sitting and resting his hands behind, the pelvis is slightly raised. Perform alternate swings with your feet forward and upward. Repeat 8-12 times with each foot.
15. I.p. - on his knees, hands on his belt. Bend over the back, then go back to the i.p. Repeat 6-8 times.
16. I.p. - also. Sit on the floor - to the left, return to the i.p. Repeat 8-12 times in each direction.
17. I.p. - lying on his stomach, fir-brush on the back of the head. Raise the head and shoulders, keep this position for 3-5 seconds, return to the i.p. Repeat 8-12 times.
18. I.p. - lying on his stomach, brush on the floor near his shoulders. Bending the leg, take your knee to the side and look at it. Repeat ~ 8-12 times with each foot.
19. I.p. Standing on all fours. After arched back, tighten the stomach and keep this position for 3-5 seconds. Repeat 6-8 times with 5-b-second intervals for rest.
20. I.p. - standing, legs together, hands are lowered. Having made a step with your left foot to the left, take your hands to the sides, bend over - inhale, return to the ip, hands to grasp the chest - exhale. Same with the other leg. Repeat 3 to 4 times.

Most special physical exercises should be performed in the alternation of contractions and relaxation of the perineal muscles, which is carried out respectively in the phase of inspiration and exhalation. To fully reduce all the muscles of the perineum, the patient should simultaneously "draw in" the anus, squeeze the vagina and try to close the external opening of the urethra.

• Isometric muscle tension should be performed every time with the greatest possible intensity. Depending on the course period of exercise therapy, the number of such muscle strains varies from 1 to 4, the duration (exposure) of the voltage is 3-7 seconds.

[1], [2], [3], [4]

Typical exercises performed in isometric mode

1. I.p. - lying on his back, legs bent at the knees and divorced, hands on the inside of the knees. Connect the knees, overcoming the resistance of the hands. Repeat 8-12 times, doing 10-15-second intervals for rest.
2. I.p. - lying on his back, holding a volleyball or rubber ball with his knees bent. Within 5-7 seconds, squeeze the ball with your knees, preventing hands from bulging your belly. Repeat 6-8 times, doing 10-15-second intervals for rest.
3. I.p. - lying on his back, legs straightened, the ball is sandwiched between the feet. Press the ball with your feet for 5-7 seconds. Repeat 6-8 times, doing 10-15-second intervals for rest.
4. I.p. - lying on the back, legs bent at the knees. Diluting the knees, raise the pelvis and strain the muscles of the buttocks for 3-5 seconds. Repeat 6-8 times, doing 10-15-second intervals for rest.

When carrying out isometric stresses, it is necessary to take into account the following peculiarities of their conduct: a) use predominantly p. Patient - lying on his back (on his side) and "antiorthostasis"; b) breathing should be uniform, with some extension of exhalation (breathing is not allowed!); c) "dissipate" and alternate muscle strains with isotonic exercises; d) after each repetition of the isometric tension, perform breathing exercises and exercises in voluntary muscle relaxation.

• Eliminate in the exercises racing exercises, accelerated walking, jumping and jumping, jerky movements, sudden changes in the positions of the trunk and lower extremities, the elements of straining, and at the beginning of the course of treatment and the torso of the trunk forward.
• All exercises should be performed at a calm pace, rhythmically. Classes are held 2-3 times daily, preferably with a musical accompaniment.
• To fix the effect, it is advisable to use physical exercises in combination with electrostimulation of the muscles of the pelvic girdle, the back group of hamstrings and acupuncture.
• It is obligatory to include in the complex of therapeutic measures elements of therapeutic massage, point and segmental reflex massage.

Postisometric muscle relaxation (IRP)

1. PIR of the pear-shaped muscle.

• I.p. Patient - lying on his stomach. The leg on the side of the relaxed muscle is bent at the knee joint and rotated to the inside. The same hand with the patient's foot is fixed on the patient's heel, the other palpates the pear-shaped muscle. On inhalation, the patient leads the shin, exerting pressure on the physician's hand. The position is fixed for 7-10 seconds. On exhalation - the doctor conducts a passive stretching of the muscle, pulling the shin in the opposite direction. Reception is repeated 3-4 times;
• i.p. Patient - lying on his stomach, knees are located at the level of the edge of the couch. The legs are bent at the knee joints. The doctor's hands cross-fix the patient's feet. At the inhalation the patient knees down, the doctor renders dosed resistance to this movement. The position is fixed for 7-10 seconds. On exhalation - the patient relaxes, the doctor conducts a passive stretching of the muscles, strengthening the dilution of the shins.

2. PIR of the muscles of the pelvic floor (muscle lifting the anus, coccygeal muscle, external compressor of the anus)

I.p. Patient - lying on his stomach, arms stretched along the trunk. The hands of the doctor crosswise fix the medial surfaces of the buttocks of the patient. On inspiration, the patient strains and reduces the buttocks, and the doctor's hands exert a metered resistance to this movement (7-10 s). On exhalation - the doctor conducts a passive stretching of the muscles, spreading the buttocks to the sides. Reception is repeated 3-4 times.

3. PIR of the large and middle gluteus muscles).

I.p. The patient - lying on his back, the leg on the side of the relaxed muscles, bent at the knee and hip joints. With the same name as the patient's leg, the physician's hand fixes the area of the ankle joint from above, the other - the knee joint. On inspiration, the patient attempts to straighten his leg with a slight effort, and the physician's hand renders the measured resistance to this movement (7-10 s). On exhalation - the doctor conducts a passive stretching of the muscle, increasing pressure on the knee and ankle joints:

• In the direction of the eponymous shoulder, mobilization of the lig occurs. Sacrotuberale;
• In the direction of the opposite shoulder, lig mobilization takes place. Sacrospinale.

Reception is repeated 3-4 times.

4. PIR of the adductor muscles of the hip.

• I.p. Patient - lying on his back, legs are divorced. The physician's hands crosswise fix the hips in the lower third of them (on the inside). On inhalation, the patient reduces his legs, and the physician's hands show a dosed resistance to this movement (7-10 s). On exhalation - the doctor conducts a passive stretching of the muscles, spreading the patient's legs to the sides. Reception is repeated 3-4 times.
• The patient is lying on his back, his leg is bent at the knee and hip joints and is diverted as far as possible to the side. One hand of the doctor fixes the knee joint from above, the other - the wing of the ilium. On inspiration, the patient tries to bring the knee, not straightening the leg, but the doctor has a measured resistance to this movement (7-10 s). On exhalation - the doctor conducts a passive stretching of the muscles, pulling the knee to the couch. Reception is repeated 3-4 times.
• The patient is lying on his back (on the edge of the couch), his legs are bent at the knee and hip joints. The doctor's hands cross-fix the patient's knees. On inhalation, the patient knees down, and the physician's hands show a measured resistance to this movement (7-10 s). On exhalation - the doctor passively stretches the muscles, increasing the dilution of the patient's thighs.

5. PIR of the posterior group of hip muscles.

I.p. Patient - lying on his back. One hand of the doctor fixes the foot in the area of the fingers, the other - the ankle joint. During inhalation, the patient performs plantar flexion of the foot, and the physician's hands show a measured resistance to this movement (7-10 s). On exhalation - the physician's hands spend the rear flexion of the foot, lifting the straight leg up. The reception should be repeated 3-4 times.

In stationary conditions, the presagesal blockade of Vishnevsky, Novokainov-alcohol blockades in Aminev have a good effect. Alcohol-novocaine epidurally-sacral blockades are used in the most persistent pains. A good effect is provided by the combination of presocal neocaine blockades with a massage of the leftists and the coccygeal muscle.

Surgical treatment of cocciogeny, as a rule, does not bring relief to patients. Cocciectomy is indicated only in case of fracture or dislocation of the coccyx.