Treatment of osteochondrosis: massage

A universally recognized method for treating osteochondrosis of the spine is complex therapy, which includes various means of physiotherapy and, in particular, massage. The experience of using massage in combination with drug therapy, physical factors, physical exercises has shown a significant role of this method in increasing the effectiveness of complex treatment of patients.

The purpose of the massage is stimulation of blood and lymph circulation in the affected area to improve regeneration processes; reduction of pain syndrome; restoration of strength and endurance of muscles (limbs and trunk); restoration of efficiency.

When prescribing a course of massage, it is necessary to establish the localization, stage and nature of the pathological process and conduct a clinical and functional examination of the patient.

In the absence of absolute and relative contraindications, massage is prescribed in the subacute and chronic stage of the disease.

The massage technique and its dosage depend on the clinical manifestations of the disease, the condition of the patient, its cardiovascular, respiratory systems and the state of the muscles, the age of the patient and the tolerability of the massage procedures (physical exertion).

Massage is one of the means of physical rehabilitation along with the use of physical exercises.

The mechanism of the massage is based on complex interdependent reflex, neurohumoral, neuroendocrine, metabolic processes regulated by the central nervous system. The initial link in the mechanism of these reactions is the stimulation of the mechanoreceptors of the skin, which convert the energy of mechanical stimuli into pulses arriving in the central nervous system; the forming responses respond to the normalization of the regulatory and coordinating functions of the central nervous system, the removal or reduction of parabiosis, the stimulation of regenerative processes and processes of restoration of the function of peripheral nerves. Excitability of the nervous system, depending on the initial functional state, the phase nature of the pathological process, the massage technique can be reduced or increased. Local reactions that arise under the influence of the direct mechanical action of the massage on the tissues of the massaged area are, to a certain extent, the expression of a generalized reaction of the organism of a reflex nature. At the same time, the appearance in the humoral environment of biologically active substances, products of decomposition of protein compounds of muscle tissue (histamine, acetylcholine, etc.), playing an active role in stimulating the adaptive-trophic function of the sympathetic part of the higher nervous system, is of some importance. As a result of involvement of all these links under the influence of metered massage techniques, mobilization and training of protective adaptive mechanisms takes place, which contributes to providing therapeutic effect in a number of diseases, and in healthy people promotes physical perfection.

Indications for massage

A. Therapeutic massage:

• stage of incomplete remission;
• remission;
• severe muscle hypotrophy;
• significant soreness in the region of spinous processes and paravertebral muscles, points of exit of the sciatic nerve, revealed by palpation.

B. Reflex-segmental massage:

• pronounced pain syndrome with stati-co-dynamic disorders;
• the presence of vascular disorders in patients in the stage of incomplete remission and remission.

Contraindications to the purpose of massage

1. Contraindications for diseases of the cardiovascular system:

• rheumatism in the active phase;
• combined mitral heart defects with a predominance of stenosis of the pulmonary veins, with a tendency to hemoptysis and atrial fibrillation;
• heart valve defects in the stage of decompensation and aortic defects with prevalence of aortic stenosis;
• circulatory insufficiency IIB and III stage, coronary insufficiency, accompanied by frequent attacks of angina pectoris or phenomena of insufficient function of the left ventricle, cardiac asthma;
• thromboembolic disease;
• aneurysms of the aorta, heart and large vessels;
• Stage III hypertension;
• late stages of cerebrovascular atherosclerosis with phenomena of chronic cerebral circulatory insufficiency III stage (according to NK Bogolepov);
• endarteritis complicated by trophic disorders, gangrene;
• significant varicose veins with trophic disorders;
• inflammation of lymph nodes and vessels;
• systemic allergic angiitis, which occur with hemorrhagic and other eruptions and hemorrhages in the skin;
• blood diseases;
• acute circulatory failure.

2. Contraindications for diseases of the central and peripheral nervous system:

• pain syndrome;
• inflammation of the substance of the spinal cord and its membranes, complicated by trophic disorders;
• benign and malignant tumors of different localization;
• tuberculous lesion of the nervous system;
• marked sclerosis of cerebral vessels with a tendency to thrombosis and hemorrhage;
• mental illness with excessive excitation, significantly altered psyche;
• excessive mental fatigue;
• diseases of the autonomic nervous system in the period of exacerbation.

3. Contraindications for skin diseases:

• various diseases of the skin, nails and scalp of infectious, fungal and unclear etiology;
• warts, various skin rashes, lesions, skin irritations, flat warts, pustular and skin inflammatory skin lesions, eczema, acute form of rosacea, herpes, molluscum contagiosum, grazes and cracks, and trophic ulcers.

4. Contraindications for respiratory diseases:

• acute feverish conditions;
• bronchoectatic disease in the stage of tissue decay;
• pulmonary heart failure of grade III;
• active form of tuberculosis;
• benign and malignant tumors of the abdominal cavity organs.

5. Contraindications for traumatic injuries and diseases of the musculoskeletal system and surgical interventions on the organs of the thorax and abdominal organs:

• acute and subacute state of the patient, accompanied by marked general and local inflammatory reactions - increased body temperature, ESR, inflammatory edema, extensive hemorrhage, bleeding, vascular thrombosis, etc .;
• purulent processes in the tissues and extensive pustular skin rashes;
• risk of bleeding and vascular aneurysms;
• acute osteomyelitis;
• tuberculous lesions of bones and joints in acute stage;
• neoplasm of bones and joints;
• acute circulatory failure;
• pulmonary edema;
• kidney and liver failure.

Therapeutic massage is divided into two parts according to its form:

• massage is common;
• massage private (local).

With a general massage, the entire body is massaged. The duration of the massage is 50-60 minutes.

The time required for massage is distributed as follows:

• 20 minutes on the trunk (10 minutes per side);
• 10 minutes for each limb (5 minutes per side).

ATTENTION! The duration of the general massage should depend on the size of the surface of the massaged body and on the relief of the muscular masses.

By private (local) massage is meant the massing of individual limbs of the body, for example, the lower extremities and back or area of the chest and upper limbs, etc.

The massaging sequence for a general massage is different. There is an opinion that a general massage should begin with the limbs.

We recommend starting with the massage of large areas of the body to accelerate the general blood and lymph circulation, which "sucking" way affects the surrounding tissues.

There are basic methods of massage:

• stroking;
• trituration;
• kneading;
• ruble (beating, patting, shaking).

Each massage procedure consists of three sections:

• introductory;
• basic;
• final.

Introductory section of the procedure allows you to gradually prepare the patient's body for increasing load. Its duration is 2-3 minutes. Use gentle massage techniques.

During the main section, a training (general and special) treatment is carried out on the patient's body. During this period, various methods of massage are used, realizing the tasks set by the doctor. Its exposition is 5-15 minutes.

In the final section, the intensity of the effects of massage techniques is reduced. It is recommended to introduce breathing exercises and exercises for small joints and muscle groups.

Methodical instructions for the therapeutic massage:

• selection of massage techniques, their sequence and intensity, the dosage of the load and the starting positions should be adequate to the general condition of the patient, his age characteristics and the state of fitness;
• the procedure should combine a general and special effect on the patient's body; so it is recommended to use physical exercises (isotonic and isometric nature);
• in the preparation of the procedure, the principle of the gradualness and consistency of increasing and decreasing the load should be observed;
• massage techniques should not enhance the pain component after the procedure, so it is necessary to use gentle methods in the first 2-3 procedures;
• only after the reduction of painful manifestations (most often from the 4th procedure) should the skin, subcutaneous tissue and muscles with a differentiated approach to the latter be affected; increases the intensity and number of massage techniques;
• point massage of pain zones on the first procedures is contraindicated in connection with the possibility of pain intensification;
• after the 2-4-th procedure, you should attach a differentiated massage of the muscles, and also add trituration and vibration techniques;
• Only with the 5th procedure is recommended to act on nerve trunks and pain points; while they are sequentially captured in subsequent procedures, using at first stroking techniques and gradually adding rubbing and vibration;
• when the pain is not clearly expressed, the techniques and sequence of effects are the same as in the case of severe pain, but the differentiated effects on muscles, nerve trunks, and pain points begin at an earlier time (during the 2-3rd procedure);
• the intensity of the effects of various techniques should be gradually increased: first apply a superficial stroking, then add a deep stroking (without increasing pain!); trituration should gradually become more vigorous, the strength of vibration and its speed, frequency, amplitude increase;
• The last two days of the course of treatment should be devoted to teaching patients self-massage techniques, recommended for later lessons at home (AF Verbov, NA Belaya).

The duration of the first 2-3 procedures of massage is 5-8 minutes, then it is gradually increased to 15-20 minutes.

Massage can be given every day or every other day. A total of 10 to 18 massage procedures are recommended for the course of treatment.

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Effect of massage on the skin

Massage mechanically removes from the skin the obsolete cells of the epidermis, while increasing the flow of arterial blood to the massaged area, which increases the local temperature, improves nutrition of tissues. The increase in the vital activity of tissues under the influence of the increased influx of arterial blood improves the elastic qualities of the skin: it becomes more elastic, smooth, elastic (cosmetic effect).

Under the influence of massage techniques, the outflow of venous blood and lymph is improved, which in turn helps to reduce swelling and stagnation not only in the area of the massaged area, but also nearer the periphery (for example, shoulder massage reduces edema in the elbow joint area, in the area forearm).

Improved cutaneous respiration, an increase in the secretion of glands embedded in the skin, help to remove metabolic products from the body. Under the influence of skin massage, the secretion of histamine and acetylcholine is enhanced, which creates favorable conditions for muscular activity, increasing the rate of transition of nervous excitation from one element to another.

Influencing the numerous nerve receptors embedded in the skin, massage causes a reaction of the body, which can be different (relaxation - excitation) depending on the techniques used, the duration of their effects, the area of the body on which massage techniques are performed.

Skin first perceives irritation, produced by massage actions. This effect can be direct as a result of direct influence on the skin, but in most cases the response depends on a complex reflex mechanism that acts through the nervous system to the entire body.

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The effect of massage on the circulatory and lymphatic systems

The lymphatic system, being an integral part of the cardiovascular system and the connecting link of all body fluids, plays an important role in maintaining homeostasis. There is no doubt that it directly participates in the processes of exchange between blood and intercellular fluid on the one hand and the intercellular fluid and cells on the other. The latter is explained by the fact that the lymphatic system is a drainage apparatus of intercellular connective tissue spaces, therefore adequate resorption and transport functions of lymphatic capillaries and vessels largely determine the intensity of metabolic processes in the microcirculatory bed. The effect of massage on the circulatory and lymphatic systems is expressed in the acceleration of the outflow of venous blood and lymph from the organs. Local strengthening of blood flow in the veins under the influence of massage causes the same increase in blood flow in adjacent veins and in more distant capillaries. Thanks to a massage that causes a moderate expansion of the peripheral vessels, the pumping work of the heart is facilitated, the work of the left atrium and left ventricle is facilitated by the fact that with the help of massage the blood is "diverted" from internal organs to the skin and to muscle groups. The sucking action of the chest cavity, in turn, provides a current of lymph. Of limbs that are at rest, lymph flows to a lesser degree. Both active and passive limb and trunk movements increase lymph flow. Acceleration of lymph flow in muscle work is obviously a consequence of an increase in the area of capillary filtration, filtration pressure and the volume of the interstitial fluid. In these cases, the lymphatic system, removing excess capillary filtrate, directly participates in the normalization of hydrostatic pressure in the interstitial space. The increase in the transport function of the lymphatic system is simultaneously accompanied by stimulation and resorption function.

Thus, the acceleration of lymph flow is a concrete expression of the involvement of the lymphatic system in regulating the volume of circulating plasma, restoring the disturbed hemostasis parameters and maintaining optimal conditions for metabolic processes in the intercellular spaces.

Massage techniques in combination with physical exercises are accompanied by changes in the functional activity of the lymphatic system, the biochemical composition of the lymph. There is a correction of disturbed homeostasis parameters, a fine adaptation of central hemodynamics and lympho-hemocirculation to the required level of metabolic processes.

The effect of massage on the muscular system and the joint-ligament apparatus

One of the physiological properties of muscles is the ability to contract, i.e. Shorten. Reduction of muscles is caused by chemical, mechanical and other irritations. To mechanical irritations is the effect of massage techniques on the musculoskeletal apparatus.

Under the influence of massage, the elasticity of muscle fibers increases, the contractile function improves, muscle hypotrophy decreases, the metabolism and assimilation by the muscle cells of various substances, lympho- and blood circulation in the muscles, their nutrition and regeneration improves. During the massage, the adhesion process can be prevented and the elasticity of the postoperative scar can be improved. The contractile function of the muscles is especially markedly increased in injuries and diseases of the locomotor apparatus. Massage removes muscle fatigue and increases the performance of muscles. Easy short-term massage quickly restores the performance of tired muscles, rather than short-term rest (passive).

Under the influence of massage, blood circulation in periarticular tissues improves, the capsular-ligamentous apparatus is strengthened, the resorption of articular effusions is accelerated, the function of the synovium and the mobility of the joints improve.

The influence of massage on internal organs and metabolism

The effect of massage on the respiratory system is manifested primarily in the fact that, thanks to reflex connections, breathing becomes deeper and less frequent (viscero-motor and viscero-visceral reflexes). Massage of the intercostal spaces improves the function of the basic respiratory muscles, which in turn, contributes to a better saturation of the body with oxygen, the removal of metabolic products, and the removal of fatigue.

Massage has a positive effect on the abdominal organs. The main role belongs to the nervous system and glands of internal secretion. The inhibition of food centers from excited motor centers is supposed. In addition, during muscular work (physical exercises in combination with massage), the ratio between the activity of the parasympathetic and sympathetic parts of the autonomic nervous system changes towards the prevalence of the latter, which has an effect on the digestive processes. Depending on the intensity of physical activity (physical exercises, massage), its effect on the activity of the gastrointestinal tract is different. Light and not very long loading increases gastric secretion and digestive capacity of gastric juice. More stressful work causes a decrease in acidity and digestive power of gastric juice, as well as inhibition of gastric motility. Heavy physical exertion (various intense and lengthy massage techniques combined with physical exercises) completely suppress the reflex reflex phase of gastric secretion and significantly inhibits the neurochemical phase. In accordance with this, a massage or physical exercise performed immediately after ingestion inhibits the suction in the stomach during the first hours of the secretory period. If muscle loads are carried out 2-2.5 hours after a meal, they can even to a certain extent increase the secretion of gastric juice and motor function of the stomach.

Significant stresses cause both a delay in the secretion of gastric juice and bile secretion; oppression is expressed the stronger, the higher the intensity of the load. With the correct dosage of massage and exercise, the secretion of pancreatic juice and its lipolytic activity can be intensified. Muscle work does not inhibit the synthesis of digestive enzymes in the pancreas tissue. Only their excretion into the intestinal cavity is oppressed. Adaptation to the systematic use of massage and physical exercises removes the depressing effect of the load on the digestive processes.

Under the influence of massage, the acid-base balance is not disturbed due to the increasing ability of the blood to absorb oxygen, which prevents the development of acidosis and increase the amount of lactic acid, so massage, especially used after considerable physical exertion, creates favorable conditions for oxidation-reduction processes, facilitates the removal of the final products of metabolism substances from the body.

Under the influence of massage significantly increases urination, especially if it is carried out after intense physical exertion. Accordingly, the release of nitrogenous substances from the body increases. Moreover, such activation of urination after vigorous general massage remains almost within a day. Since the increase in the separation of urine is more significant in the massage of fatigued muscles than un-tired muscles, it should be considered as a positive factor, which accelerates the removal of the final products of metabolism from tired muscles.

The effect of massage on the nervous system

The nervous system first perceives a mechanical irritation applied to the patient's skin by the hands of a massage therapist during the procedure.

Applying various massage techniques, changing their strength and duration of exposure, you can change the functional state of the cerebral cortex, reduce or increase the excitability of the central nervous system, strengthen broken reflexes, improve nutrition and gas exchange of nerve fibers and conductivity of nerve impulses.

The nervous system, and especially its central departments, play one of the decisive roles in the mechanism of involvement of the hypothalamic-pituitary-adrenal system in response to vibrational stimulation and take part in the implementation of protective-adaptive reactions of the body. The action of certain massage techniques (for example, vibration) on the body is carried out with the participation of higher parts of the central nervous system, including the cerebral cortex, which is confirmed by the possibility of a conditioned vascular reflex to a mechanical stimulus (massage techniques). Consequently, the reaction of the body to the effect of massage is carried out by closing the reflex arc at various levels from axonreflex or segmental reflexes to higher vegetative formations and the cerebral cortex.

The effect of massage techniques on any reflexogenic zone is accompanied by a general reaction of the organism, which goes beyond the limits of the irritated metamer, which is adaptive in nature.

Under the influence of massage, the excitability of the nervous system may increase or decrease depending on its functional state and the method of massage effect. For example, stroking causes positive emotions, a pleasant state of rest and relaxation. At the same time, vigorous massage techniques (for example, kneading) can cause unpleasant sensations, adverse vegetative reactions.

It has been established that the leading role in the formation of pain belongs to the cerebral cortex and that pain can diminish or completely disappear under the action of the conditioned stimulus. Such an irritant is massage, provided it is used strictly according to the indications, taking into account the functional state of the organism, the stage and form of the disease. Adequate response of the body to the effects of various massage techniques is manifested by a pleasant sensation of heat, relieving muscle tension, reducing the pain component, improving overall well-being. Conversely, if the massage increases pain, causes adverse reactions of the cardiovascular system, spasms of the vessels, a manifestation of general weakness, then its conduct is contraindicated. It is established that the most pronounced reaction from the affected organ can be obtained by stimulation with a massage of a certain skin zone associated with a diseased organ by segmental-reflex relationships. For example, the heart responds to the massage techniques in the field of C ₇ vertebral body, and the left subclavian region and the stomach - to the irritation of the massage Th ₅ vertebral body or the skin of the abdomen in the area of the projection of the stomach to the abdominal wall. When the region of the sacrum is effaced, the peristalsis of the intestine is strengthened. Massage of the lumbosacral and inferior thoracic spine has a regulating effect on the circulation of the pelvic organs and lower limbs. Such zones are called reflexogenic. They are rich in vegetative innervation. Elective massage in these zones was called reflex segmentation.

Massage also has a pronounced effect on the peripheral nervous system, improving blood supply, oxidation-reduction and metabolic processes in the nervous tissue.

The use of various massage techniques and their combinations is called a massage procedure. The procedure can be local, when individual segments of the body are massed and common - when the entire body is massaged.

Local massage has a stimulating effect on the neuromuscular system and oxidation-reduction processes in muscles, it has a beneficial effect on weakened muscles, improves regenerative processes with damage to bones and joints, improves muscle tone with flaccid and normalizes it with spastic paralysis, etc. Local massage can be used in the field of severe pain, swelling of the tissues and other pathological changes in them or in the area of unchanged tissues (for example, when the injured limb is immobilized, a healthy limb is massaged). The resulting pulses react reflexively to the affected limb.

Under the influence of general massage, blood circulation and contractility of the heart muscle improve, blood flow to the heart increases, stagnant phenomena in tissues and organs decrease, all kinds of metabolism, secretory function of the organs increase, diuresis increases, urea, uric acid, sodium chloride and other salts. General massage helps to lower high blood pressure and improve breathing function. There are almost no diseases in which massage would not be shown in the general complex of therapeutic measures.

Segment-reflex massage

When it is carried out, mechanical action is exerted not on parts of the body, but on the areas of the skin that are associated with certain segments of the spinal cord, and through them - with the internal organs innervated by these segments.

Sequence of carrying out of massage receptions:

• back massage: development of paravertebral zones; this leads to a decrease in peripheral reflex changes; the direction of the massage movement - from the caudal to the cranial divisions
• massage the most affected areas of the pelvis, chest, cervical region and limbs;
• massage of the muscles of the limbs; the direction of massage movements - from the distal to the proximal parts;
• massage of superficial tissues;
• massage of deeply located tissues;
• massage of the exit zones of segmental roots; the direction of the massage movement - from the periphery to the spine.

The position of the patient during the massage - lying or sitting, the muscles are as relaxed as possible.

Massage dosing:

A. The exposure dose is determined by:

• number and response of receptors exposed;
• the state of the nerve pathways that conduct excitation.

B. The dosage of the massage depends on:

• the size of the massaged area;
• location of the massaged zone;
• massage techniques;
• changes in the patient's tissues;
• the duration of the massage procedure;
• duration of intervals between massage procedures;
• the number of individual procedures;

B. The dosage of the massage also depends on:

1. Species and stages of the disease:

• in the acute stage only weak effects are used;
• In the chronic phase, intensive effects are used;

2. The patient's age:

• for children under 10 years of massage effects should be weak;
• for 15-30-year-old patients massage effects should be more intense;
• for persons over 60 years of age - of medium intensity.

3. Intensity of pressure:

• it should increase from the surface to the depth of the tissue and decrease from the caudal-lateral to the cranial-medial sites.

4. Intervals between procedures:

• on average 2-3 procedures per week are recommended;
• in the absence of contraindications and good tolerability of the massage, a daily procedure is possible.

5. Total number of procedures:

• Massage should be stopped when all reflex manifestations are eliminated;
• an average of 6-12 procedures are required for treatment.

Acupressure

Acupressure causes a response at a distance that does not have a close anatomical connection with the stimulation zone. It is known that the impact on the point organizes the energy balance, stimulates or calms (depending on the technique of influence) the vegetative system, regulates trophic processes, etc.

In the procedures of acupressure, inhibitory and stimulating techniques are used.

• Brake (sedative, soothing, analgesic) effect:
  • the entrance to the BAP (biologically active points) is achieved by smooth circular stroking with the transition to rubbing and continuous pressing. The effect is gradually increasing;
  • The direction is the rotation from the center of the point to the outside; clockwise;
  • sedative effect gives gripping, tingling and continuous vibration;
  • exit from the BAP - a gradual decrease in the intensity of admission;
  • the duration of exposure to one BAT is 3-5 minutes. Expressed, so-called "prescribed sensations": numbness, aches, raspiranie, heat in BAT, "goosebumps" along the corresponding meridian.

Indication - appointed with the aim of providing a soothing, analgesic, antispasmodic and relaxing effect on the neuromuscular apparatus.

• Stimulating (tonic, stimulating) effect:
  • entrance to BAT - impulsive, sharp, short-term (2-3 s) rotation (from the outside inwards, ie counterclockwise), patting, pushing with the finger or vibration;
  • exit from the BAP - a quick, sharp finger removal (1-2 seconds);
  • duration of exposure per BAP - from 30 seconds to 1-2 minutes;
  • feelings of the patient are minimal: minor pain and raspiranie without irradiation.

Indications - is appointed to stimulate the neuromuscular system. Sequence of massage actions

1. The points of the head are massaged earlier located on the trunk and extremities.
2. BAT of the back - up to the front surface of the body.
3. Torso to BAT of extremities.
4. First, massage the BAP of the upper limb, then the lower limb is massaged and, finally, with symmetrical action, first the BAP of the left extremities, and then the right ones.
5. Corporal points massage before auricular.

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Connective tissue massage

Connective tissue massage is the massage of the reflex zones in the connective tissue. When diseases of the internal organs, vessels and joints, there are pronounced reflex changes in the subcutaneous connective tissue, first of all - a violation of its elasticity.

Signs of increased tension of the subcutaneous connective tissue:

• when palpation there is pain (painful sensations);
• When massaging a dermograph reaction appears in the form of a broad band;
• with a sudden increase in tension, it is possible to form a skin roller in place of the stroke.

The method of massage. Tension the connective tissue with the pads of the fingers. Massage Technique:

• cutaneous - carry out a shift between the skin and the subcutaneous layer;
• Subcutaneous - conduct a shift between the subcutaneous layer and the fascia;
• fascial - displacement is carried out in fasciae.

ATTENTION! All kinds of technology combines tension irritation. The patient's lying position on the side is considered to be optimal, since the muscles relax better, the therapist works at a more physiological and thus economical diagonal position of the fingers, hands and shoulder girdle, the patient eliminates unwanted vegetative reactions.

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