Treatment of osteochondrosis: massage

A generally accepted method of treating spinal osteochondrosis is complex therapy, which includes various means of therapeutic exercise and, in particular, massage. Experience in using massage in combination with drug therapy, physical factors, and physical exercises has shown the significant role of this method in increasing the effectiveness of complex treatment of patients.

The purpose of the massage is to stimulate blood and lymph circulation in the affected area to improve regeneration processes; reduce pain; restore muscle strength and endurance (limbs and torso); restore working capacity.

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 stages of the disease.

The massage technique and its dosage depend on the clinical manifestations of the disease, the patient's condition, his cardiovascular, respiratory systems and muscle condition, the patient's age and his tolerance of massage procedures (physical activity).

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

The mechanism of action of 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 irritation of the mechanoreceptors of the skin, which transform the energy of mechanical stimuli into impulses entering the central nervous system; the resulting responses contribute to the normalization of the regulatory and coordinating function of the central nervous system, the removal or reduction of parabiosis manifestations, stimulation of regenerative processes and processes of restoring the function of peripheral nerves. The excitability of the nervous system, depending on the initial functional state, the phase of the pathological process, and the massage technique, can decrease or increase. Local reactions that arise under the influence of the direct mechanical action of massage on the tissues of the massaged area are, to a certain extent, an expression of the generalized reaction of the body of a reflex nature. In this case, the appearance of biologically active substances in the humoral environment, products of the breakdown of protein compounds of muscle tissue (histamine, acetylcholine, etc.), which play an active role in stimulating the adaptive-trophic function of the sympathetic part of the higher nervous system, is of certain importance. As a result of the involvement of all these links under the influence of dosed massage techniques, mobilization and training of protective-adaptive mechanisms occurs, which helps to ensure a therapeutic effect in a number of diseases, and in healthy people contributes to physical improvement.

Indications for massage

A. Therapeutic massage:

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

B. Reflex-segmental massage:

• severe pain syndrome with static-dynamic disorders;
• the presence of vascular disorders in patients in the stage of incomplete remission and remission.

Contraindications to massage

1. Contraindications for cardiovascular diseases:

• rheumatism in the active phase;
• combined mitral heart defects with predominant stenosis of the pulmonary vein openings, with a tendency to hemoptysis and atrial fibrillation;
• heart valve defects in the stage of decompensation and aortic defects with a predominance of aortic stenosis;
• circulatory failure stage IIB and III, coronary insufficiency accompanied by frequent attacks of angina pectoris or signs of left ventricular insufficiency, cardiac asthma;
• thromboembolic disease;
• aneurysms of the aorta, heart and large vessels;
• hypertension stage III;
• late stages of atherosclerosis of the cerebral vessels with symptoms of chronic cerebral circulatory insufficiency stage III (according to N.K. Bogolepov);
• endarteritis complicated by trophic disorders, gangrene;
• significant varicose veins with trophic disorders;
• inflammation of the lymph nodes and vessels;
• systemic allergic angiitis, occurring with hemorrhagic and other rashes 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 spinal cord and its membranes, complicated by trophic disorders;
• benign and malignant tumors of various localizations;
• tuberculous lesion of the nervous system;
• severe sclerosis of cerebral vessels with a tendency to thrombosis and hemorrhage;
• mental illnesses with excessive agitation, significantly altered psyche;
• excessive mental fatigue;
• diseases of the autonomic nervous system during an exacerbation.

3. Contraindications for skin diseases:

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

4. Contraindications for respiratory diseases:

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

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

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

Therapeutic massage is divided into 2 parts according to its form:

• general massage;
• private massage (local).

During a general massage the whole body is massaged. Duration of the massage is 50-60 min.

The time required for the massage is distributed as follows:

• 20 min per torso (10 min per side);
• 10 minutes for each limb (5 minutes for each side).

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

Local massage refers to the massage of individual parts of the body, such as the lower limbs and back, or the chest area and upper limbs, etc.

The sequence of massage during general massage varies. There is an opinion that general massage should start with the extremities.

We recommend starting with a massage of large areas of the body to accelerate general blood and lymph circulation, which has a “sucking” effect on the surrounding tissues.

There are different basic massage techniques:

• stroking;
• trituration;
• kneading;
• chopping (tapping, patting, shaking).

Each massage procedure consists of three sections:

• introductory;
• main;
• final.

The introductory section of the procedure allows the patient's body to gradually prepare for the increasing load. Its duration is 2-3 minutes. Gentle massage techniques are used.

During the main section, a training (therapeutic general and special) effect on the patient's body is carried out. During this period, various massage techniques are used to implement the tasks set by the doctor. Its exposure is 5-15 minutes.

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

Guidelines for performing therapeutic massage:

• the selection of massage techniques, their sequence and intensity, load dosage and starting positions must be adequate to the general condition of the patient, his age characteristics and fitness level;
• the procedure should combine general and special effects on the patient's body; therefore, it is recommended to use physical exercises (isotonic and isometric);
• when drawing up a procedure, the principle of gradualness and consistency of increasing and decreasing the load should be observed;
• massage techniques should not increase the pain component after the procedure, therefore it is necessary to use gentle techniques in the first 2-3 procedures;
• only after the pain has decreased (usually from the 4th procedure) should the skin, subcutaneous tissue and muscles be affected with a differentiated approach to the latter; the intensity and number of massage techniques are increased;
• point massage of painful areas is contraindicated during the first procedures due to the possibility of increased pain;
• after the 2nd-4th procedure, differentiated muscle massage should be added, as well as rubbing and vibration techniques;
• Only from the 5th procedure is it recommended to act on the nerve trunks and pain points; in this case, they are successively captured during subsequent procedures, using stroking techniques at first and gradually adding rubbing and vibration;
• for mild pain, the techniques and sequence of action are the same as for severe pain, but differentiated action on muscles, nerve trunks and pain points begins at an earlier stage (during the 2nd-3rd procedure);
• the intensity of the impact of various techniques should be gradually increased: at first, superficial stroking is used, then deep stroking is added (without increasing pain!); rubbing should gradually become more energetic, the strength of vibration and its speed, frequency, and amplitude increase;
• The last two days of the course of treatment should be devoted to teaching patients self-massage techniques recommended for subsequent sessions at home (A.F. Verbov, N.A. Belaya).

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

Massage can be prescribed daily or every other day. In total, 10 to 18 massage procedures are recommended for the course of treatment.

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The effect of massage on the skin

Massage mechanically removes dead epidermal cells from the skin, while increasing the arterial blood flow to the massaged area, thereby increasing the local temperature and improving tissue nutrition. Increased tissue vitality under the influence of increased arterial blood flow improves the elastic properties of the skin: it becomes more elastic, smooth, and firm (cosmetic effect).

Under the influence of massage techniques, the outflow of venous blood and lymph improves, which in turn helps to reduce swelling and congestion not only in the massaged area, but also in areas located closer to the periphery (for example, shoulder massage reduces swelling in the elbow joint, in the forearm).

Improved skin respiration, increased secretion of glands embedded in the skin, contribute to the removal of metabolic products from the body. Under the influence of skin massage, the release of histamine and acetylcholine increases, which creates favorable conditions for muscle activity, increasing the speed of transition of nervous excitation from one element to another.

By affecting numerous nerve receptors embedded in the skin, massage causes a response from the body, which can be different (relaxation - excitation) depending on the techniques used, the duration of their impact, and the area of the body on which the massage techniques are performed.

The skin is the first to perceive the irritation produced by massage actions. This effect can be direct as a result of immediate influence on the skin, but in most cases the response depends on a complex reflex mechanism that acts through the nervous system on 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 a connecting link of all liquid environments of the body, plays an important role in maintaining homeostasis. There is no doubt about its direct participation in the processes of exchange between blood and intercellular fluid on the one hand and 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 predetermine 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 organs. Local increase in 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. Massage, which causes moderate dilation of peripheral vessels, facilitates the pumping work of the heart, facilitates the work of the left atrium and left ventricle due to the fact that with the help of massage the blood is “diverted” from the internal organs to the skin and muscle groups. The suction action of the chest cavity, in turn, ensures the flow of lymph. Lymph flows out of the limbs at rest to a lesser extent. Both active and passive movements of the limbs and trunk increase the flow of lymph. Acceleration of lymph flow during muscle work is obviously a consequence of an increase in the area of capillary filtration, filtration pressure and volume of interstitial fluid. In these cases, the lymphatic system, removing excess capillary filtrate, directly participates in the normalization of hydrostatic pressure in the interstitial space. An increase in the transport function of the lymphatic system is simultaneously accompanied by stimulation of the resorption function.

Thus, acceleration of lymph flow is a specific expression of the participation of the lymphatic system in the regulation of the volume of circulating plasma, restoration of disturbed indicators of homeostasis and maintenance of optimal conditions for metabolic processes in the intercellular spaces.

Massage techniques combined with physical exercises are accompanied by changes in the functional activity of the lymphatic system, the biochemical composition of the lymph. Correction of disturbed homeostasis indicators occurs, fine adaptation of central hemodynamics and lymph-hemomicrocirculation indicators to the required level of metabolic processes.

The effect of massage on the muscular system and the articular-ligamentous apparatus

One of the physiological properties of muscles is the ability to contract, i.e. shorten. Muscle contraction is caused by chemical, mechanical and other irritants. The effect of massage techniques on the muscular-ligamentous apparatus is also related to mechanical irritants.

Massage increases the elasticity of muscle fibers, improves contractile function, reduces muscle hypotrophy, improves metabolism and absorption of various substances by muscle cells, lymph and blood circulation in muscles, their nutrition and regeneration. During massage, it is possible to prevent the occurrence of adhesions and improve the elasticity of the postoperative scar. Contractile function of muscles is especially noticeably increased in injuries and diseases of the locomotor apparatus. Massage relieves muscle fatigue and increases muscle performance. Light short-term massage restores the performance of tired muscles faster 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 joint effusions is accelerated, the function of the synovial membrane and joint mobility are improved.

The effect of massage on internal organs and metabolism

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

Massage has a positive effect on the abdominal organs. The main role here belongs to the nervous system and endocrine glands. It is assumed that the food centers are inhibited by the excited motor centers. In addition, during muscle work (physical exercises combined 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 affects the digestive processes. Depending on the intensity of physical activity (physical exercises, massage), its effect on the activity of the gastrointestinal tract varies. Light and not very long-term exercise increases gastric secretion and the digestive capacity of gastric juice. More strenuous work causes a decrease in acidity and the digestive power of gastric juice, as well as inhibition of gastric motility. Heavy physical activity (various intense and long massage techniques combined with physical exercises) completely suppresses the complex reflex phase of gastric secretion and significantly inhibits the neurochemical phase. Accordingly, massage or physical exercises performed immediately after eating inhibit the secretion of gastric juice in the first hours of the secretory period. If muscle loads are performed 2-2.5 hours after eating, they can even increase the secretion of gastric juice and the motor function of the stomach to a certain extent.

Significant loads cause both a delay in the secretion of gastric juice and bile secretion; the inhibition is expressed the more strongly, the higher the intensity of the load. With the correct dosage of massage and physical exercises, the secretion of pancreatic juice and its lipolytic activity can increase. Muscle work does not inhibit the synthesis of digestive enzymes in the tissue of the pancreas. Only their secretion into the intestinal cavity is inhibited. Adaptation to the systematic use of massage and physical exercises removes the inhibiting effect of the load on digestive processes.

Under the influence of massage, the acid-base balance is not disturbed due to the increased ability of the blood to absorb oxygen, which prevents the development of acidosis and an increase in the amount of lactic acid, therefore massage, especially when used after significant physical exertion, creates favorable conditions for oxidation-reduction processes and helps remove the end products of metabolism from the body.

Under the influence of massage, urine output increases significantly, especially if it is performed after intense physical activity. Accordingly, the excretion of nitrogenous substances from the body increases. Moreover, such activation of urine output after an energetic general massage lasts for almost a day. Since the increase in urine output is more significant during massage of tired muscles than untired ones, it should be considered a positive factor accelerating the removal of end products of metabolism from tired muscles.

The effect of massage on the nervous system

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

By using various massage techniques, changing their strength and duration of action, it is possible to change the functional state of the cerebral cortex, reduce or increase the excitability of the central nervous system, strengthen impaired reflexes, improve the nutrition and gas exchange of nerve fibers and the conductivity of nerve impulses.

The nervous system, and especially its central sections, play one of the decisive roles in the mechanism of involving the hypothalamic-pituitary-adrenal system in the response to vibrational stimulation and participate in the implementation of protective and adaptive reactions of the body. The effect of certain massage techniques (for example, vibration) on the body is carried out with the participation of the higher sections 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 body's reaction to the effect of massage is carried out due to the closure of the reflex arc at various levels from the axon reflex or segmental reflexes to the higher vegetative formations and the cerebral cortex.

The impact of massage techniques on any reflexogenic zone is accompanied by a general reaction of the body that goes beyond the irritated metamere, which is adaptive in nature.

Massage can increase or decrease the excitability of the nervous system depending on its functional state and the massage technique. For example, stroking causes positive emotions, a pleasant state of peace and relaxation. At the same time, vigorous massage techniques (for example, kneading) can cause unpleasant sensations, unfavorable vegetative reactions.

It has been established that the leading role in the formation of pain belongs to the cerebral cortex and that pain can decrease or completely disappear under the influence of a conditioned stimulus. Such a stimulus is massage, provided that it is used strictly according to indications, taking into account the functional state of the body, the stage and form of the disease. An adequate reaction of the body to the effect of various massage techniques is manifested by a pleasant sensation of warmth, relief of muscle tension, a decrease in the pain component, and an improvement in overall well-being. On the contrary, if massage increases pain, causes adverse reactions of the cardiovascular system, vascular spasms, and manifestations of general weakness, then its implementation is contraindicated. It has been established that the most pronounced reaction from the affected organ can be obtained with irritation by massage of a certain skin zone associated with the diseased organ by segmental-reflex relationships. For example, the heart reacts to massage techniques in the area of the C ₇ vertebral body and the left subclavian region, and the stomach - to irritation by massage in the area of the Th ₅ vertebral body or abdominal skin in the area of the projection of the stomach on the anterior abdominal wall. Tapping the sacrum area increases intestinal peristalsis. Massage of the lumbosacral and lower thoracic spine has a regulating effect on the blood circulation of the pelvic organs and lower extremities. Such zones are called reflexogenic. They are rich in vegetative innervation. Selective massage in these zones is called reflex-segmental.

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 massaged, and general, when the entire body is massaged.

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

Under the influence of general massage, blood circulation and contractility of the heart muscle improve, blood flow to the heart increases, congestion in tissues and organs decreases, all types of metabolism and secretory function of organs increase, diuresis increases, excretion of urea, uric acid, sodium chloride and other salts from the body is activated. General massage helps to reduce high blood pressure and improve respiratory function. There are almost no diseases for which massage would not be indicated in the general complex of therapeutic measures.

Segmental reflex massage

When it is carried out, it is not the body parts that are subjected to mechanical action, but rather the areas of the skin that are connected to certain segments of the spinal cord, and through them, to the internal organs innervated by these segments.

Sequence of massage techniques:

• back massage: working on paravertebral zones; this leads to a reduction in peripheral reflex changes; direction of massage movement - from caudal to cranial sections
• massage of the most affected areas of the pelvis, chest, neck and limbs;
• massage of the muscles of the limbs; direction of massage movements - from distal to proximal sections;
• massage of superficial tissues;
• deep tissue massage;
• massage of the exit zones of segmental roots; direction of massage movement - from the periphery to the spine.

The patient's position during the massage is lying or sitting, with the muscles maximally relaxed.

Massage dosage:

A. The dose of exposure is determined by:

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

B. The massage dosage depends on:

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

B. The massage dosage also depends on:

1. Type and stage of the disease:

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

2. Age of the patient:

• for children under 10 years old, massage effects should be weak;
• for patients aged 15-30 years, massage effects should be more intense;
• for people over 60 years old - medium intensity.

3. Pressure intensities:

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

4. Intervals between procedures:

• On average, it is recommended to carry out 2-3 procedures per week;
• if there are no contraindications and the massage is well tolerated, the procedure can be performed daily.

5. Total number of procedures:

• massage should be stopped when all reflex manifestations have been eliminated;
• On average, a course of treatment requires 6-12 procedures.

Acupressure massage

Acupressure causes a response at a distance, which has no close anatomical connection with the irritation zone. It is known that the impact on the point organizes the energy balance, stimulates or calms (depending on the technique of impact) the vegetative system, regulates trophic processes, etc.

In acupressure procedures, inhibitory and stimulating techniques are used.

• Inhibitory (sedative, calming, analgesic) effect:
  • entry into BAP (biologically active points) is achieved by smooth circular stroking with a transition to rubbing and continuous pressure. The effect gradually increases;
  • direction - rotation from the center of the point outward, i.e. clockwise;
  • the sedative effect is provided by gripping, pinching and continuous vibration;
  • exit from BAT - gradual reduction in the intensity of intake;
  • duration of impact on one BAP - 3-5 min. Expressed, so-called "intended sensations": numbness, aches, distension, warmth in the BAP, "goosebumps" along the corresponding meridian.

Indications: prescribed to provide a calming, analgesic, antispasmodic and relaxing effect on the neuromuscular system.

• Stimulating (tonic, stimulating) effect:
  • entering the BAT - pulsed, sharp, short-term (2-3 sec) rotation (from outside to inside, i.e. counterclockwise), patting, pushing with a finger or vibration;
  • exit from BAT - quick, sharp removal of the finger (for 1-2 s);
  • duration of exposure to one BAP - from 30 sec to 1-2 min;
  • The patient's sensations are minimal: minor pain and distension without irradiation.

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

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

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Connective tissue massage

Connective tissue massage is a massage of reflex zones in connective tissue. In diseases of internal organs, vessels and joints, pronounced reflex changes in the subcutaneous connective tissue occur, primarily - a violation of its elasticity.

Signs of increased tension in the subcutaneous connective tissue:

• pain (painful sensations) occurs during palpation;
• when massaging, a dermographic reaction appears in the form of a wide strip;
• With a sharp increase in voltage, a skin ridge may form at the site of the stroke.

Massage technique. The connective tissue is stretched with the fingertips. Massage technique:

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

ATTENTION! All types of technique are united by tension irritation. The optimal position for the patient is considered to be lying on the side, as the muscles relax better, the massage therapist works with a more physiological and thus economical diagonal position of the fingers, hands and shoulder girdle, the patient is excluded from unwanted vegetative reactions.

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