Treatment of osteochondrosis: muscle stretching

The muscle containing the active trigger points (TP) is functionally shortened and weakened. When attempting to passively stretch it, pain occurs. The limit of passive stretching of the muscle, at which pain occurs, can be determined by differential tests. The amplitude of movement, at which the affected muscle is in a contracted state, remains almost within the normal range, but additional contractile force in this position obviously becomes painful.

An example of a phenomenon that occurs when a shortened muscle contracts is the scalene muscle spasm test. The pain when the affected muscle contracts is replaced by its weakness if this muscle has "learned" to avoid this contraction. Some muscles located in the zone of reflected pain from the TP of other muscles are apparently also in a weakened and shortened state.

Rigidity and relatively painless but progressively decreasing range of motion often occur in the presence of latent TPs that impair muscle function but do not reflect spontaneous pain. In these cases, muscles "learn" to limit movement to a range that does not cause pain.

Muscle stretching has become a routine treatment for osteochondrosis of the spine in the last 5 years. As a rule, this procedure causes faster inactivation of myofascial TPs and with less discomfort for the patient than local injection or ischemic compression. To completely relieve symptoms that have developed with recent myofascial TP damage to a single muscle, it is sufficient to passively stretch it. In cases where a group of muscles is damaged (for example, in the deltoid region) and their TPs interact with each other, all muscles should be stretched.

Gentle gradual stretching of the muscle without anesthesia is a more effective means of inactivating TP than anesthesia without stretching.

"Fresh", acutely arising TPs in one muscle can be inactivated by passive stretching of the muscle and subsequent application of hot compresses to it without anesthesia. To inactivate chronic TPs, both stretching and anesthesia are required.

The stretching procedure is not sufficient for the complete restoration of muscle function. Since the affected muscle has "learned" to limit its function, it should be "retrained" to function normally. This requires adequate preparation of the patient for therapy, selection of physical exercises for the affected muscle, a certain sequence of using various means of exercise therapy in treatment.

Trigger Point Inactivation Technique:

A. Muscle Relaxation: The affected muscle cannot be stretched effectively unless it is fully relaxed.

Complete muscle relaxation is achieved through:

• comfortable patient position;
• exercises in active relaxation of various muscle groups both for individual segments of the body and for the limbs and torso simultaneously.

Muscle relaxation exercises are conventionally divided into:

• for exercises to relax individual muscles at rest in the initial position - lying and sitting;
• exercises to relax individual muscle groups or muscles of individual body segments after their preliminary isometric tension or after performing simple isotonic movements;
• exercises in relaxing individual muscle groups or muscles of individual body segments in combination with active movements performed by other muscles;
• exercises to relax the muscles of individual body segments, combined with passive movements in these same segments;
• exercises to relax all muscles at rest in the initial position - lying down;
• a combination of passive movements with breathing exercises.

B. Muscle stretching. I.p. - lying, sitting;

• one end of the muscle should be stabilized so that the pressure of the therapist's hand on the other end passively stretches it;

ATTENTION! Most often, the stretch itself causes pain and reflex muscle spasm, which prevents effective stretching. If the muscle is spasmodic and tenses under the doctor's hand, the force applied to it should be reduced in order to maintain the original level of tension in it.

• During and after muscle stretching, the patient should avoid sudden movements;
• if the doctor feels that the muscle has become tense, he must immediately reduce the force applied, since until the muscle relaxes, it cannot be stretched;
• after the muscle is fully stretched, its reverse contraction should be smooth and gradual;
• applying a moist hot compress immediately after the procedure warms the cooled skin and promotes further muscle relaxation;
• After warming the skin, the muscle stretching procedure can be repeated.

Muscle Stretching Techniques

A. Passive muscle stretching.

Patient's initial position - lying down, sitting; - maximum possible relaxation of the affected muscle;

• slow, smooth (without stopping!) stretching of the affected muscle to the maximum possible length;
• applying a moist hot compress to the affected muscle.

ATTENTION! Pain from muscle strain should be moderate. B. Staged stabilization. Patient's initial position - lying, sitting;

• maximum possible relaxation of the affected muscle;
• the patient alternately contracts agonistic and antagonistic muscle groups;
• During these movements, the doctor provides measured resistance, thus maintaining isometric tension in the contracting muscles.

ATTENTION! Alternating tension of one or another muscle group promotes gradual lengthening of the affected muscle. This mechanism is based on reciprocal inhibition.

B. Post-isometric relaxation (PIR) consists of a combination of short-term (5-10 sec) isometric work of minimal intensity and passive stretching of the muscle in the following 5-10 sec. Such combinations are repeated 3-6 times. As a result, persistent hypotension occurs in the muscle and the initial soreness disappears. It should be remembered that:

• the patient's active effort (isometric tension) should be of minimal intensity and of sufficiently short duration;
• an effort of medium, and especially high, intensity causes changes in the muscle, as a result of which muscle relaxation does not occur;
• significant time intervals cause muscle fatigue, too short an effort is not capable of causing spatial restructuring of the contractile substrate in the muscle, which is therapeutically ineffective.

The therapeutic effect is achieved by using the respiratory synergy of relaxed muscles. It is known that the muscles of the head, neck, chest, and abdominal wall participate synergistically in the act of breathing. As a rule, the muscles tense up during inhalation and relax during exhalation. Thus, instead of voluntary tension, one can use involuntary (reflex) contraction of the muscle during breathing. Inhalation should be deep and done slowly for 7-10 seconds (isometric tension phase). Then, hold your breath for 2-3 seconds and exhale slowly (muscle stretching phase) for 5-6 seconds.

There is another type of synergy used in PIR - oculomotor. They are manifested by coordinated movement of the head, neck and trunk in the direction of the gaze. This type of synergy is effective in relaxing the muscles-rotators of the spine, extensors and flexors of the trunk.

The use of oculomotor and respiratory synergies is quite effective. In this case, the doctor first asks the patient to direct his gaze in the necessary direction, then take a slow breath. After holding his breath, the patient directs his gaze in the opposite direction and exhales slowly.

PIR has a multifaceted effect on the neuromotor system of striated muscle tone regulation. Firstly, it helps to normalize proprioceptive impulses; secondly, it establishes a physiological relationship between proprioceptive and other types of afferentation. The relaxing effect of PIR is practically not realized on clinically healthy muscles, which excludes the side effects of the technique.

D. Postreciprocal relaxation. The methodical technique includes a combination of PIR synergist with activation of its antagonist. The procedure is as follows:

• preliminary stretching of the affected muscle (for 5-6 s) to pre-tension;
• isometric muscle tension (with minimal effort) for 7-10 s;
• active work (concentric contraction) of the antagonist of the affected muscle (with sufficient force) for 7-10 s;
• maintaining the achieved position of the segment with a stretched agonist in a state of pre-tension and a shortened “non-working” antagonist.

The relaxing effect of PRR is based on the mechanism of reciprocal inhibition. Let us recall that this type of inhibition is caused by the interaction of afferent flows arising in the neuromuscular spindles of the antagonist muscles.

D. Stretching and extension. This technique has been known for a long time and has found wide application in traumatology and orthopedics under the name of redressing ligaments, scars and fascia. The essence of the technique is to apply a passive effort of sufficient duration and intensity against the restriction. As a result of stretching, the boundaries of the anatomical barrier are expanded first of all, which subsequently contributes to the stretching of the boundaries of the functional capabilities of the muscle. Unlike PIR, a constant stretching force is applied for a sufficient period of time (up to 1 minute or more). During this period, the patient makes several breathing movements.

ATTENTION! The passive state of the patient is the leading one in this treatment method.

Muscle stretching can be performed both along the axis and across. The need for transverse muscle stretching may arise in cases where it is impossible to perform stretching along due to joint pathology or muscle hypotonia. The method is as follows: the patient and index fingers of both doctor's hands grasp the distal and proximal muscle sections in relation to the myofascial point (point), respectively, fixing both poles of the latter. The next movement consists of parallel displacement in opposite directions of the grasped muscle sections. In this case, it is possible to use respiratory synergies.

Thus, stretching is a fairly effective technique that has become quite widespread in eliminating the shortening of many active structures.