Treatment of osteochondrosis: physical exercises in water

Underwater massage, traction treatment and correction by position in the aquatic environment, therapeutic swimming have various therapeutic effects on the patient's body. The use of physical exercises in the aquatic environment for therapeutic purposes in diseases of internal organs and damage to the locomotor apparatus is based on the reduction of body weight in water, the hydrostatic effect on the body, the influence of the thermal factor and the positive effect on the emotional sphere of the patient.

The pressure of a column of warm water during physical exercise has a positive effect on peripheral circulation. Active movements in water, especially in the peripheral segments of the limbs, help venous outflow, lymph circulation, and reduce swelling in the joint area. The physiological effect depends on the sequence of movements in all starting positions - lying down, on all fours, kneeling, sitting, standing; the positioning reactions of the head and neck are used to facilitate the performance of certain movements by the trunk and limbs; walking training begins in bed with passive immobilization, simultaneous movements of the leg and the opposite arm are performed with the help of an instructor. Only after the patient has mastered these movements is their active performance possible.

Gradually, as many different variants of initial positions as possible are introduced that inhibit reflexes. With the help of a reflex-inhibitory pose, a favorable background is created for teaching active movements; the reaction to balance is trained by moving the body's center of gravity when the trainer pushes it in different directions. By training installation reactions and reactions to balance, correct

Warm water improves arterial blood circulation and venous blood outflow, helps reduce pain and relax muscles. During physical exercise and swimming, the respiratory function is activated (the depth of breathing and VC increase). This is facilitated by exhaling into the water: the resistance of the water column at the moment of active (forced) exhalation leads to strengthening of the respiratory muscles.

A person's stay in water approaches a state of weightlessness. Active movement in an aquatic environment can be performed with minimal muscular effort, since the braking effect of the weight of limb segments on movement is sharply reduced. In water, the amplitude of movements in the joints increases, movements are performed with less muscular tension, and with additional effort, the resistance of rigid soft tissues is more easily overcome (A.F. Kaptelin). To increase the load on the muscular system, increase muscle strength, exercises are used at a fast pace and with a change in direction, creating vortex flows of water. The compaction of the water column during movements counteracts them. The force of the counteraction of the water mass to movements (physical exercises, swimming, etc.) also depends on the volume of the immersed body part. For example, an increase in the surface of a limb or torso segment immersed in water leads to an increase in the load on the working muscle groups. The contrast of the force load on the muscles at the moment of transferring the limb from the aquatic environment to the air helps to strengthen them. The aquatic environment facilitates not only joint movements, but also some locomotor functions - body movement and walking. As a result of the decrease in body weight in water, movement (especially in patients with paresis of the lower limb muscles) is facilitated.

Physical exercises in water

In everyday practice, active and passive physical exercises are used in therapeutic procedures.

Passive physical exercises are used in the absence of active movements in the joints due to various neurological disorders (paralysis, deep paresis, etc.), as well as in cases of persistent post-traumatic movement disorders, contractures, and joint deformations.

Passive exercises in water are performed at a slow pace, with the fullest possible range of motion, and sufficient force of external influence. Visual control of the patient is necessary during passive movement. Fixation of the limb segment located above is mandatory (using the instructor's hands or special devices), the method of fixation is determined by the localization of the lesion. In stiff joints, in addition to passive movements, exercises are performed to create a greater range of motion.

Depending on the functional state of the muscles that determine movements in a particular joint, active physical exercises in water are performed with reduced physical load on the muscles or with additional load. Changing the load on the locomotor apparatus is achieved by choosing the initial positions of the body (lying, sitting, standing, hanging), supporting the limb or its segment in water using special devices (water dumbbells, floats, etc.), using gymnastic equipment (gymnastic walls, handrails in water, etc.).

Additional physical load on the muscular-articular apparatus is achieved by: accelerating movements; changing the direction of movements in the water (creating vortex water flows); performing exercises first in the water and then outside it (strength contrast); using special devices (hand and foot fins, foam dumbbells, etc.); performing exercises in the water on gymnastic apparatus (handrails, trapezes, etc.).

Therapeutic swimming

The deterioration of general coordination of movements associated with the disease requires long-term learning of elements of swimming movements on land. In this case, it is necessary to select the most comfortable body position for the patient (sitting, lying on the back, on the stomach) and the swimming style taking into account motor capabilities. Teaching exhalation into water does not begin immediately (adaptation to the aquatic environment), but after ensuring a stable position of the patient in the pool. It is recommended to begin developing general coordination of arm and leg movements when swimming at the moment of sliding on the chest. Patients with various pathologies of the locomotor system or neurological disorders are taught the interconnected work of the arms and legs in water with the support of the body using a special "hammock" suspended in the pool. This helps the patient develop coordination of movements without wasting muscle effort and attention on maintaining the body on the surface of the water, increases self-confidence. In the process of practicing leg movements, special foam rafts are used.

Patients are taught swimming according to the following scheme: learning the technique of swimming on land; practicing the technique of arm and leg movements at the side; learning the joint, interconnected, coordinated work of the arms and legs with the support of the body with a special "hammock"; free swimming (with gymnastic apparatus and equipment).

The choice of swimming style is determined by functional tasks (general strengthening effect, improvement of respiratory function, strengthening of certain muscle groups, correction of posture, etc.). For example, to eliminate stooping, freestyle swimming on the back is taught. The "dolphin" swimming style, due to the high general physical load, complex coordination of movements, the danger of excessive mobilization of the lumbar spine, is less acceptable in medical practice (A.F. Kaptelin).

In some cases it is advisable to deviate from the principles of classical swimming and combine, for example, two styles - arm movements in the "breaststroke" style, leg movements in the "crawl" style. This combination of movements is better absorbed by sick children and is easier to coordinate.

Swimming training sessions should be conducted carefully in terms of load dosage, without first determining the distance and speed of swimming. Later, as the patient's functional and physical capabilities improve, after a short session at the edge of the pool and practicing individual elements of a certain swimming style (similar to a warm-up in sports), it is recommended to swim first 25-50, and then 75-100 m.

The main contraindications to physical exercise in the pool and swimming:

• mental illness, skin and venereal diseases, acute inflammatory processes, unclosed wounds and ulcers, infectious diseases, general serious condition, dysfunction of the cardiovascular system, tumor processes, tendency to bleeding after intra-articular fractures (early stages after injury), trophoneurotic disorders, instability of the spine (osteochondrosis of the spine, scoliotic disease).
• Correction by position in an aquatic environment allows increasing the amplitude of passive movements with persistent limitation of the range of motion in the joints (with secondary changes in tissues after long-term immobilization of the limb, as well as due to cicatricial processes and post-traumatic functional disorders).

Correction by position in water provides deep, complete relaxation of periarticular muscles under the influence of heat, which allows the most intensive impact on the altered tissues. Of particular importance is the long-term, continuous and gradually increasing corrective effect on retracted tissues as the muscles relax.

The corrective effect, leading to tissue tension, can be expressed in the pressure of a load oriented in a certain direction, “corrective positioning” of the limb (torso), short-term holding of limb segments by the instructor’s hands, the use of fixing splints, etc.

The main indication for correction by position in water is limited movement in joints and contractures of various etiologies and severity.

The effectiveness of water position treatment is determined by the intensity of the corrective action, but it should not be excessive and accompanied by painful sensations, this can give the opposite effect - lead to reflex muscle tension. It is better to use medium, rather than excessive corrective efforts within the range from 2-5 to 10 kg.