Treatment of osteochondrosis: physical exercises in water

Underwater massage, traction treatment and correction by position in the aquatic environment, therapeutic swimming have a different therapeutic effect on the patient's body. Use with therapeutic purpose for diseases of internal organs and damages of the locomotor apparatus of physical exercises in the aquatic environment is based on the reduction of body weight in water, hydrostatic action on the body, the influence of the thermal factor and the positive impact on the emotional sphere of the patient.

The pressure of a column of warm water in the process of performing physical exercises positively affects the peripheral circulation. Active movements in the water, especially in the peripheral segments of the limbs, help venous outflow, lymph circulation, reduce swelling in the joints. The physiological effect depends on the sequence of motion in all the IP's. - lying, standing on all fours, kneeling, sitting, standing; the adjusting reactions of the head and neck are used to facilitate the performance of certain movements of the trunk and limbs; the training of walking begins in bed with passive immobilization, simultaneous movements of the foot and the opposite hand are conducted with the help of an instructor. Only after the assimilation of these movements by the patient is possible their active implementation.

Gradually, as many different variants of initial positions as possible inhibit reflexes are introduced. With the help of the reflex-inhibitory posture, a favorable background is created for learning active movements; the upbringing of the reaction to equilibrium is carried out by moving the center of gravity of the body when it is pushed by the methodologist in various directions. Through the education of adjusting reactions and reactions to equilibrium, a correct

Warm water improves the arterial blood circulation and the outflow of venous blood, helps to reduce pain and relax muscles. In the process of performing physical exercises, swimming, the breathing function is activated (the depth of breathing increases, JEL). This is facilitated by exhalation in water: the resistance of the water column at the time of active (forced) expiration leads to the strengthening of the respiratory musculature.

A person's stay in water is approaching a state of weightlessness. Active movement in the aquatic environment can be performed with minimal muscular effort, as the inhibitory effect of the weight of limb segments on movement is drastically reduced. In the water, the amplitude of movements in the joints increases, movements are performed with less muscle tension, and with an additional effort it is easier to overcome the resistance of rigid soft tissues (AF Kaptelin). To increase the load on the muscular system, increase the strength of the muscles use exercises at a rapid 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 counteraction to the mass of water movements (physical exercises, swimming, etc.) also depends on the volume of the submerged part of the body. For example, an increase in the surface of a limb segment or a trunk immersed in water leads to an increase in the load on working muscle groups. The contrast of the force load on the muscles at the time the limb is transferred from the aquatic environment to the air makes them stronger. The aqueous environment facilitates not only movements in the joints, but also some locomotor functions - body movement and walking. As a result of weight loss in the water, movement (especially in patients with lower limb muscles) is facilitated.

Physical exercises in water

In everyday practice, active and passive physical exercises are used in LH 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 with persistent post-traumatic motor disorders, contractures, deformities of the joints.

Passive exercises in water are performed at a slow pace, with the possible full amplitude of movements, and sufficient external force. It is necessary to visually monitor the patient with passive movement. It is necessary to fix the above segment of the limb (with the help of the instructor's hands or special devices), the method of fixation is determined by the localization of the lesion. In the stiff joints, in addition to passive movements, perform exercises to create a greater amplitude.

Depending on the functional state of the muscles that determine the movements in this or that joint, active physical exercises in the water are performed with reduced physical exertion 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, in the vise), supporting the limb or its segment in water with the use of special devices (water dumbbells, floats, etc.), using gymnastic equipment (gymnastic walls, handrails in water, etc.).

Additional physical load on the musculo-articular apparatus is achieved: acceleration of movements; change in the direction of movements in the water (creation of vortex flows of water); performing exercises first in the water, and then outside it (power contrast); the use of special devices (hand and foot fins, foam dumbbells, etc.); exercise in the water at gymnastic projectiles (handrails, trapezoids, etc.).

Therapeutic swimming

The deterioration of general coordination of movements associated with the disease requires a long learning of the elements of swimming movements on land. In this case, it is necessary to choose the most comfortable position for the patient (sitting, lying on his back, on his stomach) and the style of swimming, taking into account the motor abilities. Exhalation training in water does not begin immediately (adaptation to the aquatic environment), but by ensuring a stable position of the patient in the basin. Education of the general coordination of movements of the arms and legs during swimming is recommended to begin at the moment of slipping on the chest. Patients with different pathology of the locomotor apparatus or neurological disorders teach the interrelated work of hands and feet in water with the support of the trunk with the help of a special "hammock" suspended in the pool. This helps the patient to develop coordination of movements without spending muscle effort and attention to maintaining the body on the water surface, increases self-confidence. In the process of working out foot movements use special foam plastic rafts.

Patients are taught swimming according to the following scheme: learning the techniques of navigation on land; perfecting the technique of movements of hands and feet at the side; training for joint interrelated coordinated work of hands and feet with the support of the trunk with a special "hammock"; free swimming (with gymnastic objects and shells).

The choice of style of swimming is determined by functional tasks (general strengthening effect, improvement of the function of breathing, strengthening of certain muscle groups, correction of posture, etc.). For example, to eliminate stoop, they teach you to practice freestyle on your back. Style swimming "dolphin" in connection with a large general physical load, complex coordination of movements, the danger of excessive mobilization of the lumbar spine in medical practice is less acceptable (AF Kaptelin).

In a number of cases it is advisable to depart from the principles of classical swimming and combine, for example, two styles - hand movement with the style "breaststroke", foot movements - with the style "krol". This combination of movements is better absorbed by sick children and easier to coordinate.  

Training sessions of swimming should be carried out carefully regarding the loading dosage, without first determining the distance and the speed of navigation. In the future, as the functional and physical capabilities of the patient improve, after a short sitting at the side of the pool and working out individual elements of a certain style of swimming (like a warm-up in sports) it is recommended to swim first 25-50, and then 75-100 m. 

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

• mental illnesses, skin and venereal diseases, acute inflammatory processes, unclosed wounds and ulcers, infectious diseases, general severe condition, dysfunction of the cardiovascular system, tumor processes, inclinations to bleeding after intra-articular fractures (early periods after trauma), trophoneurotic disorders, instability of the spine (osteochondrosis of the spine, scoliotic disease). 
• Correction by the position in the aquatic environment allows to increase the amplitude of passive movements with a persistent limitation of the range of movements in the joints (with secondary changes in tissues after prolonged immobilization of the limb, as well as due to scarring and posttraumatic functional disorders).

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

Corrective action leading to tissue tension can be expressed in a direction-oriented pressure of the load, "corrective styling" of the limb (trunk), short-term holding of limb segments by the hands of the instructor, the use of fixation tires,

The main indication for the correction of the situation in the water is the limitation of movements in the joints and contractures of different etiology and severity.

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