Treatment of osteochondrosis: muscle stretching

The muscle, which contains active trigger points (TT), is functionally shortened and weakened. When trying to passively stretch it, pain occurs. The limit of passive stretching of the muscle, the nose of which does not cause pain, can be determined with differentiated samples. The amplitude of the movement, in which the affected muscle is in a contracted state, remains almost normal, but the additional contractile force in this position obviously becomes painful.

An example of the phenomenon that occurs when a shortened muscle is shortened is a test for spasm of the staircase muscle. Pain with contraction of the affected muscle is replaced by its weakness, if this muscle "learned" to avoid this reduction. In a weakened and shortened state, apparently, there are some muscles lying in the zone of reflected pain from TT of other muscles.

Stiffness and relatively painless, but progressively decreasing in amplitude movement often arise in the presence of latent TT, which violate muscle function, but does not reflect spontaneous pain. Muscles in these cases are "trained" to limit movements within the limits that do not cause pain.

The stretching of the muscles over the past S years has become an everyday therapeutic procedure in the treatment of osteochondrosis of the spine. Typically, this procedure causes a faster inactivation of myofascial TT and less discomfort for the patient than a local injection or ischemic compression. To completely remove the symptoms that developed with the recent defeat of myofascial TT of a single muscle, it is sufficient to passively stretch it. In the same cases, when a group of muscles is affected (for example, in the deltoid region) and their TT interact with each other, all muscles must undergo stretching.

Careful gradual muscle stretching without anesthesia is a more effective means of inactivating TT than anesthesia without stretching.

"Fresh", acute TT 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 TT, stretching and anesthesia are required.

The stretching procedure is not sufficient to completely restore muscle function. Since the affected muscle "learned" to limit its function, it should be "retrained" to normal functioning. This requires adequate preparation of the patient for therapy, the selection of physical exercises for the affected muscle, a certain sequence of use of a variety of drugs in treatment.

The procedure for inactivating trigger points:

A. Relaxation of the muscle: the affected muscle can not be effectively stretched if it is not fully relaxed.

Full relaxation of the muscle is achieved due to:

• comfortable posture of the patient;
• exercises in the active relaxation of different muscle groups for individual segments of the body, and for the limbs and trunk at the same time.

Exercises in relaxation of muscles are conditionally divided:

• on exercises in relaxation of individual muscles in rest and rest. - lying and sitting;
• exercises in relaxing individual muscle groups or muscles of individual segments of the body 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 in relaxing the muscles of individual segments of the body, combined with passive movements in these segments;
• exercises in relaxing the resting musculature in the ili. - lying down;
• combination of passive movements with breathing exercises.

B. Stretching of the muscle. I.p. - lying down, sitting down;

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

ATTENTION! Most often, stretching itself causes pain and reflex spasm of the muscles, which serves as an obstacle to effective stretching. If the muscle is spasmed and tense under the arm of the doctor, the effort applied to it should be reduced to maintain the initial level of tension in it.

• During and after stretching the muscles, the patient must avoid sudden movements;
• if the doctor has felt that the muscle has strained, he must immediately reduce the applied force, since until the muscle relaxes, stretching it is impossible;
• after a full stretching of the muscle, its reverse contraction should be smooth and gradual;
• the application of a moist hot compress immediately after the procedure warms the cooled skin and promotes further relaxation of the muscle;
• After warming the skin, the stretching procedure can be repeated.

Methods of stretching the muscle

A. Passive stretching of the muscle.

I.p. Patient - lying down, sitting; - the maximum possible relaxation of the affected muscle;

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

ATTENTION! Pain when stretching the muscle should be moderate. B. Staged stabilization. I.p. Patient - lying down, sitting;

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

ATTENTION! The alternating tension of one or the other group of muscles contributes to the gradual lengthening of the affected muscle. This mechanism is based on reciprocal inhibition.

B. Postisometric relaxation (IRP) is the combination of short-term (5-10 s) isometric work of minimal intensity and passive stretching of the muscle in the next 5-10 seconds. Repetition of such combinations is carried out 3-6 times. As a result, in the muscle there is a persistent hypotension and the initial soreness disappears. It should be remembered that:

• the patient's active effort (isometric tension) should be of minimum intensity and short enough;
• the effort of the middle, the greater the intensity, causes changes in the muscle, as a result of which the muscle relaxation does not occur;
• significant time intervals cause fatigue of the muscle, too short-term effort is unable to cause in the muscle spatial rearrangements of the contractile substrate, which is ineffective from a therapeutic point of view.

The therapeutic effect is achieved using respiratory synergy of relaxed muscles. It is known that the muscles of the head, neck, chest, abdominal wall are synergistically involved in the act of breathing. As a rule, on inspiration, muscles tighten, on exhalation - relax. Thus, instead of an arbitrary stress, one can use an involuntary (reflex) contraction of the muscle during breathing. The inspiration should be deep and carried out slowly for 7-10 seconds (isometric voltage phase). Then follows a breath hold for 2-3 seconds and a slow exhalation (the stretching phase of the muscle) for 5-6 seconds.

There is another type of synergy used in the PIR, oculomotor. They are manifested by a coordinated movement of the head, neck and trunk in the direction of the view. This kind of synergy is effective in the relaxation of the muscles-rotators of the spine, extensor muscles and flexors of the trunk.

Effective oculomotor and respiratory synergy are effective enough. In this case, the doctor first asks the patient to direct the gaze to the necessary side, then take a slow breath. After holding the breath, the patient directs his gaze to the opposite side and performs a slow exhalation.

The IRP has a multifaceted effect on the neuromotor system of regulation of the tonus of the striated muscle. First, it contributes to the normalization of proprioceptive impulses; secondly, it establishes the physiological relationship between proprioceptive and other afferentiation. The relaxing effect of PID is practically not realized on clinically healthy muscles, which excludes the side effect of the technique.

G. Postrestriprochnaya relaxation. The methodical method involves the combination of a synergist PID with the activation of its antagonist. The procedure is as follows:

• preliminary stretching of the affected muscle (within 5-6 s) to pre-stress;
• isometric muscle tension (with minimal effort) for 7-10 s;
• active work (concentric reduction) of the antagonist of the affected muscle (with sufficient effort) for 7-10 seconds;
• retention of the achieved position of the segment with the stretched agonist in the state of prestress and a shortened "non-working" antagonist.

The relaxing effect of RLP is based on the mechanism of reciprocal inhibition. Recall that this type of inhibition is due to the interaction of afferent flows that arise in the neuromuscular spindles of muscle-antagonists.

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

ATTENTION! Passive state of the patient with this method of treatment is the leading one.

The stretching of the muscles can be carried out both along the axis and across. The need for transverse stretching of the muscle can arise in cases of impossibility of stretching along due to the pathology of the joint or hypotension of the muscle. The method is as follows: the patient and index fingers of both hands of the doctor grab the distal and proximal muscle segments, respectively, relative to the myofascial point, fixing both poles of the latter. The next movement consists in the parallel displacement in opposite directions of the trapped muscle regions. It is possible to use respiratory synergy.

Thus, stretching is a fairly effective technique, which is widely used in eliminating the shortening of many active structures.