In accordance with the nature of the fractures and the stages of treatment, the entire course of physical therapy for bone fractures is divided into three periods: immobilization, restoration of function and training of function.

I period - immobilization (general tonic)... It clinically coincides with the formation of primary callus. Rehabilitation means are: segmental massage, massage of healthy tissues, massage of an uninjured limb; electrophoresis, electrical stimulation; Exercise therapy. Physiotherapy exercises are prescribed immediately after the plaster cast has completely dried or pain relief after applying the hood. The early timing of the appointment of exercise therapy is explained by the need to eliminate the manifestations of traumatic disease, to prevent the occurrence of hypodynamia, to facilitate the adaptation of the body to immobilization.

General tasks of exercise therapy during the immobilization period: improving the course of the main nervous processes; normalization of the patient's emotional tone; improving the activity of internal organs; activation of general metabolic processes.

Special tasks of the 1st period: a) improving the trophism of the immobilized limb and preventing muscle atrophy; b) prevention of dysfunction of the joints of the immobilized limb, the formation of stiffness and contractures, the development of the necessary temporary compensation.

General therapeutic tasks are solved with the help of general developmental exercises. They are performed from all possible starting positions during immobilization and should cover all muscle groups. Exercise therapy classes include breathing exercises (static and dynamic), attention, coordination of movements, stretching and relaxation of muscles, corrective exercises. The pace of the exercise is slow.

To solve special problems of the first period, the following exercises are included:

1. Exercises for a symmetrical limb (improve blood supply and trophism in the immobilized limb).

2. Exercises in the joints of the affected limb free from immobilization (performed first with the help, and then independently).

3. Ideomotor exercises for the immobilized limb (focus on performing the movement in the affected area).

4. Exercises in static tension of the muscles of the immobilized limb (promote the convergence of bone fragments, stimulate regeneration processes at the fracture site, improve blood supply and trophism).

5. Exercises contributing to the formation of compensation: strengthening the healthy leg and arms to prepare for walking in case of a lower limb injury; improving the quality of movement of a healthy hand in case of injury upper limbs and etc.

6. Exercises in pressure along the axis of the limb (with fractures of the bones of the thigh and lower leg): on a box, a special support or headboard.

7. Exercises in lowering the immobilized limb below the level of the bed.

II period - the period of restoration of function. Clinically, during this period, the final formation of callus occurs and the function of the affected limb can normalize. It is characterized by: atrophy of the immobilized limb; limited movement in the joints; insufficient strength of the callus.

The general treatment objectives are the same as in the first period. The set and dosage of general educational exercises are significantly expanded, outdoor games are added. The pace of the exercise is medium.

The special tasks of the II period include: a) the final formation of callus; b) elimination of muscle atrophy; c) restoration of movements in the joints of the affected limb; d) restoration and normalization of the function of the affected limb; e) elimination of unnecessary temporary compensation; f) restoration of posture, normalization of motor skills, improvement of their quality.

Special exercises of the II period:

1. Active gymnastic exercises for the affected limb from facilitating initial positions (such initial positions provide movement in the joints of the diseased limb with minimal muscle tension).

2. Exercises in light conditions, where body weight becomes less and muscle tension is relieved (exercises in warm water).

3. Exercises with a healthy limb, exercises in swinging movements to increase the range of motion in the joints against the background of muscle relaxation.

4. Resistance exercises (to restore muscle strength).

5. Exercise walking (with fractures lower limbs).

6. Passive exercises (prescribed with good consolidation of fragments). The limb should be completely relaxed.

III period - the period of training the function. During this period, possible residual phenomena are eliminated. Rehabilitation means: segmental reflex massage; training on simulators; ice massage (cryomassage); special exercises; sauna (bath); electrical stimulation.

Special tasks of the III period are: a) complete rehabilitation of the patient's body; b) restoration of motor skills; c) achieving perfection of the function of the injured limb; d) the formation of the most beneficial permanent compensation (if the usefulness of the function cannot be ensured).

Exercise therapy means of the third period:

1. General developmental exercises, the general physical load in the classroom increases, expanding the capabilities of the body.

2. Applied exercises that include the affected limb in the work: various options for walking with fractures of the lower extremities, gripping with injuries of the hand, etc.

3. Exercises to form and consolidate the skills of correct posture.

4. Gymnastic exercises for coordination, balance, attention, exercises with objects and simple apparatus.

5. Outdoor games, appropriate to the patient's age and capabilities.

Injuries of the musculoskeletal system cause disturbances in the anatomical integrity of tissues and their functions, accompanied by both local and general reactions from various body systems. Changes in muscles and joints are not only the result of the injury itself, but are also aggravated by immobilization. Injuries are always accompanied by pain, impaired movement function.

In the treatment of fractures, the fragments are repositioned (reduction) to restore the length and shape of the limbs and fix them until the bone fusion. Immobility in the damaged area is achieved by fixation, traction or surgery.

More often than others, in 70-75% of patients with fractures, the method of fixation is used by applying fixation bandages made of plaster and polymer materials.

When applying traction (extension method), the limb is stretched with the help of weights to match the fragments for several hours to several days (the first repositional phase). Then, in the second retention phase, the fragments are kept until complete consolidation and the prevention of recurrence of their displacement.

With the surgical method, the fragments are compared by fastening them with screws or metal clamps, bone grafts (open and closed matching of fragments are used).

Physiotherapy is an obligatory component of complex treatment, as it helps to restore the functions of the musculoskeletal system, has a beneficial effect on various systems the body according to the principle of motor-visceral reflexes.

It has been accepted that the entire course of exercise therapy is subdivided into three periods: immobilization, postimmobilization and recovery.

Exercise therapy begins from the first day of injury with the disappearance of severe pain.

Proceedings for the appointment of exercise therapy: shock, large blood loss, the risk of bleeding or its appearance during movement, persistent pain syndrome.

Throughout the entire course of treatment, when using exercise therapy, general and special problems are solved.

I period (immobilization)

In the first period, the bone fragments come together (formation of primary callus) after 60-90 days. Special tasks of exercise therapy: improve trophism in the area of \u200b\u200binjury, accelerate fracture consolidation, help prevent muscle atrophy, joint stiffness, and develop the necessary temporary compensations.

To solve these problems, exercises are used for a symmetrical limb, for joints free from immobilization, ideomotor exercises and static muscle tension (isometric), exercises for an immobilized limb. The process of movement includes all intact segments and joints that are not immobilized on the injured limb. Static muscle tension in the area of \u200b\u200binjury and movement in immobilized joints (under a plaster cast) is used when the fragments are in good condition and are fully fixed. The danger of displacement is less when connecting fragments with metal structures, bone pins, plates; when treating fractures with the help of Ilizarov, Volkov-Oganesyan and others, more early dates include active muscle contractions and movements in adjacent joints.

General developmental exercises, breathing exercises of a static and dynamic nature, exercises for coordination, balance, with resistance and weights contribute to the solution of general problems. Initially, lightweight IP, exercises on sliding planes are used. Exercise should not cause pain or make it worse. For open fractures, exercises are selected based on the degree of wound healing.

Massage for diaphyseal fractures in patients with a plaster cast is prescribed from the 2nd week. They start with a healthy limb, and then act on the segments of the injured limb, free from immobilization, starting above the injury site. In patients undergoing skeletal traction, massage of a healthy limb and extrafocal massage on the damaged limb begins from the 2nd or 3rd day. All massage techniques are used, and especially those that promote muscle relaxation on the affected side.

P about t and in about the c and and I: purulent processes, thrombophlebitis.

ll period (post-immobilization)

Period II begins after removing the plaster cast or traction. The patients developed the usual callus, but in most cases the muscle strength is reduced, the range of motion in the joints is limited. In this period, exercise therapy is aimed at further normalizing trophism in the area of \u200b\u200binjury for the final formation of callus, elimination of muscle atrophy and achievement of normal range of motion in the joints, elimination of temporary compensation, and restoration of posture.

When using physical exercises, it should be borne in mind that the primary bone callus is not yet strong enough. In this period, the dosage of fortifying exercises is increased, a variety of PIs are used; prepare for getting up (for those on bed rest), train the vestibular apparatus, teach how to move on: crutches, train the sports function of a healthy leg (in case of a leg injury), restore normal posture.

For the affected limb, active gymnastic exercises are used in lightweight, PI, which alternate with relaxation exercises for muscles with increased tone. To restore muscle strength, exercises with resistance, objects, at the gymnastic wall are used.

Massage is prescribed for muscle weakness, hypertonicity and is carried out according to the suction technique, starting above the site of injury. Massage techniques alternate with elementary gymnastic exercises.

III period (recovery)

In the III period, exercise therapy is aimed at restoring the full range of motion in the joints, further strengthening the muscles. General developmental gymnastic exercises are used with greater stress, supplemented by walking, swimming, physical exercises in the water, mechanotherapy.

Exercise therapy for spinal injuries

There are fractures of the spine with and without disturbance of stability (stability) - compression fractures of the vertebral bodies without damage to the ligaments, intervertebral discs.

Methods of treatment:

• simultaneous reduction with the imposition of a plaster corset;
• gradual staged reduction;
• functional method;
• operational methods.

When the bodies of the thoracic and lumbar vertebrae are fractured, the functional method is most often used, in which the patient is placed on a functional bed (a shield is placed under the mattress) with a raised head end, a cotton-gauze roller is placed under the lumbar region. At the same time, the patient's own weight is stretched with the help of the straps held behind the armpits.

During this period, during treatment with traction, exercise therapy is prescribed from the 3-4th day. In the early days, exercises are used for small and large joints of the arms and legs (without lifting the legs from the bed) and breathing exercises. Exercises with spinal flexion are gradually added with support on the arms and feet bent at the elbows and legs bent at the knees. During classes, the bed is placed in a horizontal position. Classes are carried out 3-4 times a day for 10-15 minutes. 7-14 days after the trip, they are allowed to turn on their stomach (without bending the torso). In this position, exercises are used in bending the spine with support on the hands, and later on without support.

Period II includes exercises with significant muscle tension, but with the obligatory condition of painlessness during movements. During the first month of this period, exercises with the separation of the legs from the bed are carried out only in turn. Add PI while on all fours. For 1-2 weeks. before permission to get up, they teach the transition to a kneeling position with a bent back. The duration of each lesson is increased to 20-30 minutes. The use of exercise therapy is aimed at strengthening the muscles of the back, abdominal muscles, pelvis, arms, legs. At the beginning of the 2nd month. use tilting of the body to the sides and light turns in positions on the back, and subsequently on the stomach.

The duration of the lesson is up to 40-45 minutes several times a day with an emphasis on special exercises that strengthen the muscles of the trunk.

For fractures of the bodies of the lumbar vertebrae after 6-12 weeks. after injury (if localized in the thoracic region - earlier), it is allowed to stand up from a prone position or from a kneeling position without bending forward. When getting used to the vertical position, walking is added. Sitting is allowed after 3-6 months. 5-10 minutes several times a day. At the same time, they include forward bends of the torso, but at first with an arched back. Classes continue after discharge for a year or more.

When treating in a plaster corset, bed rest is prescribed for 7-15 days. Exercise therapy begins on the 2-3rd day, using restorative and breathing exercises in the PI on the back, with a small load. With permission to get up and walk before removing the plaster corset, exercise therapy is aimed at stimulating regeneration, the formation of a muscle corset by strengthening the muscles of the back and abdominal muscles. Exercises in the PI are performed lying on the back, stomach, kneeling. After removing the corset, the first time exercise therapy is carried out in the same IP. Bends forward include with caution after 8-10 weeks. after the fracture.

In osteosynthesis, physical exercises are prescribed from the first days in the IP lying on the back, abdomen, from the 10-18th day they are allowed to get out of bed and include exercises in the IP while standing. At the level of damage, isometric muscle tension is used. Extension of the spine in periods I and II is not used.

For vertebral fractures in the cervical spine, traction is used behind the head. In case of injury without disturbing the stability of the spine, exercise therapy is started in the first days. A few days later, they put on a neck corset, a Shants collar and are allowed to sit and walk. Accordingly, for exercise therapy include PI sitting, standing. After removing the immobilization, exercises are used to restore mobility and strengthen the muscles of the neck - turns, tilts of the head back and forth. These exercises are combined with general strengthening exercises, they are carried out at a slow pace.

In case of fractures of the transverse and spinous processes of the vertebrae, patients are placed in bed with a shield under the mattress for 2-4 weeks. Traction is added with severe pain syndrome. Exercise therapy is prescribed from the first days according to the method of treatment of compression fractures, but the time required for the transition to higher loads is reduced. Turn to the stomach is allowed after 4-6 days, PI on the knees - after 8-12 days. IP standing and walking - after 2-3 weeks.

In case of spinal fractures complicated by dysfunctions of the spinal cord and its roots, special effects are added to the tasks of exercise therapy to restore muscle function (paralyzed or paretic) and treat traumatic illness.

Exercise therapy for injuries chest

In case of fractures of the ribs, sternum, breathing exercises are used from the first day; at first include diaphragmatic, then chest breathing, teach coughing. Gradually, breathing exercises are combined with fortifying the arms and legs in various starting positions available to the patient. For open injuries, the exercise therapy technique is similar to that used in planned operations on the chest.

Exercise therapy for fractures of the bones of the girdle of the upper extremities and upper extremities

For fractures of the clavicle or scapula, exercise therapy is prescribed from the first days after the injury. In the first period, exercises are used for the hand, tsaltsy, forearm; in the supine position - abduction of the hand. These movements are combined with restorative, relaxation exercises and breathing exercises. In period II, exercises for the muscles of the shoulder girdle are added. In the sch. Period include exercises with resistance, weights, with objects.

For fractures of the bones of the hand, exercise therapy is prescribed from the 2-3rd day. General strengthening and breathing exercises for intact segments are combined with special exercises for the joints of the injured hand. These are ideomotor, isometric and dynamic exercises. In the first period, lightweight IP is used. In the II period, exercises are complicated, in the III period, muscle strength and normal movements are restored.

In case of fractures of the upper and middle parts of the humerus, rotation should not be applied before fusion occurs. Use q resistance exercises for the hand and fingers.

For fractures of the bones of the lower third of the shoulder and in the area of \u200b\u200bthe elbow joint, special exercises are used for the shoulder joint, for the hand and fingers. In the II period, supination and pronation of the forearm, flexion and extension on a smooth surface or an inclined plane are included, further flexion and extension without effort are added.

With diaphyseal fractures of the forearm bones, exercises for supination and pronation are prescribed with good fusion, and in the first period they tend to use active exercises for the fingers.

In case of fractures of the bones of the hand, exercises are used from 1-2 days for intact joints and ideomotor exercises for damaged ones. In period II, they begin to include active exercises for damaged segments of the hand and fingers with support for the hand. Special exercises are required for each phalanx of the fingers. They use objects (sticks, clubs, balls, ladders, expander).

Exercise therapy for fractures of the pelvic bones

Exercise therapy is used in the first days after injury. In the first period, breathing exercises are used, gymnastic for the upper limbs, neck muscles. For the lower extremities, movements in lightweight PIs with incomplete amplitude are permissible, without effort, alternating with relaxation exercises. Ideomotor and isometric exercises are used for the pelvic muscles. In the first 2 weeks. on the side of the fracture, lifting the straightened leg is excluded. In the II period, prepare for standing, walking. The transition to standing up is carried out from a prone position. In case of fracture of the sciatic and pelvic bones, the sitting position is not used. In the III period, all IP are allowed. Special training includes lower limb movements, bends, torso turns, learning to walk, squats. For acetabular fractures for 6-10 months. exclude support on the leg on the side of the injury. Exercises for the hip joint are performed in lightweight PIs.

Exercise therapy for fractures of the lower extremities

For fractures of the femoral neck, therapeutic exercises begin on the 1st day, using breathing exercises. On the 2-3rd day, include exercises for the abdominal press. In the first period, during traction treatment, special exercises should be used for the joints of the lower leg, foot, and fingers. The procedure begins with exercises for all segments of the healthy limb. In patients with a plaster cast, static exercises for the muscles of the hip joint are used on the 8-10th day. In the II period, it is necessary to prepare for walking and restore walking with the fusion of fragments. Exercises are prescribed to restore muscle strength. First, with the help, and then actively, the patient performs abduction and adduction, raising and lowering the leg. They teach to walk with crutches and further without them. In the III period, the restoration of muscle strength, full mobility of the joints continues.

With surgical treatment - osteosynthesis - the period of stay of the patient on bed rest is significantly reduced. After 2-4 weeks. after the operation, they are allowed to walk with crutches. To walk the patient in bed, exercises for the hip joint are used, offering to sit down with the help of various devices (straps, "reins", fixed bars over the bed).

In case of fractures of the diaphysis and distal femur in the first period, special exercises are used for joints free from immobilization. For the damaged segment, ideomotor and isometric exercises are used. In case of fractures of the hip and leg bones in period I, pressure can be applied along the axis of the limb, lowering the immobilized leg below the level of the bed, at the end of the period, walking in a plaster cast with crutches is allowed, but the degree of support is strictly dosed. In the second period, the volume of exercises is expanded taking into account the strength of the callus and the state of reduction. In the III period, with good fusion, walking is trained, gradually increasing the load.

In case of periarticular and intraarticular fractures of the distal femur, it is necessary to strive for an earlier restoration of movements in the knee joint. With correct reposition and the outlined fusion, isometric exercises are used at first, then active ones - flexion and extension of the lower leg, lifting the leg (with a short-term deactivation of the load traction (with skeletal traction). Increase the load very gradually, slowly. During exercises for the knee joint, the area of \u200b\u200bthe hip fracture fixed by hands, cuffs.

After osteosynthesis, the technique of physiotherapy exercises is similar to that used for a plaster cast, but all loads begin earlier than with conservative treatment. When treating with Ilizarov and others, in the first days, isometric exercises in the area of \u200b\u200bthe operated segment and exercises for all non-immobilized joints are used.

With open injuries of the knee joint and after operations on the joint, remedial gymnastics is used from the 8-10th day, exercises for the joint from the 3rd week. after operation. With closed injuries, remedial gymnastics is included from the 2-6th day. In the first period of immobilization, isometric exercises in the area of \u200b\u200binjury are used, as well as exercises for intact joints and a healthy leg. In patients without immobilization, exercises with a small amplitude are used for the knee joint with the help of a healthy leg in a PI lying on its side. For the ankle and hip joints, active exercises are used, supporting the thigh with the hands. In period II, active exercises are mainly used with caution for the knee joint area with axial load to restore walking. In the III period, support function and walking are restored.

In case of fractures of the shin bones during treatment with traction in the first period, exercises for the toes are used. Be very careful when incorporating knee exercises. This can be done by moving the hip when raising and lowering the pelvis. In patients after osteosynthesis, walking with crutches is allowed early with an attack on the affected leg and gradually increase the load on it (axial load). In the second period, continue exercises for full support, restoration of the range of motion in the ankle joint. Exercises are used to eliminate foot deformities. Period III exercises are aimed at restoring the normal range of motion in the joints, strengthening muscle strength, eliminating contractures, and preventing flattening of the arches of the foot. For fractures of the tibial condyles, be very careful only after 6 weeks. allow the weight of the body to load the knee joint. In osteosynthesis, exercises for the knee and ankle joint are prescribed for the 1st week, and the axial load after 3-4 weeks.

In case of fractures in the ankle area, with any immobilization, exercises are used for the muscles of the lower leg and foot in order to prevent contractures, flat feet.

For fractures of the foot bones in the first period, ideomotor and isometric exercises are used for the muscles of the lower leg, foot; in the PI lying with a raised leg, movements in the ankle joint are used, active ones - in the knee and hip joints, in the absence of contraindications, exercises with pressure on the plantar surface. Support on the foot when walking with crutches is allowed if the foot is positioned correctly. In period II, exercises are used to strengthen the muscles of the arch of the foot. In the III period, correct walking is restored.

For all injuries, exercises in water, massage, and physiotherapy are widely used.

Approximate complexes of medical gymnastics

Exercises for the ankle and foot joints

1. IP - lying on your back or sitting with legs slightly bent at the knee joints. Flexion and extension of the toes (active passively). Flexion and extension of the foot of the healthy leg and the patient alternately and simultaneously. Circular movements in the ankle joints of the healthy leg and the patient, alternately and simultaneously. Turning the foot inward and outward. Extension of the foot with an increase in the range of motion using a tape with a loop. The pace of the exercise is slow, medium or variable (20-30 times).
2. IP is the same. The socks of the feet are laid one on top of the other. Flexion and extension of the foot with resistance from one leg while moving the other. Slow pace (15-20 times).
3. IP - sitting with legs slightly bent at the knee joints Grasping small objects with the toes (balls, pencils, etc.)
4. IP-sitting: a) the feet of both legs on the rocking chair. Active flexion and extension of the healthy and passive - the patient. The pace is slow and medium (60-80 times), b) the foot of the sore leg on a rocking chair. Active flexion and extension of the foot. The pace is slow and medium (60-80 times).
5. IP - standing, holding on to the bar of the gymnastic wall, or standing with hands on the belt. Raising toes and lowering to the whole foot Raising toes and lowering to the entire foot. The pace is slow (20-30 times).
6. IP - standing on the 2-3rd rail of the gymnastic wall, grip with hands at chest level. Springing movements on toes, try to lower the heel as low as possible. Average pace (40-60 times).

Knee exercises

1. IP - sitting in bed. The leg muscles are relaxed. Grabbing the patella with the hand. Passive displacement of it to the sides, up, down The tempo is slow (18-20 times).
2. IP - lying on the back, the sore leg is bent, supported by the hands on the thigh or rests on the roller. Flexion and extension of the EG knee joint with the heel off the bed. The pace is slow (12-16 times).
3. IP - sitting on the edge of the bed, legs lowered: a) flexion and extension of the affected leg in the knee joint with the help of the healthy one. Slow pace (10-20 times); b) active alternating flexion and extension of the legs in the knee joints. Average pace (24-30 times).
4. IP - lying on his stomach. Flexion of the affected leg at the knee joint with gradual overcoming of the resistance of a load weighing from 1 to 4 kg. The pace is slow (20-30 times).
5. IP - standing with support on the headboard. Raise the sore leg bent at the knee joint forward, straighten it, lower it. The pace is slow and medium (8-10 times).

Exercises for the hip joint

1. IP - lying on his back, holding the cord tied to the headboard with his hands. Transition to a half-sitting and sitting position. The pace is slow (5-6 times).
2. IP - lying on your back or standing. Circular movements with a straight leg outward and inward. The pace is only slow (6-8 times).
3. IP - lying on your back, holding the edges of the bed with your hands: a) alternate raising of straight legs; slow pace (6-8 times); : b) circular movements alternately with the right and left leg. The pace is slow (3-5 times).
4. IP - lying on its side, sore leg on top. Abduction of the leg. The pace is slow (4-8 times).
5. IP - standing sideways to the headboard, leaning on it with his hand: a) raising the leg forward and taking it back; b) taking the legs and arms to the side. The pace is only slow (8-10 times).
6. SP - standing, socks together. Lean forward, try to reach the floor with your fingertips or palms. Medium to fast pace (12-16 times).

Exercises for all joints of the lower limb

1. IP - lying on his back, the foot of a sick grave on a padded ball. Rolling the ball to the body and into the SP. The pace is slow (5-6 times).
2. IP - lying on your back, holding the edges of the bed with your hands. "Bicycle". Medium to fast pace (30-40 times).
3. IP - standing facing the headboard with support by hands: a) alternately raising the legs forward, bending them at the knee and hip joints... The pace is slow (8-10 times); b) half-squat. The pace is slow (8-10 times); c) deep squat. The pace is slow (12-16 times).
4. IP - standing, sore leg one step forward. Flexion of the affected leg at the knee and tilt of the trunk forward to the "lunge" position. The pace is slow (10-25 times).
5. IP - standing facing the gymnastic wall. Climbing the wall on toes with additional spring squats on the toe of the sore leg. The pace is slow (2-3 times).
6. IP - hanging with his back to the gymnastic wall: a) alternating and simultaneous lifting of the legs bent at the knee joints; b) alternate and simultaneous lifting of straight legs. The pace is slow (6-8 times).

Some exercises in immobilizing plaster casts; exercise to prepare for walking

1. IP - lying on the back (high plaster hip bandage). Tension and relaxation of the quadriceps femoris muscle ("patella game"). The pace is slow (8-20 times).
2. SP - the same, holding the edges of the bed with your hands. Foot pressure on the instructor's hand, board or box. The pace is slow (8-10 times).
3. IP - lying on your back (high cast). With the help of the instructor, turn to the stomach and back. The pace is slow (2-3 times).
4. IP - the same, the arms are bent at the elbow joints, the healthy leg is bent at the knee joint with support on the foot. Raising the sore leg. The pace is slow (2-5 times).
5. IP - lying on your back on the edge of the bed (high plaster hip bandage). Leaning on your hands and lowering the sore leg over the edge of the bed, sit down. The pace is slow (5-6 times).
6. IP - standing (high plaster hip bandage), holding one hand on the headboard or hand on the belt. Bending the trunk forward, putting the affected leg back on the toe and bending the healthy one. The pace is slow (3-4 times).
7. IP - standing on a gymnastic bench or on the 2nd rail of a gymnastic wall on a healthy leg, the patient is freely lowered: a) swinging the affected leg (12-16 movements); b) writing off the figure eight with the sore leg (4-6 times).
8. IP - walking with crutches (not leaning on the sore leg, slightly approaching the sore leg, loading the sore leg). Options: walking with one crutch and a stick -, with one crutch, with one stick.

Exercise therapy for scoliosis

S k about l and about z is a lateral curvature of the spine. Occurs in children's and adolescence... The causes of scoliosis: trauma, congenital changes, paralysis, dysplasia, etc. Scoliosis is distinguished by their localization: cervical, cervicothoracic, thoracolumbar, lumbar, lumbosacral and total, covering the entire spine. The curvature can have one arc (C-shaped scoliosis), two arcs (S-shaped) or more (several vertices). Scoliosis is necessarily accompanied by a rotation of the vertebral body to the convex side, which leads to the appearance of a muscle ridge in the lumbar region and a rib hump in the thoracic region.

Exercise therapy and massage are indispensable elements in complex conservative and surgical treatment.

The clinical and physiological rationale for the use of exercise therapy and massage is their ability to favorably influence the function of the musculoskeletal system, contributing to the reduction or stabilization of the processes of spinal deformity. Exercise therapy tasks:

• create conditions for the restoration of a normal body position, strengthen the muscles of the trunk, increase their strength;
• in early stages strive to correct the defect, in the later ones - to prevent the aggravation of the process;
• teach correct posture, help normalize the functions of the respiratory and cardiovascular systems,
• have a tonic effect.

Forms of exercise therapy: remedial gymnastics, gymnastics in water. Gymnastic exercises are used in the PI while lying on all fours. Train the muscles of the back, gluteal region, abdomen. To correct the defect, special corrective exercises of two types are used - symmetrical and asymmetrical. With symmetrical exercises, the middle position of the spine is maintained. The muscles on the side of the bulge are tense more intensely, on the concave side they are stretched.

Asymmetric exercises are selected for a special effect on the curvature of the spine. Symmetrical exercises are used more often. The procedure also includes static and dynamic breathing exercises, exercises to develop correct posture in a standing position, and general strengthening exercises. To increase the mobility of the spine, exercises on all fours, mixed hanging, exercises on an inclined plane are used.

Pool activities include pool side exercises, inflatable swimming, rafting and free swimming.

There are three degrees of curvature of the spine.

With scoliosis of the I degree, symmetrical, general strengthening special exercises are used to strengthen the muscles of the back, abdominal press, chest, corrective, exercises in combination with breathing, exercises for the development of coordination, the development of correct posture. They use walking, exercises in the PI while lying on the back, stomach, standing, including exercises with a ball, and medical medicine. With a weak muscle corset, classes are carried out only in the supine position.

With scoliosis of the II degree, dynamic breathing exercises are added when walking, including asymmetric exercises, exercises with weights with dumbbells, clubs; balance exercises. IP - standing, lying on your back, stomach, side. More time is spent on corrective exercises (anti-bending, detorsion exercises). The latter in the presence of torsion.

With III degree of scoliosis, 65-70% of the time, classes are carried out in the position of unloading the spine (lying). Along with restorative and breathing exercises, special corrective, detorsional exercises are used.

If scoliosis does not progress within two years, sports are recommended: breaststroke swimming, volleyball, basketball, skiing.

Scoliosis massage

The task of massage:

• strengthen the muscles of the back and abdomen and normalize their tone,
• reduce the feeling of muscle fatigue,
• reduce pain when they appear,
• improve lymph and blood circulation;
• improve respiratory function,
• help to strengthen the whole body.

Massage is used for scoliosis of all degrees with conservative and surgical treatment. Massage the back, abdomen, chest.

For grade I scoliosis, stroking, rubbing, kneading and vibration are used. With II and III degrees - on weakened muscles, all the above techniques, and on muscles with increased tone - stroking and vibration. The costal hump is influenced by all methods, and especially by vibration, patting the fingers, avoiding strong blows, using pressure, trying to smooth out the deformation by mechanical means. The back is massaged while lying on the stomach, a small pillow is placed under the stomach, a low roller is placed under the ankle joints, the arms are placed along the body or they are bent in front of the chest. The head lies straight or turned in the opposite direction to scoliosis.

When massaging the abdomen and chest in front, the patient lies on his back, a low roller is placed under the knee joints, a small pillow is placed under the head, and the arms are placed along the body.

In the position on the side (opposite to the side of thoracic scoliosis), one hand is placed under the head, with the other hand the patient rests in front of the chest.

With a double curvature of the spine in its different parts, the back is conventionally divided into four sections: two thoracic and two lumbar, for each of which various techniques are selectively applied, taking into account the state of muscle tone. Massage at the beginning of the procedure is carried out nonselectively, using techniques of superficial and deep stroking. Then carry out a differentiated effect on the above sections, starting with the chest. The masseur should be on the side of the massaged area.

After the operation, massage is prescribed at a time depending on the severity and complexity of the operation. Initially, light stroking, rubbing, vibration is used without touching the scar. After 30 days, kneading and tapping is added in the area of \u200b\u200bthe costal protrusion, then massage of the abdomen and legs is added. The duration of the procedure is 20-30 minutes. For the course - 20-25 procedures daily or every other day. The break between courses is at least 14 days. Treatment courses are repeated several times a year.

Exercise therapy for flat feet

Flat feet are caused by flattening of the arches of the foot of varying degrees and can be congenital and acquired (after injuries, paralysis, large constant loads, immobilization, etc.). Physiotherapy is aimed at strengthening the musculo-ligamentous apparatus that supports the arch of the foot.

General strengthening and special exercises are used. Special exercises include exercises for the muscles of the lower leg and foot with grabbing and shifting objects with the toes, rolling with the soles of a stick. Apply walking on toes, heels, outer edge of the foot.

An approximate set of exercises for remedial gymnastics with flat feet
IP - sitting on a chair, without objects

1. The leg is thrown over the knee of the other leg - rotate the foot from the outer edge of the foot to the inner edge.
2. Spread and slide your fingers.
3. Feet on the floor. Make crawling movements with the foot forward and backward (each leg separately, and then simultaneously).

IP - sitting on the floor, with objects

1. Hands back, resting on the palms, legs bent at the knees. Put a stick under the feet; raise the pelvis, roll the stick back and forth with tables.
2. Grab various objects (pencil, stick, ball) with your toes.
3. "Scripture with feet" (pencil or chalk grab all the toes turned with the outer edge of the foot down).
4. Put on socks hands-free, grabbing the sock with the toes of both feet.

IP - standing and in motion, with objects

1. Walk on "skis" on parallel gymnastic sticks. Strive so that the feet do not slip off the poles. Walking is carried out in a straight line with turns, without breaking the parallelism of the sticks.
2. Squat while standing on parallel sticks.
3. Walk one stick back and forth.
4. Grab balls with your toes.

IP - standing and in motion, without objects

1. Climb on one toe and two toes.
2. Raise and lower the inner edges of the foot.
3. Walk on the outer edge of the foot.

Exercise should not cause fatigue, pain. Therapeutic gymnastics is complemented by foot and leg massage. The massage is carried out in courses of 20-25 procedures, after a break of 10 days, the massage is resumed. It is advisable to learn self-massage.

Exercise therapy for congenital clubfoot

Congenital clubfoot is manifested by adduction, supination, and plantar flexion of the foot. Therapeutic gymnastics begins from the 7-10th day after birth, since at this time the tissues are malleable and the correct position of the foot can be formed. Treatment can be conservative with the use of bandages, plaster casts, and also operative. All types of treatment require exercise therapy. They use active exercises, as well as passive ones for stretching shortened muscles and ligaments; extension, abduction and adduction, supination and pronation of the feet. Therapeutic exercises are combined with massage and the wearing of orthopedic shoes.

Exercise therapy for congenital muscle torticollis

Congenital torticollis is caused by contracture of the sternocleidomastoid muscle, the same muscle on the opposite side is overstretched. Therapeutic exercises and massage begin as soon as this pathology is found in a newborn in the first weeks after birth. For the affected muscles, massage is used to relax, the muscles of the opposite side are massaged to increase their tone. Use very careful passive exercises, smoothly turning and tilting the head to the side opposite to the affected muscle. In the position on the side (on the healthy side), the back is unbend and at the same time the head is tilted towards the bed in the healthy side and turned towards the affected side. Exercises are carried out 3-4 times a day. Positional treatment is carried out with sandbags, placing the head in the correct position.

In cases of surgical treatment with subsequent immobilization, exercises are used to prevent complications: general strengthening, breathing, relaxation. After immobilization, passive and active exercises are used for the muscles of the neck, trunk; develop the correct posture.

Exercise therapy for joint diseases

Diseases of the musculoskeletal system are divided into:

1. inflammatory;
2. degenerative (non-inflammatory);
3. traumatic
4. tumor.

Exercise therapy and massage are used only for the first three groups. There are independent forms of arthritis and forms caused by other diseases.

Rheumatoid arthritis is a severe inflammatory disease of the joints, often leading to early disability. The disease is caused by a violation of the immune systems in the body. The contributing factors are foci of infection in the body. The inflammatory process covers individual elements of the tissues of the joints, arising initially in the loose layer of the synovial membrane of the joint. The process can be limited to this, but more often in the future there is a diffuse damage not only to the joint itself, its ligamentous apparatus, but also to the tissues adjacent to it, with the involvement of the epiphyseal parts of the bone and soft tissues in the process. Infiltration and edema are formed, which ultimately leads to significant limitation or loss of joint function with subluxation, contractures, up to the formation of ankylosis.

Small joints of the hands and fingers are more often symmetrically affected, in the elderly, on the contrary, large joints: knee, hip.

In the first period of the acute course of the process, the disease is manifested by pronounced inflammatory changes in the joint, pain in the joints, swelling, and often reddening of the skin. Exudate inside the joint leads to a change in its shape - defiguration - and disrupts the function of movement. The temperature may rise.

In the subacute period, there is a tendency to relapse with moderate pain in the joints, an intermittent increase in body temperature to 37.3-37.5 ° C.

In the joints, not only exudative, but also proliferative changes are expressed, which leads to the development of contractures and ankylosis. Significant dysfunctions of movement in the joints are accompanied by changes in the cardiovascular system, gastrointestinal tract, and kidneys.

In the chronic stage, joint pain intensifies without pronounced inflammatory changes, without an increase in body temperature in the joint area. There are contractures, ankylosis, deformities of many joints, subluxation of small joints.

In severe cases, patients are bedridden for years, cannot take care of themselves.

Rheumatoid arthritis is characterized by simultaneous damage to the valves of the heart and, over time, a heart defect forms. The disease proceeds in the form of attacks - rheumatic attacks.

Gouty arthritis is caused by a violation of the exchange of purines, leading to an increase in the content of uric acid in the blood and the deposition of its salts in various organs, especially in the synovial membrane of the joints, tendons, cartilage, articular surfaces of bones. In this case, acute inflammation of the joint and the formation of multiple nodules can occur. Usually one metatarsophalangeal joint of the toe is affected. There is a deposition of salts on the terminal phalanges of the fingers, in the muscles of the arms and legs in the form of grains. With gout, sudden acute attacks occur with sharp pains, high body and skin temperature. The attack lasts 3-10 days, after which all the phenomena disappear. Attacks are repeated 1-2 times a year, become more frequent over time, and their duration lengthens.

Deforming osteoarthritis. A common disease of the joints of a dystrophic nature, affecting most often middle-aged and elderly people. Often leads to long-term loss of performance and even disability. In this disease, degeneration of the articular cartilage occurs, the articular surfaces of the bones change, osteophytes (bone growths) appear along their edges. At the same time, the soft tissues surrounding the joint are affected.

The most loaded joints are affected - knee, hip, shoulder and feet. The disease begins gradually; there are slight pains on movement, which stop at rest. The pains are worse in the evening and better after a night's sleep.

Initially, there is no effusion in the joints. Defiguration, joint deformity and limitation of movement appear in the late period.

Exercise therapy is shown in the subacute and chronic periods of joint diseases. In the acute period, only position treatment is used.

Exercise therapy task:

• impact on the affected joint and ligamentous apparatus in order to develop their mobility and prevent further dysfunction;
• strengthening the muscular system and increasing its performance, improving blood circulation in the joints and periarticular apparatus, stimulating trophism and combating atrophic phenomena in the muscles;
• counteracting the negative effects of prolonged bed rest (stimulation of the function of blood circulation, respiration, metabolism, etc.)
• increasing the general tone of the body;
• reducing pain by adjusting the affected joints to a dosed load;
• desensitization of the body to fluctuations in meteorological factors, increased fitness and general working capacity of the patient.

The means and form of exercise therapy: position treatment, morning hygienic gymnastics, remedial gymnastics, mechanotherapy, exercises in water, massage.

Position treatment - correct, functionally beneficial resting position of the limb. Already in the acute stage, the tendency to perversion of normal motor acts should be eliminated. The patient is taught to self-control, he must monitor the correct functional and beneficial position of the whole body and affected limbs, learn to relax the muscles, and also breathe deeply. In case of damage to the elbow joint, it should be bent at an angle of 90 ° or slightly less; fixation in the extended position is unacceptable). The forearm should be in a position midway between pronation and supination. The brush should be slightly extended; the palm should be facing the front surface of the body. The hand laid on the pillow should be abducted in the shoulder joint by at least 25-30 ° and gradually up to 90 °. The shoulder should be brought out 30-40 ° forward from the frontal plane, and sometimes also rotated outward. During the process in the metacarpophalangeal joints, there is a tendency to limit extension in them. In these cases, overextension of the interphalangeal joints develops, often leading to subluxation and complete limitation of movement. In this case, the terminal phalanges are bent (type I). During the process, flexion contractures develop in the interphalangeal joints; at the same time, hyperextension may appear in the metacarpophalangeal joints, which is especially pronounced in the end joints (type II).

Sometimes both forms are found in the fingers of one hand. When the joints of the hand are affected, there is a tendency to the formation of so-called "walrus fins", that is, deviation of the hand and four fingers to the elbow side.

In type I disorders, the roller is placed under the metacarpophalangeal joints with their possible full extension (doing this without effort) and with bent interphalangeal joints and extended end joints. In view of the gradual increase in the tone of the muscles that extend the middle phalanges, the patient should be taught to relax them, after which they can be temporarily bandaged to the roller.

In type II disorders, the roller should be laid so that the metacarpophalangeal joints remain free, the interphalangeal joints would be adjacent to the roller in a position of possible full extension, and the end phalanges were attached with a bandage in a relaxed state, slightly bent to the roller. If you have a tendency to develop "walrus fins", you need to make sure that the hand does not sag with an inclination to the elbow.

In the presence of effusion in the knee joint, the patient lies with the leg in a bent position, so contractures develop rapidly, often in all three joints (knee, hip and ankle). To prevent this, the sore leg should be placed on a pillow in a state of complete muscle relaxation. The foot should be placed at a 90 ° angle to the lower leg using a box, board, to prevent horse foot contractures.

To prevent the development of flexion contracture of the hip joint, the patient should be temporarily placed on his back with only a small pillow under the nape. In addition, when laying the patient at the edge of the bed, you can try to passively move the leg and, if possible, lower it down, maintaining the usual angle of flexion in the knee joint, creating conditions for the foot (floor or box). In this position, you can try to increase knee extension by slightly swinging the knee joint. In the subacute stage, treatment with the position is continued and morning hygienic exercises, therapeutic exercises, mechanotherapy, exercises in water (the latter are only for arthrosis and ankylosing sponduloarthritis) are added. Therapeutic exercises are carried out in the IP lying, sitting, standing. The choice of PI is determined by the localization of articular lesions, the degree of preparedness of the cardiovascular system and all the muscles of the patient for a particular physical activity. In case of damage to the joints of the lower extremities, you should first practice lying down, which ensures maximum relaxation of the muscles of the whole body, including the lower extremities; without this, it is impossible to relieve tension and increase the range of motion in the joints. Even with damage to the joints of the upper extremities, in the beginning, preference should be given to the lying position, and later - sitting, standing. In case of damage to the lower extremities, walking is included only in the form of training, corrective, so as not to aggravate the deficiencies in gait, but to eliminate them.

Active (including relief) and passive exercises are used. Relaxation and breathing exercises are widely used. Relaxation is taught on healthy limbs, and then on affected ones. Includes special exercises to strengthen the back muscles. During exercise, the range of motion should be gradually increased, taking into account that the more pronounced the pain, the less the load on the joint should be. With passive movements, do not exceed the physiological norms of movement in the joint. After increasing the amplitude with passive exercises, repeat this exercise actively.

The procedures use exercises with objects (balls, gymnastic sticks, clubs, dumbbells, medicine balls), on apparatus (gymnastic wall, gymnastic bench). Classes are conducted individually or unite patients with homogeneous lesions into small groups (4-5 people); this allows you to choose PIs that are the same for everyone. In such a group, exercises are individualized in terms of amplitude, tempo and the number of their repetitions. If the formation of homogeneous groups is impossible, nevertheless, it is necessary to strive for an individual approach and after classes in a group add "revision" for the affected joints; to teach the patient the exercises that he must perform independently 3-4 times a day for 5-7 minutes.

In the chronic stage, when persistent contractures, partial and complete ankylosis are observed, the tasks of remedial gymnastics are not limited to the effect on these joints, since an increase in the range of motion by several degrees in large joints will not improve functions. In these cases, it is necessary to exert a general effect on the body, using all the remaining motor capabilities in order to activate metabolic processes, improve blood circulation and respiration. Exercises for unaffected nearby joints should be specifically applied. If in the acute and sub-acute stages adaptive movements are not allowed, then in the chronic one they should be used to develop relatively beneficial compensation.

With arthrosis, a feature of therapeutic gymnastics is the effect on large muscle groups with a sufficient load; when overweight, it is necessary to promote its reduction in order to avoid increased stress on the joint. When exercising directly for the affected joints, lightweight and unloading PI should be used, swinging movements are advisable; when walking, handrails, crutches are first used. Lessons in the pool are very effective.

In the presence of synovitis, therapeutic exercises should be more gentle, the pace of the exercises is medium and slow, the amplitude of the movements is painful. Relaxation exercises in combination with stretching the muscles of the arms, legs, and back dominate. Preferred PIs are lying on their back, on their side, on their stomach, while sitting.

In the absence of synovitis, but with severe pain syndrome, limitation of movement in the joint, the procedures are also gentle, the above provisions are observed. With regression of pain syndrome, the total load is increased. The pace of exercise is slow, medium and fast. IP - lying, sitting. The proportion of exercises with a gradually increasing effort, static stress, exercises that contribute to an increase in the range of movements, strengthening the muscles of the arms, legs and back, and the formation of correct posture is significant. Reduce rest pauses between exercises, increase the number of restorative exercises. The features of exercise therapy consist in strengthening the muscles surrounding the affected joint, unloading the affected joint and acting on the nearby joints to enhance their compensatory function in this disease.

The duration of the therapeutic gymnastics procedure for arthritis and arthrosis increases gradually from 10-12 minutes at the beginning to 30-40 minutes in the middle and at the end of the course of treatment.

Morning hygienic gymnastics consists of simple exercises with the obligatory inclusion of movements for the small joints of the arms and legs.

Mechanotherapy

It is advisable to use devices of the pendulum type with a load of various weights.

According to the degree of volitional participation of the patient in the implementation of movements on the apparatus of mechanotherapy, they are divided into three groups: passive, passive-active and active.

BASIC TASKS OF MECHANOTHERAPY:

• an increase in the range of motion in the affected joints;
• strengthening weakened hypotrophied muscles and improving their tone;
• improving the function of the neuromuscular apparatus of the exercised limb;
• increased blood and lymph circulation, as well as tissue metabolism of the affected limb.

Before starting the procedures on mechanotherapy devices, the patient must be examined. It is necessary to check the range of motion in the joint using a protractor, measuring the strength of the hand muscles with a dynamometer (if the wrist joints are affected), to determine the degree of muscle wasting of the limb visually and by measuring it with a centimeter, as well as the severity of pain at rest and during movement.

The method of mechanotherapy is strictly differentiated depending on the characteristics of the clinical forms of the lesion. The severity of the exudative component of inflammation in the joint, the activity of the rheumatoid process, the stage and duration of the disease, the degree of functional insufficiency of the joints, and the peculiarities of the process should be strictly taken into account.

Indications for the use of mechanotherapy:

• limitation of movement in the joints of any degree;
• muscle hypotrophy of the limbs;
• contractures.

P about t and in about the show:

• the presence of ankylosis.

In accordance with the systematization of exercises on mechano-therapeutic devices, passive-active movements with a large element of activity should be used.

The mechanotherapy course consists of three periods: introductory, main and final.

In the introductory period, exercises on mechanotherapeutic apparatuses have a gentle training; mostly - a training character; in the final, elements of training are added to continue independent exercises in medical gymnastics at home.

Mechanotherapy is prescribed simultaneously with therapeutic exercises. It can be used in the subacute and chronic stages of the disease, with severe, medium and mild disease. The exudative component of inflammation in the joint, the presence of an accelerated erythrocyte sedimentation rate (ESR), leukocytosis, subfebrile temperature is not a contraindication for mechanotherapy. With a pronounced exudative component in the joint with hyperemia and an increase in the temperature of the skin above it, with a pronounced activity of the rheumatoid process, mechanotherapy procedures are added with great care, only after 4-6 procedures of therapeutic exercises with their minimum dosage and with a gradual increase. The same conditions should be observed with significant limitation of joint mobility.

With ankylosis of the joints, mechanotherapy for these joints is impractical, but nearby non-ankylosis joints should be trained on apparatus as early as possible for preventive purposes.

Applying mechanotherapy, one should adhere to the principle of sparing the affected organ and gradual exercise.

Before the procedure, the patient must be explained the importance of mechanotherapy. It must be carried out in the presence of medical personnel, who can simultaneously observe several patients working on different devices. The mechanotherapy room should have either an hourglass or a special signal clock.

The mechanotherapy procedure is carried out with the patient sitting at the apparatus (with the exception of procedures for the shoulder joint, which are carried out in the patient's standing position and for the hip joint, which are carried out in the supine position).

The position of the patient on the chair should be comfortable, with support on his back, all muscles should be relaxed, breathing should be arbitrary.

In order to maximize sparing of the affected joint, exercises begin with the use of a minimum load: at a slow pace that does not cause pain intensification, with a small range of motion with frequent rest pauses. The duration of the first procedure is no more than 5 minutes, and in the presence of a significantly pronounced pain syndrome, no more than 2-3 minutes. In seriously ill patients, the first procedures of mechanotherapy can be carried out without a load in order to facilitate the patient's reception. First, the load is increased during the procedure in terms of its duration, and subsequently - by the weight of the load on the pendulum.

If the movement in the joint is limited due to the exudative component of inflammation and pain, mechanotherapy is used after the therapeutic gymnastics procedure. Gradually exercise all affected joints.

In the first days, the procedure of mechanotherapy is carried out once a day, exercising all the affected joints, then twice, and in trained patients - up to three times a day (no more). The load is increased very carefully, both in the number of procedures per day and in the duration of the procedure and the weight of the applied load. It is necessary to take into account the degree of wasting of the exercised muscles, the severity of the pain syndrome, the tolerance of the procedure, and those patients in whom these symptoms are less pronounced can more actively increase the load.

Observing the general provisions of mechanotherapy procedures, it should be individualized for different joints.

Wrist joint. When exercising this joint, they act on the flexors, extensors, instep supports and pronators of the hand; PI of the patient - sitting on a chair.

To exercise the flexors of the hand, the hand in the pronation position is placed on the bedding of the apparatus for the exercised limb and fixed with soft straps. The weight of the load on the pendulum is minimal - 1 kg, the duration of the procedure is 5 minutes. After 4-5 days, the duration of the procedure is increased every 2 days by 1-2 minutes, bringing its duration to 10 minutes.

Gradually, the weight of the load on the pendulum should be increased to 2 kg. This increase depends on the clinical course of the disease: a decrease in the activity of the process, a decrease in exudative phenomena in the joint, a decrease in pain, an increase in mobility in an exercised joint. The duration of the mechanotherapy procedure for the wrist joint can be increased to 20-25 minutes, and the weight of the load - up to 3-4 kg. Movements are carried out at a slow pace.

The right and left arms are alternately trained in the pronation position, and then in the supination position, while both the flexors and extensors of the hand are uniformly trained.

To increase the range of motion in the wrist joint, training is performed on an apparatus for supination, pronation, and circular movements. In this case, the hand is in the middle position - between pronation and supination, that is, the hand and forearm should, as it were, be a continuation of the axis of the apparatus.

Using soft straps with a fastener, the limb segment located below the joint to be developed is fixed.

Elbow joint. When exercising the elbow joint, the flexors and extensors of the forearm and shoulder are affected. PI of the patient - sitting on a chair. The shoulder is fixed to the support, the forearm is bent in the supination position; the axes of movement of the pendulum and the joint must coincide. With active flexion in the elbow joint, the movement of the pendulum is performed in the opposite direction, extension is passive. For active extension in the elbow joint, the forearm is bent and pronated, flexion is passive. The weight of the load on the pendulum is 2 kg, the duration of the procedure is 5 minutes. After 4-5 days, the duration of the procedure every two days is increased by 1-2 minutes, bringing its duration to 10 minutes.

The duration of the procedure can be increased to 20-25 minutes, and the weight of the load on the pendulum - up to 4 kg.

Shoulder joint. When using the apparatus for the shoulder joint, they affect the flexors, extensors, abductors and adductors of the shoulder muscles. PI of the patient - standing. The axillary region rests on the fork of the apparatus, set according to the patient's height. The arm is straightened and lies on the extended tube, which is installed at any angle to the swing bar. The duration of the procedure is from 5 to 15 minutes, the weight of the load is 2 kg.

When developing the shoulder joint, the duration of the procedure and the weight of the load are limited, despite the participation in the movement of a large muscle group, since the standing position is tiring for the patient, while a heavy load increases the pain.

The hip joint. When you exercise this joint on the apparatus, you can act on the muscles that rotate the hip inward and outward. PI of the patient - lying. The leg is fixed with splints and cuffs in the area of \u200b\u200bthe thigh and lower leg. The foot is fixed with a stop holder when rotating it outward, which contributes to the active rotation of the hip inward; rotation of the foot inward promotes active rotation of the thigh outward. The duration of the procedure is from 5 to 25 minutes, the weight of the load is from 1 to 4 kg.

Knee-joint. With the help of the apparatus, the flexors and extensors of this joint are affected. PI of the patient sitting. The chair and thigh rest must be at the same level. The thigh and lower leg are fixed with straps on a moving arm with a stand. With an extended leg, the patient does active flexion, with a bent leg, active extension. The duration of the procedure is from 5 to 25 minutes, the weight of the load is immediately large - 4 kg, in the future it can be increased to 5 kg, but no more.

Ankle joint. When using the apparatus for this joint, the flexors, extensors, abductor and adductor muscles of the foot are affected. PI of the patient - sitting on a high chair. The exercised foot is fixed on the foot bed with the help of belts, the second leg is on a support 25-30 cm high. The patient sits, knee bent - active flexion of the foot, with a straightened knee joint - its active extension. In the same IP, abduction and adduction of the foot are performed. The duration of the procedure is from 5 to 15 minutes, the weight of the load is from 2 to 3 kg. When exercising the ankle joint, fatigue of the lower leg muscles occurs faster, and therefore an increase in the duration of the procedure and the weight of the load above is undesirable.

During mechanotherapy procedures, an increase in the load can be achieved by changing the position of the weight on the pendulum, lengthening or shortening the pendulum itself, changing the angle of the stand to support the exercised segment, which is fixed with a toothed coupling.

Therapeutic exercises are carried out in a pool with fresh water with deforming osteoarthritis, water temperature 30-32 ° C. The tasks of the introductory section of the procedure are adaptation to the aquatic environment, identifying the degree of pain and limitation of movements, the ability to swim, duration 3-6 minutes. In the main section (10-30 minutes), training tasks are carried out. The final section of the procedure - it is 5-7 minutes - is characterized by a gradual decrease in physical activity.

It is preferable to perform exercises from the PI: sitting on a hanging chair, lying on the chest, on the stomach, on the side, imitating "clean hanging"; the volume of general physical and special load during the procedure is changed due to the different depth of immersion of the patient in water, the rate of exercise performance, changes in the specific weight of exercises for small, medium and large muscle groups with varying degrees of effort. They also change the ratio of active and passive exercises, with elements of relief and relaxation of muscles, with inflatable, foam floating objects and shells, exercises on a hanging chair, with fins-gloves and fins for legs, with water dumbbells, exercises of a static nature, imitating "clean »And mixed, isometric tensions, breathing exercises, rest pauses, imitation of swimming elements in sports styles (crawl, breaststroke), subject to the principle of load dissipation. Passive exercises are carried out with the help of an instructor or with the use of floating objects (rafts, rubber rings, "frogs", etc.), exercises without support on the bottom of the pool. Active movements prevail in the water. The range of motion at the beginning of the procedure is limited to painful, sharp jerking movements are excluded. As a result of the procedure, the intensification of pain, paresthesia, and convulsions should not be allowed. The course of treatment consists of 10-17 procedures, the duration of the procedure is 15-20 minutes.

Remedial gymnastics in the pool:

• patients with severe pain syndrome with symptoms of reactive secondary synovitis;
• first 3 days after joint puncture.

Restoration of functions of injured limbs. Normalization of the neuromuscular system. Adaptation to household and industrial loads.

For patients with fractures, the specialists of the R + clinic draw up an individual set of therapeutic physical exercises. Such a complex is prescribed from the first days after the injury and is divided into three periods.

Immobilization period. The injured limb is fixed

The exercises are aimed at:

weakening of the general and local manifestations of traumatic illness;
for the prevention of complications from organs and systems that provide vital activity.

During this period, along with exercises of a general nature, everyday movements can be prescribed: walking with crutches, elements of self-service, etc.).

Postimmobilization period. Fracture healing and removal of fixation from the injured limb

The set of exercises includes:

• active movements in all joints of the injured limb, allowing to increase the mobility of the joints;
• static muscle tension, allowing to develop muscle strength and endurance, to normalize the functional state of the neuromuscular apparatus.

Exercise is usually done at moderate to high intensity. Additionally, hydrokinesis therapy (gymnastics in the pool), mechanotherapy (exercise on simulators), and targeted occupational therapy can be prescribed.

Recovery

Residual motor and coordination disorders of the injured limb are eliminated - contracture, muscle wasting, lameness, etc.). The patient is prepared for muscle tensions inherent in a healthy body.To do this, exercises for strength, speed, endurance and coordination are introduced into the complex, as well as elements of some sports - basketball, badminton, skiing, running, jumping, etc.

Features of exercise therapy for some types of fractures

For fractures of the pelvic bones

In the first period, classes consist of breathing exercises and vigorous hand movements; in some cases, the trunk may be involved in the movements. The movements for the legs are selected simple, with a small amplitude; usually run with support.

In the second period, exercises for both legs, which are more complex in coordination and intensity, are introduced: successive knee extension, raising a straight leg and short-term active holding of it, etc.

In the third period, most of the exercises are aimed at training the strength and endurance of the muscles of the foot, lower leg, thigh and gluteal region. These are mainly squats and walking, and it is important to ensure that the correct walking pattern is observed. To increase the effectiveness of the complex, the exercises can be performed in the therapeutic pool.

For clavicle fractures

As a rule, general health exercises are prescribed, which are supplemented with special movements - flexion and extension in the elbow and wrist joints, rotation of the forearm, slight abduction in the shoulder joint with a gradual bringing to an angle of 90 °. As the fracture consolidates (grows together), the prescribed exercises are complicated by the use of gymnastic apparatus.

For scapula fractures

A set of general health exercises in combination with movements in the elbow and wrist joints. About 2 weeks after the injury, the shoulder joint is involved in movement. After removing the immobilization, active movements are introduced into the complex in the shoulder joint in all planes. Rehabilitation exercises are started only after an x-ray examination, ascertaining the union of the fracture.

For fractures of the central section of the humerus

During the immobilization of the injured limb, general strengthening exercises for the muscles of the trunk, lower limbs and a healthy arm are shown, as well as isometric tension of the shoulder muscles. These exercises can be supplemented with special exercises for the injured limb - flexion and extension in the elbow joint, rotation of the forearm, movements along all axes in the wrist joint, as well as various finger movements. Attention is also paid to the development of compensatory skills that allow the patient to engage in basic self-care.

After the termination of immobilization, exercises are introduced into the complex to restore the function of the elbow and shoulder joints and improving the functional state of the muscles of the injured limb. Hydrokinesis therapy can be prescribed - exercises in the therapeutic pool.

In the third period, with the help of exercises, the full range of motion in the joints, strength and endurance of muscles, speed and coordination of movements are restored. The patient is being prepared for household and industrial activities.

For fractures of the forearm bones

The complex begins with active movements of the joints of the injured limb, free from immobilization. In addition, static tension of the immobilized muscles, imaginary movements in the elbow joint and rotational movements of the forearm are performed. Medical gymnastics for the joints of the fingers of the hand is carried out.

After the immobilization is canceled, exercises are prescribed to restore the function of the elbow joint. For this, a combined device can be used, which allows the movement in the wrist joint and rotation of the forearm with a dosed load.

During the recovery period, residual movement disorders are eliminated, the functional state of the neuromuscular apparatus of the forearm is normalized; adaptation of the patient to everyday and industrial loads.

For hip fractures

In the first period, a set of exercises is aimed at maintaining the basic functions of life support and preventing pressure sores, congestion in the lungs, disorders of the gastrointestinal tract, etc. Breathing exercises are of particular importance. These exercises are combined with movements for the muscles of the arms, trunk, intact leg, including special exercises that prepare it for the upcoming support function.

In the second period, preparation of the patient's transition from a horizontal to a vertical position is carried out. The patient gradually learns to get out of bed without the risk of an orthostatic reaction (dizziness, fainting). The complex introduces exercises to restore muscle strength and range of motion in the joints of the injured limb.

In the third period, a full-fledged (if possible - correct) walking pattern is restored.

For fractures of the central thigh and fractures of the shin bones

During the period of immobilization of the injured leg, the complex consists of general developmental and breathing exercises, as well as movements in the joints of the intact limb. These exercises are complemented by movements for the injured limb, including imaginary movements in the knee and hip joints. During the same period, it is recommended to sit on the bed with your legs down. After 2-3 weeks, it is allowed to walk with crutches. At the same time, exercises are added that make it possible to exclude flat feet of a healthy limb and restore the correct walking pattern.

After the immobilization is canceled, the exercises are aimed at activating the regenerative processes in the fracture area and training the supporting function of the injured leg. The classes include special exercises to restore mobility in the knee and ankle joints. Much attention is paid to the restoration of strength and endurance of the muscles of the injured limb, especially the quadriceps muscle of the thigh, which has the main load during walking. In order to create the most favorable conditions for the restoration of musculoskeletal function, exercise performance can be shown in the therapeutic pool.

In the third period, residual dysfunctions of the joints and muscles and the walking mechanism are eliminated. Coordination, power and speed qualities are restored. After the patient has begun to walk on his own, it is recommended to introduce elements of accelerated walking, running and jumping exercises into the set of exercises.

For fractures of the hand

A set of exercises for such fractures is compiled based on the nature of the fracture and takes into account which bones and phalanges were damaged. At the same time, regardless of the method of treatment, exercises are prescribed from 2-3 days after the injury, provided that the patient is in a satisfactory condition, there is no inflammation, bleeding, severe pain and swelling. Active full-amplitude movements for healthy fingers and exercises involving elbow and shoulder movements are used.

When immobilization is canceled, exercises are prescribed that train the main types of capture. Occupational therapy and imitation of sports games (for example, handball) are recommended to actively restore the functionality of the damaged hand.

The final stage is the restoration of strength, endurance, speed qualities, precise coordination of movements with the hand and fingers, as well as adaptation of the limb to physical activity, taking into account household and professional needs.

For foot fractures

The complex begins with exercises that improve the blood supply to the damaged area and stimulate regenerative processes. If the patient is shown walking with crutches, it is required to pay attention to the correct positioning of the foot.

In the second period, exercises are introduced into the complex to restore the support-spring function of the foot. The movements of the interphalangeal, metatarsophalangeal, subtalar and ankle joints are used.

The main task of the third period is to restore the correct patterns of walking, running, jumping. Endurance and speed are developed, for which exercises are prescribed that train the muscles of the injured limb, namely the plantar muscles and the muscles of the lower leg.

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A spinal fracture is a very serious injury that requires long-term treatment, patience and a strong desire to regain health. Fractures of the spine are different: from compression - to a fracture with a ruptured spinal cord, in which a person becomes disabled. Physiotherapy exercises play a significant role in the rehabilitation of patients with spinal fractures. For stable uncomplicated spinal fractures, the recovery process takes about one year. Fractures complicated by incomplete rupture of the spinal cord will take longer, but the goal is complete rehabilitation. And in case of spinal fractures with a ruptured spinal cord, the task of exercise therapy is to adapt the patient to a life with limited mobility. Physiotherapy exercises for spinal fractures is based on an individual approach to each patient, which depends on the degree of damage to the vertebrae and spinal cord, neurological symptoms, as well as the patient's discipline. Therefore, the article discloses only the principles and stages of exercise therapy for this injury. Attention is paid, which greatly accelerates the recovery of patients and enhances the effectiveness of therapeutic exercises, massage and other procedures. After recovery, it is recommended to regularly perform and exercise in the pool health group. Unfortunately, spinal injuries are common, they have complications, it is not easy to treat patients with spinal fractures, but imagine what joy both you and your "student" will have when movements appear, when he can walk. This is a second birth! We do miracles with our own hands. You need to start, do and believe that everything will work out.

The article has three main parts:
Exercise therapy for stable uncomplicated spinal fractures without plaster fixation;
Exercise therapy for stable uncomplicated spinal fractures with wearing a corset;
Exercise therapy for complicated spinal fractures.

Fractures of the spine often occur as a result of indirect trauma: when falling from a height to the legs, buttocks, head; less often - with a direct injury - a direct blow to the back. Fractures of the vertebrae can be compression (along the axis of the spine), comminuted with damage to the vertebral bodies, arches and processes.

With fractures of the spine, the ligamentous apparatus is also injured. In this regard, a distinction is made between stable fractures (without rupture of ligaments) and unstable ones, in which a rupture of the ligaments occurred, and there may be secondary displacement of the vertebrae and damage to the spinal cord.

Spinal fractures are classified as uncomplicated (without spinal cord injury) and complicated (with spinal cord injury). Spinal cord injury can be incomplete and complete. The manifestations of traumatic injuries of the nerve pathways of the spinal cord depend on the location and depth of the injury. With a complete rupture of the spinal cord, neurological symptoms are detected immediately: the patient does not feel the legs. With an incomplete rupture of the spinal cord, neurological symptoms increase over several days, since there is edema and hematoma, which increase the compression of the nervous tissue. After about a week, it is clear to the traumatologist at what level the spinal cord was damaged.

Neurological symptoms in spinal fractures at various levels.

I - IV cervical vertebrae	Spastic paresis of all limbs, loss of all types of sensitivity, pelvic disorders. The prognosis for life is unfavorable, since there is edema ascending to the brain.
V - VII cervical vertebrae	Flaccid paralysis of the upper limbs and spastic paresis of the lower limbs develop. Loss of all kinds of sensitivity. Pelvic disorders.
I - IX thoracic vertebrae	The upper limbs are not affected. Spastic paralysis of the lower extremities. Pelvic disorders.
X chest - II sacral	Flaccid paralysis of the lower limbs. Pelvic disorders. Bedsores of the lower extremities appear early, as the vegetative section is damaged.
III - V sacral	Pelvic disorders only.

Physiotherapy exercises for spinal fractures.

With a spinal fracture, the patient is hospitalized.
The patient lies on a mattress on a wooden board.
Fixation of the fracture site and creation of a muscular spine corset is carried out.
Patient care and treatment depends on the severity of the injury.
If there is a complete or partial rupture of the spinal cord and paralysis, it means that special attention is paid to the prevention of pressure ulcers, since with this injury, not only motor and sensory functions suffer, but also autonomic disorders occur, metabolism and microcirculation of blood in the tissues below the site of spinal injury are disrupted. brain.
It is produced with the help of pillows, prevention of sagging feet, as well as prevention of congestion in the lungs.

Inflation of balloons.
- Blowing air from the lungs through a long tube (from the drip system) into a bottle of water.
- Diaphragmatic breathing.
- Full breathing with sound on exhalation (oo-oo-uff, oo-oo-uhh, chijzh, chizz, rrrrrrr).

An application is recommended in which the head and foot end of the bed can be raised to redistribute the blood in the body to avoid stagnation.
Physiotherapy exercises with passive and active movements and therapeutic massage of the affected limbs are carried out.
First you need to remember the rules that you need to religiously follow.

1. You cannot sit for a long time after an injury.
2. Forward bends are prohibited.

Physiotherapy exercises for stable uncomplicated spinal fractures.

For stable, uncomplicated fractures, the plaster corset is usually not applied. (In the case when the patient is undisciplined, a special corset is put on. Then the patient is not in the hospital for long).

Applicable physiotherapy exercises for spinal fractures in order to create a muscle corset, muscles - back straighteners (posture), preparation for standing up, and then for walking.

You can't sit for a long time! The doctor allows you to sit down when the patient can walk for 1.5 hours without rest without pain. This is usually possible by the end of 4 - 5 months.

I period. First week after spinal injury. Exercise therapy is appointed from the first day.
Tasks: activate the respiratory and cardiovascular systems, prepare the patient for the main activities.
Exercises for small and medium muscle groups in combination with breathing exercises are included. Leg movements in facilitated conditions: without lifting the heels from the bed, only alternating movements (sometimes with one leg, then with the other). Excludes exercises with raising and holding a straight leg. You can raise your pelvis.
Duration of classes is 10 - 15 minutes on the bed.
At the end of the first week, the patient should raise one straight leg by 15 0 and not experience pain.

II period. The goal of the second period is to strengthen the muscles of posture and corset of the spine, to promote the formation of physiological curves of the spine and to prepare for standing up.

Until the end of the first month since the injury physical activity gradually increases (both the number of repetitions of exercises, and the time of exercise).
Approximately two weeks after a stable uncomplicated spinal fracture, the patient is allowed to rotate on his stomach. At this time, correction begins with a position: a roller is placed under the chest and shoulders (the height of the roller changes under the supervision of a doctor), under the feet - a roller 10-15 cm high.In this position, the patient lays for 20-30 minutes several times a day for easy extension of the spine.

This stage includes "Extension" exercises for back muscles holding the position with extension of the spine for some time to strengthen the muscles of the back.

one). The starting position is lying on your back. Extension in the thoracic region with support on the elbows.

We complicate the task. Starting position lying on your back, legs bent at the knee joints, feet on the bed. Extension of the spine with support on the elbows and feet.

2). The starting position is lying on your stomach. Raising the head and upper shoulder girdle with support on the forearms.

Gradually complicating the task: the same without relying on hands.

Then raising the head and upper shoulder girdle without support on the hands, holding the position for 5 - 7 seconds.

Extension in the thoracic region, leaning on the arms outstretched forward (that is, a stronger extension than leaning on the forearms).

Extension in the thoracic region with the separation of the arms extended forward from the bed.

Extension in the thoracic region with a separation of the arms extended forward + lifting one straightened leg.

This period includes exercises with lifting legs from bed... Remember the task at hand - to strengthen the muscular corset of the spine.

one). "Bicycle" alternately with each leg.

2). Lying on your back, legs bent, feet on the bed. Place the heel on the knee of the other leg (alternately with each leg).

3). Lying on your back, legs bent, feet on the bed.
1 - Take the straightened right leg to the side, put.
2 - Put the right leg on the left (leg to leg), relax the muscles.
3 - Take the straightened right leg to the side again, put it down.
4 - Return to starting position.
The same with the other leg.

4). Sliding the feet on the bed with alternating leg movements.

5). Lying on your back, take your legs to the sides at the same time: then legs apart, then together, sliding your feet along the bed and slightly lifting them to reduce friction and provide tension for the muscles of the abdomen and the front of the thighs.

6). Lying on your back, legs closed together, straight. Take the opposite arm and leg to the sides:
1- right arm + left leg,
2 - return to starting position;
3 - left arm + right leg,

7). Imitation of walking lying on the back.
1 - Simultaneously raise up the straightened right arm and left leg.
2 - Return to starting position.
3 - Simultaneously raise up the straightened left arm and right leg.
4 - Return to starting position.

8). Lying on your back, legs straightened, lying on the bed.
1 - Put the right leg on the left, try to raise the right leg, and the left leg prevents this, there is no active movement. Hold tension for 7 seconds.
2 - Return to starting position.
3 - Put the left leg on the right, try to raise the left leg, and the right leg prevents this, resists. Hold tension for 7 seconds.
4 - Return to starting position.

nine). Lying on your back, legs bent at the knees, feet on the bed, raise the pelvis.

ten). Lying on your back, bend your legs at the knee and hip joints, then straighten your legs up (feet to the ceiling) and keep them in an upright position for 10 seconds, gradually bringing them up to 3 minutes day by day.

Gradually we train the holding of straightened legs at an angle of 45 0. While lifting and holding the straightened legs at an angle, it is necessary to press the lower back to the bed as much as possible with the abdominal muscles.

At the end of the first month from the onset of the disease are connected exercises for spinal fracturesin the knee-wrist and knee-elbow positions. The task of exercise therapy at this stage is preparing to get up - becomes the main target. You should continue to strengthen the muscle corset of the spine, posture, and leg muscles. Particular attention should be paid to the formation of physiological curves of the spine.

Let us recall the order in which the physiological curves of the spine are formed in infant from birth to one year old and take this sequence as a principle for the recovery of patients with spinal fractures.

At 2 - 3 months, the child keeps his head lying on his stomach, physiological lordosis is formed cervical spine.

At 4 months - rests on the forearms, rolls from the abdomen to the back.

At 5 months - lying on his stomach, he leans on his palms, raising his head and upper shoulder girdle, rolls from the abdomen to his back and back, the skill of crawling on the stomach is formed.

At 6 months - the baby gets into a knee-wrist position, at this time he can release one hand to take a toy.

At 7 months in the knee-wrist position, it crawls first backward, then forward, sits down. At that time physiological kyphosis of the thoracic spine is formed.

At 8 months - improving crawling, trying to get up.

At 9 months - the baby stands and walks at the support. At that time physiological lordosis of the lumbar spine is formed.

So, let's conclude:
cervical lordosis is formed when the head is lifted in a prone position;
thoracic kyphosis - when sitting down;
lumbar lordosis - when getting up.
The development of the child proceeds from the head to the legs and from the proximal parts of the limbs to the distal ones (the distal parts of the limbs are the hands and feet, the proximal parts are closer to the body). In approximately this order, new exercises should be added in adult patients, gradually complicating the tasks every day and striving to prepare for getting up. An important exception is that you cannot sit for a long time until the doctor permits.

So first therapeutic exercises for spinal fractures limited to exercises in the supine position without lifting the legs from the bed;
after two weeks - exercises are added lying on the stomach with raising the head and thoracic region;
by the end of the month, it is allowed to raise the legs in the supine and prone position, as well as exercises in the knee-wrist position.
We train the patient to stand up first on your knees, then get up near the bed, but not from a sitting position, but from a standing position in a knee-wrist position. The patient first stands on the floor with one leg, then lowers the other leg, squats slightly and, pushing off the bed with his hands, straightens on his legs. At first he stands for 5 - 10 minutes, then the standing time gradually increases. You can connect leg exercises: rolling from heel to toe, "trampling" - transferring the weight of the body from one foot to another, walking on the spot with hands on the high headboard or the bar of the wall bar with a high hip lift, overlap the shins back alternately with each leg , balance training in the form of standing on one leg. Preparation for getting up requires special attention, the timing is individual, depending on the severity of the patient's condition under the supervision of a doctor.

Periodically held functional test for back muscles... If the test is positive, then you can walk.

one). Lying on his stomach, the patient raises his head, shoulders and both legs. The test is considered positive if it can hold this position for 2 - 3 minutes, up to 14 years old - 2 minutes, children under 11 years old - 1.5 minutes.

2). Lying on your back, raise your straightened legs at an angle of 45 0 and hold in this position for 3 minutes.

III period. From this moment, when you can walk, exercises lying on your back, lying on your stomach and standing in the knee-wrist position become more complicated, the number of repetitions increases, exercises in the starting position are added. These are back and side bends, half-squats with a straight back and half-hangs on a bar with bent legs (feet touching the floor).

! Do not do exercises in the initial sitting position and bends forward, even if the patient is allowed to sit.

IV period. Complete restoration of the vertebrae occurs approximately one year after the fracture. Further classes in the group of post-traumatic osteochondrosis are performed. Particular attention is paid to posture. The muscles that support the posture are strengthened by exercises in the starting positions lying on the stomach and standing in the knee-wrist position.

Physiotherapy exercises for stable uncomplicated fractures of the spine while wearing a corset.

The corset is used when the patient is not disciplined. If immobilization is carried out using a corset, then the patient is not in the hospital for long. This means that the spinal injury was with a slight compression fracture.

While wearing a corset Exercise therapy for spinal fractures sets the task to improve the functioning of the respiratory and cardiovascular systems, to prevent the appearance of excess weight due to the patient's low mobility. We take into account that when wearing a corset, patients are worried about shortness of breath.

Such patients are engaged in the group method 3 times a week for 35 - 40 minutes.
Exercises for arms and legs in combination with breathing exercises are included.
The starting positions are used lying, in the knee-wrist position and then gradually standing.
You can't sit!
Are applied isometric exercises for abdominal muscles to strengthen the abdominal muscles. For example.

one). Starting position lying on your back, legs bent at the knees, feet on the floor, arms along the body.
1 - raise your head, shoulders and arms, look forward, stay in this position for 7 seconds (you need to count like this: "Twenty-one, twenty-two, twenty-three ...", etc.).
2 - Return to the starting position, relax (relaxation is best done on exhalation).
3 times.

2). The starting position is lying on your back, legs are straightened, arms along the body.
1- Raise your head, shoulders and arms, stretch your arms forward, look at your feet, stay in this position for 7 seconds. (You can use the feet, for example, do the extension of the feet (feet towards yourself)).
2 - Return to starting position, relax on exhalation.
3 times.

3). The starting position is lying on your back, legs are straightened, the right leg is on the left.
1 - Raise your head, shoulders and arms, stretch your arms forward, look at your feet. The left leg tends to rise up, and the right one prevents this. Hold this position for 7 seconds.
2 - Return to starting position, relax on exhalation.
3 - The same, placing the left foot on top of the right. Raise your head, shoulders and arms, stretch your arms forward, look at your feet. The right leg tends to rise up, and the left prevents this. Hold this position for 7 seconds.
4 - Return to starting position, relax on exhalation.
3 times.

The corset is usually removed after 2 - 3 months, but not immediately, but first they are allowed to sleep without a corset, then stand without a corset for 15 minutes, and so on, gradually increasing the time spent without a corset. Therapeutic gymnastics is carried out first in a corset, then without a corset, gradually expanding the motor regime: the initial lying positions - in the knee-wrist position - standing.

We orient patients to long-term walking until pain appears at the site of the spinal fracture. You can gradually increase walking up to 10 km per day.

Then (about a year later) begins Exercise therapy for spinal fractures Period IV: therapeutic exercises as in osteochondrosis of the spine, of course, without a corset. If you need to wear a corset for some more time, then it is put on after therapeutic exercises. You need to know that the corset is put on and off in the supine position. You can get advice on wearing a corset from your doctor on an individual basis.

By this time, patients have the skill of exercising exercise therapy, and they can do it at home on their own every day, strengthening the muscular corset of the spine, posture and performing exercises to stretch the spine and relax tense back muscles, since back pain creates a protective muscle tension in which the body seeks to immobilize the sore spot. You need to be able to relieve this tension by consciously relaxing the muscles; this will help reduce pain and improve blood microcirculation in the affected area. That is, we strengthen muscle strength and physiological tone and relieve abnormal (excessive) muscle tone in the back.

Open the article Pay attention to the alternation of exercise and relaxation exercises. This technique helps to relieve tension in the muscles of the back, the nervous system calms down, the effects of stress reactions recede, and other tasks of PH are also solved in osteochondrosis of the spine: strengthening the muscular corset of the spine and posture, stretching the spine. This therapeutic exercise has a therapeutic effect on all parts of the spine: on the cervical, and on the thoracic, and on the lumbar. All exercises are performed slowly, smoothly, without sudden movements, as if you are in water. From time to time there are clicks in the spine - this means that the vertebrae are in place, that you are doing the exercises correctly.

* I want to give you good advice from an experienced exercise therapy instructor: this set of exercises can be successfully used for many other diseases. For example, neuroses, VSD, hypertension, kidney disease, joints and paralysis. The secret of the positive effect lies in the fact that the patient keeps the problem organ with his inner gaze during the exercise; then the healing energy of movement is directed to the right place. Attention to the diseased organ makes those muscle groups work, which must be affected in a particular disease. So, with urinary incontinence, attention is paid to the pelvic floor, with nephroptosis, thoughts about the correct position of the kidneys (posture and abdominal press are strengthened). In this case, if the spine is damaged during therapeutic exercises, you need to focus on the fracture site.

Efficiency improvement recommendation Exercise therapy for spinal fractures... Before therapeutic exercises, influence the spine area in the "Insect" system on the fingers from ... It is not difficult, does not take much time, and the benefits are great: you will significantly speed up the healing process and reduce the likelihood of complications during exercise.

So, on each finger, imagine a little man - your double, who, as it were, sits with his arms and legs folded. In this position, he looks like an ant. Therefore, the correspondence system is called "Insect". It is easy to determine the area of \u200b\u200bthe spine in it and act on it with the usual self-massage of the fingers. You just need to understand that you do not massage the fingers, but the spine zones on the fingers. Your fingers are now the body control panel. During self-massage of the spine zone on all fingers, you need to think that the spine is healthy; intervertebral discs are young, elastic; the ligamentous apparatus of the spine is strong, holds the vertebrae well in place; the posture is correct, the muscle corset is strong; microcirculation of blood in the tissues of the spine is excellent; the fracture site "heals" successfully. What you imagine, what information you put with the help of thought, will happen in the body. It really works. Be sure to check for yourself the effectiveness of this method.

* In addition to the "Insect" system in Su-Jok therapy, there are many different correspondence systems of the human body on different parts of the body: on the hands, on the feet, on the ears, and so on. The system is selected in which the organ that needs to be treated is most pronounced. Several different systems cannot be used simultaneously on one procedure, only one.

Physiotherapy exercises for unstable complicated spinal fractures (with spinal cord injury).

Therapeutic gymnastics is prescribed immediately after determining the level of spinal cord lesions, taking into account neurological symptoms: spastic or flaccid paralysis. For both types of paralysis, posture treatment is used (laying the limbs in a physiological position and frequent changes in body position in bed), therapeutic massage, passive and active gymnastics, ideomotor exercises with impulses sending, in which the patient mentally performs any movements ...
Recovery of walking after a stroke.

Do not be surprised that exercise therapy is recommended for strokes, since the principles of restoring the nervous system are the same. With flaccid paralysis, recovery is longer and more difficult than with spastic paralysis. Remedial gymnastics for spinal fractures differs in that it is impossible to sit for a long time, so sitting exercises will have to be replaced with exercises lying on the stomach, standing in the knee-wrist position and standing when he can stand.

I very much welcome exercises lying on the floor: the patient feels spaciousness and a desire to move, there is a psychological separation from the bed, with which he subconsciously associates his illness, when parting with the illness there is hope for recovery (at least not boring!), And the effectiveness of the exercises increases.

A patient with flaccid paralysis is given the task of lying on the floor to roll from one edge of the carpet to the other and back, helping him to move his limbs and verbally encouraging: “Come on, come on, come on, myself!”. That is, we activate the "student", encouraging them to apply maximum efforts to independent movement.

It is also a good exercise to crawl (on the stomach) while lying on the floor. It is necessary to bend one leg of the "student", put your foot against the patient's foot for support and instruct to push off to move forward. It's okay that it doesn't work right away. Day by day the result will be. Especially if you use Su-Jok therapy before class. If paralysis is incurable, then it doesn't matter therapeutic exercises for spinal fractures will be beneficial, since all systems of the body are activated, and the nervous system too; trophism of tissues improves, stagnation is eliminated; and also the patient's mood improves.

For the rest of the exercises, see the article ... Do what you get, gradually adding more complex exercises to simple movements.

In the patient's bed, make devices so that he can pull himself with his hands on the strap attached to the horizontal bar above the bed. Wide leg straps can be attached to the same crossbar: the patient tries to move his legs, laid in the loops of the straps, back and forth, straightening and bending the legs, and spreading the legs. You can purchase a novelty - a sling system (the complex is equipped with special suspensions that support the arms and legs; exercises should be performed lying down).

This concludes the lecture. Let's briefly summarize.

Let us remember the important points of exercise therapy for spinal fractures, they need to be learned by heart.

You can't sit for a long time!
The transition to the vertical position is carried out bypassing the sitting down phase.
Standing up is performed from the knee-wrist position.
Forward bends are prohibited.
Sudden movements are not allowed.
The exercises are performed gently, smoothly, as if you are in water.
You can only walk after a positive functional test for the back muscles.
Walking for a long time until pain appears at the site of the spinal fracture.
Walking gradually increases to 10 km per day.
Emphasis on correct posture to evenly distribute the load on the spine while standing.

Information on Exercise therapy for spinal fractures a lot, as you can see, it takes a few more articles to study, but it is necessary. It may be necessary to periodically re-read them. You may have an idea. It's great. I will be glad if you share your experience.

Among all known fractures of the forearm bones, the most common is a fracture of the radius at a typical site and a fracture of the distal metaepiphysis. The fracture is usually caused by falling onto an outstretched arm. Clinical signs of a fracture of the radius in a typical location: swelling, pain, bayonet deformity of the forearm. To clarify the diagnosis, radiography is required. First aid for fractures of this type is transport immobilization. The main goal of treatment of fractures of the radius is to achieve stable fixation of fragments, anatomical reduction, restoration of painless hand and finger movements. If the fracture is without displacement of the fragments, then a plaster cast is applied for a period of 4 weeks. Working capacity, as a rule, is restored by 6 weeks. After the termination of the main treatment, the patient is prescribed therapeutic exercises, massage, exercises in warm water.

Methods of treatment for fracture of the radius

The essence lies in an integrated approach to rehabilitation, which includes: physiotherapy exercises, massage, physiotherapy. These funds are prescribed taking into account the place of the fracture, the chosen method of treatment, the motor regime, the period of the traumatic illness, the general condition of the victim. Rehabilitation means are prescribed for three periods: immobilization, postimmobilization, and restorative.

Exercise therapy tasks in the first period

The main tasks of physiotherapy exercises in the immobilization period are: prevention of difficulty in mobility in the joints, acceleration of regeneration processes bone tissue, muscle atrophy, restorative and psycho-regulatory effects, self-service skills training. Exercise therapy in this period involves the use of 75% of breathing, general developmental exercises aimed at joints free from immobilization, as well as 25% of special exercises aimed at the damaged surface. Exercises for the injured upper limb include: exercises for the fingers, shoulder, elbow joints of the injured hand, exercises for the muscles of the shoulder and forearm, ideomotor exercises. Exercises are performed from the starting position: lying, sitting, standing. The following forms of physiotherapy exercises are distinguished: remedial gymnastics, morning hygienic exercises, independent exercises.

Exercise therapy tasks in the second and third periods

Exercise therapy in the second post-immobilization period is aimed at restoring impaired motor functions, eliminating muscle atrophy and difficulty in mobility in the joints. The remedies for exercise therapy in this period are 25% of general developmental and breathing exercises, 75% of special exercises for the injured hand. The list of exercises includes the following: exercises for the wrist joint and fingers, exercises for all joints of the upper limb, resistance exercises, in warm water, with light weights and in block apparatus. Physiotherapy in the second period is carried out in the form of remedial gymnastics, independent exercises, morning hygienic gymnastics. Duration of classes is from 25 to 45 minutes.

Exercise therapy in the third recovery period pursues the following goals: elimination of residual post-traumatic complications, restoration of impaired functions, labor rehabilitation, general training of the body. The essence of exercise therapy is the appointment of general developmental and respiratory exercises, and against their background, additional exercises with weights, resistance and stretching exercises are recommended. Sports elements are added: aerobics, swimming, sports games. An important role in the final recovery period is assigned to occupational therapy, mechanotherapy, games with different mobility. Exercise therapy in the recovery period includes: morning and therapeutic exercises, sports games. As well as physiotherapy exercises Massage and physiotherapy procedures are used as a means of rehabilitation for fractures of the radius. In the first period, segmental reflex massage is prescribed. Particular attention is paid to the massage of the fingers of the injured limb. From physiotherapeutic procedures are used: UV radiation, calcium electrophoresis. In the second period, the massage is of a slightly different nature: the segments are massaged above and below the fracture site using all known massage techniques, the fracture site itself is massaged by light stroking, rubbing. Physiotherapy procedures: UHF therapy, calcium electrophoresis, paraffin, ozokerite applications, magnetotherapy, laser therapy, incoherent polarized radiation from the Bioptron lamp. Massage techniques in the third period depend on the complications after the injury, their degree. Among the phytotherapeutic procedures, one should single out: mud therapy, balneotherapy, electro-magnetic laser therapy.

Exercise

A set of exercises is performed while sitting at the table.

Starting position - put your hands on the table, palms down. Clench your fingers into fists, then unclench. Repeat the same, but hands, palms up.

The starting position is the same. The forearms do not come off the table surface, raise the hand, carry out dorsiflexion. Turn the forearm with the palm up, raise the hand, the forearm does not come off the table, perform palmar flexion.

The starting position is the same. The forearm does not come off the table, turn the hand with the palm up and down. Repeat several times.

Starting position - rest your elbows on the table, put your forearms vertically. Alternately bend and unbend the fingers, then together.

The starting position is the same. Bend and unbend the arm at the wrist joint: dorsal and palmar flexion.

Starting position - elbows on the table, palms turn towards each other, put forearms upright. Perform movements in the wrist joint towards yourself, and then away from yourself.

The starting position is the same, turn your hands with your palms towards you, return to the starting position, turn your hands with your palms away from you, return to the starting position.

Starting position - put the outstretched sore hand on the table. Without taking your fingers off the table, raise your elbow.

Starting position - with the elbows of both hands rest on a table shoulder-width apart, put your forearms vertically. Press your palms together, with your fingers straight, perform movements from the beginning towards yourself, then away from yourself.

Starting position: performing movements with the brushes alternately to the right and left.