Muscle tension. Muscular-tonic thoracic syndromes Muscular defence of the abdomen

Panchenko Natalya Nikolaevna, neurologist

Electrospondylography. Computer complex for functional express diagnostics of the spine “Medicrin-Vertebro”

In outpatient practice, a neurologist often encounters a combination of vertebrogenic pathology nervous system with diseases internal organs. Such patients usually become patients of either a therapist or a neurologist, who have to resolve issues of differential diagnosis to establish main reason in the mechanism of pathological pain impulses.

Spondylogenic disorders in some patients can be only one of the links in the pathological process, in others they turn out to be the main cause of the disease.

Considering the single mechanism of pathogenesis, the differential diagnosis of primary vertebrogenic pain and secondary viscero-vertebral syndromes is difficult.

Therefore, when making a diagnosis to a doctor during an outpatient appointment, it is important to answer the following questions:

• is there primary disorder in visceral systems for subsequent detection of somatic pathology
• is there primary spondylogenic disorder
• is there spondylogenic visceropathy?(dysfunction of visceral systems, spondylogenic)

And this means that you need distinguish signs, When

• disorders of the spinal column are a “trigger” for diseases of the visceral organs associated with the corresponding PDS,
• and diseases of internal organs, accompanied by reflex changes in the skin, muscles, spine (viscerosomatic, viscerovertebral syndrome)

It is often difficult to determine which disorders are primary.

Only this approach can ensure timely specialized hospitalization of patients upon detection of acute damage to internal organs, as well as provide differentiated and optimal therapy for neurological patients suffering from combined viscero-vertebrogenic pathology.
The following vertebrovisceral relationships can be distinguished:

• primary vertebrogenic disorder feigns internal illness
  internal disease simulates vertebrogenic pain
  internal disease causes reflex(pseudo-root) reaction in the segment, and, as a consequence, blocking in the corresponding PDS
• the internal disease that caused the functional block in the PDS has already been cured; the remaining functional block in the PDS simulates an internal disease
  primary vertebrogenic disorder becomes a pathogenetic factor of internal disease

More often in clinical practice, the doctor is faced with VERTEBRvisceral syndrome, which is due to the fact that degenerative processes in the spine lead to chronic irritation of the nervous structures and manifest themselves in the periphery with various syndromes, including visceral ones in the form of:

• painful
• muscular-tonic
• angiospastic
• neurodystrophic syndromes,

as well as in the form of syndromes not related to the musculoskeletal system, when osteochondrosis affects the pathomorphosis of such diseases as:

• cardialgic syndrome of complex genesis (with ischemic heart disease in combination with osteochondrosis)
• angina pectoris
• myocardial dystrophy
• discirculatory encephalopathy in the vertebrobasilar region
• neuropsychiatric diseases: enuresis in children; cholecystopathy, biliary dyskinesia; diseases and dysfunctions of the bladder and gastrointestinal tract; diseases of the lungs, pleura.
• spondylogenic irritation of the stellate ganglion and the vertebral nerve, the sympathetic plexus of the vertebral artery and cardiac sympathetic nerves can lead to the formation of vertebral artery syndrome and segmental autonomic dysregulation of cardiac activity.

But in outpatient practice there are also VISCEROSOMATIC SYNDROMES, When

Primary diseases of internal organs appear (masked)

skin, muscle, vascular reflexes in the form of:

• referred pain
• zones of hyperesthesia
• muscle defence in the corresponding metameres, which can simulate vertebral pathology in diseases of the internal organs (peptic ulcer of the stomach and duodenum, pancreatitis, cholecystitis, aortic aneurysm).

In this case, the doctor is faced with a somatic mask of an internal organ disease in the form of a somatic equivalent of visceral disorders: viscerosomatic and in particular viscerovertebral neurological syndrome.

Examples of diseases of internal organs, accompanied by referred viscero-vertebral pain syndrome.

• disorders in the muscles that provide external respiration; lung diseases (bronchial asthma, obstructive bronchitis, etc.)
• contralateral scoliosis
• homolateral tension of the pelvic and lower back muscles in gynecological diseases
• compensatory disorders in the muscles that determine postural balance in the musculoskeletal system
• defence m.iliopsoas for appendicitis
• functional blocking of the corresponding spinal motion segment
• mild mydriasis
• facial hemispasm on the affected side
• characteristic pseudoradicular pain in the segment and distant pain
• hyperesthesia in the Zakharyin-Ged zones

Most often, viscerovertebral syndrome in outpatient practice occurs in the form of pectalgia and muscle deflation in diseases of the abdominal organs.

Featured below clinical case– an example of secondary viscerovertebral syndrome in the thoracic spine as a mask of lung disease.

Clinical case. Description.

A 36-year-old man consulted a neurologist at a private medical center with complaints of discomfort and pain in the upper thoracic spine and interscapular region on the right, somewhat intensifying with active movements in the spine.

Status neurologicus: ChMN-N

The reflex sphere is without features.

Status localis: left-sided scoliosis in the thoracic spine, pronounced local muscular defence of the paravertebral muscles on the right at the level of the upper thoracic SMS,

At the level D2-D10 on the right there is a zone of mild hyperesthesia, the presence of local autonomic disorders in the form of local pastiness of the subcutaneous tissues and muscles, redness of the skin. Moderate pain on palpation of paravertebral points and interspinous ligaments, functional blockade of the upper thoracic SMS.

From the anamnesis:

I gradually became ill. There were no provoking moments in the form of heavy lifting, injuries, or prolonged static loads on the spine. For last months low-grade fever and cough were noted.

Neighbors in a communal apartment are sick with tuberculosis.

To objectify vegetative and reflex symptoms, it was used

The diagnostic complex for the integral assessment of the state of the functional visceral systems of the body “Medicrin TM” was used (with software) according to the method of I. Nakatani.

Electropuncture diagnostics according to I. Nakatani’s method is used to determine electropuncture profiles of diseases by system in clinical practice of the Ministry of Health of the Russian Federation (Methodological recommendations No. 2002/34 of December 15, 2002).

The essence of the method: the basis of electrospondylographic diagnostics is the viscerocutaneous sympathetic reflex.

Conducted measurement of electrical conductivity of spondylogenic skin areas(SKZ),

localized in the projection

• sympathetic trunk
• sympathetic points of the bladder meridian
• spinal dermatomes
• PDS projection zones

The electrospondylography method and the developed methodology for integral diagnostics of the state of the function of the spinal column and spondylosystem allow:

• conduct integral assessment of the functional state of the spondylosystem from the standpoint of a systems approach;
• identify on early stages pathological condition of the spinal column and disturbance of physiological balance in the spondylosystem;
• assess spinal column function as part of the biological system - spondylosystem;
• evaluate function of vertebral motor segments(PDS) system of sympathetic biologically active spondylogenic skin zones:
  • define type of impairment of the functional state of the SMS for spondylogenic diseases
  • (FB) and muscular-ligamentous dysfunction in the tested skin areas;
  • assess the “functional reserves” of spinal motion segments.
• evaluate spinal column function:
  • determine the type of impairment of the functional state of the spinal column in spondylogenic diseases
  • PDS level with functional blockades(FB) and musculo-ligamentous dysfunction by functional relationships;
• determine type of dysfunction of the vertebrobasilar system(VBS);
• evaluate change in autonomic regulation of PDS function:
  • determine the type of disorder of spondylogenic autonomic-visceral regulation (SVVR) of the functional visceral systems of the body against the background of spondylogenic disorders;
  • identify spondylogenic visceropathies (spondylogenic visceralgic, viscerodysfunctional and viscerodystrophic)
  • interpret them
  • assess the “integrative reserves” of the autonomic nervous system;
  • allows for an integral differential diagnosis between visceral somatic pathology and spondylogenic visceropathies
  • assess the mutual influence of the spondylosystem and visceral systems of the body

The following data from additional research methods were obtained.

X-ray of the lungs: signs of focal tuberculosis of the upper lobe of the right lung in the stage of decay.

To exclude tuberculous spondylitis, a

X-ray of the thoracic spine: No bone destructive changes or signs of leakage were detected.

Results of electrospondylography.

Graphic indicators electrical conductivity of projection skin zones at the level C7- Th10 vertebral motor segments on the right are determined in the “blue” corridor zone, which was a sign disorders of the autonomic-visceral regulation of the lungs of the viscero-ischemic type and corresponded to a destructive process in the lungs.

Using the ESG diagnostic method in this clinical case, it was possible to:

• identify disorders of the functional state of the spinal column of the ischemic type with a reflex ischemic component at the level of the PDS, “responsible for the autonomic regulation of the function of the heart and lungs”, predominantly on the right (homolateral to the lesion in the lung)
• identify simultaneous violation of autonomic-visceral regulation functions cardiovascular system and respiratory system of viscero-ischemic type
• identify the localization of spondylovisceral functional relationships, their meridional dependence (lung meridians on both sides, heart and pericardium meridians on the right are involved)
• objectify viscero-vertebral syndrome at the level of the upper thoracic SMS: decrease in the electrical conductivity profile at the level of the upper thoracic SMS (can be considered an analogue of a vegetative test, equivalent to skin hypothermia in vegetative disorders)

• Exit of altered electrical conductivity of skin zones beyond the boundaries of segmental innervation of the lungs on the right, as well as involvement of segments opposite side(left) indicates the spread of irritation to the sympathetic trunk.

Thus, the ESG method makes it possible to assess changes in the autonomic regulation of the SMS function, the functional state of the spinal column and the spinal system as a whole in spondylogenic skin zones (SCZ), localized in the projection of the sympathetic trunk.

This allows the use of the electrospondylogram method for the differential diagnosis of somatic pathology and spondylogenic visceropathies.

This clinical case can be considered a striking exampleviscero-somatic reflex:

• viscero-vertebral(muscle defence)
• viscerocutaneous(local vegetative manifestations)
• viscero-sensory(zone of hyperesthesia, hyperalgesia)

During a neurological examination and electrospondylography, the following complementary results were obtained:

• signs viscero-sensory reflex(zone of hyperesthesia and hyperalgesia) during neurological examination
• the “blue corridor” zone on the electrospondylogram, corresponding to a decrease in the electrical conductivity profile and coinciding with the zone of impaired autonomic innervation)
• propagation zone exit viscero-sensory reflex beyond the boundaries of the dermatomes corresponding to the upper thoracic segments of the spinal cord and the zones of innervation of the lungs, as well as the spread of the zone of decreased electrical conductivity to the opposite side, is apparently associated with the involvement of the borderline sympathetic trunk.

Thus, the pathological process in the right lung in the stage of disintegration became the cause of reflex viscerovertebral syndrome in the upper thoracic spine with the formation of functional blockade and circulatory disorders in the area of ​​the corresponding SDS.

Somatovisceral disorders are based on neurometameric connections that ensure the interaction of the components of the metamer, including the following structures:

• skin
• spinal motion segment with its
  • muscular
  • fasciolar
  • ligamentous structures
• certain areas of the viscera
• vessels have functionally related innervation mechanisms
• somatic and autonomic parts of the nervous system

All these structures mutually determine the function of this metamer, which explains viscero-somatic (including viscerovertebral) syndromes.
This explains the similarity of the clinical picture in this clinical example with vertebrogenic pathology.

The presence of close connections between the upper thoracic SDS and the lungs through the sympathetic formations of the thoracic region with the corresponding segments of the spinal cord allows for coexistence two simultaneous circles of pathological impulses:

Conclusion.

The presented clinical case suggests that identifying vertebral syndrome in a patient with spinal osteochondrosis requires a comprehensive, comprehensive examination to identify a somatic disease, confirm or exclude its spondylogenic origin.

Without taking into account the pathogenetic influence of diseases of other organs on spinal osteochondrosis and its clinical manifestations, and the reverse influence of osteochondrosis on these organs in modern medicine, it is impossible to adequately program both treatment, rehabilitation and preventive measures. Reflex changes and their accurate recognition in diseases of internal organs are of great practical importance simply because they can be established using the simplest means constantly used by doctors. They sometimes enable early diagnosis, which is later confirmed by sophisticated laboratory methods in hospitals Yakovlev Vitaly Sergeevich, author of the method computer diagnostics with an integral assessment of the functional state of the spondylosystem (spinal system) - electrospondylography (ESG), doctor of the highest category, neurologist, chiropractor, reflexologist, member of the Moscow Professional Association of Manual Therapists.

Algorithm for diagnosing vegetative-visceral disorders

• examination of the patient should begin with thorough orthopedic examination and studying neurological status. Pay attention to:
  • vertebral
  • Muscular
  • neurovascular
  • neural symptoms.
  • signs of interest in the corresponding part of the spine:
    • pain on palpation of paravertebral points and interspinous ligaments
    • limitation of mobility – functional blockade of the PMS
  • the presence of local vegetative disorders.
    • redness or pallor of the skin in the area of ​​innervation of the affected vegetative formations;
    • regional disorders of thermoregulation and sweating m
    • local swelling or tissue pastiness
    • other skin trophic disorders, muscle wasting
    • symptoms of damage to the nodes of the borderline sympathetic trunk: paresthesia, sympathalgia, itching in the area of ​​innervation of the affected ganglion.
  • Confirm and objectify autonomic disorders possible using special tests: skin thermometry, study of reflex dermographism, pilomotor reflex, adrenaline skin test.
  • What matters most is identification of asymmetries and local vegetative disorders on certain areas of the body.
• Additional neuroorthopedic examination:
  • X-ray of the spine with mandatory functional X-ray spondylography.
  • computed and magnetic resonance imaging.
  • electromyographic study helps determine the degree of involvement of the spinal cord, roots and peripheral nerves in the pathological process
  • rheovasography – disorders of peripheral circulation that occur as a result of damage to vegetative formations (V.V. Proskurin, 1993).
  • to objectify the type of disorders in spondylogenic visceropathies, we developed by V.S. Yakovlev was used. electrospondylography method.

Scalenus syndrome (also called scalenus syndrome) is a group of symptoms including pain, numbness and weakness in the neck, shoulder or arm. The cause of symptoms is compression or damage to nerves or blood vessels in the costoclavicular space. The costoclavicular space is located between the collarbone and the upper rib, on both sides of the body. Most of the vessels (arteries and veins) and nerves supplying the arm pass through this space. Narrowing of this space can cause compression of nerves and blood vessels, which interferes with the normal functioning of the upper limb. The cause of narrowing can be various conditions, such as injury, obesity, congenital anomalies, and postural disorders. But sometimes it is not possible to find out the specific reason for the narrowing.

Types of scalene syndrome.

• Neurogenic - in which compression of the brachial plexus occurs. This is the most common type of SLM
• Venous - with this type, compression of the subclavian vein occurs. Occurs in 4% of cases.
• The arterial type is the rarest, in which compression of the subclavian artery occurs.

Scalenus syndrome can cause severe pain and diagnosis is often difficult. SLM can affect many aspects of life (work performance, rest, physical activity). In the absence of adequate treatment, this syndrome can lead to damage to the vascular nerves and even sometimes to limb atrophy. But at present, the treatment of this syndrome is quite successful.

Causes of the disease

To function properly, blood vessels and nerves need a certain amount of space. Compression of the vessels in the costoclavicular space can lead to injury or, in rare cases, loss of a limb. In order for nerves and blood vessels to function properly, they need adequate space. When compression occurs, their function is accordingly impaired. Compression of the blood vessels at the outlet of the chest can impair blood flow to and from the arm. It can also promote the formation of a blood clot, which can further slow or completely block blood flow through the damaged vessel. If a clot ruptures, it can travel down into the arm, blocking small blood vessels in the arm. Sometimes, the clot migrates to the lungs, a life-threatening condition called pulmonary embolism. Nerves also need space to be able to stretch when the arm moves. If the nerve as it exits the chest wall is compressed or cannot move freely, the patient will not be able to move the arm as normal. Pain and sensory disturbances in the hand often accompany this condition.

Risk factors for scalene muscle syndrome (SMS):

• Gender - Women are more likely to have SLM syndrome than men.
• Age - The syndrome most often develops between the ages of 20-50.
• Diseases - SLM - syndrome is often associated with another disease, such as damage to the rotator cuff, osteochondrosis of the cervical spine, injury to the brachial plexus, diabetes mellitus, hypothyroidism.

Reasons

SLM occurs as a result of compression of the nerves or vessels at the exit of the chest. Main reasons:

• Trauma - A traumatic episode may cause damage to the bone or soft tissue at the thoracic outlet. Most people with SLM have a history of one or another episode of an accident, injury at work or at home.
• Congenital anomalies, such as an extra rib or a tight ligament connecting the spinal column to a rib, can reduce the costoclavicular space.
• Poor posture - sagging shoulders or excessive forward tilt of the head can put compression on the area where nerves and blood vessels exit the chest.
• Frequent, repetitive movements can wear down the tissues and lead to SLM. An example would be movements associated with raising the arm (the collarbone lowers and the costoclavicular space decreases), such as swimming, baseball, tennis, weightlifting.
• Other causes: Weight gain (pregnancy or obesity), overdeveloped neck muscles (from weightlifting or martial arts), or holding your arms in one position for a long time (working on a computer) can put additional pressure on nerves and blood vessels. Diseases that impair nerve function, such as hypothyroidism and diabetes, may be predisposing factors for neurogenic SLM.

Symptoms

Symptoms of SLM vary depending on whether the blood vessels or nerves are compressed.

Symptoms of nerve compression

• Pain or tenderness in the neck, shoulder, arm
• Numbness or tingling in the neck, shoulder, arm
• Muscle weakness or areas of muscle failure in the arm
• Difficulty performing fine motor tasks; fatigue

Arterial Compression Symptoms

• Swelling of the hand
• Changes in skin color - the hand or fingers turn pale
• Changes in skin temperature - the arm or fingers are cooler than the rest of the skin
• Small black spots on fingers
• Weak or absent pulse in the arm
• Pulsating tumor in the collarbone area

Venous Compression Symptoms

• Swelling of the hand
• Pain or deep tenderness in the neck, shoulder, or arm
• Numbness, tingling, or heaviness in the arm
• Changes in skin color - the hand or fingers become bluish
• Seal in the area of ​​the subclavian vein
• Visually noticeable venous network on the chest.

Complications

For a long time, some patients reflexively react to pain with muscle fixation. They have to hold a rigid certain position in order to reduce pain. But, unfortunately, this reflex muscle defense aggravates the course of the disease and, ultimately, leads to increased pain. Muscle defence, in turn, then requires separate treatment. It is important to begin treatment for SLM in its early stages. If left untreated, SLM can cause significant nerve or vascular damage, including limb loss.

Diagnostics

Diagnosing SLM can be difficult. Symptoms vary in nature and severity, depending on the individual. In addition, the symptoms are similar to those that occur with other diseases (for example, damage to the rotator cuff, diseases of the cervical spine leading to compression of the roots, etc.). Medical history and physical examination help to clarify the onset of the disease, the nature of symptoms, and their dependence on body position. In addition, there are external signs this disease (swelling of the arm, discoloration, loss of sensitivity, limited range of motion in the shoulder). During a physical examination, the doctor may perform procedures (manipulations) to identify symptoms (pulse pressure in the arms in various positions of the arm, both sick and healthy).

Instrumental research methods

• Electromyography (EMG) - EMGs help check how nerves and muscles are functioning. Small needle electrodes are inserted into the muscle where the problem is. Electrodes measure the electrical activity of the muscle innervated by a particular nerve. The pathological response of a muscle provides information about the condition of the nerve going to that muscle. In addition, EMG allows you to determine the speed of impulse transmission along a nerve fiber. This is done using electrodes placed on the skin. The speed of impulse conduction along each nerve fiber has a certain average value, and a deviation indicates damage to the nerve fiber.
• X-ray allows you to diagnose bone changes in the chest and ribs (the presence of an additional cervical rib).
• Laboratory examinations - general blood tests, blood for hormones, blood for sugar help in diagnosing SLM.
• Magnetic resonance imaging (MRI) - allows you to visualize the soft tissues of the body MRI to find out the cause of compression of a nerve or vessel.
• Computed tomography (CT) - allows you to more clearly visualize changes in bone tissue.
• Ultrasound examination - Using an ultrasonic wave, it is possible to visualize soft tissues, blood vessels, the presence of blood clots and stenoses.
• Angiography - X-ray examination using contrast is used to diagnose vascular lesions. Angiography of arteries and veins is used to diagnose blocks and other problems in the blood vessels.

Treatment

Drug treatment

• NSAIDs are non-steroidal anti-inflammatory drugs. These medications help reduce pain and inflammation (swelling and redness). For example: aspirin, ibuprofen (Advil), naproxen (Aleve), and celecoxib (Celebrex) movalis
• Muscle relaxants - often used to treat muscle spasms, these drugs can relieve pain by relaxing the muscles. Cyclobenzaprine (Flexeril), carisoprodol (Soma), diazepam (Valium), methocarbamol (Robaxin), and tizanidine (Zanaflex).
• Neuropathic drugs - The principle of their action is based on changes in the neurotransmitter transmission of pain impulses to the spinal cord and brain. Medicines that may help reduce pain by affecting neurotransmitters include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), venlafaxine (Effexor), amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramine) ), doxepin (Sinequan), and amoxapine (Ascendin).
• Opioids - Narcotic analgesics are used only when very severe pain after the possibilities of using conventional analgesics have been exhausted. A combination of opiates with NSAIDs is possible (to enhance the analgesic effect).

Exercise therapy

Physical therapy is one of the most important components of SLM treatment. Selecting certain exercises helps improve posture and proper distribution of muscle loads. Exercises help increase range of motion in the limb. Stretching and strengthening the shoulder muscles and pectoral muscles may help to increase and relieve pressure on the nerves and blood vessels in the costoclavicular space.
. There is a wide range of movements, both passive and active.

Physiotherapy

Various physiotherapeutic techniques can relieve swelling, inflammation, restore blood circulation and reduce compression of nerves.

Manual therapy

The use of certain manual therapy techniques allows you to mobilize the spine and ribs and increase the range of motion in the shoulder joint.

Blockades

Sometimes used for differential diagnosis and treatment. But, taking into account the anatomical features of this area, injections should be carried out by a doctor with experience in performing such manipulations.

Acupuncture (acupuncture)

Acupuncturists believe that a healthy body contains channels through which energy flows. When these channels close, the energy is blocked, which leads to various diseases. Needles are inserted into certain points (biologically active). In certain cases, acupuncture can reduce pain and restore conduction along nerve fibers.

Massage can help relieve stress and relax tense muscles. Massage helps increase blood flow to body tissues and helps muscles get rid of metabolic waste products.

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Neurological complications in spinal osteochondrosis

The first stage of neurological complications in spinal osteochondrosis

Clinical manifestations at the first stage of neurological complications of osteochondrosis are caused by protrusion of the IVD back towards the spinal canal and irritation of the posterior longitudinal ligament, rich in pain receptors.

The main manifestation of this stage is local pain syndrome. The features of this syndrome depend on the location of the damaged SMS, which is reflected in the name of the variants of the clinical syndrome. If it manifests itself at the lumbar level, it is designated as lumbago, lumbodynia, if at the cervical level - cervicago, cervicalgia, if at the thoracic level - thoracalgia. Thoracalgia due to osteochondrosis is rare, since the thoracic spine is inactive.

Along with local pain at the level of the affected SMS, due to a reflex muscle reaction, in the first stage there is a pronounced tension ("defense") of the paravertebral muscles, which leads to increased pain and flattening, smoothing of the cervical or lumbar physiological lordosis (depending on the location of the pathological process ), as well as limited mobility of the spine. In the acute period, defense of the paravertebral muscles can be considered as a defensive reaction.

When examining a patient, pain in the spinous processes and paravertebral points may be detected at the level of manifestations of discopathy and IVD protrusion. Depending on the characteristics of the level of damage to the PDS, the clinical picture in the first stage of neurological manifestations has some specific signs:

1. Cervicago - cervical lumbago. It is characterized by acute pain in the neck, provoked by head movements, tension of the neck muscles due to irritation of the receptors of the ligamentous apparatus of the cervical spine. Cervicago lasts, with immobilization of the cervical spine and adequate treatment, usually 7-10 days.
2. Cervicalgia - severe pain and paresthesia in the cervical spine due to irritation of the receptors of the meningeal branches of the spinal nerves. On examination, there is pronounced tension in the neck muscles, fixation of the head, pain in the spinous processes of the cervical vertebrae and paravertebral points, which can persist for 2-3 weeks.
3. Lumbago or lumbodynia. Conventionally, they differ from each other in the degree of severity and duration of pathological manifestations. Characterized by flattening of the lumbar lordosis (board symptom) and a pronounced limitation of movements in the lumbar spine due to pain in the acute period.

In the first stage of neurological manifestations in osteochondrosis, there are no signs of radicular syndrome and, as a rule, tension symptoms are negative.

Over time, adaptation occurs to irritation of the pain receptors of the posterior longitudinal ligament. The extinction of pain syndrome in cervicalgia and lumbodynia is facilitated by immobilization of the affected SMS. Pain, which usually occurs acutely or subacutely, with compliance with the orthopedic regimen and adequate treatment, gradually decreases. In this case, the exacerbation of the pathological process is transformed into a stage of remission, which can last indefinitely.

Exacerbations of cervicalgia or lumbodynia may recur. Each exacerbation indicates an additional displacement of the IVD (its protrusion or prolapse), leading to increased pressure on the posterior longitudinal ligament, which over time leads to its thinning and decreased strength. During the next episode, which provokes additional prolapse of the IVD towards the spinal canal, perforation of the posterior longitudinal ligament occurs, which leads to the development of the second stage of neurological complications in osteochondrosis.

The second stage of neurological complications in osteochondrosis or the stage of discogenic radiculitis

The posterior longitudinal ligament undergoes perforation more often in the area of ​​the thinned edge (“where it is thin, it breaks”), and not in its central, most durable part. Thus, posterolateral IVD herniation occurs more often than posteromedial (median) herniation.

As a result of perforation of the posterior longitudinal ligament, prolapsed IVD tissue penetrates into the epidural space, often in the dorsolateral direction, that is, close to the intervertebral foramen and the spinal roots and radicular arteries passing through it. In such cases, the disc can directly irritate the spinal roots and spinal nerve, causing radicular syndrome at the level of the affected spinal segment.

However, among the causes of pathological effects on the spinal roots, not only mechanical factors are important, but also biochemical and immunological ones. They are caused by the reaction of the tissues of the epidural space to the penetration of a fragment of IVD cartilaginous tissue into them that forms a hernia. The cartilage tissue found in the epidural space performs the functions of an antigen in such cases. As a result, a focus of aseptic autoimmune inflammation appears in the epidural space. In such cases, the nerve roots are also involved in the inflammatory process. This allows us to explain the often occurring prolongation of pain in the second stage of neurological complications in osteochondrosis. This stage can be called radicular stage or stage of discogenic radiculitis .

The term "radiculitis" was used a long time ago, when most diseases of the peripheral nervous system were recognized as a consequence of infectious damage to the nerve roots. Later, when this version was rejected, it caused heated debate for some time, but with the recognition of the development of epidural aseptic inflammation in discogenic pathology, the term “sciatica” was rehabilitated and again gained recognition, although the interpretation of its essence has undergone fundamental changes.

In each case of discogenic radiculitis, certain radicular symptoms are characteristic:

1. Neri's symptom: passive forward tilt of the head in a patient lying on his back causes a pain reaction at the level of the affected SMS. However, in the case of lumboischialgia or ischioradiculitis, involuntary flexion of the affected leg at the hip and knee joint also occurs simultaneously.
2. Dejerine's symptom: the appearance or intensification of pain at the level of the pathological focus when coughing, sneezing or straining. If in the first stage of neurological complications of lumbar osteochondrosis the pain is mainly median and local, then in the second stage it is more often lateralized and radiates along the corresponding spinal roots and peripheral nerves.

Thus, the second (radicular) stage of neurological complications in spinal osteochondrosis is characterized by pain at the level of the affected SDS and radicular symptoms, usually homolateral to the side of the protrusion of the disc herniation .

Irritation of the posterior spinal roots and spinal nerve causes radicular pain, which radiates to the area of ​​the corresponding dermatome, myotome, sclerotome and is accompanied by reflex tension of the corresponding muscles. The radicular symptoms that arise in this case are characterized by specificity due to the localization of the affected SDS: cervicoradicalgia, thoracoradicalgia or lumboradicalgia.

Cervical sciatica

A manifestation of cervicoradicalgia, or cervical radiculitis, with osteochondrosis of the cervical spine can be, often occurring, secondary neuralgia of the occipital nerves. It is characterized by constant, sometimes sharp pain in the occipital region, caused by irritation of the occipital nerves, formed from fibers passing through the cervical spinal nerves C II - C III. In this case, patients usually fix their head, slightly tilting it back and to the side.

With neuralgia of the greater occipital nerve, the pain point is located on the border of the middle and internal third line connecting the mastoid process and the occipital protuberance; with neuralgia of the lesser occipital nerve, the pain point is usually detected behind the sternocleidomastoid muscle at the level of its upper third (Kerer's point).

Cervical radiculitis with osteochondrosis is a consequence of compression of the spinal roots or spinal nerves, as well as the result of the development of local aseptic autoimmune epiduritis at the same level. The presence of cervical radiculitis can be confirmed by: irradiation of pain in the zone of irritation of the spinal roots, the appearance of symptoms of loss of functions against the background of cervical radicalgia (hypoesthesia with elements of hyperpathy in the occipital region, features of the hypoesthesia zone, decreased muscle strength, and with prolonged, chronic pain syndrome - and their hypotrophy).

With vertebrogenic cervical or cervicothoracic radiculitis, Sperling's symptom may be positive: tilting the head towards the affected roots leads to increased pain due to an increase in radicular compression in the area of ​​the intervertebral foramina.

Often, with cervical osteochondrosis, complicated by manifestations of cervicalgia and cervical radiculitis, which is in remission, nocturnal dysesthesia of the hands occurs (Wartenberg brachialgia, Putman-Schultz nocturnal brachialgia) - pain, dysesthesia, paresthesia that arise in the area of ​​the SDL-Sush dermatomes during sleep and disappear with active movements of the hands. Nocturnal hand dysesthesia most often occurs in women during menopause. Regarded as a consequence of brachial plexus strain or secondary hemodynamic disorders. The course of this clinical syndrome can take on a chronic relapsing nature and last for years.

Sometimes, with cervical osteochondrosis with symptoms of radicalgia or cervical radiculitis, along with a reflex muscular-tonic reaction, vegetative-trophic disorders occur, which, in particular, can manifest themselves in the form of glenohumeral periarthritis (frozen shoulder syndrome or Dupleix syndrome). Chronic glenohumeral periarthritis in combination with edema and other vegetative-trophic changes in the area of ​​the hand and wrist joint is known as the “shoulder-hand” syndrome (Steinbrocker syndrome). It is often regarded as a neurodystrophic and vegetative-vascular syndrome in cervical osteochondrosis.

Lumbosacral radiculitis

In clinical practice, lesions of the spinal roots and spinal nerves are more common in lumbar osteochondrosis, since protrusion of the intervertebral disc predominantly occurs at the lumbar level.

The second stage of neurological manifestations in osteochondrosis of the lumbar spine is characterized by lumboradicalgia or lumbosacral radiculitis, especially often manifested in the form of lumboischialgia or ischioradiculitis.

In this case, lateralized lumbar pain is observed, usually combined with pain radiating along the sciatic nerve, that is, lumbar ischialgia syndrome, or ischioradiculitis, occurs. This is due to the fact that of the SMS at the lumbar level, the most vulnerable are the lower ones, which bear a particularly large load, and therefore the roots and spinal nerves L4-S1 are most often involved in the pathological process.

If with lumbodynia there is usually a straightening of the lordosis at the level of pain, then with lumboischialgia scoliosis is also characteristic, often with a convexity towards the irritated roots. In both cases, patients strive for immobilization of the lumbar spine. With lumbodynia, patients spare mainly the lower back, with lumbar sciatica - also the sore leg. In cases of lumboischialgia, patients also prefer to keep the sore leg semi-bent at the hip and knee joints.

When examining a patient with lumbosacral radiculitis, areas of the body that are painful when pressed can be identified - Hara’s pain points. The anterior point of the Hara is located slightly below the navel on the midline of the abdomen (pressure is transmitted to the anterior surface of the L5 vertebra and the adjacent intervertebral discs), the posterior point of the Hara is above the transverse processes of the L4-L5 vertebrae, the iliosacral is above the joint of the same name, the iliac - above the posterior superior spine of the iliac crest. In addition, Haar's pain points are present in the Achilles tendon area (pain when squeezing it) and on the heel (painful tapping on the heel with a neurological hammer).

Vale's pain points identified during lumbosacral radiculitis should also be taken into account. They are located in the middle of the gluteal fold, between the ischial tuberosity and the greater trochanter (the place where the sciatic nerve exits the small pelvis), at the superoposterior iliac spine, in the middle of the back of the thigh, in the popliteal fossa, behind the head of the fibula, in the middle of the gastrocnemius muscle, behind the external condyle, at the infero-posterior edge of the outer ankle, on the dorsum of the foot in the area of ​​the first metatarsal bone.

Domestic neurologists Ya. M. Raimist and V. M. Bekhterev described the following pain points for lumbosacral radiculitis: Raimist’s pain points - detected by lateral pressure on the spinous processes of the lumbar vertebrae; medioplantar ankylosing spondylitis pain point - in the middle of the plantar surface of the foot.

As a rule, with lumboischialgia, one of the main symptoms of tension is positive - the Lasegue symptom. To identify this symptom, the patient is placed on his back with his legs straightened, then one and then the other leg, straightened at the knee joint, is bent at the hip joint. In this case, on the side of lumboischialgia, pain occurs or sharply intensifies along the sciatic nerve and in the lumbar region. In such cases, it is usually taken into account at what angle relative to the horizontal plane it is possible to raise this leg. If after this the same leg is bent at the knee joint, the pain decreases or disappears. At the same time, hip flexion becomes possible to a much greater extent.

The symptom of sitting is also very demonstrative in ischioradiculitis: the patient lying on his back cannot sit up on the bed, while keeping his legs straight at the knee joints, as pain arises or intensifies along the sciatic nerve, and reflex flexion of the lower leg occurs on the side of ischioradiculitis.

In cases of lumbosacral radiculitis, when trying to sit up in bed from a supine position, the patient rests his hands on the bed, behind the body (tripod symptom, or Amoss symptom).

V. M. Bekhterev (1857-1927) established that with lumbar sciatica, a patient sitting in bed can often stretch out the sore leg, but only after bending the leg on the healthy side at the knee joint (Bekhterev’s symptom with lumbar sciatica). It is also known that if a patient with lumboischialgia sits in bed, then passive pressing of the knee on the side of the pathological process is accompanied by an involuntary abduction of the body back (symptom of abduction of the body).

With ischioradiculitis, in the case of dysfunction of the L5 motor nerve root or the motor portion of the spinal nerve, the standing patient cannot, leaning on the heel, straighten the foot, cannot walk, leaning only on the heels, since the foot hangs down on the affected side (Alajuanin-Turel symptom) .

With lumbosacral radiculitis and ischioradiculitis, pathological influences on the nerve roots and spinal nerves can cause not only their irritation, but also a disruption in the conduction of nerve impulses along their constituent nerve fibers. This is manifested by a decrease in the strength of the muscles innervated by the affected spinal nerve, suppression of tendon (myotatic) reflexes due to a violation of their reflex arc. Thus, when the upper lumbar spinal roots (L2-L4) and the femoral nerve are involved in the process, a decrease in the knee reflex occurs, and with ischioradiculitis, the Achilles reflex occurs. Moreover, along with movement disorders, paresthesia, hypalgesia, sometimes with elements of hyperpathia, anesthesia, and sometimes disturbances in the trophism of denervated tissues are possible in the corresponding dermatomes.

With discogenic lumboischialgia, the pelvis of a standing patient is in a horizontal position, despite the presence of scoliosis. When there is a curvature of the spine of another etiology, the pelvis is tilted and is at one angle or another relative to the horizontal plane (Vanzetti's symptom). In addition, with lumboischialgia, bending the torso of a standing patient towards the affected side does not lead to a decrease in the tone of the lumbar muscles on this side, as is normally observed, however, it is usually accompanied by increased pain in the lumbar region and along the sciatic nerve (Rothenpieler's symptom) .

Normally, in a standing position with support on one leg, relaxation of the ipsilateral and tension of the contralateral multifidus muscle is noted. With lumbar ischialgia, relying only on the affected leg is not accompanied by relaxation of the ipsilateral multifidus muscle on the affected side, and both the contralateral and ipsilateral multifidus muscles are tense - a symptom of ipsilateral tension of the multifidus muscle by Ya. Yu. Popelyansky.

When examining a patient with lumboischialgia in a standing position, on the affected side, a lowered position, smoothness, or disappearance of the gluteal fold (Bonnet sign) is noted, caused by hypotonia of the gluteal muscles. Due to hypotonia and hypotrophy of the gluteal muscles on the affected side, the intergluteal gap, especially its lower part, is warped and shifted to the healthy side (Ozechowski’s gluteal symptom).

In case of damage to the spinal roots or spinal nerve S1, sciatic and tibial nerves, the patient cannot walk on tiptoe, since on the affected side the foot drops onto the heel. In this case, hypotension and hypotrophy of the calf muscle are possible (Barre's symptom in ischioradiculitis). In such cases, some laxity of the Achilles tendon is noted on the affected side, which, as a rule, is somewhat widened and flattened, and the posterior malleolar groove is smoothed (Oppenheim's symptom). In this case, a loss or decrease in the Achilles reflex from the heel tendon is detected - Babinsky's symptom in ischioradiculitis. Described by a French neurologist ^|. VaYnzK!, 1857-1932.

If a patient with damage to the S 1 roots and the corresponding spinal nerve kneels on a chair and his feet hang down, then on the healthy side the foot “falls” and forms approximately a right angle with the anterior surface of the leg, and on the affected side the foot is in a plantar position. flexion and a similar angle turns out to be obtuse (Wechsler's symptom). In patients with a similar pathology, hypoesthesia or anesthesia in the 5m zone of the dermatome on the side of the pathological process can be noted - Sabo's symptom (Srabo).

To differentiate lumbodynia and lumbar ischialgia in osteochondrosis of the lumbar spine, you can use L. S. Minor’s test. When performing this test for lumbodynia, the patient tries to get up from the floor, first kneeling, and then slowly rises, resting his hands on his hips and sparing the lower back. With lumboischialgia, the patient, when getting up, first of all rests his hands and healthy leg on the floor, while the affected leg is set aside and maintains a half-bent position all the time. Thus, the patient first sits down, resting his hands on the floor behind his back, then leans on the healthy leg bent at the knee joint and gradually assumes a vertical position with the help of the same hand. The other hand makes balancing movements at this time. When a patient with lumbar ischialgia has already stood up, the sore leg still does not perform a supporting function. It does not touch the floor with the entire sole, but mainly only with its anteromedial part. If a patient with lumbar ischialgia is asked to rise on his toes, then his heel on the affected side turns out to be higher than on the healthy side (Minor's symptom, or Kalitovsky's high heel symptom).

If the pathological process manifests itself mainly in the II-IV lumbar SMS, which happens infrequently, the pain radiates along the femoral nerve. In this case, there may be a decrease in the strength of the muscles - hip flexors and leg extensors, loss of the knee reflex, decreased sensitivity in the corresponding dermatomes, and the symptoms of Wasserman and Matskevich tension are usually positive.

Wasserman's symptom is checked as follows: the patient lies on his stomach; The examiner strives to maximally straighten the patient’s leg on the affected side in the hip joint, while at the same time pressing his pelvis to the bed. With a positive Wasserman sign, pain occurs on the anterior surface of the thigh along the femoral nerve.

Matskevich's symptom is also caused in a patient lying on his stomach by sharp passive flexion of his lower leg. Pain in this case, as in Wasserman syndrome, occurs in the area of ​​innervation of the femoral nerve. With positive symptoms of Wasserman and Matskevich tension, the pelvis usually spontaneously rises (a symptom of the Russian neurologist V.V. Seletsky).

Of particular practical interest when examining patients with lumbosacral radiculitis is the symptom of stretching and pushback. When checking this symptom, a patient with lumbosacral radiculitis hangs for a while, holding the crossbar of a horizontal bar or gymnastic wall with his hands, and then lowers himself to the floor. If the disease is caused by discogenic pathology, then while hanging from your arms, pain in the lumbar region may weaken, and when lowered to the floor, it may intensify. In such cases, the domestic neuropathologist A.I. Zlatoverov, who described this symptom, considered the treatment of the patient using the traction method to be promising.

Exacerbations of the second stage of neurological manifestations in osteochondrosis, alternating with remissions of varying duration. can be repeated many times. After 60 years, ossification of the ligamentous apparatus leads to a gradual limitation of the range of motion in the spine. Exacerbations of discogenic radiculitis are becoming less and less common. Lumbar pain that occurs in older people is more often associated with other causes, and in differential diagnosis, first of all, one should keep in mind the possibility of developing hormonal spondylopathy and metastases of malignant tumors in the spine.

However, with radiculitis caused by osteochondrosis of the spine, it is possible to develop disturbances in the blood supply to the nerve roots, spinal nerves and spinal cord, as well as the development of cerebral vascular pathology. In such cases, we can talk about the development of the third and fourth stages of neurological disorders in osteochondrosis.

The third, vascular-radicular, stage of neurological disorders in spinal osteochondrosis.

Vascular-radicular conflict

Ischemia of the corresponding roots or spinal nerve in patients with spinal osteochondrosis, complicated by the formation of an IVD hernia and the occurrence of occlusion of the corresponding radicular artery, leads to the development of movement disorders and to impaired sensitivity in a certain myotome and dermatome.

The development of paresis or paralysis of muscles and sensory disorders is usually preceded by an awkward or sudden movement, followed by short-term acute pain in the lumbosacral region and along the peripheral, often sciatic, nerve (“hyperalgic crisis of sciatica”), with muscle weakness immediately occurring. , innervated by the ischemic spinal nerve. At the same time, sensory disorders occur in the corresponding dermatome. Typically, in such cases, occlusion of the radicular artery occurs, which passes into the spinal canal along with the L5 spinal nerve. In this case, the acute development of the syndrome of “paralytic sciatica” is characteristic.

The syndrome of “paralytic sciatica” is manifested by paresis or paralysis on the affected side of the extensors of the foot and fingers. With it, a “stepping” (“stamping” or “cock” gait) occurs, which is characteristic of dysfunction of the peroneal nerve. While walking, the patient raises his leg high, throws it forward and at the same time slams the front of the foot (toe) on the floor. “Paralytic sciatica”, which occurs as a result of circulatory disorders in the S1 radicular artery, is observed less frequently in spinal osteochondrosis with symptoms of discopathy. Acute ischemia in the spinal roots and spinal nerves at other levels is extremely rarely diagnosed.

The fourth stage of neurological manifestations in spinal osteochondrosis

Osteochondrosis of the spine can cause disruption of blood flow in the largest radicular arteries involved in the blood supply to the spinal cord, and in this regard, called radicular-spinal or radiculomedullary arteries. The number of such arteries is very limited and disruption of hemodynamics in them leads to a disruption of the blood supply not only to the spinal nerves, but also to the spinal cord. Disturbances in the blood supply to the spinal cord and cauda equina caused by a herniated intervertebral disc can be recognized as the fourth stage of neurological manifestations in osteochondrosis .

If the functions of the radicular-spinal arteries at the cervical level are disrupted, the patient may develop a clinical picture of cervical discirculatory myelopathy, which in its clinical picture resembles the manifestations of the cervical-superior-thoracic form of amyotrophic lateral sclerosis.

In 80% of people, the blood supply to the lower thoracic and lumbosacral levels of the spinal cord is provided by only one large radicular spinal artery - the artery of Adamkiewicz, which penetrates the spinal canal along with one of the lower thoracic spinal nerves. In 20% of people, in addition, there is an additional radicular-spinal artery - the Deproge-Hutteron artery, which often enters the spinal canal along with the fifth lumbar spinal nerve. The blood supply to the caudal spinal cord and cauda equina depends on it. The functional insufficiency of these arteries can cause the development of chronic cerebrovascular insufficiency of the spinal cord, manifested in the form of intermittent claudication syndrome. This is characterized by weakness and numbness of the legs that occurs during walking, which may disappear after a short rest.

The most severe manifestation of the fourth stage of neurological disorders in spinal osteochondrosis, complicated by the formation of an IVD hernia, must be recognized as acute disorders of the spinal circulation such as spinal ischemic stroke.

Possible, sometimes dangerous, manifestations of complicated cervical osteochondrosis include hemodynamic disorders of varying severity in the vertebrobasilar region.

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Muscle tension in the anterior abdominal wall- a symptom most often found in cases of damage to hollow organs and muscles of the anterior abdominal wall.
During examination baby immediately after an abdominal injury, N. G. Damier (1960) noted increased tension in the muscles of the abdominal wall precisely at the site of the bruise. During laparotomy, the author found a damaged section of the intestine, which, in his opinion, due to paralysis of peristalsis, remains in the place where it was damaged. A distinct tension in the muscles of the anterior abdominal wall was noted by E. S. Kerimova (1963) in 128 adult patients out of 155, of which 105 were diffuse in nature, and local in only 23 patients. Emphasizing the importance and demonstrativeness of this symptom, the author considers it insufficiently complete, since tension often appears only a few hours after injury (in 53 patients, muscle tension was recorded only 6 hours after injury).

As our observations show, children with closed injuries of hollow organs, after several hours from the moment of injury, local tension in the muscles of the abdominal wall disappears and in most patients, diffuse tension is already noted.

Spilled abdominal wall tension was noted in 47 children with various injuries of hollow organs, and 45 of them were admitted to the hospital 1.5 hours or later after the injury. Local tension was noted in 23 patients (11 children from this number were admitted within an hour after the injury and 12 patients later). The discussion about the mechanism of local stress continues to this day.

According to B. S. Rozanov et al. (1960), tension in the abdominal wall is a consequence of rapidly developing peritonitis. However, A. A. Bocharov (1967) believes that this symptom is the result of a protective reaction of the body, ensuring sufficient immobility of the intestines. This assumption, apparently, is most likely in the interpretation of the mechanism of tension of the anterior abdominal wall, since it is difficult to imagine that after an injury the phenomena of peritonitis will have time to develop in such a short time. In 3 children, we did not detect tension in the anterior abdominal wall, which may be due to shock, which developed as a result of concomitant severe combined injuries. Although some surgeons (Leifer L. Ya., 1934; Gaisinsky B. E., Vasilenko D. A., 1956) explain the lack of tension in the muscles of the anterior wall as a result of their paresis, which arose due to overstretching of their fibers at the time of injury, or paresis intestines and increasing flatulence.

At the same time, there are others views on the mechanism of tension of the muscles of the anterior abdominal wall. Tension of the muscles of the anterior abdominal wall can be caused by a reflex act due to irritation of the intercostal and lumbosacral nerves, i.e., with chest bruises, retroperitoneal hematomas, etc. Therefore, the surgeon’s focus is only on such a seemingly very reliable symptom as Tension of the anterior abdominal wall, considered by many surgeons to be a direct indication for surgical intervention, can sometimes lead to serious tactical errors.

Flatulence in children with damage to a hollow organ

Most authors subdivide early and late flatulence. Early flatulence, developing immediately after injury, according to A. P. Krymov (1912), I. N. Askalonov, G. I. Lukashin (1935), N. I. Minin (1939), B. E. Gaisinsky ( 1941), is explained by trauma to the neuro-reflex apparatus* and does not indicate damage to the hollow organs. At the same time, late flatulence, which occurs several hours after the injury, leads the surgeon to think about peritonitis developing in the patient.

Separate surgeons(Kerimova E. S., 1963; Mikeladze K. D., Kuzanov E. I., 1965) noted bloating in adult patients in the first hours after injury. Thus, E. S. Kerimova observed early flatulence in 44 out of 155 patients, and in 21 flatulence occurred within the first 6 hours after damage to various parts of the intestine.

Of the 70 children operated on in hospital with intestinal injuries, 45 also had symptoms of flatulence, and in the first hours after the injury (up to 6 hours) this symptom was determined in 32 Children and in 13 after 12 hours. Our data show that in children with injuries to hollow organs, both early and late flatulence.

Therapeutic exercises for osteoporosis are important element conservative treatment this pathology. A set of physical exercises should be compiled by a specialist, taking into account the specifics of the disease and the characteristics of the human body. There are many various systems, which make it possible to ensure a positive result in the treatment of osteoporosis in people of different ages, with to varying degrees severity of the disease. When carrying out exercise therapy, medical supervision and complete elimination of the risk of complications from excessive stress are necessary. A sense of proportion and systematic exercise are important principles of physical therapy.

The essence of pathology

At its core, osteoporosis is a pathology of a systemic nature, causing changes in the bone structure (friability, fragility) as a result of metabolic disorders in bone tissue and caused by a deterioration in metabolic processes (primarily the absorption of calcium and magnesium). As the disease progresses, various bone tissues throughout the skeleton are affected, but the most dangerous is damage to the spine, which can be expressed by sagging vertebrae.

Bones with osteoporosis become brittle, causing them to fracture even under light loads. The risk of fractures increases significantly for older people, in whom this pathology occurs very often. Big problems arise with osteoporosis of the hip joint, because... A fracture of the femoral neck often leads to complete immobilization, and in severe cases, to death.

The development of osteoporosis leads to the following consequences:

• bone loss;
• curvature of the spinal column;
• frequent bone fractures;
• muscle weakness;
• reduction in human growth.

According to the severity of the disease, there are 3 stages: initial, moderate and severe osteoporosis. The main symptom of the disease is pain, especially in the spine.

What does therapeutic gymnastics give?

Why is physical therapy for osteoporosis recognized as an important element of comprehensive treatment? This is facilitated by the numerous positive effects of normalized physical activity on the human body. First of all, there is a direct connection between physical exercise and increased muscle strength and maintenance of bone size. It has been proven that systematic exercise for half an hour 3-4 times a week can ensure an increase in bone mass by 4-6%, which reduces the manifestation of one of the main manifestations of the disease. Strengthening muscles ensures greater preservation of bones, and therefore reduces the risk of fractures.

A properly selected set of exercises for osteoporosis with regular exercise provides the following results:

• stimulation of metabolic processes (both at the tissue and cellular levels);
• activation of osteoblasts, i.e. cells that form bone structure;
• normalization of metabolic processes, in particular, improvement of calcium absorption.

Of course, physical exercise alone for osteoporosis cannot cure the disease, but in combination with vitamin therapy, proper nutrition and drug therapy, the effectiveness of complex treatment increases 4-5 times.

Principles of compiling exercise sets

The development of exercise therapy for osteoporosis is a responsible undertaking that requires taking into account many important factors. First of all, you should consider general rules conducting classes:

1. Regularity. Only systematic training provides real help. The minimum is considered to be daily charging lasting 16 - 25 minutes. It’s even better if the load is evenly distributed throughout the day.
2. Smoothness of movements. Only slow movements without any risk can gradually stimulate muscle and bone tissue. Loads should be increased gradually. Classes begin with the simplest exercises.
3. Elimination of pain. If pain or discomfort occurs, exercise should be stopped.
4. The right mood. Exercises are beneficial only if they are performed voluntarily, with the desire and belief that they will help.
5. Complete elimination of injuries.
6. Exercises for osteoporosis are developed and supervised by a specialist. They must take into account the type of disease, the stage of its development, the age of the patient and the presence of other diseases.

There are 3 main types of exercises that have a beneficial effect on the treatment process:

• with a load from your own body;
• with artificial resistance and weights;
• for balance.

In the first case, the exercises are carried out in a vertical position of the torso, which provides the load due to its own weight. They are most suitable for the spine and upper thighs. It has been established that this type of exercise increases bone density by 1 - 1.5% over the course of a year.

Artificial resistance is created on simulators, when using expanders, and conducting exercises in water (including swimming).

The third type of exercise therapy includes exercises for balance and coordination of movement, which should reduce the risk of fractures from loss of balance.

One of the options that provides all 3 types of training is yoga for osteoporosis.

Taking into account the basic principles of the formation of a therapeutic physical training complex, the following types of training are distinguished:

1. Aerobics. It is particularly effective in strengthening the muscular system of the lower extremities. The main types of movements in this direction include: climbing stairs, dance movements, walking.
2. Strength exercises. Mainly aimed at strengthening the back, neck and muscles of the upper limbs. A typical example is hanging from a horizontal bar.
3. Water gymnastics. It can have a positive effect on the entire skeleton and all muscle groups. The simplest training is swimming in a pool.
4. Flexibility exercises. Especially noted: yoga, stretching.

The weekly complex is compiled so that it includes exercises of all listed categories, and it is advisable to perform them one by one.

Spine training

Gymnastics for osteoporosis of the spine includes 3 types of exercises: warm-up (warm-up muscles), main complex and cool-down (relaxation of the spine). The main part takes into account the possibility that the vertebra may sag as the disease develops.

1. Starting position (IP): standing with the spinal column straight and arms raised. Slowly rise onto your toes and then lower onto your heels. This “rolling” is repeated 8 - 12 times.
2. Walk with your knees raised as high as possible. Duration 1.5 - 2.5 minutes.
3. IP: standing, legs together, arms down. The body is slowly tilted to the side, alternately in different directions. Number of repetitions - 6 - 7.
4. Bend forward from a standing position with arms raised up, clasped together. The exercise is repeated 8-12 times.
5. IP: standing, feet shoulder-width apart, arms spread to the sides. Smoothly raise your arms up and then lower them in front of you.

The main complex includes the following exercises:

1. IP: lying on your back, arms directed along the body. The arms rise up, and at the same time, the socks are pulled towards themselves. The exercise is carried out 8 - 12 times.
2. Similar IP. The legs (both at the same time) bend and straighten at the knees, while the heels do not lift off the surface.
3. IP: lying on your stomach with your arms extended above your head. The legs are lifted off the surface as much as possible, without bending the body. Number of repetitions - 6 - 7.
4. IP: lying on your side with support on your hand, the second hand on your belt. Leg swings are carried out (6 - 8 times).
5. IP: standing with your hands resting on any support. Alternate lunges are made with one leg, bending it at the knee.

At the final stage, you can carry out the following movements:

1. Slowly roll over in a lying position from your back to your stomach. The arms are extended above the head.
2. Crawling on all fours with a slight arch of the back.
3. Move backwards on all fours, rounding your back.
4. “Hugging” yourself while standing.
5. Relaxed lying on a hard surface flat surface 4 - 6 minutes.

These exercises can be performed regularly and at any age. This complex is suitable as gymnastics for osteoporosis for older people.

A special method for treating the spine was developed by S. M. Bubnovsky. They are offered the following set of exercises:

1. Relaxation of the back. It is carried out on all fours.
2. Arching of the back. IP is the same. The back arches as you exhale and bends as you inhale.
3. Moving on all fours with a stretching step.
4. Leveling up. IP: support on the palms of the hands and knees. The body is stretched forward as much as possible without bending in the lumbar region.
5. Back stretch. The IP does not change. The body is lowered by bending the arms at the elbow.
6. Abdominal stretching. IP: lying on your stomach, hands behind your head. Legs bend at the knees. The body bends, lifting the shoulder blades off the surface, and the elbows touch the knees.
7. Lifting the pelvis. IP: lying on your back, arms along your body. Raising the pelvis as you exhale and lowering as you inhale - 20-25 times.

Gymnastics for the hip joint

When treating osteoporosis, it is especially important to take measures to strengthen the muscles of the hip area. For regular classes, we can recommend the following complex:

1. IP: lying on your back, arms along the body. The legs are slightly raised and crossed without bending. One movement lasts for 25 - 35 seconds.
2. IP: lying down with legs apart, shoulder-width apart. Pull your socks towards you.
3. IP: lying on your back. The legs are bent at the knee and alternately pressed against the body.
4. IP: lying down, arms apart, legs bent at the knees. The lower body is rolled in different directions with emphasis on the hands.
5. IP: standing with your hands resting on the back of a chair. 8 - 12 squats are done, with the feet turning outward.

Therapeutic gymnastics, even in the simple version above, provides a noticeable positive effect on osteoporosis. Complexes may include other, more complex exercises with loads on other muscles. It is important that exercise therapy is developed and supervised by a professional, and that classes are carried out regularly and in a good mood.

Ekaterina Yurievna Ermakova

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A program of gymnastic exercises conducted under the guidance of a trained professional is quite effective method treatment of pain due to intervertebral disc pathology.

An integrated approach to therapeutic exercises usually consists of teaching the patient to move correctly and a set of specific exercises that help relax spasmodic muscles and normalize their work, generally strengthen the muscle corset and help maintain the spine in a neutral position (straight) during everyday activities.

People who suffer from pain caused by a herniated disc should avoid activities that place undue stress on the lower back or require sudden twisting movements, such as in soccer, golf, ballet, and weight lifting.

Additional aerobic exercise(with low intensity, for example, walking, exercise bike, swimming) it is possible to start a little earlier than gymnastics, two to three weeks from the start of therapy. Running is not recommended, at least until the pain has disappeared and the back muscles have become stronger.

Until the muscles that make up the back corset are well trained, you should avoid exercises that create pressure on the lower back (for example, squats with additional load). You must constantly remember that performing gymnastic elements should be slow and gentle.

Types of gymnastic exercises for a herniated disc.

There are various types and types physical activity, which are used for the successful treatment of pain in spinal hernias. Stretching exercises are best suited to reduce pain symptoms, while strengthening exercises are more suitable for restoring lost functions (increasing mobility).

Exercises most often used for disc pathology can be divided into:

– Low-intensity aerobic exercise. This includes swimming, cycling and walking, through which the abdominal and back muscles are strengthened without excessive strain. Water gymnastics is especially useful, as water helps to minimize the load on the spine during exercise.

– Yoga, tai chi, qigong. Various sets of gymnastic exercises, invented in East Asian countries, combine physical techniques with meditation, which allows you to achieve psychophysical balance, which effectively prevents relapses of lumbar pain.

– Stabilization exercises (or strength training). Practicing this type of gymnastic exercise results in increased muscle strength in the abdomen and lower back, while improving mobility, strength and endurance in general, as well as further increasing flexibility in the joints of the hips and knees.

– Stretch marks. These exercises are most effective in reducing pain, but the best results, as practice shows, can be achieved in combination with strength training.

Exercises to strengthen your abdominal muscles

– Torso sit-ups (useful for strengthening weak upper abdominal muscles). To perform them, you need to lie on your back, bend your lower limbs at the knees, and place your arms crossed on your chest. Raise your upper body fifteen to twenty centimeters from the floor, hold for 2 to 5 seconds, then slowly lower to the starting position. Exhale on the way up, and inhale on the way down. You should aim to perform two sets of ten times. If you are experiencing neck pain, clasp your hands behind your head for support.

– To strengthen those muscles that make up the lower abdominal press, lie on your back and alternately and slowly raise your straightened legs 30 - 50 centimeters from the floor. Fix them in the upper position for ten seconds, then slowly lower them as well. Aim for two sets of ten lifts.

– Lie on your back (as a rule, in a calm, relaxed state, a gap will form between your back and the floor). By tensing the muscles of the anterior abdominal wall, press your back to the floor so that the gap disappears, remain in this position for eight to ten seconds, return to the starting position. Perform the technique 8 – 10 times.

Exercises to relax your back muscles

– Raising the pelvis. Lie on your back, bend your knees well. Tighten your buttocks and stomach so that your lower back rises slightly above the floor, freeze in this position for a second. Lower yourself back to the floor and relax. Try to breathe evenly. Smoothly lengthen the exercise to 5 seconds. Then move your feet a little further away from your body and try again.

– Extension exercise. From a prone position on your stomach with your arms pressed to your chest and your elbows bent, slowly lift your upper torso onto your elbows, keeping your hips and pelvis on the floor (Fig. 4). Freeze in this position for five seconds and return back to the floor. Gradually increase your stay in the extended position to thirty seconds. Repeat 10 times.

When the considered exercise seems easy to perform, you can move on to a more complex form - rise not on your elbows, but on fully straightened arms. If for one reason or another it is difficult for you to lie down, a similar exercise can be performed while standing, slowly arching your back back, hands on your hips. However, it is still preferable to do this exercise while lying down.

Stretching the back muscles.

– Lying on your back with your knees bent and your legs placed together and your arms spread to the sides, carefully and slowly lower your knees to the floor from side to side, holding in the extreme positions for twenty seconds.

– While on your back, grab the shin or thigh of one leg with your hands and slowly pull your knee towards your chest to the maximum. Hold for ten to twenty seconds, then do the same with the other leg.

– While lying on your back, gently pull the knees of both legs towards your chest (Fig. 9). After twenty to thirty seconds, slowly return to the starting position. Do two sets of 6 times.

– Sit on your shins, bend and, with your arms outstretched, stretch forward without lifting your buttocks from your heels (Fig. 10). After twenty to thirty seconds, slowly return to the starting position. Perform two sets of 6 times.

Exercises to strengthen your back muscles

– Lying on your stomach (you can use something like a bolster or pillow for comfort and to create elevation) with your hands clasped behind your back, raise your shoulders and upper torso. After being in this position for about five seconds (further increasing to 20 seconds), return to the original position. Perform 8-10 times.

– From a position lying on your stomach (with your head and chest lowered to the floor, and your arms stretched above your head), slowly raise your arm and the opposite leg, straightened at the knee, five to ten centimeters from the floor, fixate for a couple of seconds (gradually increasing to twenty) and return to original position. Repeat eight to ten times.

- Half bridge. From a position on your back with your lower limbs bent at the knees, slowly lift your lower back and buttocks off the floor. Hold this position for five to ten seconds, then slowly lower down. Perform a couple of sets of ten half-bridges.

– Lie on your stomach, place your hands under your head. Alternately lift your legs with your knees slightly bent, holding them in the upper position for five seconds. Perform eight to ten lifts.

Similar exercises can be done while in a 4-point position (with palms and knees as support points). At the same time, you should avoid twisting or sagging of the body.

– Raise your legs backwards and upwards, one at a time, slightly bent at the knees, holding them at the top for five seconds, then slowly lower them. Perform two sets of ten raises.

– Standing on all fours, simultaneously raise your straightened arm and the same leg on the opposite side, hold for three to five seconds. Don't forget to keep your back straight. Alternating arms and legs, repeat eight to ten times.

Gymnastics provides an excellent opportunity to increase flexibility and endurance, as well as strengthen certain muscle groups that maintain the neutral position of the spine. Exercise should not be done in isolation, but as part of a broader program to help you return to normal life at home and at work.

Combining exercise with psychological and motivational support, such as cognitive behavioral therapy, can make the patient's efforts more confident and focused.

What is spinal lordosis: symptoms, treatment, exercises.

If you look at the silhouette of a person from the side, you will notice that his spine is not straight, but forms several bends. If the curvature of the arch is directed backwards, this phenomenon is called kyphosis. The curve of the spine with a convexity forward is lordosis.

• What is lordosis
• Reasons
• Types of disease
• Symptoms of lordosis
• Lordosis is smoothed or straightened - what does this mean?
• Lordosis in a child
• Treatment of lordosis
• Treatment of cervical hyperlordosis
• Treatment of lumbar hyperlordosis
• Exercises and gymnastics

There is cervical and lumbar lordosis. In a healthy person, these curves provide shock absorption to the spine. With a significant increase in the physiological curvature of the spinal column, pathological lordosis occurs in the cervical or lumbar regions.

Hyperlordosis may not be accompanied by pathological symptoms. However, it is dangerous due to its complications from the musculoskeletal system and internal organs.

What is lordosis

Lordosis is a curvature of the spinal column with its convexity facing forward. Normally, it appears in the cervical and lumbar regions during the first year of life, when the child learns to sit and walk. Lordosis in the neck area is most pronounced at the level of the V - VI cervical vertebrae, in the lumbar area - at the level of the III - IV lumbar vertebrae.

Physiological lordosis helps a person:

• absorb shocks when walking;
• support the head;
• walk in an upright position;
• bend over with ease.

With pathological lordosis, all these functions are disrupted.

Reasons

Primary lordosis can occur with the following diseases:

• tumor (osteosarcoma) or metastases of a malignant neoplasm in the vertebra, as a result of which defects form in the bone tissue;
• spinal osteomyelitis (chronic purulent infection accompanied by destruction of the vertebrae);
• congenital malformations (spondylolysis);
• spondylolisthesis (displacement of the lumbar vertebrae relative to each other);
• injuries and fractures, including those caused by osteoporosis in older people;
• spinal tuberculosis;
• rickets;
• achondroplasia is a congenital disease characterized by impaired ossification of growth zones;
• osteochondrosis; in this case, hyperextension of the spine is combined with increased muscle tone and serves as a sign of a severe course of the disease.

Factors leading to the appearance of secondary lumbar lordosis:

• congenital hip dislocation;
• contracture (decreased mobility) of the hip joints after osteomyelitis or purulent arthritis;
• Kashin-Beck disease (impaired bone growth due to deficiency of microelements, primarily calcium and phosphorus);
• cerebral palsy;
• polio;
• kyphosis of any origin, for example, with syringomyelia, Scheuermann-Mau disease or senile deformity;
• pregnancy;
• poor posture when sitting for a long time or lifting heavy objects;
• iliopsoas muscle syndrome, complicating diseases of the hip joints and the muscle itself (trauma, myositis).

Increased lumbar lordosis occurs when the body's center of gravity moves backward. Lordosis in pregnant women is temporary and disappears after the birth of the child.

Pathological lordosis of the cervical spine is usually caused by post-traumatic deformation of soft tissues, for example, after a burn.

Predisposing factors to the development of hyperlordosis are poor posture, excess weight with fat deposits large quantities belly fat and growing too fast childhood. Interestingly, many years ago a connection was proven between constantly wearing high-heeled shoes and the incidence of hyperlordosis in women.

Types of disease

Depending on the level of damage, cervical and lumbar pathological lordosis are distinguished. Depending on the time of appearance, it can be congenital or acquired. It rarely occurs in the prenatal period. Often this pathology of the spine is combined with other types of curvature, for example, scoliotic deformity.

Depending on the degree of mobility of the spine, pathological lordosis can be unfixed, partially or completely fixed. With an unfixed form, the patient can straighten his back; with a partially fixed form, he can change the angle of the spine with a conscious effort without achieving full straightening. With fixed lordosis, changing the axis of the spinal column is impossible.

If the cause of the pathology is damage to the spine, lordosis is called primary. It occurs after osteomyelitis, with malignant tumors, fractures. If it occurs as a result of the body’s adaptation to a shift in the center of gravity due to other diseases, these are secondary changes. Secondary hyperlordosis accompanies pathology of the hip joints. It is often combined with scoliosis.

In children and young people, hyperlordosis often goes away after the cause of the disease is eliminated. Spinal curvature in adults, on the contrary, is often fixed.

Hyperlordosis can be an individual feature of the figure. In this case, it is not associated with other diseases and does not cause serious symptoms.

Symptoms of lordosis

With hyperlordosis, the vertebral bodies move forward relative to the axis of the spine and fan out. The spinous processes - bony outgrowths on the back surface of the vertebrae - come closer together. Intervertebral discs become deformed. Incorrect tension and spasm of the neck or back muscles occurs. Nerves and vessels leaving the spinal canal may be pinched. The joints between the processes of the vertebrae and the ligaments running along the spinal column suffer.

These phenomena create conditions for the occurrence of the main symptoms of pathological lordosis:

• violation of the correct body shape;
• change in posture;
• pain due to compression of the spinal cord roots;
• difficulty moving.

The younger the patient, the faster he develops secondary chest deformation. At the same time, the functioning of the heart and lungs is disrupted, and shortness of breath appears during physical exertion. With severe pathology, the digestive system and kidneys suffer. Thus, the patient is concerned about the manifestations of reflux esophagitis (heartburn), bloating and constipation due to weakness of the abdominal muscles. Nephroptosis develops - prolapse of the kidney.

With hyperlordosis, the shape of other parts of the spine also changes, which enhances the change in posture. The figure becomes “kinked”, the gluteal region protrudes significantly back, the chest and shoulder blades deviate in the same direction. However, such deformity may not be noticeable in obese patients. External measurement of the angles of the spine in this case is not informative enough. This may lead to diagnostic errors.

Pain in the affected area (most often in the lower back) intensifies after exertion (walking, standing) or being in a position that is uncomfortable for the patient. The patient cannot sleep on his stomach. With cervical hyperlordosis, pain spreads to the neck, shoulders, and upper limbs. Signs of compression of the vertebral arteries may be detected - dizziness, diffuse headache.

During examination, signs of kypholordotic deformation of the back are usually determined: a deflection in the lower back, a protruding thoracic spine and shoulder blades, raised shoulders, a protruding abdomen, and hyperextended legs at the knees. With cervical hyperlordosis, the angle between the upper and lower parts of the neck is more than 45 degrees. Head tilts forward and to the sides are limited.

Fixed lordosis is often a complication of intervertebral hernia. The first symptoms of the disease appear in middle-aged people. Curvature of the spine is accompanied by spasms of the lumbar and gluteal muscles. When you try to straighten your back, sharp pain occurs in the hip joints. There is a violation of sensitivity in the lumbar region and lower extremities, which is associated with concomitant damage to the roots of the brain.

Due to disruption of the normal shape of the spine, improper distribution of the load on the bones, ligaments and back muscles occurs. They are constantly tense, as a result of which their weakness develops. A “vicious circle” arises when the muscular corset ceases to support the spinal column. If you look at the patient from behind, in some cases you can notice the “reins symptom” - tension in the long muscles located parallel to the spine at the edges of the lumbar depression.

The gait becomes “duck-like.” The patient bends forward not due to movements in the spine, but due to flexion only in the hip joints.

With a long-term course of pathological lordosis, complications may arise:

• pathological mobility of the vertebrae with their displacement and pinching of the nerve roots (spondylolisthesis);
• multiple pseudospondylolisthesis (decreased stability of intervertebral discs);
• herniated intervertebral discs;
• inflammation of the iliopsoas muscle (psoitis, lumbar myositis);
• deforming arthrosis of the spinal joints, accompanied by limited mobility and chronic pain.

You should definitely consult a doctor if you experience the following symptoms, which may be caused by these complications:

• numbness or tingling in the limbs;
• “shooting” pain in the neck or back;
• urinary incontinence;
• muscle weakness;
• loss of coordination and muscle control, inability to bend and walk normally.

Quantitative characterization of spinal curvature is carried out using a simple device that measures the degree of curvature. This manipulation is called “curvimetry” and is performed by an orthopedist during the initial examination of the patient.

To diagnose the disease, radiography of the spine is performed in direct and lateral projections. A photograph may be taken in the position of maximum flexion and extension of the spinal column. This helps to determine mobility, that is, to recognize fixed lordosis. For radiological diagnosis of hyperextension, special measurements and indices are used. They do not always reflect the true severity of the disease, so the interpretation of the x-ray report should be carried out by the clinician examining the patient.

With a long-term course of the disease in the lumbar region, the spinous processes of the vertebrae, pressed against each other, grow together. Signs of osteoarthritis are visible in the intervertebral joints.

In addition to radiography, it is used computed tomography spine. It allows you to identify the cause of the pathology and clarify the extent of damage to the nerve roots. MRI is less informative because it better recognizes pathology in soft tissues. However, it can be very useful in diagnosing a herniated disc.

Each person can find out whether he has pathological lordosis. To do this, ask an assistant to look at the line of your lower back from the side, and then lean forward, lowering your arms. If the curvature in the lumbar region disappears, this is physiological lordosis. If it persists, you should consult a doctor. Another simple test is to lie on the floor and place your hand under your lower back. If it moves freely, there is probably excess lordosis. The likelihood of this pathology increases if the curvature does not disappear when pulling the knees to the chest.

Lordosis is smoothed or straightened - what does this mean?

Normally, the curvature of the spine in the neck and lower back is formed in the first years of life under the influence of walking.

Physiological lordosis can be smoothed or straightened. The flattening of the bend is called hypolordosis. When examining a person's body from the side, his lumbar deflection is not determined. In most cases, this is a sign of intense contraction of the back muscles due to pain caused by myositis, neuritis, radiculitis or other diseases.

Another reason for smoothing the physiological curves of the spinal column is whiplash injury resulting from a road traffic accident. With a sudden movement, the ligaments that hold the spine are damaged, and a compression fracture of the vertebral bodies also occurs.

Smoothed lordosis is often accompanied by long-term back pain. Posture is disrupted, the body leans forward, and the stomach protrudes. A person cannot fully straighten his knee joints without losing balance.

The main method of combating such deformity is physical therapy aimed at strengthening the abdominal muscles and correcting posture.

Lordosis in a child

The first signs of physiological curves are present in a person immediately after birth. However, in infants they are weakly expressed. Intensive formation of lordosis begins after the child has learned to walk, that is, by the age of 1 year. Anatomical structures are fully formed by the age of 16–18 years, when ossification of growth zones occurs.

Lordosis in children is often more pronounced than when it develops in adulthood. The earlier the pathology occurred, the stronger the deformation. Lordosis in children is accompanied by impaired functioning of the lungs and heart. Deformations and compression of other organs may occur.

Sometimes spinal curvature appears in children for no apparent reason. This is benign juvenile lordosis. This form of pathology occurs with excessive tone of the muscles of the back and hips. With age, the manifestations of this condition spontaneously disappear.

Hyperlordosis in a child can be a symptom of injury, in particular hip dislocation. The reasons for this condition are car accidents or falls from a height.

Other causes of lordosis in children are associated with neuromuscular diseases. They are registered quite rarely:

• cerebral palsy;
• myelomeningocele (bulging of the spinal cord through a defect in the spinal column);
• hereditary muscular dystrophy;
• spinal muscular atrophy;
• arthrogryposis is a congenital limitation of movement in the joints.

Treatment of lordosis

In mild cases, hyperlordosis does not require special medical intervention. This refers to unfixed lordosis, which disappears when the torso bends forward. For such patients, only therapeutic exercises are indicated.

This disease is treated by a vertebrologist or orthopedist. You should consult a doctor if there is a fixed deformity that does not disappear when bending over. Therapy is also necessary for long-term back or neck pain.

To eliminate pathological curvature of the spine, it is necessary to treat the disease that caused it. When the normal position of the center of gravity is restored, pathological lordosis most often disappears.

Thermal procedures (baths, paraffin, ozokerite), therapeutic massage and special gymnastics are carried out. Special positioning and spinal traction may be required.

It is necessary to unload the spine. The preferred sleeping position is on your back or side with your knees bent. It is necessary to normalize weight.

For pain, painkillers and medications are prescribed to relax the muscles. Prevention of vitamin D deficiency in children is important.

One of the methods of conservative orthopedic treatment is the use of corsets and bandages that support the spine in the correct position. It is better to entrust the choice of a corset to a specialist. If the deformation is mild, you can purchase such a product yourself. In this case, you should pay attention to elastic models.

For more serious deformities, rigid corsets with metal inserts or elastic plastic elements are selected. This product is invisible under clothing, provides air exchange and removes moisture. The use of support devices helps to get rid of back pain, improve posture and form “muscle memory”, which will help maintain the achieved results in the future.

There are devices with which the human body is attracted to the chair. Devices have been developed to restore the functioning of motor centers in the brain, which are used in the treatment of cerebral palsy (Gravistat).

In severe cases, spinal surgery may be performed. It is indicated mainly for primary lordosis. Surgical method used for progressive deformation of the spine, accompanied by disruption of the lungs, heart or other organs. Another indication for such intervention is chronic pain, which significantly worsens the patient’s quality of life.

Metal staples are used to restore the normal axis of the spine. In this case, artificial immobility of the spine is formed - arthrodesis. This technique is used in adults. For children, special designs can be used to change the degree of bending as they grow. For example, the Ilizarov apparatus is used to eliminate spinal deformities.

Surgical correction of hyperlordosis is an effective but complex intervention. It is carried out in leading orthopedic institutions in Russia and other countries. To clarify all questions regarding the operation, you need to contact an orthopedist-traumatologist.

An indirect method of correcting lordosis is surgery to eliminate hip dislocations, the consequences of spinal fractures and other root causes of deformity.

Treatment of cervical hyperlordosis

To get rid of cervical hyperlordosis and its symptoms, the following methods are used:

1. Limiting the load on the cervical spine. Avoid work that requires you to tilt your head back (for example, whitewashing a ceiling). When working at a computer for a long time, you need to take regular breaks, do light exercises and self-massage.
2. Self-massage of the back of the neck: stroking and rubbing in the direction from bottom to top and back, grasping the shoulder girdle.
3. Therapeutic exercises to strengthen the neck muscles and improve blood circulation in the brain and upper limbs.
4. Dry heat: heating pad, paraffin compresses; they can be used in the absence of intense pain.
5. Physiotherapy with devices for home use (Almag and others).
6. Regular courses of therapeutic massage of the cervical-collar area (10 sessions 2 times a year).
7. If pain intensifies, use non-steroidal anti-inflammatory drugs in the form of tablets, injection solutions, as well as ointments and patches (diclofenac, meloxicam)
8. If signs of vertebral artery syndrome appear (nausea, headache, dizziness), the doctor will prescribe medications that improve cerebral circulation(ceraxon).
9. Treatment of pain syndrome includes muscle relaxants (mydocalm) and B vitamins (milgamma, combilipen).
10. When pain subsides, therapeutic mud is useful.

Treatment of lumbar hyperlordosis

Hyperlordosis of the lower back requires the use of the following treatment methods:

1. Limiting work in a standing position and regular gymnastics.
2. Courses of therapeutic massage of the back and lumbar region twice a year for 10 - 15 sessions.
3. The use of thermal procedures, for example, paraffin compresses.
4. Physiotherapy: electrophoresis with novocaine, electrical stimulation, ultrasound therapy.
5. Balneotherapy: hydromassage, underwater traction, aqua aerobics, therapeutic baths with pine extract or turpentine.
6. Nonsteroidal anti-inflammatory drugs orally, intramuscularly, locally; muscle relaxants, B vitamins.
7. Spa treatment, swimming.
8. Use of special restraint devices (corset, bandage, tapes).

Exercises and gymnastics

The goals of therapeutic exercises for hyperlordosis:

• posture correction;
• increased mobility of the spine;
• strengthening the muscles of the neck and back;
• improving heart and lung function;
• normalization of the patient’s general well-being and emotional state, improving his quality of life.

• circular rotations back and forth with arms bent at the elbows;
• bending the neck to the sides;
• exercise “cat” - alternate arching and deflection in the lower back while standing on all fours;
• “bridge” exercise - raising the pelvis from a supine position;
• squats while simultaneously bending the body forward;
• any exercises while sitting on a large gymnastic ball (rolling, jumping, warming up the shoulder girdle, bending, turning to the sides).

Therapeutic exercises for hyperlordosis should be carried out effortlessly. It shouldn't cause any discomfort. All exercises are repeated 8-10 times, done at a slow pace, stretching the spasming muscles. If pain worsens, exercise should be avoided.

1. Raise and lower your shoulders while sitting or standing.
2. Circular movements of the shoulders back and forth.
3. Smoothly tilt the head forward and backward, avoiding excessive tilting.
4. Tilts of the head to the shoulders.
5. Turns the head to the sides.
6. Clasp your hands behind your back crosswise, spread your shoulders;
7. Draw imaginary numbers from 0 to 9 with your head, avoiding excessive hyperextension of the neck.

Gymnastics for lumbar hyperlordosis:

1. In a standing position:

• bending the torso forward, pulling the body towards the hips;
• tilt to each foot in turn;
• squats with outstretched arms moving backward (imitation of skiing);
• walking with high knees; you can additionally press the thigh to the body;
• stand with your back to the wall, try to straighten your spine, stay in this position for a while;
• standing against the wall, slowly tilt your head, then bend at the thoracic region and lower back, without bending the body at the hip and knee joints; After this, smoothly straighten up.

1. In a lying position:

• relax your back muscles and press your lower back to the floor, fix this position;
• pull your legs to your knees, roll on your back; you can try to raise your pelvis and stretch your legs above your head;
• put your forearms on your chest, sit down without helping yourself with your hands; lean forward, trying to reach your feet with your fingers, return to the starting position and relax your back muscles;
• holding your hands behind your head, raise and lower your straightened legs; if you have difficulty, lift each leg in turn.

1. While sitting on a low bench, imitate the movements of a rower: bending forward with arms extended.
2. At the Swedish wall:

• stand facing the stairs, grab the bar at chest level, perform a squat with your back stretched, bringing your knees to your stomach;
• stand with your back to the stairs, grab the bar above your head, bend your knees and hips, pull them to your chest and hang;
• from the same position, raise your legs straightened at the knees;
• from the same position, perform a “bicycle”; if there are difficulties, raise your bent legs alternately, but be sure to hang on the crossbar;
• From the previous position, make alternating swings with straight legs.

It is better to learn such exercises under the guidance of a physical therapy instructor. In the future, these exercises should be performed at home once a day, preferably after a light massage of the corresponding muscles.

Spinal lordosis is a curvature of the spinal column in the sagittal plane, that is, noticeable when viewed from the side. The resulting arc is convexly facing forward. Lordosis is a physiological condition necessary for upright walking. The causes of excessive lordosis may be damage to the vertebrae themselves or diseases of the hip joints, surrounding nerves and muscles.

The leading manifestations of hyperlordosis are back deformation, gait disturbance, and chronic pain. Treatment includes elimination of the underlying disease and a variety of physiotherapeutic methods. Massage and exercise are aimed at straightening the spine, strengthening the muscles of the neck or back and improving blood circulation in surrounding tissues. In severe cases, surgical treatment is indicated.