Treatment methods for spinal diseases have changed dramatically over the past half century: “complete rest” and bed rest are recognized as effective only at the first stage of the fight against infectious lesions of the musculoskeletal system (MSA), but the threat of disruption of the trophism of muscle tissue and the elasticity of the ligamentous apparatus has forced a reconsideration of views on “ harmfulness" of physical activity. Therapeutic exercise is an independent medical discipline aimed at the prevention and treatment of all types of diseases of the musculoskeletal system, as well as its rehabilitation until the complete restoration of motor functions after injuries and temporary immobilization.

Spinal diseases and mobility disorders

Known spinal diseases are conventionally divided into 3 groups:

• degenerative: osteochondrosis, chondrosis, spondylosis, spondyloarthrosis;
• infectious-inflammatory and autoimmune: spondylitis, various types of arthritis (including spondyloarthritis), rheumatoid arthritis, ankylosing spondylitis, osteoporosis, osteomyelitis;
• arthropathy (microcrystalline arthritis, allergic arthropathy).

Degenerative diseases slowly and persistently destroy the cartilage and bone tissue of the vertebrae and paravertebral joints, preventing simple movements (bending in all directions). Deformation of the vertebral bodies and articular joints, reduction of intervertebral spaces and gradual ankylosis (fusion) lead to the transformation of the spine into a motionless semblance of a bamboo cane.

Inflammatory diseases of any etiology act much faster and in some cases more destructive: necrotization of bone and cartilage tissue can disrupt supporting structures, deform ligaments and muscle attachments to the spine.

Therapeutic exercise can slow down and reverse degenerative processes in the spine and adjacent tissues, as well as correctly distribute the recovering tissues and give them the necessary strength during the regeneration period.

Therapeutic exercise (physical therapy) is a scientifically based set of physical activities designed to stimulate regenerative processes and prevent degenerative processes. As a type of functional therapy, exercise therapy is an effective component of complex treatment of all types of musculoskeletal disorders, diseases of the respiratory, cardiovascular and nervous systems.

Forms and methods of physical therapy

The familiar morning exercises or “exercises” are the first type of physical therapy that is recommended for adults and children to prevent diseases of the spine and joints. Daily exercise improves the trophism of muscle tissue, strengthens the cardiovascular and respiratory systems, tones and prepares the body for more serious physical activity. Morning physical exercise takes 10-20 minutes (the time required depends on the person’s condition and the complexity of the exercises).

Classes with patients are conducted according to two schemes: group and individual. Group exercise therapy is intended, first of all, for the prevention of degenerative diseases and rehabilitation after a course of treatment (with minimal damage to the musculoskeletal system). Patients are selected into a group according to their profile: level of load, set of exercises, duration of classes. Individual sessions with the patient are conducted according to a specially drawn up plan.

After a course of physical therapy, a physiotherapist and instructor evaluate the effectiveness of the classes, the patient’s condition and recommend repeated or special classes at home or in equipped rehabilitation centers.

In physical therapy, there are 2 types of exercises: active (performed by the patient without assistance) and passive (performed with the help of a specialist or mechanical simulators).

Active exercises, in turn, are divided into the following techniques:

• therapeutic walking (performed at a given speed, at an agreed distance; during the exercise, the heartbeat and breathing rate are monitored);
• health path (a complicated type of therapeutic walking with dosed ascent);
• sports exercises and games (gymnastic and athletic exercises performed according to a specific plan and under the supervision of a specialist instructor).

According to the level of load, training is defined as:

• therapeutic (exercises designed to form internal compensation to reduce stress on a damaged organ or part of the body);
• tonic (exercises aimed at improving trophism and accelerating the regeneration of damaged tissues);
• training (exercises aimed at restoring performance and endurance under increased loads).

Exercise therapy for degenerative diseases

Degenerative diseases of the spine do not have direct causes for development, such as infections, but violations of the integrity of the cartilage tissue of the intervertebral discs, facet joints and ligaments occur according to a certain scenario:

• degradation of the endplate between the vertebral body and the intervertebral disc that supplies and produces cartilage cells;
• dehydration and mechanical damage to the dense fibers of the annulus fibrosus (from the outer edge, the destruction moves inward, to the centrally located nucleus pulposus);
• reduction of the distance between the vertebrae (stenosis of the foramina, compression of the spinal nerve roots);
• protrusion of intervertebral discs, leading to hernial protrusion;
• degeneration of joint capsules (reduction of hyaline pads, deficiency of synovial fluid, sclerotization of the heads of the articular processes).

Age-related changes in cartilage and bone structures occur due to nutritional deficiency and a natural decrease in the rate of cell renewal. Therapeutic exercise solves the problem of slowing down degeneration by improving local blood circulation, toning tissues and increasing the elasticity of the ligamentous apparatus of the moving elements of the spine.

An important feature of degenerative diseases is incorrect posture: this is both one of the causes of the development of diseases and one of the most serious consequences. Spinal curvatures can affect the normal functioning of the internal organs of the chest, abdominal cavity and pelvic region. Exercise therapy corrects posture to prevent scoliosis, hyperlordosis and hyperkyphosis.

Stenosis of the intervertebral foramina, through which sensory nerve roots pass to the spinal cord, causes increased pain and at the same time partial loss of sensitivity in the limbs and internal organs. Spinal traction exercises help release nerve conductors and improve motor skills.

To prevent degenerative diseases of any type, moving, gymnastic and strength exercises, sports games, developing correct posture (static exercises), walking and health paths are recommended. Swimming is considered a sport that harmoniously develops all muscle groups of the back and limbs, and if there is a pool, it is always included in the course of treatment. The result of the exercises should be improved blood circulation, strengthening of the muscle corset, reduction of pain and correction of posture.

During the treatment of a developed disease and rehabilitation after a course of treatment, physical activity should be used in accordance with the training plan drawn up by an exercise therapy instructor (kinesiotherapist or physiotherapist).

• before starting the workout, perform warm-up exercises (it is possible to use light self-massage to reduce pain);
• at the initial stage, exercises are performed with minimal amplitude;
• It is recommended to perform movements smoothly, without jerking;
• training should be carried out regularly, without interruptions (daily short-term exercises are more useful for maintaining the plasticity of the spine).

The set of exercises depends on the location of the main lesion, but it is recommended to subject adjacent parts of the spine to stress in order to avoid expansion of the degeneration zone. The painful sensations that the patient experiences when performing exercises should not exceed in intensity the conditional indicator “tolerable pain”, i.e. The patient cannot be brought to the level of the “pain threshold”, because severe pain syndromes can reduce pain sensitivity and cause increased daily pain.

When stiffness of the limbs and contractures have developed, exercise therapy classes consist of passive exercises aimed at improving the mobility of the spine and joints. The attending physician prescribes exercises performed on special machines and with the help of a specialist.

Therapeutic exercise for inflammatory diseases of the spine

Inflammatory diseases of the spine differ from degenerative diseases by more extensive and complex tissue damage, which creates a number of tasks for physical therapy in restoring the musculoskeletal system:

• improving the innervation of affected and dependent parts of the body, increasing the tone of the nervous system;
• improving the mobility of affected joints and spinal segments;
• preventing atrophy of the muscles and ligaments of the back;
• improving blood and lymphatic circulation, accelerating metabolism and tissue regeneration;

Treatment of inflammatory diseases begins with anti-inflammatory and anti-infective therapy. During acute inflammation, bed rest is recommended to minimize the rate of blood circulation (to avoid hematogenous spread of infection throughout the body). Bed rest involves positioning the body with the limbs maximally extended to prevent contractures of the flexor muscles.

After active drug treatment, the subacute phase of the disease begins, regression of inflammatory processes. A patient who is able to perform independent movements is prescribed simple exercise therapy to maintain muscle tone and spinal mobility. For a patient who is unable to rise without assistance, passive exercises are prescribed to adapt to future loads and improve the mobility of the affected joints and ligamentous-muscular system. Massage and physiotherapy (electrical stimulation, phoresis with drugs) reduce pain syndromes and improve muscle trophism.

• Start each workout with a warm-up to warm up the ligaments. Massage will help you get rid of painful sensations during your first workouts;
• exercises should be simple, monosyllabic (without twisting elements);
• at the initial stage, all movements are performed with a minimum amplitude, slowly. As the condition improves, the range of movements can be increased, focusing on the intensity of the pain syndrome.

In the presence of serious contractures, training begins with passive exercises using special techniques (traction). When stretching, it is recommended to relax the muscles of the limbs and back as much as possible.

Doctor S.M. Bubnovsky developed a set of exercises aimed at restoring motor functions of the spine and large joints affected by degenerative diseases, as well as postoperative rehabilitation and restoration of musculoskeletal mobility. The doctor’s personal experience (consequences of severe injuries and disability) and the extensive scientific and practical work embedded in the technique helped many people who had lost hope of restoring mobility to return to a normal lifestyle. The technique is called “kinesitherapy” - “treatment with movement”.

According to the doctor-author of an effective system of exercises, the human body contains everything necessary for the restoration of all tissues of the musculoskeletal system, and for this there is no need to resort to the use of complex biochemical substances (medicines and stimulants) - it is enough to “awaken” hidden reserves - regenerative processes - with the help of precisely calculated physical activity. Strength and stretching exercises can tone, improve blood circulation and supply the necessary “building materials” to cartilage and muscle tissue.

The task facing the kinesitherapist is to study the problems created by the disease, identify weak points (joints, ligaments and muscles) and develop a set of exercises that develop the marked part of the body. The specificity lies in the calculation of loads and directions of movements that maximize the use of the developed mobile unit of the musculoskeletal system.

A set of exercises to suppress pain in the back and joints is performed by the patient independently. Stretching, bending and loading exercises on the abdominal muscles (antagonists of the spinal muscles) improve the trophism of all muscles and reduce pain caused by “radicular syndrome”.

Particular attention is paid to training the deep back muscles responsible for the correct position of the vertebrae and posture. The development of muscle strength in this group provides not only high-quality stabilization of the spinal column, but also improved blood circulation in the back of the spine.

Doctor S.M. Bubnovsky designed a complex simulator with which the patient has the opportunity to train any individually selected muscle group and work out any joint. “MTB” (“Bubnovsky’s Multifunctional Trainer”) is made up of blocks and weights (gravity mechanism). It can be used in lying, sitting and standing positions. The exercises are based on pull-ups “towards you” and “away from you”. As the patient’s condition improves, it is necessary to perform complex movements, with an element of “twisting”.

Another component of the technique is cryoprocedures, “hardening” with very cold water or very cool air. Short-term exposure to ultra-low temperatures on the surface of the body stimulates the body, improves blood circulation, and increases the flow of oxygen into tissues.

The kinesiotherapist develops an individual set of exercises based on a comprehensive examination (x-rays, measuring the maximum loads that the patient can bear) and “guides” his client throughout the entire course of treatment: notes progress and difficulties, introduces new exercises. The effect of the exercises is the cessation of degenerative processes in the cartilaginous tissues of the intervertebral discs, joints and ligaments, an increase in the patient’s muscle strength and relief from pain in the back and limbs.

Methodology V.I. Dikulya: restoration of mobility

Doctor med. Sciences V.I. Dikul developed a method for restoring and maintaining mobility of the musculoskeletal system affected by spinal fractures, intervertebral hernias and operations. Physical exercises using the Dikul method are indicated for rehabilitation after injuries and operations, getting rid of contractures and improving the elasticity of ligaments. Exercises have also been developed for patients with cerebral palsy.

According to the method, treatment is divided into three stages:

1. Preparatory: over the course of several training sessions, the patient adapts to various loads (cardiological, respiratory and physical). Breathing exercises, yoga, Pilates.
2. Therapeutic: exercises and loads are aimed at increasing the tone of the “muscle corset” of the body and reducing pain.
3. Trainer: exercises increase muscle strength in the affected area of ​​the body, improve the elasticity of ligaments and joint mobility. The patient receives an individual complex for working at home.

During the treatment, stimulating procedures are used: massage, physiotherapy, acupuncture, drinking mineral water to maintain salt balance in the working body.

Having himself suffered a compression fracture, threatening paralysis of the lower extremities, V.I. Dikul restored the mobility of the spine and developed amazing muscle strength, which made him an example of the effectiveness of his own technique.

Doctor V.I. Dikul and S.M. Bubnovsky agreed that the human body is a self-healing system, and proved that healing the most complex lesions of the spine requires not so much medications and complex equipment as the will and desire to control one’s own body.

Articles on the topic

One of the important components of medicine is therapeutic exercises. Movement is the basis of health, a stimulator of growth and development of the body. Exercise therapy is an integral part of the rehabilitation period, since exercises are aimed at rapid recovery from illness.

Exercise therapy (therapeutic physical education) in medical practice is a therapeutic and prophylactic method that helps the body recover from illnesses, as well as prevent their development.

Physical activity for each patient is selected individually, based on age, health status and other factors. Physical activity restores the functionality of many organs and systems and affects the patient’s psycho-emotional state.

The main benefits of physical therapy exercises:

1. Normalization of metabolism.
2. Restoration of water-salt balance.
3. Formation and consolidation of new skills.
4. Reduced pain.
5. Improved blood circulation.

In addition, physical therapy helps strengthen and heal the body, stimulate blood circulation in the pelvis, and also prevent congestion in the abdominal cavity.

The exercise therapy instructor selects special physical exercises depending on the individual characteristics of the patient.

This method of rehabilitation strengthens muscles, normalizes motor and absorption function.

Therapeutic physical education classes are used in the following areas:

• Traumatology
• Cardiology
• Pulmonology
• Neurology
• Gynecology

Exercise therapy methods are widely used for various diseases of the digestive system: colitis, gastritis, ulcers, liver pathologies, etc.

In most cases, forms of exercise therapy are used in orthopedics and traumatology. Medical gymnastics helps get rid of scoliosis, osteochondrosis and other postural diseases.In traumatology, therapeutic exercises accelerate wound healing, stimulate the functions of damaged limbs, help with diseases of the musculoskeletal system and joints, as well as in the treatment of contractures.

In pediatric practice, medical gymnastics can reduce the manifestation of paralysis and possible spinal defects.

Physical exercises are of great importance in rehabilitation treatment for lung diseases. Exercises help to activate blood circulation, restore the rhythm of breathing movements, and increase the depth of breathing.

Therapeutic physical culture is actively used for pathologies of the heart and blood vessels. In addition, rehabilitation specialists have developed programs for heart defects, coronary insufficiency, high and low blood pressure.

Useful video - Review of exercises to perform after a heart attack:

Exercise therapy has found wide application in diseases of the nervous system, neuroses, and paralysis. In gynecological practice, therapeutic exercises are used not only in the treatment of gynecological diseases, but also in the prenatal and postpartum period.

Therapeutic exercises are prescribed in the preoperative period on the abdominal cavity and chest area. The complex includes the following classes: correct diaphragmatic breathing, breathing and general development exercises. Exercise therapy is of particular value during the rehabilitation period. Exercises quickly restore the impaired functions of the affected organ.

Forms and types of exercise therapy

The main forms of exercise therapy include:

1. Morning exercises. Performed at home after waking up. The exercises should not be difficult and are selected based on the patient’s degree of load and physical development. In the morning, classes last about 10-30 minutes. The set of classes includes exercises for various muscle groups. It is useful to combine with short exercise in the fresh air.
2. Physiotherapy. Gymnastics classes are aimed at restoring the function of the body or an individual organ. Each lesson has an introductory, main and final part. At the first stage, the patient is prepared for increasing load, and at the final stage, breathing exercises are performed, as well as exercises aimed at the middle muscle groups. All this helps reduce physical stress.
3. Exercises in water. Hydrokinesitherapy or aquagymnastics has a positive effect on the patient’s condition. Classes help relieve pain, restore poor posture, get rid of osteochondrosis, arthrosis and other diseases of the musculoskeletal system. Exercises can be performed with special equipment.
4. Health running. One of the accessible and simple types of cyclic exercises that has a beneficial effect on the functioning of the cardiovascular system. Jogging can be alternated with walking and breathing exercises.
5. Therapeutic walking. Helps normalize gait after injuries, diseases of the musculoskeletal system, etc. Walking can be dosed according to the length of the distance, speed of movement, and also taking into account the terrain.

In addition, therapeutic physical culture includes a set of physical exercises for independent performance, a health path (dosed walking and climbing), physical culture performances, excursions and holidays. These forms are used after final recovery for prophylactic purposes in sanatoriums, resorts, etc.

To achieve the best effect, not 1-2 methods are used, but a whole complex in combination with massage and water therapy.

Most exercises are selected and performed according to an individual program.Classes can be conducted individually or with a group. The first type of classes is usually carried out for seriously ill people. During individual classes, the doctor can control the load and dose the exercises.In many cases, the group method of exercise therapy is more common. Groups are formed taking into account the disease and its stage. Classes are usually attended by 10-15 people, but small groups of 3-5 people can also be formed.

There is also a consultative method of conducting exercise therapy. Typically, the patient performs independent exercises at home, if for some reason he cannot attend group classes, or continues rehabilitation after illness at home. The patient masters a set of exercises under the guidance of a qualified specialist, and then continues to perform them at home.

Contraindications

When choosing exercises, the doctor takes into account many factors: deviations in mental development, concomitant diseases that are undesirable to perform if the underlying disease is present.

Physical therapy exercises are contraindicated in the following cases:

• Bleeding (external or internal).
• Complications after surgery.
• The patient's serious condition.
• Heart rhythm disturbance.
• High blood pressure.
• Increased body temperature.
• Neoplasms.
• Pronounced pain syndrome.

It is prohibited to perform therapeutic exercises in cases of increased ESR of unknown origin, progressive diseases, inflammatory and infectious diseases, as well as in the presence of a foreign body near large vessels. When prescribing exercise therapy, indications and contraindications should be taken into account, since the form and method of therapeutic exercises are selected with this in mind.

Unfortunately, even young children are not immune from problems with the spine and poor posture, because modern children spend more and more time with their parents at home watching TV or with a phone and tablet in their hands. And such a lifestyle will certainly affect the condition of the child’s musculoskeletal system. But if it is problematic for adults to correct the curvature of the spine, then in children this is all possible with the help of exercise therapy. This is physical therapy that compensates for the lack of physical activity. We will look at what features it has in children and what benefits it brings in our article.

What is exercise therapy

This is a set of exercises that is more reminiscent of yoga because it is performed smoothly and slowly. The basis of physical therapy is the use of the main function of our body - movement. The whole complex consists of selected exercises combined with proper breathing.

Exercise therapy was identified as a separate branch of medicine only in the 20th century, but Plato also noted that movement is the same healing power as medicine. Therapeutic exercise is not only exercises, but also water procedures, regular walking, and outdoor games.

Positive aspects of exercise therapy

In order for the body to develop normally, it is important not only proper nutrition, but also constant physical activity. Adults often forget about this when they start scolding their kids for being too active. Exercise therapy for children is not just physical therapy, it also plays an educational role:

• The child receives some hygiene knowledge.
• Knows the world around him better.
• Learns to relate himself to the world around him.

What benefits does physical therapy give to a child? This is a question parents often ask, believing that only serious sports can bring benefits. But this is far from true. Physical therapy exercises:

• promote the harmonious development of the musculoskeletal system;
• posture is formed correctly;
• strengthens the back muscles;
• If there is asymmetry in posture, correction occurs.

Exercise therapy is a complex that can prevent posture problems. Therapeutic exercise develops endurance, strength, and improves coordination of movements.

Also thanks to exercise therapy:

• immunity is strengthened;
• the body becomes less susceptible to various pathogens;
• the child adapts better to school;
• the functioning of the whole organism is normalized;
• sleep and appetite improves.

Children especially need exercise therapy for diseases of the musculoskeletal system. But preliminary consultation with a specialist is necessary to select an effective complex.

Types of exercises

Some believe that physical therapy is an ordinary gymnastics complex, but experts say that any active recreation can be classified as exercise therapy. Often classes with children are held in a playful way so that the kids find it interesting.

All exercises included in the complex can be divided into:

1. Are common. They are used to strengthen the entire body.
2. Special exercises are aimed at a specific system, for example, exercise therapy for fractures will promote rapid healing and restoration of mobility of the damaged limb. If there is scoliosis or flat feet, then exercises are selected to correct these pathologies.

All exercises can also be divided into groups:

• Active movements.
• Static holding poses.
• Passive. These exercises are usually included in the complex for infants, because the baby cannot yet do them on his own.

The nature of the exercises also differs; they are:

• Respiratory.
• Relaxing.
• Stretching.
• Corrective.
• Coordination.

Taking into account what abnormalities the child has in the musculoskeletal system, the specialist selects a set of exercises.

Contraindications for exercise therapy

Despite the enormous benefits of therapeutic exercises, it is not indicated for all children; contraindications include:

• The presence of any pathologies in acute form.
• Malignant tumors.
• Frequent bleeding.
• Heart disease.
• Heart rhythm disturbances.
• The child is not feeling well.
• Heat.

Even in the absence of contraindications, if a child gets sick with a common cold, then it is worth interrupting exercise therapy for several days and resuming after recovery.

Features of children's exercise therapy

Since classes are conducted with children, the instructor must prepare thoroughly. It is important to choose as many exercises as possible in a playful way. But you still need to consider the following points:

• Age of kids.
• Level of physical development.
• State of mind.
• Development of fine motor skills.

Therapeutic gymnastics contributes not only to the correct formation of posture in a child, strengthening the body, but also to the normalization of the cardiovascular system.

Some rules for exercise therapy

This is a complex that must be performed in compliance with certain rules that can make classes more effective:

• Before the first lesson, you must visit a doctor, because if there are serious pathologies of the musculoskeletal system, medical attention may be required.
• Classes should be conducted by specialists who can adequately assess the child’s condition.
• It is necessary to load the baby gradually.
• Exercise therapy exercises should not cause pain to the child when performed.
• To make it more interesting for children, it is necessary to select a variety of exercises and include playful moments.
• You should not start performing the complex immediately after eating; at least 45 minutes should pass.

• It is necessary to practice in a room that is well ventilated.
• If the complex is done with a baby, then it should begin and end with a pleasant stroking, but for older children, relaxation and breathing exercises are done at the beginning and end of the complex.
• Some people believe that the exercise therapy complex does not require a warm-up, but this is not so. It is also divided into introductory, main and concluding parts.
• A course of exercise therapy is usually prescribed by a doctor and can be repeated several times throughout the year.

Features of exercise therapy for scoliosis in a child

Considering that our children now spend much more time looking at computer monitors than in active movement, it is not surprising that many already have incorrect posture in elementary school. If everything is still not so advanced, then there is every chance of returning the child’s straight back.

To do this, it is important to choose the right exercises, and only an orthopedist who needs to be visited can do this with knowledge. In serious cases, not only gymnastics may be required, but also the use of a special corset.

Depending on the type of spinal curvature, exercises are selected:

1. If thoracic kyphosis is diagnosed, then exercise therapy for children must include exercises to strengthen the muscles of the shoulder girdle, as well as stretching the chest muscles.
2. If you have a flat back, you need to choose exercises so that the muscles of the back, legs, and shoulder girdle are evenly strengthened.
3. Scoliosis requires exercises to increase the mobility of the spine, improve coordination of movements, and stretch the spinal column.

Exercise therapy for the shoulder and lumbar regions is not important; it requires that the exercises be performed regularly. If you practice only a couple of times a week, there will be no effect.

Approximate complex for preschoolers

It has already been noted that for children it is necessary to include many playful moments in the complex, but we can highlight the main exercises:

1. You need to start the complex with a warm-up. You can start by walking with your knees raised high for a few seconds, on your toes and heels.
2. Swinging your arms to the sides, simultaneously rise on your toes.
3. Exercise with a gymnastic stick. Lift her off the floor, lift her up with outstretched arms and put her back on the floor.
4. Swing your legs from a position lying on your stomach, while your pelvis should not lift off the floor.
5. Exercise "swallow".
6. Half squat, bending your knees, and move your arms back, returning to the starting position. Your back should be straight during the exercise.
7. Movement coordination exercise: take turns standing on one leg with your arms spread to the side.

Exercises can be done using various gymnastic equipment, for example, jump ropes, balls, hoops.

Sample complex for schoolchildren

After warming up, you can begin to perform the following exercises:

1. Lower and raise your hands with the ball, while your elbows should be spread to the side.
2. Keeping your back straight, you need to lower and lift the ball behind your head.
3. Place one hand behind your back from above, and the other from below and try to fasten them into a lock.
4. Bend to the side with arms spread to the side.
5. Take a position lying on the floor and arch your back without lifting your pelvis.
6. From a kneeling position with emphasis on your hands, bend and round your back.
7. Lie on your stomach and simultaneously raise your legs and shoulders, holding for a few seconds.
8. Exercise "bicycle".

After finishing the complex, you must walk around and do breathing exercises. During classes, the trainer must monitor the correct execution of the exercises, breathing and the position of the child’s back.

Poor posture is not a death sentence. If parents pay attention to this in a timely manner, the special complex will not only quickly return a straight back to the child, but will also strengthen the entire body.

The French philosopher Voltaire gave humanity a wise saying back in the 18th century: “Movement is life.” It is difficult to disagree with a great thinker when your back hurts or your legs ache, and life turns into a nightmare. Thus, without any doubt, we can consider therapeutic physical culture a clear embodiment of Voltaire’s intelligent thought and an effective method of returning the joy of movement to a person.

Exercise therapy as a clinical branch of medicine

Few of us know that doctors classify physical therapy as a separate clinical section, which studies the treatment and prevention of diseases using physical education methods. As an independent scientific discipline, exercise therapy, according to the state standard, has been assigned a scientific specialty code number 14.00.51. This means that physical therapy is included in the list of medical sciences, which allows us to talk about it as a scientifically based method of combating various diseases.

Specialists involved in exercise therapy are trained in medical universities at the medical and pediatric faculties. Additional areas of training in the discipline include: and massage. The main means of physical therapy or exercise therapy are all types of physical activity, including swimming, games, bath procedures, tourism,.

Beneficial effects of exercise therapy

By stimulating the body's natural reflexes, a set of therapeutic exercises has a special effect on it, helping:

• activate its physiological functions;
• improve the adaptation of organs and tissues to new conditions;
• speed up recovery processes;
• normalize metabolism;
• normalize water-salt metabolism;
• improve psycho-emotional mood;
• stop the development of the disease;
• increase resistance to negative external factors.

The effect of exercise therapy can be general and localized, which is supported by patients performing physical exercises that correspond to the indications.

Treatment mechanism

The therapeutic value of special physical exercises is that they have a multi-level positive effect on all human tissues, organs and systems. Doctors identify the following mechanisms of therapeutic effect from exercise therapy:

1. Toning. By having a stimulating effect on the nervous system, exercise therapy improves its functioning and stimulates the functions of the endocrine system and other organs. Training has a positive effect on the emotional state of the patient, toning the entire body.
2. Trophic action. Negative processes occurring in the body during illness negatively affect organs and tissues, changing their cellular structure. Disturbances occur in metabolic processes. Therapeutic exercises trigger cell regeneration and have a beneficial effect on the functions of the cardiovascular and respiratory systems, which leads to increased metabolism. The process of resorption of pathological formations and the growth of healthy tissues and blood vessels is underway.
3. Formation of compensation. Exercise therapy helps replace functions lost due to illness, improves the condition of tissues and organs, and allows the body to adapt to new living conditions with minimal negative consequences. Shortness of breath disappears and stabilizes.
4. Normalization of functions. Partially or completely lost functions are restored. There is a large-scale improvement of the body.

Conclusions on the therapeutic effects of exercise therapy are made on the basis of many years of observations and research. All systems of human life are closely interconnected, which allows physical therapy methods to carry out healing work at all levels.

Contraindications

As with any other medical methods and means, there are contraindications for exercise therapy. Experts do not recommend physical therapy if the patient:

• the temperature has risen;
• risk of bleeding;
• severe pain when doing exercises;
• serious condition.

The decision to use exercise therapy or refuse it is made by the attending physician, who bases it on the individual indications and condition of the patient at the time of its adoption.

Useful video - Therapeutic physical training at home

Types of funds

The main means of exercise therapy for various diseases and injuries are various exercises designed for targeted impact on problem muscle groups and joints. The physical activity received by patients during these exercises is divided into ideomotor and gymnastic. The first types of therapeutic exercises are in the area of ​​mental processes and are used for rehabilitation. The latter are aimed at developing endurance, strength, restoring impaired coordination and improving the mobility of joints and the limbs of the body in general.

Therapeutic gymnastics exercises can be of the following nature:

1. Statistical and dynamic. With static muscle tension, the patient holds himself in a certain position for some time. In dynamic movement, when performed from various starting positions, muscles are trained for strengthening and joints for mobility.
2. For stretching and relaxation, helping to relieve muscle tension and correctly distribute the load.
3. Active and passive. The first type is performed by the patient himself, the second is performed by the doctor. Methods of passive physical exercises are included in the treatment complex for paralysis and paresis.
4. Separately for different parts of the body. They are used for minor lesions and improve the functions of a specific area of ​​the body.

According to the form of execution, they can be preparatory, balance or corrective. The combined use of gymnastic and breathing exercises gives a general healing effect, relieves congestion and improves the functioning of all systems. Corrective movements work on the spine, improving posture and mobility.

Varieties of forms

When developing a complex for the entire period of treatment for an individual patient, it includes various forms of exercise and exercise therapy. The goal pursued by specialists is to carry out comprehensive rehabilitation of the body, prevent the development of diseases and restore motor activity to the patient. The objective application of forms used to restore body functions using physical therapy methods is clearly shown in the table:

If exercise therapy means are used for children, then their forms are of a playful nature. For example, as forms of exercise therapy, volleyball or football on the sandy bank of the river. Walking on uneven surfaces helps correct it. Swimming lessons are useful for teenagers to help cope with poor posture and signs of scoliosis. Horse dressage is recommended for sick children.

Whatever form the doctor and patient choose for exercise, they must be dosed and take into account the general condition of the body. At the peak of the development of the disease, loads are dosed to a minimum and are aimed at creating compensation and preventing complications. The intensity of the loads used during the recovery period increases significantly. The process does not end after the main task is completed. Exercise therapy retains its healing function and is beneficial at any age.

Video - Exercise therapy, basic exercises to improve health

• Individual approach to the patient in accordance with his motor capabilities and condition.
• Consciousness – a meaningful attitude of the patient to the proposed physical exercises, the direct active participation of the patient himself in the process of performing physical exercises and monitoring the correctness of their implementation, which is achieved by a skillful explanation of the methodologist.
• Visibility – demonstration of physical exercises combined with explanation.
• Systematicity – regularity of exercises with a gradual and consistent increase in load: from simple exercises to more complex ones, from known to unknown (in each lesson, include one complex new exercise or 2 simple ones).
• The principle of consolidation of skills – engage in physical exercise constantly so as not to lose the results achieved.
• Cyclicality alternating exercise with rest.

Forms of therapeutic physical culture

• Hygienic (morning) gymnastics prepares the body for daytime activity after sleep, which reduces the activity of nervous processes and muscle tension. During sleep, pulse and breathing become slower, the activity of nervous processes decreases, intestinal motility slows down, digestion processes slow down, and metabolism decreases. Hygienic gymnastics is designed to activate all these processes. Classes are held before breakfast, in the absence of contraindications (as determined by the doctor), in a ventilated room in light clothing that does not restrict movement, for 15-20 minutes, preferably to the accompaniment of music.
  The gymnastics complex consists of 10-15 exercises from various starting positions for all muscle groups, including exercises for coordination, flexibility, relaxation, correcting posture, and self-massage. The load must correspond to the state of health, age, gender, and physical development. For men, it is recommended to include strength exercises: with dumbbells, expanders, with moderate static tension; for women – exercises to develop flexibility, strengthen the abdominal muscles, pelvic floor; the elderly should avoid strength exercises, widely use breathing exercises and muscle relaxation, self-massage of the head and neck to improve blood supply to the blood vessels of the brain; children should include exercises to correct posture, develop flexibility, coordination of movements and balance.
• Physiotherapy– the main form, which also includes independent exercises by patients (fractional load), in which mainly gymnastic exercises are used for therapeutic and prophylactic purposes.
• Walks(walking, skiing, cycling, boating).
• Close-range tourism– hikes for 1-3 days reduce tension in the nervous system and improve autonomic functions.
• Healthy running (jogging), during which all skeletal muscles are involved and the nervous system experiences significant tension.

Class organization methods

• Individual (with seriously ill patients).
• Group (based on the principle of the uniform nature of the disease or injury and the level of the functional state of the body).
• Independent.

Each lesson includes three sections: introductory, main and final. Introductory section(warm-up) consists of several general developmental exercises, sequentially covering all muscles, takes 10-20% of the total time. Main section takes 60-80% of the total time, consists of special exercises in relation to this disease, which must be alternated with general developmental exercises. Final section takes 10-20% of the total time. The load is gradually reduced in order to normalize the increased activity of the cardiovascular and respiratory systems (slow walking combined with deep breathing).

Movement Modes is determined by the attending physician strictly individually.

For hospitals

Mode I

• Strict bed rest prescribed for seriously ill patients - light massage, passive exercises for the limbs with partial and full range of motion 2-3 times a day for 5-10 minutes and deep static breathing every hour.
• Extended bed rest prescribed when the patient’s general condition is satisfactory. Active eating and active toileting, independent turns on one side, transition to a sitting position in bed 2-6 times a day for 5-40 minutes, basic exercises for the limbs with breathing exercises are allowed.

Mode II

• Semi-bed (ward)– stay in the ward out of bed sitting 50% of the time, moving around the floor, walking slowly (at a speed of 60 steps per minute) at a distance of 100-150 m. Therapeutic exercises are performed according to individual indications: in the initial position lying, sitting, standing, or with objects weighing up to 0.5 kg. Gradually include exercises for the trunk muscles. Duration of classes is 20-25 minutes.

Mode III

• Free– walks within the hospital, for a distance of up to 1 km at a speed with rest every 200 m at a speed of 60-80 steps per minute. Classes are held in the exercise therapy room for 25-30 minutes. Use objects weighing up to 1 kg, games.

The pulse rate in adults should not exceed 108 in adults and 120 beats per minute in children.

For clinics, sanatoriums and resorts

• Gentle (for exhausted, overworked and convalescing) – similar to free mode. Dosed walking on level ground for a distance of 1.5-3 km at a slow to medium pace is also allowed, resting every 10-20 minutes, swimming with the use of support devices for 10-20 minutes.
• Gentle-training– physical activity is made more difficult, exercises are performed for 30-45 minutes, with objects (weighing up to 3 kg), on apparatus. Prescribed dosed walking on level ground at an average and fast pace for an hour for a distance of up to 4 km, a health path with an elevation of 5-10 degrees for a distance of 2-3 km for 1 hour with rest every 10-15 minutes, swimming for 10 -30 minutes. They use rowing boats, volleyball, badminton, and tennis.
• Coaching The regimen is prescribed to persons without significant deviations in health and physical development, that is, practically healthy people. The physical activity is great; dosed walking and running are prescribed. Sports games are played according to general rules. An increase in heart rate up to 120-150 beats per minute (in the elderly up to 120-130 beats per minute), an increase in systolic blood pressure up to 150 mm Hg is acceptable. Art., reducing the minimum to 55 mm Hg. Art.

Physical therapy is indicated for almost all diseases.

General contraindications to the use of physical therapy are:

• general serious condition of the patient;
• risk of bleeding;
• unbearable pain when performing physical exercises;
• febrile and acute inflammatory diseases;
• malignant tumors.

Exercise therapy is prescribed by the attending physician; a physician-specialist in exercise therapy selects the methodology, determines the nature of the classes, dosage and controls the performance of physical exercises. The procedures are carried out by exercise therapy instructors, guided by the doctor’s recommendations regarding the nature of the disease.

Amount of physical activity must correspond to the patient’s condition and physical capabilities. The overall intensity of physical training depends on the patient's individual tolerance to physical activity.

In the selection and application of general strengthening and special targeted exercises, the clinical manifestations of the disease or injury and the methodological principle - from a healthy organ to a sick one - are taken into account. The optimal combination of general and specific (local) is used in exercise therapy for any pathology, but it is especially important to take this into account in orthopedics, traumatology and neurology. The total load should be distributed evenly and consistently across all muscles to prevent fatigue and improve blood circulation. The load is adjusted based on the physiological curve - the pulse rate during the session, which is recorded graphically. Dosage depends on the number and location of the muscles involved in the exercises, the form of movement, amplitude, strength, rhythm, tempo of movements, duration of exercise and complexity of the exercises. For each patient determine:

• density of classes(the time of actual exercise, expressed as a percentage of the total exercise time) for inpatients should not be higher than 50% (in the first days of classes it is 20-25%), in other cases a density of up to 80-90% is acceptable;
• (ANDP) starting positions (lying, sitting, standing). IP lying on the back, on the stomach, on the side provides stable balance, maximum relaxation of skeletal muscles, facilitates the performance of exercises, is prescribed to patients on bed rest, for diseases of the spine. IP while sitting eliminates significant static tension in the muscles of the lower extremities, creates freedom of movement of the limbs, neck and torso, and is prescribed for weak patients and for diseases of the lower extremities. Standing IP is characterized by a high center of gravity and a small support area. Balance is maintained with the direct participation of different parts of the nervous system due to the contraction of many muscles of the body. The most stable position is a standing position with legs wide apart;
• number of muscle groups participating in the exercise, selection of exercises for them, the ratio of breathing exercises to general strengthening and special ones aimed at restoring impaired functions (1:1, 1:2, 1:3, 1:4, 1:5). You should start with exercises for small muscle groups. When performing complex exercises, the load increases. The more breathing exercises, the less the load. To develop muscle strength (paresis and wasting), isometric exercises with high tension and dynamic exercises are used, which are performed slowly but with great resistance;
• number of repetitions of each exercise, pace (slow, medium, fast) and range of motion in the joints;
• duration of the lesson. The total duration of an individual lesson is 5-20 minutes, a group lesson is 15-40 minutes;
• independent studies– performing special exercises throughout the day;
• use of game exercises, music– to create positive emotions, objects and equipment in order to change the load. Thus, exercises with a gymnastic stick reduce tension in the muscles of the sore arm and increase the load on the muscles of the healthy arm.

Normally, during exercise, the possibility of increasing the intensity of the load is felt, there is no discomfort or pain in the chest, an increase in the normal rate of breathing, loss of coordination, pallor, or heart rhythm disturbances. Immediately after exercise you feel “muscular joy”, you should feel good. The time for recovery of heart rate and blood pressure to initial values ​​in healthy people should not exceed 3 minutes. During the break between loads there may be slight fatigue, but no more than 2 hours, there are no sleep or appetite disturbances, local fatigue persists for no more than 12 hours.