Lfk basics. Exercise therapy means. Classification of physical exercises in exercise therapy and their characteristics
1.2. Indications and contraindications for the use of remedial therapy
Exercise therapy is indicated for almost all diseases and injuries. The improvement of methods of treating patients in recent years expands the possibilities of using exercise therapy and allows it to be used at an earlier date, even for those diseases for which it was not previously used. This is also facilitated by the development of new methods of exercise therapy.
Contraindications to exercise therapy are divided into absolute and relative. Concerning absolute, then their circle is extremely small: it is absolutely impossible to use exercise therapy for malignant neoplasms, for certain mental states, etc. relative contraindications, then they, in turn, are divided into temporary and contraindications by means. Temporary contraindications involve refusal to use physical exercise under certain conditions of the patient, when it is undesirable to activate the physiological processes in the body. So, exercise therapy cannot be used in the acute period of the disease, in the general serious condition of the patient, at high temperatures, with severe pain, with the danger of severe bleeding, with intoxication, with a sharp decrease in the adaptive capabilities of the body, etc. As for contraindications by means, they imply a refusal to use certain types of physical exercises or modes of their use, starting positions for a given disease or injury. For example, in case of deformations of the musculoskeletal system during exercise, one should avoid the initial standing positions and especially sitting. In case of hypertension, exercises of a speed-strength nature, with straining, etc., should be excluded from the remedies used for exercise therapy.
1.3. Movement and health
What is the reason for the effective use of physical exercise in clinical practice? Without a doubt, the fact that the very physical activity is an integral attribute of a living organism, its improvement and development.
1.3.1. Evolutionary prerequisites for motor activity
Analysis of the conditions of evolution of the animal world shows that the main one among them was the change in the environment. At the same time, for survival, animals required more and more perfect forms of movement. And this is natural, since it was movement that turned out to be the main condition for preserving and ensuring life: maintaining thermal stability, obtaining food, protecting (passive or active) from enemies and realizing the instinct of reproducing offspring (it is these four aspects of life that constitute the basis of animal life). Naturally, therefore, environmental changes conditioned the improvement of adaptation of animal organisms in evolution precisely through the complication of the forms of movements, and this, in turn, led to corresponding changes in the anatomy of the musculoskeletal system and in the functional systems for ensuring motor activity. So, the appearance at a certain stage of the development of our planet of land and the emergence of fish on it made it difficult for the conditions of their movement, which led to the appearance of lever limbs. The more complex forms of movements required their more perfect nervous regulation, which led to a sharp leap in the development of the forebrain; the need for a more adequate blood supply led to the emergence of a three-chambered heart, and the need for a higher level of gas exchange led to the appearance of lungs ... This is how, apparently, amphibians appeared.
Thus, muscle activity is one of the mechanisms of integration (unification) of the functional systems of the body, their "attunement" to a given level of activity. Violation of this mechanism leads to a functional reorientation, when each of the systems begins to work primarily to provide, to compensate for the weakest link in the body, which at the moment is distinguished by the greatest stress of function. Those. in this case, it is not the natural activity of a person that becomes the regulator of the vital activity of the organism, but the dominant (due to its weakness, working in the most intense mode) morphological and functional focus. In a sick organism and in a person in a “third state” (ie, transitional from health to illness), such a focus should be a pathologically (or functionally) altered system.
Arising in the process of evolution the leading role of the movement was entrenched in the mechanisms of ontogenetic development. In the studies of I.A. Arshavsky, it was convincingly shown (1967) that in the process of intrauterine development, the establishment and formation of functional systems, as well as the whole organism, are predetermined by the motor activity of the fetus, which, in turn, depends on the lifestyle of the pregnant woman. And after birth the full development of an individual's genetic program is primarily determined by his adequate motor regime.
Survival in the animal world is associated with the need for a constant struggle for existence, requiring periodic, but systematic maximum manifestations of adaptive reserves with an appropriate level of motor activity. But this requires the most complex coordination of all functional systems, which ensures the activity of the organism as a whole. That is why in the animal world the strongest survives and gives the most viable offspring - the one who is stronger, more agile, faster, i.e. one who is of higher physical condition. Moreover, the very struggle for existence predetermined, in the opinion of physiologists, a certain level of physical activity that an animal needs to survive (it is assumed that for a person weighing 70 kg, such a minimum is about 1600 kcal of energy expenditure per day) 1.
The evolutionary dependence of the preservation of life on motor activity has become entrenched in the genetic code of an animal organism, including humans. That is why I.A. Arshavsky noted that "the life of the organism, its growth and development are governed by physical activity." That is why in each age period the level of physiological activity and the viability of the organism are determined to a large extent by the current motor activity and the state of skeletal muscles.
During the overwhelming time of human existence on Earth, the very conditions of life demanded from him the implementation of a genetically predetermined requirement for movement, since in order to preserve life he had to recruit an evolutionarily justified norm of motor activity in search of food, protection from enemies, etc. In recent decades, especially during the period of active introduction into production and everyday life of machines and mechanisms, in all to a greater extent a person frees himself from the need to move (Table 1).
Table 1
Changes in the ratio of the types of energy used in the course of the socio-economic development of mankind (in %, by I.V. Muravov, 1987)
The table shows that over the past century and a half, the share of human and animal muscle energy in the energy supply of technological processes has decreased to an insignificant level. Comfortable dwellings, the development of a network of transport communications and many other achievements of civilization ultimately led to such a low level of physical activity modern man that there was reason to call him "an active bum": he works not with his muscular energy, but mainly with the strength of his mind.
Lack of movement - hypokinesia - causes a whole complex of changes in the functioning of the body, which is usually denoted as hypodynamia. The causes of hypokinesia can be both objective (physiological, professional, clinical) and subjective (everyday, educational, partly - climatogeographic). But regardless of the type of hypokinesia, the hypodynamic consequences caused by it are quite definite and natural. The fact is that, according to the “law of convolution of functions as unnecessary” I.A. Arshavsky, the capabilities of any body system correspond to the level of activity demanded from it, the material base for which is the activity of the DNA and RNA of the cell and the enzymes that provide them. A decrease in the level of functioning of the system leads to atrophy and / or dystrophy of its tissues with a decrease in functional reserves. Therefore, there is nothing surprising in the fact that as a result of hypokinesia, almost all functional life support systems, the activity of which is determined precisely by movement (respiration, blood circulation, blood composition, digestion, thermoregulation, endocrine glands, etc.) and which work "for movement", all in less in demand in their maximum capabilities. Hence - and those health problems that are associated with physical inactivity. In general, they can be presented as follows.
A decrease in human motor activity, as shown by the example of volunteers who agreed to forced long-term (from two weeks to three months) immobilization, leads to a compensatory restructuring of all sides of metabolism: mineral, fat, protein, carbohydrate, water. Physical inactivity causes noticeable changes in the immunological properties of the body and in thermoregulation.
Fundamental changes as a result of hypokinesia have undergone the implementation of the mechanisms of stress, which in the animal organism has arisen as the most important link in adaptation to changing environmental conditions. The stress arising from life-threatening factors (hunger, cold, danger, the struggle for a sexual partner) has the ultimate goal of quick and effective preparation of the body for muscle activity and its implementation. At the same time, the nervous and humoral components of stress cause an instant increase in the reaction rate and muscle tone, a sharp increase in the activity of oxygen transport systems, which should provide subsequent muscle activity with nutrients and oxygen. In humans, while the physiological mechanisms of stress are common with animals, the conditions for its occurrence and implementation differ markedly. First, in people, stress is mainly associated not with the struggle for survival, but with social motives (love, career, culture, and the processes of work and learning, etc.). Secondly, most often a person fails, for various reasons, to logically complete stress with movement, therefore, a state of mental stress increases, and It is precisely with the absence of the final link in the mechanism of stress - movement - that the so-called diseases of civilization are widely spread in modern man.
Thus, the conditions of modern life lead to the fact that, to a large extent, the main condition for ensuring the safety and maintenance of life, formed by evolution, is turned off - movement. On the other hand, numerous studies have shown that regular exercise not only allows you to achieve a high level of health, but also contributes to a noticeable prolongation healthy life person. Undoubtedly, this is due to the fact that physical culture ensures the fulfillment of the evolutionarily conditioned requirement of adequate human motor activity.
Therapeutic physical culture is indicated for all diseases: in the clinic of internal and nervous diseases, in traumatology, in surgical pathology, gynecological and other diseases.
Contraindications are extremely limited and in most cases are temporary. This applies to diseases accompanied by a general serious condition of the patient due to shock, infection, large blood loss, severe injury, etc. Contraindications to the use of exercise therapy are also: severe pain, the risk of bleeding, an increase in body temperature above 37.5 ° C and conservative treatment of malignant tumors
Assessment of the impact and effectiveness of exercise therapy. According to the data of medical and pedagogical observations (with the study of the reaction of the pulse, respiratory rate and blood pressure), the total load on the patient's body during physical exercises is revealed. Based on these data, physiological load curve - this is the name of the graphic representation of the degree of influence of physical exercises on the body.
Methods of medical and pedagogical assessment of the effect of exercise therapy on the patient's body depend on the disease, means, forms of exercise therapy and include monitoring changes in the general condition of the patient, changes in heart rate at the height of the load during rest, in the activity of the cardiovascular, respiratory systems, for the appearance of shortness of breath, fatigue. To take into account the effectiveness of the influence of physical exercises on the patient's body, functional and diagnostic methods can be used. So, in a trauma clinic, such methods will be: anthropometric measurements (the circumference of the limbs on different levels, dynamometry, goniometry), electromyography, myotonometry and others, in diseases of the cardiovascular system - electrocardiography, pulsometry, etc.
In addition to the listed methods, functional tests specific for various diseases are used to take into account the functional state of the body under the influence of physical exercises.
The subjective and objective data obtained during the surveys are assessed on the basis of comparing the results of the beginning and the end of the observation period.
Questions and tasks for self-control
1. To reveal the concept of "Remedial physical culture". To reveal the principles of health-improving training.
2. Explain the mechanisms of the therapeutic action of physical exercises.
3. List the means and forms of exercise therapy. Their characteristics.
4. To characterize the ways of dosage of physical exercises.
5. To reveal the course of remedial physical culture, its periods, tasks, duration, motor modes.
6. What are the indications and contraindications for the use of remedies for exercise therapy?
Chapter 3. Massage in medical physical culture
The main remedy for exercise therapy is physical exercises, used in accordance with the objectives of treatment, taking into account the etiology, pathogenesis, clinical features, functional state of the body, general physical performance. Fixed assets include - massage and natural factors of nature, the use of which enhances the effect of physical exercises and allows them to be widely used in various environmental conditions and combinations. An integral part of Exercise therapy are mechanotherapy, robotic technology, occupational therapy.
Physical exercises are divided into gymnastic exercises, applied sports exercises, games.
1 . Gymnastic exercises are specially selected combinations of natural movements for a person, divided into constituent elements... Applying gymnastic exercises, selectively affecting individual muscle groups, you can improve the general coordination of movements, restore and develop strength, speed of movement and dexterity. They constitute the most extensive group and are subdivided on the basis of four characteristics: anatomical, performance activity, species characteristic, and the use of objects and projectiles.
Anatomically gymnastic exercises are divided into exercises for: a) small muscle groups (hand, feet, face); b) medium muscle groups (neck, forearms, legs); c) large muscle groups (thighs, shoulders, trunk, pelvis). It is necessary to differentiate exercises due to the fact that the amount of physical activity depends on the amount of muscle mass included in the movement.
Based on the activity of the exercise are divided into active (performed by the patient independently), active-passive exercises (performed in combination: by the patient himself in combination with the help of an instructor-methodologist for exercise therapy), passive (performed by the hands of an instructor-methodologist for exercise therapy with the patient's volitional effort). On different stages rehabilitation, exercises corresponding to the degree of activity prevail.
To a greater extent, preference is given to active exercises, which, in turn, are subdivided into lightweight (on a sliding surface, pendants, in water), free (without a force component), with strengthening (volitional, burdening, resistance, etc.), relaxation and muscle strain (stretch). Passive exercises are divided into those performed by exercise therapy specialists and independent passive muscle relaxation. Passive exercise are prescribed to prevent stiffness in the joints in cases where the patient cannot perform these movements. They stimulate the possibility of active movements due to the reflex influence of afferent impulses arising in the skin, muscles, joints.
By species(nature) exercises are divided into:
a) general developmental, special and respiratory;
b) ordinals and combatants;
c) preparatory or introductory;
d) corrective;
e) exercises to develop coordination of movement and balance;
f) exercises in throwing and catching;
g) relaxation exercises;
h) resistance;
i) hangs and stops;
j) jumps and jumps;
k) rhythmoplastic movements.
General developmental (restorative) exercises. It is used for healing and strengthening the body, increasing physical performance and psychoemotional state of those involved, activating blood circulation, breathing. These exercises facilitate and enhance the healing effect of the specific exercises.
Special exercises -and selectively affect various organs and systems, providing a direct therapeutic effect. For a healthy person, exercises for the trunk are general strengthening; with osteochondrosis, scoliosis, they are classified as special, since their action is aimed at solving therapeutic problems - increasing the mobility of the spine, correcting the formed deformity, strengthening the surrounding muscles. Exercises for the legs are general strengthening for healthy people, and after surgery on the lower extremities, trauma, paresis, diseases of the joints, these same exercises are special.
The same exercises, depending on the method of their application, can solve different problems. For example, extension and flexion in the knee or other joint in some cases is aimed at developing mobility, in others - to strengthen the muscles surrounding the joint (exercises with weights, resistance), in order to develop muscular-articular feeling (accurate reproduction of movement without visual control) ... Usually, special exercises are used in combination with general developmental and breathing exercises.
Breathing exercises(static, dynamic and drainage). Static breathing exercises are performed in various starting positions without moving the legs, arms and trunk. These include diaphragmatic breathing - during inhalation, the diaphragm contracts and descends, which increases the negative pressure in the chest cavity, and the lungs are filled with air. At the same time, intra-abdominal pressure rises and the abdominal wall protrudes. During exhalation, the diaphragm relaxes, rises, the abdominal wall returns to its original position. Dynamic breathing exercises are performed in combination with movements of the limbs, trunk, etc.
Drainage exercises include breathing exercises that purposefully enhance the outflow of exudate from the bronchi (they are used for various diseases of the respiratory system). It is necessary to distinguish between drainage exercises (breathing) and postural (positional) drainage - specially set body positions aimed at the outflow of exudate through the respiratory tract according to the "gutter" principle. Breathing exercises have a calming effect in violation of the nervous regulation of various functions of the body, they are used for more quick recovery when tired, for unloading, rest after a series of general developmental or special exercises.
To enhance the therapeutic effect of special physical exercises in the early stages of rehabilitation, "position treatment" is used. Under treatment position is understood as a special laying of the limbs or trunk in a position opposite to the vicious one, which contributes to the achievement of a certain corrective position with the help of various devices (splints, fixing bandages, adhesive plaster traction, rollers, etc.). Such treatment is used to create a physiologically favorable position for the restoration of muscle function, which is especially important for preventing the development of degenerative phenomena in the joints and pathological synkinesias,
Ideomotor exercises - mental performance of the exercise (motor task). They improve trophism, cause a reaction from the vegetative organs, enhancing the activity of the cardiorespiratory system, metabolism. These exercises can be combined with passive movements with contractures, paralysis and paresis.
Isometric (static) exercises - physical exercises in the form of alternating tension and relaxation of individual muscle groups without corresponding movements in the joints; are used to maintain the normal functional state of the muscles of the limb, immobilized with a plaster cast, to increase muscle and vascular tone.
Sequential and marching exercises - building, turning and changing lanes in combination with normal walking and walking in different directions. They help to improve coordination of movements, vestibular function, improve walking skills, acquiring in some cases an independent therapeutic value. Their general effect corresponds to strains of moderate intensity, and are used in the second and third stages of rehabilitation. These exercises help to organize patients in group therapeutic exercises and are used at the beginning and throughout each session.
They improve the discipline of the students, increase the emotionality of the classes and the applied value. Musical accompaniment for this type of exercise is desirable, if the setting of the hospital allows it to be done. Musical accompaniment of exercises is an additional annoyance coming from the environment, surrounding man... Music combined with movement becomes the stimulus for this movement, making it easier to perform.
Preparatory, or introductory, Exercise prepares the body for the upcoming stress. Their choice depends on the tasks of the lesson, as well as on the level of the patient's physical fitness. The application is aimed at ensuring the gradual preparation of the patient for the upcoming higher load, which takes place in the main part of the therapeutic gymnastics class. The preparatory exercises follow after ordinal and constitute the content of the first part of the lesson. The prepared exercises include various elementary general developmental exercises involving limited muscle groups in active activity and carried out at a slow or medium pace and presenting the patient's body with a small physical load (separate exercises for arms, legs, trunk). Exercises are usually applied in three main starting positions- lying, sitting, standing.
Preparatory exercises are used without objects and projectiles, with objects and, in the cases shown, on projectiles.
Corrective exercises are aimed at preventing or reducing postural defects, correcting deformities of the spine, chest, feet, often combined with passive correction (stretching on an inclined plane, wearing a corset, massage). These include a variety of physical exercises performed from a certain starting position, which determines a strictly local effect. These exercises are combined with strength tension and stretching. For example, with pronounced thoracic kyphosis (kyphotic posture), physical exercises aimed at strengthening the muscles of the back have a corrective effect - the initial position is lying on the stomach, standing, stretching and relaxation pectoral muscles- starting position lying on your back; with flat feet - strengthening the muscles of the lower leg and foot - the initial sitting position.
Exercises for coordination and balance are used to train the vestibular apparatus for hypertonic disease, neurological diseases, in traumatology, are performed in the main starting positions: the main stand, on a narrow support area, standing on one leg, on toes, with open and closed eyes , with and without objects. Balance platforms of various configurations, exercises on a stabilized platform are widely used. This group of exercises includes exercises that form everyday skills lost as a result of a particular disease: buttoning up buttons, lacing shoes, lighting matches, opening a lock with a key. Exercises that restore the coordination of small muscle groups of the upper extremities - sculpting, assembling children's pyramids, mosaics, etc.
Exercises in throwing and catching... Throwing exercises include throwing and catching balls of small and large diameters, of various weights stuffed balls. Exercises in throwing develop the strength of the muscles of the belt of the upper limbs and trunk, dexterity, accuracy, coordination of movements, muscular-articular feeling. The range of positive emotions expands, interest in classes increases; in some cases, they contribute to the solution of special problems, for example, with injuries of the upper extremities. Increasing the difficulty of the exercises is achieved by increasing the distance to the target, the distance between partners and the execution of throws in motion.
Relaxation exercises- actively carried out relaxation of various muscle groups. When performing exercises, individual segments of the body (hand, foot), the limb as a whole, and the combined limbs and trunk can be involved in movement. Their action is aimed at normalizing the increased muscle tone observed in various pathological manifestations (pain contractures, spastic paresis, etc.), and improving the overall coordination of movements. These exercises are used to reduce the increased tone of arterial vessels. Used in conjunction with localized muscle tension exercises and stretching and coordination exercises.
The impact on cortical processes and autonomic functions corresponds to stresses of low or moderate intensity. With insufficient mastery by the patient of the technique of physical exercises, stiffness, increased muscle tone and inadequate enhancement of cortical and autonomic functions are observed. Relaxation is most fully carried out immediately after muscle tension. If the latter has caused local fatigue, then relaxation helps to accelerate the course of recovery processes.
In the practice of medical gymnastics, the technique is also used post-isometric muscle relaxation(FEAST). The technique is based on the reflex mechanism of lowering muscle tone after pre-tensioning the muscle. The essence, which consists in a combined short-term (5-10 s) isometric tension of minimum intensity with passive stretching of the muscle in the subsequent (for 5-10 s). Repetition of such combinations is carried out 3-6 times. As a result, persistent hypotension occurs in the muscle and the initial soreness disappears.
Resistance exercises used in the second and third stages of rehabilitation. They help to strengthen muscles, increase their elasticity, have a stimulating effect on the cardiovascular and respiratory systems, metabolism. To perform exercises with effort, the resistance provided by the hands of the instructor-methodologist for exercise therapy or a healthy limb is used. Exercises related to overcoming resistance at the time of extension of the arm, they are carried out due to the work of the extensors; resistance exercises, such as tug-of-war, are performed using the flexor muscles.
The ability to selectively influence mainly individual muscle groups (flexors, extensors, abductors, adductors) allows these exercises to be widely used in muscle wasting. The amount of resistance depends on the tasks to be solved in the classroom of medical gymnastics. After doing resistance exercises, a muscle relaxation exercise or breathing exercise should be applied.
Hangs and stops are included in the complex of medical gymnastics. Physiological value these exercises consists in a certain power voltage. Vis are used in two forms: clean and mixed. Net visas find limited use in the framework of physiotherapy exercises. Their use is permissible only if the cardiovascular system is in a favorable state, since they are accompanied by a delay in external respiration and create unfavorable conditions for the functioning of the central circulatory system. Fixed rib cage in its pure form, it causes straining, accompanied by an increase in intrathoracic pressure, a delay in the flow of venous blood to the heart, contributing to the manifestation of congestion, especially in the venous system of the head and neck and in the pulmonary circulation.
Net visas are used to strengthen and stretch the muscles of the arms and shoulder girdle, develop the range of motion in the joints of the upper extremities, unload and stretch the spine in the absence of contraindications from the cardiovascular system. Most often they are used in the practice of corrective gymnastics with children and adolescents, when restoring the function of the upper limbs, impaired due to traumatic injuries. Finish the exercise in a clean hang exercises to relax worked muscle groups or breathing in order to reduce overall physical activity.
While doing mixed hangs muscle groups of the arms, legs and trunk are involved with the obligatory capture of the projectile with the hands and support of the legs, this allows you to evenly distribute the effort to all muscle groups, without causing significant force tension and holding the breath. Due to moderate exercise, they are successfully used in remedial gymnastics. With the help of exercises in mixed hangs strengthen the muscles of the arms, legs and trunk, develop movements in the joints of the limbs and spine, selectively increase physical activity on various muscle groups and successfully combine the rhythm of movements with breathing.
Distinguish stops clean and mixed. Clean focus - emphasis on the backs of chairs, beds, etc. - is used mainly for injuries of the lower extremities. Mixed stops have frequent use. Unlike hangs, which strengthen the flexors, stops develop extensor strength. In remedial gymnastics, brushes are used against the rail of the gymnastic wall at the level of the shoulders, chest; rests on the headboard of the bed, chair, on the table and emphasis with tassels on the floor.
Jumps and jumps. Jumping they involve large muscle groups of the lower extremities (mainly) in the work, they are usually performed at a fast pace, which creates a great load on the main systems of the body, being at the same time a complex coordination exercise. Due to this they are more often used when working with children and adolescents or young people and to a limited extent - when working with people of mature and especially elderly people. Target orientation of the use of jumps: training effect on the body, increasing tone, development of speed of reaction and coordination of movements. In some cases, for special treatment, for example, in the conservative treatment of ureteral stones in the absence of contraindications. Distinguish jumping in place and moving forward, backward, to the side, with a turn.
Characteristic feature rhythmoplastic exercises is the rhythm and plasticity of movements that can be performed on the spot, with movement, without shells, with shells and objects (gymnastic stick, club, hoops, scarves, flags, etc.) with musical accompaniment. Rhythmoplastic exercises characterized by roundness, softness and smoothness of movement. These exercises are most shown for children and adolescents, in women's groups. Application rhythmoplastic exercises gives a good therapeutic effect when it is necessary to reduce the tension of the neuropsychic sphere, to create a cheerful mood that distracts the patient from painful experiences.
On the basis of the use of objects and projectiles exercises are divided:
a) without objects and shells;
b) with objects and shells (sticks, dumbbells, clubs, inflatable and stuffed balls, expanders, etc.);
c) on apparatus (gymnastic wall, bench, beam, etc.).
These exercises include exercises on mechanotherapy devices and simulators, which are especially actively used for health improvement and rehabilitation purposes. The following are widely used in medical gymnastics classes subjects: gymnastic sticks, rubber bandages, various balls (including stuffed ones), clubs, dumbbells, weights, resistance bands, jump ropes, etc. a large number of varied shells , the simplest devices and devices.
These are simple and combined rollers, semi-rollers, ladders, block devices, stepped cylinders, etc., with the help of which it is possible to enhance the development of the function of movements in various joints of the upper and lower extremities, with traumatic injuries of the central and peripheral nervous system and the musculoskeletal system. The traditional list of apparatus consists of: a gymnastic wall, a gymnastic bench, an inclined plane, a log, rings. The use of shells is aimed at the variety of the content of the lesson, at increasing physical activity, at the predominantly selective effect of exercises on individual muscle groups and joints; to facilitate the exercise technique.
2. Sports and applied exercisesrestore or improve complex motor skills, have a general healing effect on the patient's body. Sport exercises are effective for restoring general endurance, provide maximum improvement in metabolic processes, are a means of training and the development of compensatory mechanisms of the cardiovascular and respiratory systems, are very emotional in their content and method of implementation. Sport exercises corresponding to the indications take leading place at the sanatorium and outpatient stages of rehabilitation.
Of the sports and applied exercises in medical physical culture, the most often used are walking, running, jumping, throwing, climbing, exercises in balance, lifting and transferring weights, dosed rowing, skiing, ice skating, swimming, cycling, climbing a gymnastic wall and rope. These exercises are used at the final stage of rehabilitation and contribute to the final restoration of the damaged organ and the whole organism as a whole, and educate patients with perseverance and self-confidence.
Walking strengthens the muscles of the lower extremities, has an effect on the entire body as a whole due to the rhythmic alternation of tension and relaxation of muscles, improves blood and lymph circulation, respiration, metabolism. Walking is an integral part of most remedial gymnastics, along with jogging. For therapeutic purposes, running is used both in the initial manifestations of certain diseases and in the recovery stage. The method of its use depends on the state of the cardiovascular system and the degree of adaptation to physical activity... Running is combined with walking at a different pace. As the organism adapts to the proposed loads, the number and length of the run segments gradually increase.
Jumping refer to short-term intense exercise used during the recovery period. It is necessary to gradually bring the trainees to the execution of jumps, exercises are preliminarily performed to strengthen the muscles of the legs, especially the ligamentous apparatus of the ankle joint. It is necessary to draw the attention of patients to the softness of the landing. For medicinal purposes, jumping, exercises with a rope are mainly used. Throwing exercises help to restore the coordination of movements, improve the mobility of joints, increase the strength of the muscles of the limbs and trunk, the speed of motor reactions. In medical gymnastics, stuffed balls, discs, spears, balls with a loop, grenades are used.
Lasagna it is used in the form of movement with the help of arms and legs along a gymnastic wall, along an inclined or vertical staircase, less often along a rope or pole. Climbing exercises develop the strength of the arms, legs, trunk, improve coordination of movements and mobility in the joints of the upper and lower extremities. Crawl for medicinal purposes, it is used mainly in a kneeling position - knee-wrist or knee-elbow racks, which help to unload the spinal column from the action of gravity and improve its mobility.
These exercises change the ratio of the height of the position of the pelvis and the girdle of the upper extremities in combination with the movement of the arms and legs, and have a local effect on various parts of the spinal column. Crawling has a positive effect on the function of internal organs in patients with diseases of the gastrointestinal tract and with gynecological diseases, posture disorders. Crawling should be alternated with breathing exercises and exercises to relax the muscles of the upper limb girdle.
Rowing in exercise therapy is used for general training, working out the rhythm of movements, contributing to the development of deep breathing, the development and strengthening of the muscles of the upper and lower extremities, the trunk and the mobility of the spine. Increased intra-abdominal pressure during rowing has a positive effect on digestion and tissue metabolism. Training in open water has a health-improving effect on the entire body.
Cross-country skiing increase the muscle tone of the body, improve the work of the cardiorespiratory system, train the vestibular apparatus, improve mood, contribute to the normalization of the state of the nervous system, as well as skating. They are used at the sanatorium and outpatient stages of rehabilitation and are recommended for sufficiently trained persons with the skills of skiing and skating.
Exercises in the water(in the pool) are widely used in the practice of medical physical culture. Warm water helps to relax muscles, reduce spasticity, reduce the severity of the body and its individual parts, and facilitate exercise. Physical exercises in water are indicated for injuries, disorders and diseases of the musculoskeletal system, osteochondrosis, spondylosis, paralysis and paresis., Respiratory diseases.
For general health purposes, as well as to strengthen muscles and develop movements in the joints of the lower extremities, it is used a ride on the bicycle, which trains the cardiovascular and respiratory systems, the vestibular apparatus, hardens the body.
3. Games in exercise therapy, they are subdivided, in ascending order, into four groups:
1) on site;
2) sedentary;
3) movable;
4) sports games (croquet, bowling alley, small towns, relay races, table tennis, badminton, volleyball, tennis, basketball, etc.) and their elements.
Games are aimed at fostering decisiveness, perseverance, intelligence, dexterity, courage, discipline in the patient; they have a positive effect on the work of all organs and systems of the body. Depending on the degree of mobility, they are used at all stages of rehabilitation.
Massotherapy is an effective remedy for the treatment of various diseases and injuries, allows you to restore the normal activity of the whole organism. For each disease, massage techniques have been developed, which are based on the causes and pathogenesis of the disease, the clinical forms of its manifestation, the specificity of the action of certain massage techniques on the body. Massage is included in the complex of therapeutic measures carried out in various medical and preventive institutions - hospitals, sanatoriums, clinics, medical and physical dispensaries, rehabilitation centers.
Natural factors of nature are considered as a good addition to other remedies for exercise therapy. In different forms, they are present during exercise. These factors include sun, air and water. Their effect on the body, together with exercise therapy, is most fully realized in sanatoriums, dispensaries and rest homes, in resorts. Here movement, sun, air and water act as a powerful health-improving complex.
Under occupational therapy the restoration of impaired functions is understood with the help of specially selected work processes. There are three types of work-therapy: restorative, restorative, professional. General strengthening occupational therapy increases the patient's vitality, creates the psychological prerequisites for the restoration of working capacity; restorative - aimed at preventing the patient's movement disorders and restoring lost functions; professional - restores impaired production skills, is carried out at the final stage of rehabilitation treatment.
From a physical point of view, it restores or improves muscle strength and mobility in the joints, normalizes blood circulation and trophism, adapts and trains the patient to use residual functions. From a psychological point of view, occupational therapy develops attention in patients, instills hope for recovery, and maintains physical activity. Correctly organized occupational therapy is most effective in relation to the social and occupational rehabilitation of patients.
Mechanotherapy- This is the restoration of lost functions with the help of special devices. It is used mainly to prevent contractures (stiffness) of the joints. A feature of mechanotherapy is dosed, rhythmically repeated exercises on special devices or devices in order to restore mobility in the joints (pendulum-type devices), facilitate movements and strengthen muscles (block-type devices), and increase overall performance (simulators).
Exercises on mechanical devices help to improve blood and lymph circulation, metabolism in muscles and joints, and restore their function. Exercises on simulators lead to an increase in stroke and minute blood volume, improved coronary blood supply and pulmonary ventilation, and increased physical performance. They can be used for disorders of fat metabolism, chronic nonspecific respiratory diseases (without exacerbation) and cardiovascular diseases (without circulatory failure), as well as for health purposes.
Exercises on simulators are becoming more widespread in exercise therapy and in the rehabilitation of sick and disabled people. The use of simulators allows you to accurately dose the load and develop different physical qualities: endurance, muscle strength, etc. rowing machines, treadmills (treadmill), etc. To develop the strength of various muscle groups, there is a wide variety of simulators: block, power - stack, pneumatic, etc.
The founder of mechanotherapy is considered to be Gustav Zander (1835-1920), who developed 74 mechanotherapy devices, with the ability to strictly dose resistance when performing physical exercises - prototypes of modern simulators. Along with European countries, in our country in 1897, in Yessentuki, the Tsander Mechanotherapy Institute was opened, the only one that has kept the devices in working order to this day.
The improvement of simulators continues, every year new models appear or the previous models are improved. In the theory and practice of health-improving and therapeutic physical culture and rehabilitation technologies, it is customary to distinguish between two complementary groups of simulators: cardio trainers (cyclic or aerobic trainers) and strength trainers. Some simulators combine the features of both groups.
The current stage in the development of this direction of physical rehabilitation is associated with the introduction into clinical practice special robotic simulators, with extensive training simulation capabilities. Modeling mode: from completely passive to varying degrees of activity of exercises, with the implementation of continuous computer analysis and control of the patient's motor participation.
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