Laser effects on the body can be leveled out if improperly combined with other physiotherapy procedures. This most often happens when a patient is prescribed thermal procedures. Some combinations enhance the effect of laser radiation. So V.E. Illarionov (1994) recommends the combined use of GNL and ICL, ICL and PMP, the use of medicinal photophoresis (a medicinal substance is applied to the skin, and then exposed to GN or IR laser radiation); sequential use of laser irradiation and medicinal electrophoresis, the use of ultrasound, water procedures, massage are compatible with laser exposure, but should be carried out no earlier than 30 minutes later. A.A. Minenkov (1997) does not recommend combining ILBI and LOCI with general baths, general galvanization according to Vermeule, galvanic collar according to Shcherbak, electrosleep, large mud application (more than 1/3 of the body surface or the entire paravertebral zone), Charcot shower, inductothermy and UHF field in thermal dosages. The use of laser and other physical factors on the same reflex zone (collar zone) or the use of physiotherapeutic procedures on the same day is incompatible local action if it is impossible to maintain a 2-hour time interval between them.
It is difficult to agree with some statements; practice shows that the use of electrophoresis on a joint, and then laser exposure or local laser therapy and PeMP give top scores in treatment. Apparently, additional research in the future will help clarify this issue.
Lecture No. 2
Principles of prescribing physiotherapeutic treatment. Compatibility, sequence and combination of physical factors in complex treatment.
Rational use therapeutic physical factors in a particular patient requires compliance with a differentiated choice of the type of energy used and specific methods of carrying out procedures. In this case, the doctor must take into account the syndromic and pathogenetic validity of the use of a specific physical factor, the nature of the main clinical manifestations individual characteristics course of the disease, initial functional state organism and the specificity of the therapeutic effect of the selected factor. On this basis can be formulated general principles their use for therapeutic and prophylactic purposes.
1. The principle of unity of etiopathogenetic and symptomatic physiotherapy
It is implemented on the basis of the specific properties of each therapeutic factor and its influence on certain functions of the patient’s body. It is also necessary to prescribe factors that simultaneously eliminate or weaken the etiological agent of this disease, actively intervened in its pathogenesis and eliminated the manifestations of the main symptoms. Some therapeutic physical factors can influence the etiological moment (d’arsonvalization, ultraviolet radiation), the vast majority of others influence various links in the pathogenesis and axis of the symptoms of the disease, which is their indisputable advantage.
IN acute period diseases must be affected primarily by the etiological agent. For subacute and chronic inflammatory diseases procedures should be aimed at resolving the pathological process, eliminating its residual manifestations and normalizing functions various organs and systems. This principle also implies the possibility of influencing a therapeutic physical factor directly on the pathological focus (locally), reflexogenic zones and areas of segmental-metameric innervation (segmentally) and on the whole organism (generally).
2.Principles of an individual approach to treatment with physical factors
This principle comes from the main clinical thesis of S.I. Botkin “Treat not the disease, but the patient.” When prescribing physiotherapeutic treatment, it is necessary to consider:
age, gender and constitution of the patient.
Presence of concomitant diseases
The presence of individual contraindications for the use of a certain physical factor.
Reactivity of the body and the degree of training of adaptive-compensatory mechanisms.
Biorhythmic activity of the body's basic reactions.
In children, from the first days of life, it is permissible to prescribe elements of massage, hydrotherapy, aerosol therapy, and UV irradiation. From 1 month of UHF therapy, from 6 weeks medicinal electrophoresis, from 14-15 years of age microwave therapy, underwater traction of the spine.
In elderly patients, physical factors are used sparingly.
The gender of the patient determines him physical features, and the constitution gives an idea of the treatment of the nature of responses to a certain physical factor on the part of the central and autonomic nervous system.
When prescribing physiotherapeutic treatment, it is necessary to take into account the presence of concomitant diseases and select the optimal therapeutic agents that are universally suitable for both the underlying and concomitant diseases.
Great importance along with the choice of the physical factor, it has an individual selection of dosage and treatment method, for example, the intensity of UV irradiation is determined using biodosimetry, and the method of drinking mineral waters– by the ratio and duration of the phases of gastric secretion.
The effectiveness of physiotherapy depends significantly on the patient’s biorhythms. The experience of chronobiological optimization of the impact of therapeutic physical factors indicates that in patients in the morning, responses are formed against the background of the predominant tone of the sympathetic nervous system, and in the afternoon - parasymptomatic. When prescribing therapeutic physical factors in women, it is necessary to take into account background hormonal activity in different phases menstrual cycle: on the days of ovulation - a gentle treatment regimen, in terms of choosing the factor of intensity and duration applied (thermal factors that stimulate blood circulation in the pelvis are contraindicated).
An indispensable condition for the individuality of physiotherapy is the creation of a positive emotional mood in patients. To do this, it is necessary to comply with medical standards. staff requirements, delicacy and courtesy in communicating with patients.
3. The principle of course treatment with physical factors
The most pronounced therapeutic effect of most physical factors occurs as a result of a course of treatment. Its duration is 6-8 for some diseases, 8-12 for others, and less often 14-20 procedures. In this case, the morphofunctional changes that occur after the initial procedure are deepened and consolidated by subsequent ones. Depending on the dynamics of clinical manifestations of the pathological process, procedures are carried out daily or every other day. The sum of the therapeutic effects of physical factors provides a long-term effect of the course of physiotherapy, which continues after its completion. It must be taken into account that the long-term results of using some physical factors are more favorable than the immediate ones. The effect periods of most electrotherapeutic and phototherapeutic factors range from 2 to 4 weeks, and when used natural factors reach from 6 months to 1 year. At the same time, prolonged use of one physical factor increases adaptation to it and significantly reduces the effectiveness of the therapeutic effect.
4. The principle of optimal treatment with physical factors
Physical factors have unequal therapeutic effectiveness in treating a particular disease. Based on this, the parameters of the therapeutic factor and the method of its application should be optimal, i.e. correspond as much as possible to the nature and phase of the pathological process. In the acute period of the disease, predominantly low-intensity physical factors are used directly on the pathological focus, and high-intensity ones on the segmental reflex.
In the submucosal and chronic phases of the disease, the intensity of factors acting locally increases. For example, in the alternative-exudative phase of inflammation, electricity is prescribed. Low-intensity UHF field (20-30 VT0, and in infiltrative-proliferative conditions it is increased to 50-70 W.
In weakened patients, general ultraviolet irradiation is prescribed according to a slow schedule, in physically strong patients – according to an accelerated scheme, and if the patient has good reactivity – according to the main scheme.
Besides this, to clinical practice There are certain contraindications for the use of physical factors. Moreover, contraindications in physiotherapy can be general and specific. General contraindications include diseases and conditions that require physiotherapeutic treatment. Not assigned at all:
acute stage diseases.
Diseases in decompensation
Systemic blood diseases
Oncological pathology
Infectious diseases(including tuberculosis and sexually transmitted diseases)
Bleeding and tendency to it
Cachexia
Unclear diagnosis
Mental illness
5. The principle of dynamic treatment with physical factors
According to this principle, physical therapy should be tailored to the patient's current condition. Its observance requires constant correction of the parameters of the physical factors used throughout the entire period of treatment of the patient. During treatment, concomitant diseases may be identified in the patient, which may require changes in physical therapy tactics. To do this, it is possible to change the intensity and frequency of the physical factor, localization, area and duration of exposure.
If physiotherapeutic procedures are prescribed incorrectly, adverse reactions may occur from ... pathologically altered organs. The main sign of inadequacy of physiotherapy is the exacerbation of the pathological process leading to the formation of a maladjustment reaction in the patient. Such a reaction can be general (without significant changes in the affected organ or system) or local (focal).
With a general reaction that occurs as a vegetative-vascular syndrome, there is an increase in irritability, fatigue, decreased performance, sleep disturbances, changes in the temperature curve, sweating, changes in pulse, and blood pressure. An exacerbation of concomitant diseases may occur.
A focal (local) reaction is characterized by disturbances in cerebral hemodynamics, the patient's headaches, dizziness, increased pain in the area, swelling of the mucous membranes, and hyperemia. During treatment with physical factors, it is necessary to constantly monitor the body's responses and their correct clinical assessment.
For timely correction of physical treatment must be guided by clinical and laboratory indicators of the patient’s condition: pulse rate and filling, respiratory rate, condition skin and mucous membranes, temperature curve, ECG, blood test, urine test, etc.
6. Principle complex treatment physical factors
Complex treatment is carried out in two forms: combined and combined.
Combined treatment involves the simultaneous impact of several physical factors on the pathological focus. In combined treatment, physical factors are used sequentially with different time intervals or successive tumors. The high effectiveness of complex treatment with physical factors is based on their synergism, potentiation, the manifestation of new therapeutic effects, as well as on increasing the duration of the aftereffect.
When prescribing physiotherapeutic procedures, it is imperative to take into account the compatibility factor. It is not recommended to carry out the following procedures on the same day:
causing a general response of the whole organism (2-baths)
2 procedures or more, such as electrophoresis, galvanization, ultraviolet irradiation, thermal effects on one reflexogenic zone.
It is inappropriate to prescribe procedures that are similar in their physiological effect(DDT and AMT, UHF and microwave, mud therapy, general ultraviolet radiation and)
Procedures that have opposite effects - heat and cooling, stimulating and calming.
When prescribing ultraviolet radiation, electrophoresis, novocaine, diphenhydramine, infrared irradiation, thermal procedures, and massage should not be prescribed to the same area.
2 local procedures sequentially to potentiate each other’s action (UHF, inductothermy, infrared irradiation and medicinal electrophoresis, heat therapy and massage)
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LIST OF NECESSARY MEDICAL SERVICES AND PROCEDURES PROVIDED IN SPECIALIZED SANATORIUMS TO THE PATIENT ACCORDING TO HIS PROFILE... Relevant in 2018
ON THE COMPATIBILITY OF PHYSICAL FACTORS AND PROCEDURES
In sanatorium practice, the patient is usually prescribed a complex treatment, including elements of balneotherapy, instrumental physiotherapy, exercise therapy and massage. The use of certain factors can be combined (simultaneous exposure), sequential (one after the other with a short interval), alternating (every other day or in another order) and step-by-step (the first course of any procedures is followed by a course of other procedures). When correctly prescribing an individual treatment complex, physical factors seem to interact, exerting a potentiating effect and enhancing the effect. However, when prescribing procedures, one should always take into account not only the possible effectiveness, but also the incompatibility of individual procedures, which can lead to an exacerbation of the disease or simply a deterioration in the patient’s well-being or condition. So, for example, during one course of treatment, even on different days, it is impossible to use those physical factors whose mechanism of action is similar in the physical essence of the processes caused. Treatment overload should not be allowed, taking into account the nature of the disease, the body's response, age and other circumstances.
The group of incompatible factors includes: UHF and microwave, inductothermy and UHF, microwave and inductothermy, microwave and alpha therapy, general sunbathing and general UV irradiation, diadynamic and sinusoidal modulated currents, underwater intestinal lavages and intestinal irrigation. It is not recommended to take procedures using antagonistic factors during treatment: a) thermal procedures (mud, ozokerite, etc.) and bathing in cold and cool water; b) inductothermy and other thermal procedures and cool showers, bathing for inflammatory diseases; c) irradiation with UV rays and subsequent infrared or visible radiation of the same area after the use of novocaine electrophoresis, which blocks nerve endings and inhibits the development of UV erythema; e) electrophoresis sedatives(magnesium, bromine, aminazine) and soul (Charcot, Scotch, cool circular); f) electrosleep and souls (Charcot, Scottish, cool circular); g) general franklinization and Charcot or Scottish shower. It is also not recommended to prescribe two procedures affecting individual active reflexogenic zones (collar, panty zones, nasal mucosa).
It is undesirable to prescribe physical factors with the energy of which the patient has constant professional contact, for example, the use of UHF, high-power microwaves, radon baths for those who come into contact with HF, UHF, microwave generators and sources at work ionizing radiation.
Compatibility groups for physiotherapeutic procedures.
IN in some cases if necessary, general and local physiotherapy for the underlying disease can be prescribed on the same day. In this case, local procedures, as a rule, precede procedures general action. For example, a general bath, a galvanic collar according to Shcherbak, general electrophoresis according to Vermeule, electrosleep can be combined with local procedures: ultrasound, diadynamic sinusoidal modulated currents, darsonvalization, inductothermy, low-power microwave oscillations, local applications of paraffin, ozokerite, mud, etc.
When treating the underlying disease, the patient is prescribed two different physical factors with localization of the effect in the affected area. Examples: ultrasound and thermal factor (dirt, paraffin, ozokerite); ultrasound and electrical stimulation; dirt and electrophoresis medicinal substances; UHF and UV, etc.
When assigning two factors to one area, the issue of their compatibility and sequence of application is decided, taking into account the changes caused by each of the factors. These rules are also used when prescribing physiotherapy in parallel for the underlying and concomitant diseases. In a course of treatment using several factors, procedures of general and local action can be distributed according to different days. Procedures are usually carried out every other day. They are prescribed daily only when necessary (acute pain syndrome and so on.).
COMBINATION OF ELECTROTHERAPEUTIC FACTORS
Note:
0 - procedures are not combined at all for one disease and one area;
1 - combined on one day;
2 - combined on different days.
| Procedures | Galvanization and electrophoresis (general techniques) | Galvanization and medicinal electrophoresis | Electroson | Diadynamic therapy | Amplipulsetherapy | Electrical stimulation | Local darsonvalization | General darsonvalization | UHF therapy | Inductothermy | Microwave | Magnetotherapy | Ultrasound |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 |
| 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 2 | 1, 2 | 2 | 2 | |||
| 1, 2 | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | |||
| 3. Electrosleep | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | |
| 4. Diadynamic therapy | 1, 2 | 2 | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | |
| 5. Amplipulse therapy | 1, 2 | 2 | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | |
| 6. Electrical stimulation | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | |
| 7. Local darsonvalization | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 0 | 0 | 0 | 1, 2 | 2 | ||
| 8. General darsonvalization | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 2 | 0 | 0 | 0 | 0 | 1, 2 | ||
| 9. UHF therapy | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 0 | 0 | 0 | 0 | 2 | 1, 2 | |
| 10. Inductothermy | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 0 | 0 | 0 | 0 | 0 | 0 | 1, 2 |
| 11. Microwaves | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 0 | 0 | 0 | 0 | 2 | 1, 2 | |
| 12. Aeroionotherapy | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 13. Aerosol therapy | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 14. Magnetic therapy 15. Ultrasound | 2 2 | 1, 2 1, 2 | 1, 2 1, 2 | 1, 2 1, 2 | 1, 2 1, 2 | 1, 2 1, 2 | 1, 2 2 | 0 1, 2 | 2 1, 2 | 0 1, 2 | 2 1, 2 | 2 | 2 |
| 16. General Ural Federal District | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 17. Local Ural Federal District | 0 | 0 | 1, 2 | 0 | 0 | 0 | 0 | 1, 2 | 1, 2 | 2 | 2 | 2 | 0 |
| 18. Infrared radiation | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 19. Mud therapy | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 |
| 20. Paraffin, ozokerite | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 |
| 21. Radon baths | 2 | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| 22. Hydrogen sulfide baths | 2 | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| 23. Mineral baths | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 24. Carbon dioxide baths | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| 25. Fresh baths | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 26. Souls | 2 | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 | 2 |
COMBINATION OF LIGHT THERAPY, THERMAL THERAPY AND BALNEOTHERAPEUTIC PROCEDURES
| Procedures | General Ural Federal District | UFO local | Infrared rays | Mud therapy | Paraffin, ozokerite | Radon baths | Hydrogen sulfide baths | Mineral baths | Carbon dioxide baths | Fresh baths | Aerosoltherapy | Aeroionotherapy | Souls |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 |
| 1. Galvanization and electrophoresis (general techniques) | 2 | 0 | 1, 2 | 2 | 1, 2 | 2 | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 2 |
| 2. Galvanization and electrophoresis (local effects) | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 2 |
| 3. Electrosleep | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 |
| 4. Diadynamic therapy | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 5. Amplipulse therapy | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 6. Electrical stimulation | 1, 2 | 0 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 7. Local darsonvalization | 1, 2 | 0 | 1, 2 | 2 | 2, 1 | 2 | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 |
| 8. General darsonvalization | 2 | 1, 2 | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 2 | 2, 1 | 1, 2 | 2 |
| 9. UHF therapy | 1, 2 | 1, 2 | 1, 2 | 2 | 2 | 2 | 2 | 1, 2 | 2 | 1, 2 | 1, 2 | 1, 2 | 2 |
| 10. Inductothermy | 1, 2 | 2 | 1, 2 | 2 | 2 | 2 | 2 | 1, 2 | 2 | 1, 2 | 1, 2 |
Chapter 6. PHYSIOTHERAPY
Chapter 6. PHYSIOTHERAPY
6.1. Physiotherapy subject
Physiotherapy- chapter medical science, studying the influence on the human body of natural (natural) and artificially obtained (preformed) physical factors used for treatment and prevention various diseases, as well as for the purposes of medical, psychological and professional rehabilitation.
6.2. The mechanism of action of natural and preformed physical factors on the human body
The body's response to the influence of physical factors is ensured various systems body, has a complex, phase, multicomponent nature, aimed primarily at the rapid restoration of homeostasis, as well as the regulation of altered functions, adaptation of the activities of individual organs and systems and the entire organism as a whole to functioning in new, altered pathological process conditions. The interaction between physical factors and the body is based on electrical and bioenergetic processes.
There is a general generalized reaction of the body to the influence of a physical factor and local, primary specific reactions. Numerous physico-chemical changes at the site of influence of the physical factor serve as a source of irritation of various receptors and mechanisms for converting the energy of the physical factor into a nerve impulse, thereby changing the functional state of the apparatus spinal cord and central regulatory systems of the body. The body's response is expressed in various changes in central and peripheral hemodynamics.
ki, metabolic processes, trophism, respiration, reactivity and resistance of the body. As a result, the body becomes adapted to changes in the external and internal environment.
The impact of an external physical factor on a biological object initiates, first of all, changes in the electromagnetic interaction of its various structures and systems, which determines the universality of the mechanism of action of various preformed physical factors on a living organism. During the initial interaction of external physical factors with the structures of a biological object, any type of energy is transformed into electrical energy. The result of this interaction is a change in the electrical status of the cell, which leads to conformational transformations of various structures, primarily macromolecules of biological substrates and water molecules. These changes are the root cause of subsequent physicochemical processes, biological reactions and various clinical effects of physiotherapeutic factors. Moreover, the lower the intensity of the physical factor, the greater the role in the formation of reactions to it is played by highly sensitive systems. The therapeutic effect of a physical factor depends not only on the characteristics of the distribution of its energy, but also on the physical (electrical, magnetic, mechanical, thermophysical) properties of target tissues that determine the absorption of the energy of the physical factor and have selective sensitivity to this factor, as well as functional reserves of adaptation and reactivity of the body. Universal mechanisms of the organization of the central nervous system ensure the unity of the processes of development of the body's adaptive reactions to this factor. Thus, the basis of the general adaptive reaction of the body, aimed at restoring impaired functions, lies the heterogeneity (heterogeneity) of the therapeutic effects of physical factors.
6.3. Classification of therapeutic physical factors
Modern classifications of therapeutic physical factors are most often built on the basis of division according to the physical nature of the factor used, without taking into account the mechanism of its therapeutic action.
According to G.N. Ponomarenko (1999, 2002), from the standpoint of modern physiotherapy, is the most rational and promising syndromic pathogenetic approach to the selection of optimal physical methods treatment. In this case, it is necessary to proceed from the direction and selectivity of their therapeutic effect on specific pathologically altered systems of the body, taking into account the specific features
the severity of their predominant effect on the body, i.e. heterogeneity of their therapeutic effect. According to the syndromic-pathogenetic classification of physical methods of treatment (according to Ponomarenko G.N., 2002) distinguish:
. organ-nonspecific methods - methods that relieve the prevailing syndromes of the disease: pain, inflammatory, intoxication, metabolic, dystrophic, immune dysfunction, etc.;
. organ-specific methods - methods of influencing mainly the central nervous system, peripheral nervous system, cardiovascular, respiratory, hematopoietic, endocrine, gastrointestinal, musculoskeletal, skin, excretory and reproductive systems.
The selectivity of the absorption of energy from physical factors by various types of receptive cells and biological structures has been reliably established, which indicates the heterogeneity (heterogeneity) of the therapeutic effects of physical factors of different nature and the therapeutic effects formed by them. Thus, preformed physical factors have different clinical effects.
6.4. Basic physiotherapy techniques
To achieve a therapeutic effect in physiotherapy, there are various possibilities for influencing the body with therapeutic physical factors:
-locally - impact directly on the pathological focus;
-segmental-reflex- impact on reflexogenic zones and areas of segmental-metameric innervation;
-generalized(general effect) - an effect on the whole organism of a general tonic or sedative nature, as well as with the aim of increasing the nonspecific resistance of the body (immunity).
By the nature of the location relative to the body surface patient electrodes, inductors, emitters or other generators of physical factors of influence, the following physiotherapeutic techniques are highlighted.
. Contact technique - exposure to a preformed physical factor, in which the electrode, inductor or emitter is in direct contact with the surface of the patient’s body.
. Remote technique - exposure to an external physical factor in which the electrode, inductor or emitter dis-
is placed at a certain distance from the surface of the patient's body.
. Stable technique - influence by a physical factor, in which the electrode, inductor or emitter is stationary at a certain place on the patient’s body (with a contact technique) or affects the corresponding area of the body (with a remote technique) during the entire procedure.
. Labile technique - exposure to a physical factor in which an electrode, inductor or emitter is moved during a procedure along a certain trajectory along the surface of the patient’s body either contactally or remotely.
. Longitudinal technique - exposure in which electrodes, inductors or emitters are located along the pathological focus, body or limbs of the patient during the entire procedure.
. Transverse technique - During the entire procedure, electrodes, inductors or emitters are located across the pathological focus, body or limbs of the patient and directed towards each other.
6.5. General principles of application of therapeutic physical factors
The rational use of preformed physical factors involves a differentiated choice of the type of energy used and specific procedures. Exist general principles of application of physical factors for therapeutic and prophylactic purposes.
The principle of individual approach- the use of physical factors, taking into account the age, gender, constitutional characteristics of the patient, the severity of the condition, the presence of concomitant diseases, individual contraindications and the degree of training of adaptive-compensatory mechanisms.
The principle of optimal assignment of physical factors - the physical factor, the method of its application and parameters must correspond as much as possible to the nature and phase of the pathological process.
At presence of pain syndrome it is necessary to relieve it during the first 2-3 procedures.
IN acute and subacute periods of the disease it is necessary to apply factors that primarily affect the etiology and pathogenesis of the disease and symptomatic therapy.
IN recovery period diseases it is necessary to use factors aimed at replacing dead tissue areas
new of the same structure (restitution) and granulation tissue (regeneration), as well as the use of factors that provide full or partial compensation for lost functions (compensation), and physical factors that have a general tonic effect and support nonspecific resistance of the body (immunity).
IN acute period of the disease low-intensity physical factors are applied directly to the pathological focus; high-intensity factors - to segmental reflexogenic zones.
IN subacute period And at chronic course diseases the intensity of factors applied topically to the pathological focus increases.
Lack of pronounced therapeutic effect after the first procedures is not a reason to cancel this factor or replace it with another physical factor.
The principle of course treatment necessary to achieve the most pronounced therapeutic effect and ensure a long-term aftereffect of the course of physiotherapy.
Prolonged use of the same physical factor leads to habituation of the body (adaptation to the factor), which significantly reduces the effectiveness of its therapeutic effect.
Taking into account long aftereffect therapeutic physical factors carrying out repeat courses treatment only possible after effects are reduced from previous treatment. The summation of therapeutic effects and the aftereffect of preformed physical factors range from 1 to 4 months, and natural physical factors - from 6 to 12 months.
The principle of complex treatment with physical factors based on synergism, potentiation and obtaining new therapeutic effects when used combined(simultaneous impact on the pathological focus of several physical factors) and combined(sequential application of various physical factors with different time intervals or alternating courses) exposure to therapeutic physical factors.
Physical methods of treatment are used against the background of basic drug therapy; They are an addition to it, but in no case replace drug therapy.
6.6. Compatibility of various physiotherapeutic
procedures
To obtain a pronounced clinical effect, it is necessary to follow the principles of rational prescription of physical methods
treatment. At the outpatient stage of rehabilitation treatment, the number of physiotherapeutic procedures is limited. In one day it is not recommended:
Prescribe 2 general procedures;
Consistently use antagonistic factors that depress and excite the central nervous system;
Carry out multidirectional procedures (for example, heat and cooling), especially in subacute and chronic inflammatory processes;
Prescribe 2 procedures for one reflexogenic or projection zone;
Use factors similar in type of energy for one zone;
Apply factors that have a pronounced neurostimulating effect to one field;
Combine various physical factors with acupuncture. Attention!The order of administration is important
physical methods of influence and maintaining the interval between them. The effectiveness of the treatment course does not increase when it includes large quantity procedures: the most effective is the use of a complex consisting of 1 general procedure and 2 local procedures; local procedures are prescribed before general ones (to enhance local reactions).
6.7. Contraindications for physiotherapy
In physiotherapy, it is customary to distinguish general contraindications for use and contraindications for specific methods of physiotherapy.
General contraindications for prescribing physiotherapy: oncological diseases; all diseases in the stage of decompensation; systemic blood diseases; bleeding and tendency to bleed; heat body (>38 °C); severe intoxication; serious condition of the patient; cachexia (severe exhaustion of the patient); severe atherosclerosis of cerebral and peripheral vessels; decompensation of cardio-vascular system, circulatory failure stage III; respiratory failure III degree; chronic pulmonary heart failure degree III; hypertonic disease Stage III; pronounced violations heart rate and conductivity of heavy gradations; pulmonary tuberculosis in the active stage (prescription is possible only in specialized medical institutions); epilepsy with frequent status epilepticus; pronounced psychomotor agitation;
It is known that the complex use of correctly selected physical factors helps to increase the effectiveness of treatment and reduce its duration. When carrying out such treatment, the compatibility of the prescribed procedures becomes important.
Based on accumulated experience, it is recommended to rely on such general provisions when using physical factors in an integrated manner.
1. More than two electrotherapeutic procedures should not be performed on one day.
2. On the same day, it is inappropriate to use factors that are similar in their physical characteristics (for example, inductothermy and electric field UHF), and factors of multidirectional action, including thermal and cooling (for example, mud applications and cold bathing).
3. Treatment procedures that have a generalized reaction on the body should not be carried out on the same day, as this may cause an exacerbation of the disease. Let's take two different shared baths as an example.
4. It is inappropriate to carry out various physiotherapeutic effects on the same reflexogenic zone (collar area, nasal mucosa), through which the general reactivity of the body can be restructured.
5. Physiotherapeutic procedures with similar effects should not be prescribed (for example, diadynamic and sinusoidal modulated currents), since the total dose of irritants (physical factors) can develop into an optimal one and give a negative effect.
6. Ultraviolet exposure(in erythemal doses) it is not advisable to combine with galvanization, electrophoresis (especially novocaine and its analogues), thermal procedures, massage. When combining light and hydrotherapy, it should be taken into account that general UV irradiation must precede water procedures, while local irradiations are usually carried out after them.
8. Physiotherapeutic procedures should not be used on difficult days. diagnostic studies(x-ray, radioisotope, etc.).
The issue of re-prescribing courses of physiotherapeutic procedures is quite complex. When solving it, you need to take into account the physical characteristics of the factor, its biological effect, the nature of the disease, the individual characteristics of the patient, etc. The so-called “aftereffect effect” is of great importance, the essence of which is that changes in the body caused by the action of physical factors do not stop immediately, but after a certain, fairly long period, the duration of which can be many times longer than the time of exposure. It has been established that the aftereffects, especially with prolonged use of physical factors, are based on long-term changes in metabolism. Therefore, re-prescribing physical therapy methods more often than after 4-5 months is not advisable.
