What is exercise therapy? Forms and means of exercise therapy. Indications and contraindications for prescribing exercise therapy, absolute and relative contraindications

Means of therapeutic physical culture:

- physical exercise;

- natural factors (sun, air, water);

- massotherapy;

- motor mode.

In addition, additional means are used: occupational therapy and mechanotherapy.

Under occupational therapy refers to the restoration of impaired functions with the help of selectively selected labor processes.

Mechanotherapy- this is the restoration of lost functions with the help of special devices. It is used mainly to prevent and develop contractures (stiffness in the joints).

In sports practice, after injuries to the musculoskeletal system, mechanotherapy can be used to increase the range of motion in the joints; Exercises on various exercise machines are effective for strengthening muscles.

Therapeutic massage (classical, acupressure, segmental reflex, hardware, hydromassage) is used in combination with physical exercises in the process of both treatment and rehabilitation.

Classification and characteristics of physical exercises used in exercise therapy

Physical exercises used for therapeutic purposes are divided into gymnastic, ideomotor, applied sports, exercises in sending impulses to muscle contraction, dosed games, etc.

Gymnastic exercises. They are specially selected combinations of natural movements for humans, divided into elements. By using gymnastic exercises, selectively influencing individual muscle groups or joints, you can improve overall coordination of movements, restore and develop physical qualities such as strength, speed of movement and agility.

Gymnastic exercises are classified according to several main characteristics:

Anatomically, exercises for the muscles of the neck, torso, shoulder girdle, upper extremities, abdominals, pelvic floor, lower extremities.

Based on activity - active (performed by the patient himself), passive (performed by the exercise therapy instructor with the patient’s volitional effort), active-passive exercises (performed by the patient himself with the help of the exercise therapy instructor).

According to the principle of using gymnastic apparatus and apparatus - exercises without the use of apparatus and apparatus; exercises with objects (gymnastic stick, rubber, tennis or volleyball ball, medicine ball, clubs, dumbbells, expanders, jump rope, etc.); exercises on apparatus (gymnastic wall, inclined plane, gymnastic bench, rings, mechanotherapeutic equipment, uneven bars, crossbar, balance beam); exercises on simulators, etc.

By type and nature of performance - serial and drill, preparatory (introductory), corrective, for coordination of movements and in balance, in resistance, breathing, hanging, stops, jumps and jumps, rhythmic exercises, etc.

Ordinal and drill exercises. They organize and discipline patients, developing in them the necessary motor skills (forming, changing lanes, walking, turning in place, other exercises).

Preparatory (introductory) exercises. Prepare the body for the upcoming load.

Corrective exercises. Reduce postural defects and correct deformities of individual parts of the body. Often combined with passive correction (traction on an inclined plane, wearing a corset, massage). These include any movements performed from a certain starting position, which determines a strictly local impact. A combination of strength tension and stretching exercises is used. For example, with severe thoracic kyphosis (stooping), physical exercises aimed at strengthening the back muscles, stretching and relaxing the pectoral muscles, as well as the muscles of the legs and feet, have a corrective effect.

Exercises for coordination and balance. They are used to train the vestibular apparatus (for hypertension, neurological and other diseases). Performed in the following starting positions: basic stance, standing on a narrow area of ​​support, standing on one leg, on toes, with eyes open and closed; with and without objects. Coordination exercises also include exercises that develop everyday skills lost as a result of a particular disease: fastening buttons, lacing shoes, lighting matches, opening a lock with a key, etc. Modeling, assembling children's pyramids, making mosaic patterns, etc. are also widely used. . P.

Resistance exercises. They are used during the recovery training period of exercise therapy. Helps strengthen muscles and increase their elasticity; have a stimulating effect on the cardiovascular and respiratory systems, metabolism.

Breathing exercises(static, dynamic, drainage). Used in all forms of exercise therapy. They have a beneficial effect on the function of the cardiovascular and respiratory systems, stimulate metabolic and digestive processes. Their calming effect is used in case of disturbances in the nervous regulation of various body functions, for faster recovery in case of fatigue, etc.

Static breathing exercises are performed in various starting positions (without movements of the legs, arms and torso); dynamic breathing exercises are performed in combination with movements of the limbs and torso. Drainage exercises include breathing exercises specifically aimed at draining exudate from the bronchi; they are used for various respiratory diseases. It is necessary to distinguish between breathing drainage exercises and positional drainage (specially specified positional starting positions, also aimed at the outflow of exudate through the respiratory tract - according to the “gutter” principle).

Hanging, standing, jumping, jumping. Types of gymnastic exercises that are included in therapeutic physical education classes during the recovery period. They are performed strictly in doses, under the supervision of a physical therapy instructor.

Rhythmoplastic exercises. They are used at the sanatorium and outpatient stages of rehabilitation - for the final restoration of the function of the musculoskeletal system, as well as in the treatment of neuroses, diseases of the cardiovascular and other systems; are performed with musical accompaniment, with a given rhythm and tonality (depending on the functional state of the patient and the type of higher nervous activity).

Muscle stretching exercises(stretching). Used to increase the elasticity of the muscular-ligamentous apparatus and relax muscles. They also help restore muscle performance after physical activity.

Exercises in water (hydrokinesiotherapy). They are increasingly used in exercise therapy. Warm water in a pool or bath helps relax muscles, soften soft tissues, increase their elasticity, and reduce spasticity. In addition, water reduces the weight of the body and its individual parts, making exercise easier. Physical exercises in water and swimming are indicated for injuries of the musculoskeletal system, osteochondrosis and spondylosis, postural disorders and scoliosis, for paralysis and paresis and other suffering.

Ideomotor exercises also used in exercise therapy (especially at the hospital stage). Performed mentally, they not only cause weak muscle contraction, but also improve their functional state and have a trophic effect. These exercises are used for paralysis and paresis, for prolonged immobilization, when the patient cannot actively perform the exercises.

Isometric (static) exercises. The patient is asked to contract and relax the muscles of the immobilized joint while mentally imagining the movement being performed. These exercises are used when immobilizing the limbs to prevent muscle atrophy, improve blood circulation and metabolism in them (for example, when applying a plaster cast to the hip and knee joint, the patient actively contracts the quadriceps femoris muscle without making movements in the knee joint, etc.

Exercises on simulators are increasingly used in exercise therapy for the rehabilitation of sick and disabled people. The use of exercise machines allows you to accurately dose the load and develop the necessary physical qualities: endurance, muscle strength, etc. For training the cardiovascular system, the following are used: exercise bikes (foot and hand), rowing machines, treadmills (treadmill), ski simulator, etc. To develop the strength of various muscle groups, there are a variety of simulators: block, Kettler, David, etc. In our country, new generation simulators have been developed by Professor V.K. Zaitseva.

Sports and applied exercises. Of this group of exercises, dosed walking, running, and jumping are most often used in exercise therapy; throwing and climbing; balance exercises; lifting and carrying heavy objects; dosed rowing, skiing, skating, cycling, therapeutic swimming.

The use of applied sports exercises in exercise therapy contributes to the final restoration of the damaged organ and the body as a whole; instills in patients a conscious attitude towards exercise therapy and self-confidence.

Dosed walking. Strengthens the muscles not only of the lower extremities, but also of the entire body due to the rhythmic alternation of their tension and relaxation. As a result, blood and lymph circulation, breathing, metabolism are improved, and there is a general strengthening effect on the body.

Dosed running. Evenly develops the muscles of the body, trains the cardiovascular and respiratory systems, improves metabolism and respiratory function. In therapeutic gymnastics classes, running is used for patients who are sufficiently trained for it with an individual dosage (with careful medical and pedagogical control).

Dosed jumps. Refers to short-term intense exercises used during the recovery period with individual dosage (with pulse control).

Throwing exercises. They help restore coordination of movements, improve joint mobility, develop muscle strength in the limbs and torso, and increase the speed of motor reactions. In therapeutic gymnastics classes, medicine balls, discs, balls with a loop, and grenades are used.

Climbing on a gymnastic wall and rope. Helps increase mobility in joints, develop strength in the muscles of the torso and limbs, and coordinate movements.

Balance exercises. They are used for damage to the vestibular apparatus, amputation of the lower limb, diseases and damage to the nervous system.

Metered rowing. In exercise therapy it is used for the purpose of general training of the body, developing rhythmic movements that promote deepening of breathing, development and strengthening of the muscles of the upper limbs and torso, and mobility of the spine. An increase in intra-abdominal pressure during rowing has a positive effect on the digestion process and tissue metabolism. The use of rowing in conditions of clean, ionized air, saturated with water vapor, has a healing effect on the body.

Rowing lessons are prescribed in dosage form, with short pauses for rest and deep breathing indicated (with medical and pedagogical supervision).

Dosed skiing. Activates the work of the muscles of the whole body, improves metabolism, the activity of the cardiovascular and respiratory systems, trains the vestibular apparatus, increases muscle tone, improves mood, and helps normalize the state of the nervous system.

Dosed skating. Trains the cardiovascular, respiratory and nervous systems, improves metabolism, develops coordination of movements, strengthens the vestibular apparatus. Prescribed during the recovery period to well-trained individuals who know how to skate (with medical and pedagogical supervision).

Dosed therapeutic swimming. Increases heat transfer, improves metabolism, blood circulation and breathing, strengthens the muscles of the whole body, the nervous system, and hardens the body.

Dosed cycling. It is used for general health purposes, to strengthen muscles and develop movements in the joints of the lower extremities; trains the cardiovascular and respiratory systems, vestibular apparatus.

Exercises to send impulses to muscle contraction(to perform movements) are used for paralysis and paresis, when active movements are absent or sharply weakened. It is recommended to combine sending impulses with passive movements - this helps improve conduction along the centripetal and centrifugal nerves.

Dosed games (on the spot, sedentary, active and sports) used in exercise therapy to instill in the patient determination, perseverance, intelligence, dexterity, courage, and discipline; have a positive effect on the activity of all organs and systems. Games are included in activities during the recovery phase. All types of games are carried out under medical and pedagogical supervision.

Forms of exercise therapy

In exercise therapy, there are several forms of conducting classes: morning hygienic gymnastics, therapeutic exercises, independent physical exercises, therapeutic dosed walking, dosed climbing (health path), mass forms of health-improving physical culture, dosed swimming, rowing, running, etc.

Morning hygienic gymnastics (UGG). For a sick body, this is a specially selected set of physical exercises that promotes the body’s transition from a state of sleep-inhibition to active wakefulness.

Therapeutic gymnastics (LG). It is the main form of exercise therapy to restore the functions of a damaged organ and the body as a whole. The LG lesson consists of three parts: introductory, main and final. In introductory part Basic gymnastic and breathing exercises are performed to prepare the patient’s body for increasing physical activity. Main part solves basic medical problems. In this part of the lesson, special and general developmental exercises are used that have a positive effect on the damaged organ and the body as a whole. The selection of special exercises should be made taking into account the form of the disease, the clinical course of the disease, and the general condition of the patient. IN final part classes include basic gymnastic and breathing exercises that help relax muscles and reduce overall physical activity.

Independent exercise. They are carried out by patients who are conscious about performing the exercises and who know how to perform them correctly. Patients who exercise independently should have a set of physical exercises compiled by a physical therapy specialist, taking into account their illness and individual characteristics. This form is widely used to restore lost functions of the musculoskeletal system, in the treatment of nervous diseases, in traumatology, etc. Classes must be repeated several times a day.

Therapeutic dosed walking. It is used to normalize gait after injuries and diseases of the nervous system, musculoskeletal system, metabolic disorders, as well as for training the cardiovascular and respiratory systems. Therapeutic walking is dosed by changing the speed of movement, distance length, and terrain.

Dosed ascent (terrenkur). A type of measured walking with gradual ascents and descents on special routes. It is used for diseases of the cardiovascular and respiratory systems, metabolic disorders, and traumatic lesions of the musculoskeletal system and nervous system. Depending on the steepness (angle) of the climb, the path routes are divided into groups: 4-10; 11-15 and 16-20°. The most famous health path routes are located in Kislovodsk, Essentuki, Sochi.

Dosed swimming, rowing, skiing, skating, etc. They are not only a means of exercise therapy (as a type of physical exercise), but also an independent form of conducting classes. They contribute to further training of the functions of the damaged organ and the body as a whole, as well as increasing the level of performance of those recovering. They are used individually, taking into account indications and contraindications, in the appropriate dosage. Widely used for the rehabilitation of athletes, young and middle-aged people.

Mass forms of health-improving physical culture. This includes elements of sports games, close tourism, elements of sports, excursions, mass physical education performances and holidays. Used during the period of final recovery to train all organs and systems of the body; are selected individually. They are used not only for therapeutic and rehabilitation purposes, but also for preventive purposes (especially in health groups and in classes with older people).

Indications for exercise therapy

Physiotherapy applies practically for any ailments and injuries and has no age or gender restrictions. The main indications for its use are considered to be the absence, weakening or distortion of a function established as a result of disease, injury, injury or their complications when the condition of positive dynamics in the physical condition and well-being of the patient is met. It is worth emphasizing that effect of physical therapy significantly increases with earlier and systematic use in complex comprehensive treatment and rehabilitation.

Indications and contraindications for the use of exercise therapy

The life of our ancestors forced us to constantly engage in physical exercise, and a stressful situation entailed fight or flight (physical activity), at this moment the entire body was mobilized, the nervous system received biological and physiological release. Modern man has no release, the reaction of the subconscious to external stimuli ends with muscle tension, tension does not disappear anywhere, the tension of one day passes into another, this is how muscle blocks arise, energy leaks occur, and only physical exercise will help you break out of the vicious circle.

During short-term exercise for 15 minutes, the body uses glycogen to cover energy needs, and during prolonged exercise, subcutaneous fat. Entering a physical activity regime should be gradual, individual, dosed; physical exercise should become part of everyday life.

Indications, contraindications and risk factors in physical therapy

Therapeutic exercise is indicated at any age for almost all diseases, injuries and their consequences. It finds wide application:

In the internal medicine clinic;

In neurology and neurosurgery;

In traumatology and orthopedics;

After surgical treatment of diseases of internal organs;

In pediatrics;

In obstetrics and gynecology;

In phthisiology;

In psychiatry;

In ophthalmology - for uncomplicated myopia;

In oncology - in patients without metastases after radical treatment.

The list of contraindications is very small and concerns mainly the initial period of the acute stage of the disease or exacerbation of chronic diseases, the acute period of injury, the need for surgical intervention, and bleeding.

General contraindications for prescribing exercise therapy:

Acute infectious and inflammatory diseases with high body temperature and general intoxication;

Acute period of the disease and its progressive course;

Malignant neoplasms before their radical treatment, malignant neoplasms with metastases;

Severe mental retardation (dementia) and mental illness with severely impaired intelligence;

The presence of a foreign body near large vessels and nerve trunks;

Acute disorders of coronary and cerebral circulation;

Acute thrombosis and embolism;

Increasing cardiovascular failure with decompensation of blood circulation and breathing;

Bleeding;

General serious condition of the patient;

Significantly expressed pain syndrome;

Negative ECG dynamics, indicating deterioration of coronary circulation;

Atrioventricular block.

Temporary contraindications to the appointment of exercise therapy:

Exacerbation of chronic diseases;

Complications during the course of the disease;

Intercurrent diseases of an infectious or inflammatory nature;

Acute injuries;

The appearance of signs indicating the progression of the disease and deterioration of the patient’s condition;

Vascular crisis (hypertensive, hypotonic or with normal blood pressure (BP));

Heart rhythm disturbances: sinus tachycardia (over 100 beats/min.), bradycardia (less than 50 beats/min.), attack of paroxysmal or atrial fibrillation, extrasystoles with a frequency of more than 1:10.

Risk factors that may cause damage to the osteoarticular apparatus include:

Severe osteoporosis in older people, especially women;

Significant effort on the part of the patient with fragile callus, after fractures of the bones of the extremities in patients with spastic paralysis and impaired pain sensitivity. Caution should be observed after fractures to prevent the occurrence of pseudarthrosis and arthrosis.

If you have a thoracic or abdominal aortic aneurysm, you should not use exercises with force or resistance.

Therapeutic exercise can be an independent method of treatment, rehabilitation and disease prevention, and also goes well with all types of drug treatment, physiobalneotherapy, mud therapy, before and after surgery.