лечение позвоночника

• The formula of a technique of treatment
• The basic differences between defanotherapy and manual therapy
• Technology of application of defanotherapy
• Expedient of tractionally-impulsive action
• Psychophysical exercises
• The indications and contraindications to application defanotherapy
• Results of clinical trials and effects of treatment

Methodical recommendations. Edited by the head of the department of neurology of Russian State Medical University, doctor of medical sciences professor A.I. Fedin. Moscow, Russian State Medical University, 1996.

Methodical recommendations are aimed at applying original method of manual therapy in medical practice (patent N 2005456 C A61 N 23/0) with the help of which a wide range of diseases, connected with infringement of functions of a backbone (radiculopathy, neuropathogenesis, protrusion and hernia of a spinal disk without the phenomena of a sequestration, infringement of bearing and scoliosis of a backbone.

Methodical recommendations are designed for neuropathologists, traumotologists, specialists in manual therapy.

Author of the technique of treatment, candidate of medical sciences A. Bobyr.

This way of treatment is recommended for publishing by Russian State Medical Uniuersity.

Reviewers:

Head of the department of reflexotherapy of Russian Medical Academy of post-diploma education, doctor of medical sciences, professor V.S. Goidenko;

Head of the department of Kazan State Medical Academy, doctor of medical sciences, professor V.P. Veselovskiy.


The formula of a technique of treatment

In treatment of vertebral diseases the methods of manual therapy are widely applied. In spite of having a lot of positive features, these methods at the given stage of development of medicine require essential correction. The basic disadvantages of the developed methods of manipulation are their rather low efficiency because of application of technologies of local influence only on one part of a locomotorium, and high traumatism of tissues as a consequence of application of dangerous in many cases shock methods of "blasting" the bracing of the blocked vertebral joint. The technique of Defanotherapy is a new original technique of manual restoration of pathologically changed impellent stereotype and it includes: a method of diagnostics intended to takedown a local overstrain; action on a backbone by a tractionally-impulsive method on all sites of backbone in a state of hypomobility; reduction of muscles by a method of postisometric relaxation; massage or refloxotherapy methods; formation by the patient natural muscles and majorant of an optimal impellent stereotype.

The name "Defanotherapy" occurs from the French word "defans" - strain, and "therapy" - treatment, that is treatment of a strain. Operations on biokinetics of a statics and the motilities of a human body show, that the backbone and extremities is a uniform biokinetic chain, having broken which one part, other parts will necessarily be subjected to changes. Index of these changes are the spastic phenomena, both in sceletal, and in a sleek musculation, consequence that the medical science ascertains mass of diseases, which example are scoliotic illness, arthrosis, spastic colitis, hypertonia, vertebral headache and others.


The basic differences between defanotherapy and manual therapy are:

1. Manual therapeut carries out manipulation in one plane: at shock technology attacks a transversal process of a backbone in sagittal plane, and as by Levit - in a horizontal plane, while defanotherapeut carries out manipulation simultaneously in two planes: sagittal and horizontal, than the highest efficiency of treatment is achieved at a complete lack of pain and that means that there is no chance of being injured;
   
   
2. A method of diagnostics intended to takedown a local overstrain allows to process treatment without a padding X-ray inspection during treatment, and also is high performance and is prompt to carry out diagnostics of presence of sites of hypomobility in a backbone, that is very important at mass routine maintenances;
   
   
3. The procedure of Defanotherapy includes simultaneous reduction of motions in hypomobile, amomobile sites of a backbone, reduction of function of pathologically changed muscles, formation natural muscles and majorant of an optimal impellent stereotype, that in such volume it is not provided by designed procedures of manipulation;
   
   
4. The procedure Defanotherapy as against known methods of manipulation is easier in performance, that reduces expenses on teaching the given procedure.
   
   
5. Defanotherapy includes a complex of diagnostic and medical receptions enough for complete reduction of an impellent stereotype, that means it is self-sufficient partition of a medical science, applying which the doctor is capable of completely restoring the health of the patient.
   
   
6. A method of diagnostics intended to takedown a local overstrain, the fractionally-impulsive expedient of action on a backbone, system of performance of autophsycophysical exercises are patented in Russian Federation (2005456), as " An Expedient of treatment of an osteochondrosis and prophylaxis of vertebral diseases)).

Technology of application of defanotherapy

The impellent stereotype, on definition of the known scientist Karl Levit, is plurality of conditional and unconditional reflexes formatived during an ontogenesis and amounting gait, handwriting, bearing, that is all impellent processes replicating in daily life. The impellent stereotype can be optimal, when the replicating impellent processes are carried out in a self-acting regimen and do not cause negative sensations in the executor. Restriction of motions, prompt fatigability, as a consequence of inconveniences, bound with a warpage of a basin, trunk, neck, shortening of an extremity and so on specify the presence of a non-optimal impellent stereotype. In the basis of the reduction of a non-optimal impellent stereotype lays normalization of the broken perfection of systemic organization of frames and functions of the organism which has arisen as a consequence of organic myofixation and subsequent deformation of a vertebral-impellent segment (VIS). The systemic activity of an organism is shaped by dominant biological motivations the major of which is the direct maintenance of a position of a body for account of muscle frames and fissile nervous maintenance of a pose and motility. Let's stop on each of devices amounting дефанотерапию.

It is possible to reveal sites of basic changed myofixed distorted VIS and compensatory changed VIS, applying expedients known in manipulation of diagnostics but applying the method of kinestatic diagnostics. These examinations can be carried out much more precisely and easier. From a bodily machinery of a backbone it is known that at a level of a projection of myofixed VIS juxtaspinal muscles are in spastic state. To such state of muscles at surgical diseases the French scientist Mondor has given the name of "local defans". At the presence of a non-optimal impellent stereotype the condition of juxtaspinal muscles at different levels and sides of a backbone correspond to a stage of its development. But at the level of myofixed spine from the laterostasia side, even of its insignificant quantity, defans is always noticed and on the other side - hypotonia of muscles, which in case of long-lived conservation transfers in an atrophy. The degree of a hypertrophy and atrophy of juxtaspinal muscles will depend on a stage of development of an impellent stereotype and duration of degenerative processes in basic VIS, on the data of clinical observations, with rare exception, basic VIS is C1-C2.

The stages of development of an impellent stereotype distinguish the following (V. Veselovskiy): generalized, polipartial, partial, interpartial and local.

The quantity of local defans differs - from hardly appreciable inspissation up to a total spastic stricture of group of muscles. Defans can be unilateral and two-sided, but always with expressed asymmetry of strain that enables to spot the side on which will be carried out the manupulating action.

Hypomobility, as basic amounting of a non-optimal impellent stereotype is clinically reveiled:

• By restriction or lack(absence) of motions in pathologically changed VIS;
  
  
• By pain and discomfort on this site of a backbone;
  
  
• By presence of a sign "of a washing board" above the pathologically changed band;
  
  
• By weakening or disappearance of a sign "of a dermal wave";
  
  
• By palpatory determined inspissations of a fibrosis consistence with legible boundaries;
  
  
• The sign of "ice surface", at intensifying a local palpation of muscle strain, last with "crisp" disappears.

In practice the presence of hypomobility is defined by the pillows of medium, index and anonymous fingers of both hands, with which 1,5 centimeters from acanthas slip along a backbone apart. The sliding along a backbone also has denominated this method - kinestatic diagnostics. The presence of local defans of muscles is well felt after the relevant practical operation. The level of presence of revealed defans is scored through a dermal dermographism.


Expedient of tractionally-impulsive action

The tractionally-impulsive action on VIS devices causes besides mechanical response and decompression of radicular and vertebral frames of a backbone reflex-impellent effect on segmental and abovesegmental level. The stream of impulses from receptors of sheaths of intervertebral joints and muscles enters in vertebral and supraspinal departments of nervous system, through which the action on function of interior bodies is carried out. The interrelation of changes in a backbone, muscles and interior bodies is explained by a polydendritic structure of somatic afferent neurones and presence in vegetative nervous clusters multifunctional vegetative neurones the dendrites of which carry out simultaneous afferentnance of vessels, osteomuscular tissue and interior bodies. This brief theoretical digression explains the efficiency of Defanotherapy not only at treatment of a dysfunction of a backbone but also at vertebral pathology. The rather hard platen by a diameter 3-5 cm. with equal edges is necessary for carrying out of a session of fractionally-impulsive action. The platen can be made from a wooden or rubber hinge, which is turned in removable hydrophylic gaskets used for electrophoresis in physiotherapeutic studies.

The platens of the greater hardness and greater diameter are applied at treatment of the patients with the advanced muscle system, smaller density and smaller size - at treatment of the patients with the weakly advanced muscle system, and also children. Then the platen is turned in an one-time impregnated-paper towel, which on 15 cm. should sag on one of the sides of the platen. The sagging end of a towel is necessary for more convenient bracing of the platen on the chosen point spins of the patient.

The manipulation is carried out as follows: in the beginning costing the diagnostic examination by a kinestatic expedient is done and through a dermal dermographism local defans is revealed. Then the patient takes seat on a couch by a back to the doctor, the platen is stacked on the middle of the revealed defans and nestles by a housing of the doctor on the patient. After that the doctor covers the patient by the arms through axillary fields, lifts him above a couch and after achievement by the patient of a maximal relaxation, manufactures a vibratory motion by a natural housing (not a jarring!), radiating of their inferior extremities and transfered through the platen to the patient. The force of vibratory action can be controlled by augmentation or decrease of force of the platen by a housing of the doctor to a spin of the patient (lumbar or thoracal departments of a backbone), or finger of the doctor - by operation on a cervical department. The force of vibration is picked individually depending on the constitution, weight, age of the patient and from sequence of action (first or third session). At the correctly lead manipulation the doctor feels a click, local defans thus in most cases weakens or disappears. It is necessary to remember, that the positive effect needs to be achieved at minimum force of action. The lack of positive effect at poor force of action can be corrected by repeated manipulation, the excessive effort will cause long-lived morbidity on a place of action, that is certainly not permissible.

The manipulations on a backbone always need to be begun from the sacroiliocal area of a joint, then we attack the revealed hypomobility sites in lumbar, thoracal and in last turn, cervical department. On a thoracal department the technique of performance of manipulation is the same as well as on a lumbar department of a backbone. But traction is performed by keeping the patient for ulnar joints.

The action on a cervical department at performance of manipulation is carried out a little bit more difficultly, than on other departments of a backbone. The patient also takes seat on a couch by a back to the doctor, the doctor fixes the major finger on beforehand revealed local defans by other hand covers the head of the patient so that his brachium and forearm were both above zygal bones of the patient and presses the head to a thoracal cell. After that the doctor continuously turns the head of the patient in the side opposite to a local defans up to a physiological maximum, densely presses the head of the patient to a natural trunk and manufactures manipulation by performancing continuous but prompt traction of a neck and vibration of a natural housing. The vibratory wave transfers from the doctor through a major finger to area of local defans. By operation on upper three cervical spines the head of the patient should be as much as possible bent forward and in the side opposite to defans, at manipulation on the middle part (C4-C6) the neck is incurvated up to half possible and by operation on the bottom part flexion of a neck it is not required. Pay special attention that manipulation on the thrown back neck, padding rotation and supertraction during manipulation are not permissible.

Though the offered procedure of treatment falls into categories of manual procedures, but the arms of the doctor at performance of manipulation carry out a role of the supernumeraries, which anchor a body of the patient in a particular position. The first part of manipulation - traction is manufactured for score of an extension of legs of the doctor in knee joints, and second part - vibration - for score of a sharp jolting of knee joints forward, paying attention, that thus the certificate(act) of knee-bend was not carried out.

For one session it is possible to attack only one VIS, included in composition of a function part of a backbone, for the second day it is possible to prolong manipulations on other VIS's if for this purpose there are indications. Before each session it is necessary to carry out complete diagnostics of presence of local defans, comparing their performances with the previous indications. After the correctly executed manipulation volume of motions in VIS's, taking place in a state of hypomobility will increase, local defans becomes less intense and in some cases will disappear.

The course of carrying out of manipulations depends on clinical fluxion of illness, and most frequently used schema of treatment looks as follows: two sessions daily, then patient in during one month, applying psychophysical exercises, is anchoring the received resul) from the lead manipulation, then the single-pass manipulation is carried out and if after these actions the impellent stereotype is not normalized the treatment is prolonged as daily exercises and monthly manipulations on a backbone. At treatment, for example, scoliosis of the second degree the course of treatment lasts about one year. The force of a traction and vibration should be fulfilled with the expert. Self-maintained operation is better for beginning, manipulating on the physically proof patients, and only then to transfer to treatment of children and elderly patients, the operation which requires particular experience. While treating, the doctor should remember that it is possible to remove pathological infringements for two - three sessions, but to reduce function of muscles rearranged during illness according to the demands of mechanisms to frame sufficient natural muscles, and also to develop a majorant of an optimal statics and kineticses, the patient is to be convincied to carry out particular exercises long-lived time.

Essential part of Defanotherepy - action, both on separate muscles, and on groups of muscles, the author consciously omits, in view of sufficient development of this question in the medical literature (A. Liev, F. Khabirov) as this fragment of operation is not object of the Patent. But the practical doctors should remember, that without reduction muscle amounting, the same as and without normalization of mutual relation in medical effect to expect is useless.


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