лечение позвоночника

Ministry of Health of Russian Federation.

Introduction

The existence of a great number of different theories of vertebral pathology origination and methods of treatment better than other facts illustrates the authors' dissatisfaction with their quality.

According to different data [7, 20, 26] vertebral pathology is peculiar to nearly 95% of the population of Russia. The works by V. P. Veselovsky and his students [1, 2, 3, 4, 22], devoted to the unity of all the components of motor stereotype, which is formed by the state of atlanto-occipital joint and of all vertebro-motor segments (VMS), lay the basis of practical etiological concept development, pathogenesis and treatment for vertebral genesis diseases.

As K. Levit says "If there appear any positional or functional changes in one end of the vertebrae (column), they will be immediately reflectively detected all over the whole axis…"[9]. But it is to be taken into account that all the links of the biochemical chain "head-foot" [4, 9,] are involved into the process equally with the column, and there occurs a cascade rearrangement of the anatomic-functional interrelations.

It is the whole biochemical chain dependence of a single link that has become the key component of our vertebral pathology development and passing conception.

However with the increased number of observations of patients suffering from vertebral pathology we came to the conclusion that in this pathology pathogenesis organic and functional changes in the foot play an important role equally with atlanto-occipital joint, and that is why we consider it important to define the main biochemical chain, namely "head-foot", more extensively.

In the process of this conception development we and other authors have noted repeatedly that the presence of degenerative-dystrophic changes (DDC) in intervertebral disc and the accumbent tissues is an integral component in the pathology development [2, 5, 6, 14, 15, 17, 22, 24].

The initiating cause of DDC, in our opinion [1, 3], is the dissymetry of mechanic load on the terminal elements of the biochemical chain "head-foot". Gravity force dissymetry is the compensating reaction on the presence of vertebras dynamic dislocation (instability) and VMS immobility, it is regulated by vestibular system, carried through vestibulospinal tract and the motoneurons of the spinal cord front horns. This process causes dissymetry of juxstaspinal muscles tonus, which in its turn leads to a further dissymetric development of their force, weight and other biophysical properties.

The determination of the cause of spondyles disfixsation origination is the key point, which gives completeness and practical value to our conception "head-foot". More often the cause is an injury, a natal injury of cervical part of the column in particular. This opinion is confirmed in many works [1, 3, 15, 16]. For example, J. Y. Popelyansky [15] asserts that it is the natal injury that acts as one of the causes leading to dystrophic changes in intervertebral disc, and recommends making the research in this direction. A. Y. Rathner [16] together with his co-authors has described the clinics of two pathological syndromes: syndrome of peripheral cervical failure (syndrome of humeral girdle amyotrophia) and natally stipulated myotomic syndrome, having specified that the majority of the surveyed children were revealed to have the elements of the described syndromes. The results of the survey of a group of acrobats, managed by A. Y. Ratner, are also of great interest: 102 of 157 surveyed appeared to have neurologic symptoms [16]. In his time biologist Nemilov termed the dilemma of woman's narrow pelvis and comparatively large baby's head as "the biological tragedy of a fossil woman". Unfortunately this problem is still urgent nowadays in the form of scoliosis as well as another children's vertebral pathology, keeps on pursuing a modern woman making her worry about her sick children. Having surveyed 846 school children, the researchers of the Kazansk Republican Vertebralogical Centre (KRVC) [12] have discovered that 83.6% of them suffer from some vertebral pathology. M. A. Utkhuzova [23] has made a neurolgic survey of 110 babies born in the day of the medical examination. Only 8 babies were declared to be healthy, the other 92.7% were discovered to have a cerebral disfunction, and 47 of them suffered from ischemia in vertebro-basilar basin. Kubis observed children from their birth till the age of 19 with the object of the reflex discovered by him ( Kubis reflex) and he notes that 68% of the 1093 surveyed children had head joints blockage. K. Levit surveyed 245 "practically healthy" children and discovered 66% of them to have the the column cervical section blockage.

We agree with the author [7], who refers to the European researchers (T. Gaits, 1997) noting that 95% of babies in Europe are born with the pathology of cervical section of the column (CSC), and with the statistics, which shows that 98% of children appear to have head and cervical joints blockages. Other authors [20,26] point out that 96-98% of children appear to have the locomotar system biochemical abnormality.

Since a baby injured in labour and suffering from hypomobility or a full head or cervical joints blockage begins to sit, in his column there develops a nonoptimal motor pattern, which is compensated for a long period of time by the asymmetric tonic contraction of paravertebral muscular system, which leads to the asymmetry of their further development. Besides asymmetric musclar contraction implies the vectors sum asymmetry in different sections of intervertebral disc, which leads to pulpal nucleus displacement. According to Guenter-Folkmann law the displaced nucleus of intervertebral disc presses irregularly on vertebra body, and in the place of its highest pressure the growth of the vertebra slows down and the disc takes a wedge shape. Further the wedge-shape deformation of the discs bodies causes their rotation, disfixation, which, influencing the anatomic-functional interrelation of VMS, in its turn intensifies vegetative and somatic innervation breakdown of the corresponding muscular groups, which shows itself through fascial-muscular rigidity [10]. The most frequent of these disease symptoms are stated to locate in foot flexors and extensors. Thus the patient suffers from a nonoptimal or a pathologic motor stereotype (NOMS).

The motor stereotype of a man is an integral notion, which includs all biomotivational, postural vertebral syndromes, which have developed in the process of ontogenesis. The syndromes which are more minutely illustrated in medical literature are the so called syndromes of "refrain from fall", i. e. the group of antigravity syndromes. According to Levit [9], motor stereotype is a combination of conditioned and unconditioned reflexes which develop in the period of ontogenesis and form the gait, handwriting and bearing - all the motor processes met in everyday life. Motor stereotype can be optimal if the repeating motor processes are implemented in an automatic mode and do not provoke the executor's negative feelings. Movement limitation, fatigability, etc. - all this signifies the presence of nonoptimal motor stereotype (NOMS). In other words, motor stereotype is the classical Anokhin functional system, oriented in pose maintenance and body transference in space.

Regeneration of nonoptimal MS is based on the normalization of the disturbed biochemical chain structures and functions interrelation, caused by myofixation and subsequent deformation of VMS. An integrated organism functioning is formed by the dominating biochemical motivations, the most important of which is orthograde position of the body due to both osteoligamentary, muscular structures and active nervous posing and motility.

Quite a wide range of different manual therapy methods is used to optimize MS. This general conception includes quite a long list of systems and schools, sometimes very different from each other, and this causes a lot of misunderstandings, especially among the doctors not specialized in manual therapy and who did not have a chance of a more detailed study of the peculiarities of different manual therapy methods. And all this inhibits a wide spread of this school. It's noteworthy that each methodology has its merits as well as some demerits. Thus, there appears an urgent need for bringing order into the classification of different methods of impact on both separate elements and complete biochemical chain "head-foot". The work of a group of searchers from the manual therapy center governed by the Ministry of Health of Russia in revelation of certain methods of treatment [19] efficiency is the most important stage in the formation and development of independent methodologies and schools in Russian manual therapy.

Defanotherapy, the method we have worked out, is one of these schools.

The term "Defanotherapy" [1] is derived from the French word "defense" - tension, and "therapy" - treatment, i. e. treatment with tension.

The essence of the method under discussion is forming the normal correlation of tension vectors in the chain "head-foot" to optimize dynamic motor system in exchange for the pathological, nonoptimal motor stereotype.

According to Veselovsky, the objective indicators of changes in motor pattern functional system of is the presence of hypo- and hypermobility in certain VMS, the presence of pathological changes in the muscles surrounding the column and the muscles of the extremities, and this reveals itself in certain malfunctions and the formation of specific exaltation focuses - the nonoptimal stereotype dominant - in cerebral cortex.

Defanotherapy is an original method of pathologically changed MS regeneration and it includes the following parts: method of palpation diagnostics through local asymmetric tension of paravertebral musculation; impact on the column through the traction-impulsive method on all VMS in the state of hypo-and immobility; functional regeneration of muscles through postisometric and postreciprocal relaxation, massage or other relaxotherapeutic methods; formation of progressive muscular corset tension congruent with the new vectors and motor dominant congruent with it. A compulsory impact on all the pathologically changed sections of MS during one session of treating is a distinctive feature of the methodology under discussion - defanotherapy.

We consider this methodology to be original due to the presence of patented elements, i. e. kinesthetic palpation diagnostics, traction-impulsive impact (TII) on the column [1] and the mode of making autopsychophysical exercises (APPE). The methods of postisometric, postreciprocal relaxation, massage, the essential parts of defanotherapy, have been studied by eminent scientists [4, 10, 22] and are widely practiced.

The main difference of defanotherapy from other methods is the fact that the doctor practices classical methods in one plane and a defanotherapeutist practices in two planes (sagittal and horizontal) simultaneously, which allows to achieve reposition trajectory release, hence noninvasive impact. This allows to reduce the range of relative contra-indications for the manipulation and considerably increases this manipulation efficiency.

According to the results of our work and the mentioned authors, who practice the methodology, we can conclude, that:

1. The efficiency of this method considerably excels the other well-known techniques (with this method it is possible to rehabilitate column functions in 2-3 sessions, on condition there is no muscular pathology).
2. The original method of palpation kinesthetic diagnostics allows to restrict the prescription for the obligatory rontgenologic control, adequately answering the main diagnostic questions avoiding dangerous ionizing radiation.
3. An important advantage of defanotherapy is its pathogenetic tendency to eliminate the roots of vertebral pathology, which allows successful using of this technique as a prophylactic method.
4. When this method is used the formation of muscular corset together with the indispensable regeneration of optimal motor stereotype allows to reduce considerably the quantity of relapses while the remission period for chronic vertebral diseases will increase.
5. The optimization of motor stereotype occurs in the course of self-training (making autopsychophysical exercises), which curtails considerably the period of treatment and reduces the quantity of ambulance sessions.
6. Due to the simplicity of this method application and its safety specialists training in this method takes less time than in other manual therapy schools, which reduces additional specialized education expenditures.
7. The normalization of vertebral column anatomo-functional correlations can't but beneficially affect the organism somatic state, i.e. the method under discussion is sanogenetic.

Defanotherapy methodic technology.
To describe the method in general, let's dwell on each of the elements, which constitute defanotherapy. The location of myofixed and thus deformed VMS is easy to reveal when well-known manual therapy diagnostic methods are used, but the use of kinesthetic palpation diagnostic method can make it easier to fulfill. From Biomechanics it is known [4] that at the level of misfixed, "closed" VMS, paravertebral muscles are in the condition of supertension. This muscular state may be defined as "local defense (tension)". In the presence of vertebrapathology, paravertebral musclar tone at different levels and on different sides of the column will be different: at the level of myofixed vertebra on the side kipsylateral to laterolystez a local relative defense can be marked, and on the contralateral side there developes muscular hypotonia, which in case of lingering disease may develop into hypo- and atrophy. The degree of paravertebral muscles dystrophy will depend on nonoptimal NS formation phase and degenerative processes duration.

The expressiveness of paravertebral muscular local defense may vary: from barely palpable infiltration to total tension. Muscular defense may be one-sided and double-sided, but it is always characterized by a marked asymmetry of tension, which allows to reveal the side on which the manipulation should be done. In practice the presence of a changed VMS is localized with forefinger, third finger and fourth finger pads of both hands, which slide along the column at the distance of 1.5 centimeters from acanthi projection. This sliding along the column gave the name to the method - kinesthetic palpation. To determine the defense neither special skills nor hypersensibility are required - palpation paravertebral defense does not differ from abdominal wall defense customary in general surgical practice.

Traction-impulse impact method.

To conduct a session of TII a relatively hard roller is needed, 3-5 centimeters in diameter and 3-5 centimeters long with even edges. It may be made of woody or rubber shank wrapped into replaceable hydrophilic layers (baize, fustian, flannel), which are used for electrophoresis in physiotherapy rooms. The rollers of greater hardness and larger in diameter are used in treating the patients with a developed muscular system and children. Then the roller is wrapped into a disposable tissue, a 15 centimeters end of which should sag on one side of the roller. The sagging end of the tissue is needed to fix the roller on the desired part of the back.

During the manipulation on the lumbosacral and thoracal parts of the column, the patient sits on the couch his back to the doctor, the roller is laid on the center of paravertebral defense zone and the doctor presses it with his trunk to the patient. Afterwards the doctor enfolds the patient with his arms under the armpits, heaves him above the couch and, as the patient achieves a total relaxation, makes a vibratory movement with his trunk (but not a shaking!), the movement originates impulsively in the lower extremities and is transmitted through the doctor's trunk and the roller to the patient. The power of vibratory impact can be regulated by intensification or weakening the roller pressing on the manipulated zone (when loin, sacrum or thoracal parts of the column are stimulated), or the pressure of the doctor's finger (when cervical part is stimulated). The frequency of vibratory waves, excited by the doctor, depend on his psychophysical state, but in general this index is 3-6 waves a second (15-18 Hz). Vibration power and amplitude is chosen individually, depending on the constitution, weight and age of the patient and also on the sessions order (the first or the third session). If the manipulation is being held correctly, the doctor feels a "flick", the local defense in most cases slackens or disappears. The absence of positive effect as a result of deficient impact power can be improved by a remanipulation, while excessive efforts may cause a lingering sensation of pain in the place of the impact, which is inadmissible. It is noteworthy that the technique of manipulation on the thoracal part of the column is the same as on the loin, but the treatment of the column is implemented through holding the patient by his elbow joints.

The manipulations on the column are to be started from the region of sacroiliac joint and then we should bring pressure upon the determined regions of hypomobility in the loin, thoracal and, in the last instance, in the cervical part of the column.

The impact on the cervical part of the column during the manipulation is a bit more complex than on other regions. The patient also sits on the couch his back to the doctor, and the doctor fixes the first finger of his homolateral hand on the previously determined local defense, corresponding to the traverse appendix of the column, and enfolds the patient's head with the other hand, his upper arm and forearm to be above the projection of malars. Afterwards the doctor smoothly turns the patient's head opposite to the site of the local defense, tightly presses the head to his own chest and makes a traction and a vibration. The vibration waves are transmitted from the doctor's trunk through his first finger to the region of local defense. When the first three neck vertebras are stimulated the patient's head should bent maximum forward and to the side opposite to the defense, when the manipulation is held on the central neck vertebras (C4-C6) - the neck should be half-bent, and when the manipulation is held on the lower neck and on the extrathoracic vertebras - a minimal forward incline of the neck is required. It is noteworthy that during the manipulation on a thrown back neck, its extra rotation (superrotation) and its extra tractation (supertractation) on the final stage are inadmissible. Though the methodology on offer has a certain attitude toward the category of manual methods, during the manipulation the doctor's hands act only as supernumerary, which fixes the patient's trunk in a certain position. The first part of manipulation - traction is held by dint of the doctor's knees unbending in knee joints, and the second part - vibration - by dint of the doctor's knee joints jerky pushing forward, which gives a vibration impulse. During one session only one VMS, belonging to the column functional part, is to be manipulated, the next day it is permissible to go on manipulating other VMS, if there are indications for this. Before each session it is necessary to make a full diagnostics of the local defense presence, comparing their characteristics with the previous indications. After a proper manipulation the extend of mobility of VMS in the condition of hypomobility will increase, the local defense will become less marked and, in some cases, even completely disappear.

The duration and intensity of a defanotherapy course depends on the clinical flow of disease, and the most frequently used scheme of treating is the following: first 2-3 sessions are held every day, then the patient consolidates the results of the manipulation through APPE during 1-2 weeks, and in the presence of a muscular pathology, the masseur simultaneously recovers the muscular functions. The next manipulation is held at a week interval. Usually 3-4 manipulations are enough to eliminate local functional hypomobility in the presence of different dorsalgy types, but when dealing with second-third scale scoliosis or intervertebral disc hernias, the course of treatment is carried out according to a different scheme: from 6 months to half a year.

It's better to start working independently with physically strong patients and only then turn to treating children and elderly people, as this requires certain experience. Carrying out the treatment, the doctor should remember, that it is possible to eliminate pathological disorder in osteoligamentary structures in 2-3 sessions, but to recover the funcion of badly modified muscles, to create a sufficient muscular corset and to develop the dominant of OMS it is necessary to persuade the patient to make certain exercises for a long period of time.

The essential part of defanotherapy - reflexotherapeutic impact both on separate muscles and on the groups of muscles - is deliberately omitted by the author in view of the fact that the question is developed more than enough in medical literature [3, 10, 21], and all the more, this fragment of work is not the objective of the Patent. But in practice doctors should remember that it is impossible to achieve a lingering medical effect without the recovery of MS muscular component as well as without the normalization of interrelations in osteoligamentary structures.

Autopsychophysical exercises (APPE).
The complex of autopsychophysical exersise developed by us is aimed at muscles "reeducation", making them work in new conditions, which have originated from the normalization of the vectors of paravertabral muscular defense. For years or even dozens of years the patient's muscles had to reactively compensate the defects of osteoligamentary vertebral apparatus, they have been working in non-physical conditions, which affected their constitution: some shortened, others became longer, underwent fibrous degeneration.

APPE have in their title physical and psychic components, the patient should make them without assistance. The physical part of these exercises consists in straining a certain group of truncal muscles, the patient presses down with his hands in the plane perpendicular to the spinal axe. The mechanic impact is carried out at four levels: pelvis, heart, shoulders and head levels.

The approximate scheme of APPE for treating for a non-complicated vertebral pathology is like follows:

Initial position: the patient's legs are apart (a shoulder distance from each other), shoulders are unfoulded, chin is parallel to the floor. 1. Exercises are started at the level of pelvis. One patient's hand is on the region of ilium in the supra-acetabular zone, the other is dropped free. The patient takes a breath, at an outward breath he brings pressure with this hand on the trunk in horizontal plane and simultaneously puts up resistance to the pressure of the right hand and maximizes his trunk stain. On the other side the exercise is made the same way. Afterwards, the patient puts a clenched fist of his right hand on the zone of pubic symphysis and, after an outward breath, brings pressure in astero-posterior (front-back) direction, strengthening this pressure with the other hand. The movements of the trunk should be the same as in the previous exercise. In the process of making this exercise the front muscular group of the patient's trunk and thigh are strained as much as possible. The exercises at this level are concluded with postero-asterior (back-front) pressure of both hands on the sacrum zone with the proper tension of vertebral muscles and back group of thigh muscles.The question arises: with what power should the patient press on the trunk with his hands, the answer: with all his might, but it should not evoke unpleasant feelings; how long should he "stretch" his trunk - for 3-4 seconds. 2. The impact at subcapular level do not differ from the way of making exercises at the level of pelvis, and the level of impact is determined by the condition of xiphoid process and lower scapula angles. 3. The exercises at shoulder girdle level are made in the following way: the patient grasps his right shoulder with his left hand, at the outer breath clasps it, simultaneously straining the muscles of the right part of the trunk, and likewise on the opposite side. Pushing in the saggital plane at shoulder girdle level is made first on the region of breastbone handle with clinched hands, and then as low as possible on the back of the neck. 4. The impact at head level is made with putting both hands in turn on periental part of the head and further slight strain of the muscles of this side of trunk and neck. The impact on the front and back groups of muscles is made with clinched hands pressing on forehead and occipital part of the head, the last pressuring back.

During these exercises at any level the whole body should stretch at most, it should "aspire" upward, diminishing lumbar and thoracal flexures of the column. The set of exercises described above and consisting of sixteen exercises may be made at leisure, preferably at the same time.

Quantity and type of the exercises for different patients can vary according to the clinical MS conditions, namely location and direction of pathological defense vectors, development of paravertebral muscles. The most universal variant of making the exercises is like this: after the first session the patient makes exercises at the first level during 10 minutes, after the second session the patient makes exercises at the second level, and after the third session - at the third level. The duration of making the exercises depends on the disease nature, but daily it should become a minute longer, i.e. in a month the patient suffering from scoliosis will make exercises at the level of pelvis, heart, shoulders and head during 40 minutes.

The importance of individual approach to each patient according to the pathology nature, his initial condition and muscular state, his somatic status is to be emphasized once more.

APPE are able not only to impact on the trunk muscles but also to form subcortical reflexes of motor dominant. It is achieved in the following way: before making the exercises the patient writes simple, consisting of 2-3 words, phrases in the form of orders (the samples are given by the doctor) on an A-4 size of sheet. The examples of such self-orders may be the following: "The doctor has cured me", "my back is straight", "my back is strong", "my back is stable", "I am healthy" and so on. There should not be any doubtful or negative intonations in these self-directions. The essential psychotherapeutic point in treating is making the patient believe from the first session that these phrases are true. This becomes possible only on condition that the first manipulation was held efficiently (and effective), when the patient feels abatement and even disappearing of his pains or his people notice diminution of curvature, for example scoliosis, and inform the patient about this. Demonstrating the positive results of manipulative impact to the patient is one of the strongest and most important factors in removing the nonoptimal MS dominant. Simultaneous impact on the physical and psychic components of the disease gives a marvelous therapeutic effect, but only when the manipulation was carried out correctly, according to the specialist's instructions.

Research material and methods.

This work contains research results of the most frequent cases of vertebral diseases, among which we can name intervertebral disc protrusion and hernia (DH), scoliosis and headaches of vertebral origin.

Nowadays there exists a great number of research works dealing with the question of the conflict between intervertebral disc and the structures surrounding VMS and spinal cord as well as there are a lot of conceptions explaining this phenomenon. It is assumed that 80% of lumbar ishialgia cases are in fact DH. It is discopathology that in the main part causes disease effect not only in lumbar but also in cervical and thoracal parts of the column. To simplify the terminology, into the definition of DH we have included such conditions as disc protrusion (DP), when vulgar fibrous ring (FR) diverticulum into spinal canal is to be observed, and proper hernias with the break of FR, break of back vertebral ligament (BVL) or without it, sequestered and nonsequestered hernias in spinal canal. In 95% of the cases hernias are located in lumbar part of the column (LPC), nearly in 4.5% of the cases - in cervical part of the column (CPC), but it is noteworthy that at the level of C1-C2-C3 hernias would not be detected. One of the main causes of primary hernia origination in LPS is the fact that BVL are less developed at the level of L4 and L5 vertebras, at this point it is incoherently linked with vertebra bodies, whereas lumbar discs at this level have maximal hight.

Since in this work DH was regarded as one of the developments of column osteochondrosis (CO) the DH origin and development conception was bound up with degenerative-dystrophic VMS processes.

In literature vital importance is attached to mechanic theory of hernia origin [6, 7, 8, 9, 14, 15]. According to this theory unfavorable statodynamic overwork led to VMS hypomobility and in locus minoris rezistencia developed DH. The beginning of the disease falls more often after lifting weights or as a result of a trauma, and the exacerbation - after an awkward movement, i. e. decompensation in the column appears in consequence of a defective VMS disfixation, and the disfixation is caused by exogenic factor, and pathologic myofixation, as a result of traumatic factor, appears first of all in intervertebral joints. Having appeared in response to the stimulation of articulate cartilage and capsule, the reflex muscular-tonic reaction fixes intervertebral joint in a pathologic position, which creates the conditions for a further displacement of pulpal nucleus (PN). In statico-dynamic overwork condition these pathological processes are the major factor of intervertebral joints destabilization, which causes fibrous ring injury with the risk of its further break.

The majority of scientists [3, 5, 6, 13, 15, 17, 19, 22] consider DDC to be the leading squad in appearing DH. With the development of degenerative phenomena PN dehydrate, PN turgor descends, its amortization qualities disappear, and as a result of this fibrous ring gets flatter and partly overflows the limits of vertebra body. Furthermore, there appear fractures in PN, which grow as dystrophic phenomena progresses, the elements of PN take root in these fractures, which compensates BVL, causing DH. The process described above is followed by aseptic inflammation, passing through certain stages of development [6, 15, 17, 19]. This theoretic conception of hernia origin and development provides a special treatment technology, which consists of pain cupping, inflamation process reduction, normalization of blood circulation (increasing venous outflow). Conservative treatment is based upon manual therapy, which is provided to contain the direct impact on pathomorphological substrate of lumbar sector compressive syndrome [17] with the modifications depending on the hernia anatomic peculiarities. This is the essential methodology, which can be regarded as "classic", since the majority of manual therapists practice it.

We want to offer a bit different conception of DH origin and development, therefore a different method of treatment, let's call it defanotherapeutic. DH develops only when the patient has a nonoptimal MS, when muscular and vertebral components have undergone acute pathologic changes, and in most cases neural components are distinguished. Practically in all cases of DH pathological changes of paravertebral muscles, shin flexors and foot extensors can be stated. In the presence of DH in 99% of cases fascial-muscular rigidity (FMR) of ishiocrural muscular group can be stated, and, as our observations have shown, 97% of children with the signs of peripheric cervical deficiency are detected to have this very muscular pathology. The presence of FMR in ishiocrural muscular group in the process of bending the trunk forward forces the dorsal part of ligament apparatus, including BVL, to stretch excessively. This frequently repeated, perennial excessive stretching of spinal BVL leads to separation of its structural fissue, which abates its strength, and the disc is extruded asymmetrically in the direction of the vertical otrostatic pressure vector into the spinal canal region. The process of BVL strength reduction lasts for many years, and the disc or more often the remains of a generatively changed disc, pressed out into the place alien to them, complete the process of destructing the anatomic structure - BVL, which is already pierced and loosened. Till a certain moment, viz. while the static muscles of column are able to retain hypermobile vertebras and the disc in the sector, which do not cause pathologic irritation on the side of Luschk nerve, the hernia won't develop into pain, after this balance disturbance the disease manifests in different clinical exhibitings, including pain.

This conception of DH development answers a lot of questions, including the following: why teachers and housewives suffer from DH as often as minors and loaders [15], it explains the reason of asymtomatic ossified paravertebral formations, which are caused by disc retain, but stoped by the process of reparation in the prepain period. The conception shows that there is no necessity of making physical manipulations on VMS with DH, as the biochemical forces, which have pressed it out, will resist it, and this will be followed by sharpening of the disease clinical situation, and after a slightest awquard manipulative movement nonsequestered DH can turn into a sequestered one. That is why at the beginning of the course of treatment it is necessary not only to held anti-inflamatory therapy but also neutralize the forces, which eject intervertebral disc from the axe of gravity, and the disc will move slowly towards the initial position or ossify in a posture asymptomatic for the patient. First of all we mechanically eliminate the cause of the forces, which press the disc out of the anatomically fixed place, i. e. out of the place of DH origination. Hence, in our methodology manual impact on the region of hernia extrusion was excluded (paravertebral or sometimes peridural blockages were made in case a marked pain syndrome). Manual measures were made at all levels, where (a)-hypomobile VMS were detected with the help of impulse analysis, the function of paravertebral muscles and extremity muscles in the state of FMR was regenerated by dint of postisometric (PIR) or postreciproc relaxation (PRR), and then the patient was taught forming his own vertebral muscular corset and optimal MS dominant [1].

We have used this method in treating 265 patients with dorsal protrusions of intervertebral discs LPS. The patients have undergone not only the general clinical examination, but also radiological examination in two projections, computer tomography or magnitoresonant tomography (67%), during which the presence of protrusions or DH discs towards spinal canal from 3 millimeters to 12 were detected. More often pain symptoms located in the region of VMS L4-L5 and L5-S1, the age of the patients - from 19 to 65.

Among the treated patients the following groups were distinguished:
group 1: 44 (16%) patients with clinical symptoms of reflex lumbago;
group 2: 75 (28.4%) patients with clinical symptoms of lumbar ishialgy;
group 3: 146 (55%) patients with clinical symptoms of compressive, vascular-compressive radiculopathy of lumbar level.

All the patients have undergone the complex therapy: analgetics, NAIP (nonsteroid anti-inflamatory preparations), vascular therapy. The conservative treatment is based on defanotherapy [1]. The first course of treatment consisted of 2-3 sessionsof impact by traction-impulsive method on the blocked VMS (the level of DH location and two VMS above and below were not stimulated manually), after and during manipulation the muscles in state of FMR have been subjected to PIR and massage. From the first day of treatment the patients made autopsychophisical exercises, which were individually selected and could be made at home. The fourth session of manual impact was held in seven days, the next - in two weeks, then in a month, in two, three and six months. Because of acute pains nineteen patients have undergone sacral peridural blockage, except for the above-mentioned therapy.

After the first course of treatment (in a week) the patients felt that pain symptoms disappeared or reduced significantly: in the first group -64% of the patients, in the second - 59%, in the third - 54%. In a month and a half the clinical effect from the therapy was the following: disappearance or considerable reduction of DH was stated in 89% of cases in the first group, 82% of cases - in the second, 79% of cases - in the third. Neurological symptoms, which manifest in the form of vertebral, muscular-tonic, vegetative-irritational syndromes, knee jerk and achilles' reflex anizoreflexion, segmentary disturbance of sensitivity in all the groups have diminished by 72% on average.

Discircuit encephalopathy (DEP) syndrome is a disease, which is also thoroughly studied in our clinic with the object of treating it by dint of defanotherapy. DEP is a relatively widespread disease and many specialists come across its developments in their daily routine. Biochmical deviations in cervical part of the column play an important role in DEP formation and maintenance, but there are very few works, in which the correlation of dynamic stereotype state and DEP is pointed out, and the available ones are not concrete enough [6, 7, 15, 25]. The presence of blockage at the level of cervicooccipital joint and first VMS are accompanied by disbalance of neck muscles, which leads both reflex and mechanic vertebral-basilar veins constriction [3, 6, 7], which causes both limitation of blood streaming to the brain and hindrance for outflow of venous blood. Furthermore, CPC pathology is one of the causes of secretion disturbance and neurolymph resorption (NLR). According to literary data hernias treatment usually includes dehydrational therapy, diet, diuretic substances and remedies oppressing NLR secretion. In complicated cases lumbar punctures with NLR evacuation are prescribed, and to maintain a permanent decompression different shunt operations are performed. But a minute efficiency of the mentioned methods of treatment makes the researchers search for some other approaches in treating for DEP. Long-lasting observations made in our clinic have shown that it is possible to considerably influence DEP process if the treatment oriented in MS optimization is carried out.

The research was held in our institute clinic with 91 patient, ageing from 7 to 20. During the checkup the following symptoms were detected:

91 patients suffered from headaches of a permanent or paroxysmal character;

46 patients suffered from giddiness, the result of vestibulocochlear disturbance, which manifests in imbalance, "rocking", nausea, "sense of collaps";

12 patients - from nasal bleeding; 32 patients - from worsening of sight; vegetative and emotional lability manifested in an undue fatigability, 79 patients - from distraction; 7 patients - from enuresis.

Standard pack of vertebral and somatic examination included: kinesthetic palpation detecting of VMS in the state of hypomobility, analyses of muscular system state with the object of FMR manifestation, CPC regeneration through the open mouth, Doppler phonography (USHD - ultrasonic hernia diagnostics) of brachyocephalic veins, vilisial circle and extremity veins, echoencephalography (EchoEG), ophthalmologic checkup. In neurological status reflex dissociation on the axe was detected, which confirms the presence of astenovegetative syndrome. During manual diagnostic all the patients were detected to have functional blockage in atlantooxcepital joint and motor segment C1-C2. In the X-ray diagrams of CPC the presence of asymmetry in dentyform vertebra C2 appendix location toward lateral masses can also be seen: both to the right and to the left visually toritcollis and functional scoliosis of the first or second degree could be detected in all the cases. Practically all the patients (89) had muscular FMR - neck rotators, 81 - suffered from FMR of ishiocrural group of both extremities.USHD of all the patients showed the data, pointing at extravasal compression of spinal artery intracranial segment (on the left and on the right), and also the signs of venous outflow. EchoEG data show the distention of the III brain ventricle by 10-30% ( up to 10% - 26 persons, 10-20% - 54 persons, over 30% - 11 persons) of age standard. The data of ophthalmologic research show that all the patients have congestive discs of optic nerve, few of them suffer from high eyepressure.

The course of treatment lasted 6 months: during the course each patient has undergone 5-6 sessions of traction-impulse impact, which were divided in the following way: 3 sessions at the beginning of the course, one session in 1-2 weeks, in a month, in 2-3 months. The sessions of postisometric relaxation on the fascially rigid muscles were held at the beginning of the course from4 to 20 sessions, moreover, the patients made APPE at home daily. During the whole period of treatment the patients did not take any pharmaceutic drugs.

Symptoms	Before the treatment	After the treatment	%	P
Headache	91	4	95.6	<0 001
Nasal bleeding	12	1	91.8	<0 05
Giddiness	52	3	94.1	<0 001
Worsening of sight	22	9	59.2	<0 05
Vegetative and emotional lability	39	8	79.5	<0 05
Enuresis	7	1	85.7	<0 05
Blockage in cervicooccipital joint	91	3	96.7	<0 001
Functional toritcollis	91	3	96.7	<0 001
FMR of neck rotators	40	2	95.0	<0 001
FMR of ishiocrural muscular group	78	7	90.1	<0 05
EchoEG: distraction of III ventricle - to 10% - to 20% - to 30%	26 54 11	9 23 5	65.4 57.4 44.6	<0 05
Presence of congestive discs of optic nerve	90	12	86.7	<0 05

Defanotherapy treats well the group of postural deviations connected with malposture, including scoliosis.

The term "scoliosis", proposed by Halen in the second century B.C., is preserved till our days and means a stable lateral curvature of the spine. There is no necessity to dwell on the great number of theories of its origin, but, being practical doctors, we tend to support a conception of the scoliotic disease (SD) origin, which is based on recognition of initial trauma, more often birth trauma, nonoptimal MS formation, asymmetric PN location, which, according to Guenther-Faulkmann law forms sphenoid in vertebra bodies and, as a result of this process, idiopathic form of scoliosis is ascertained. Recently there appear more and more periodicals, which confirm the conception of initial pathologic changes in CPC with the development during the further pathobiomechanic disturbances [7, 26].

The basic method of the conservative treatment of scoliosis, as it was 50 years ago, remains therapeutic physical training, corset wearing or column fixation through laying the patient into plaster "beds". By professor Vetrile's words, who devoted himself to surgical treatment of SD, we use the methods of manual therapy before performing an operation, the stiff column to become lithe and pliable. So we can conclude, that if the effect of a better flexibility is achieved at the fourth stage of scoliosis, and it is at this stage that the operation is usually performed, at the third and all the more at the second and first stages of SD, manual therapy (MT) can give good results. But we agree with professor Vertile that as an instrument of the local regeneration of mobility in a certain spinal segment manual therapy is contra-indicated. As we assert, any hypomobility is the result of sanogenetic reaction of the organism, and this hypomobility can be removed only when the state of all the links of motor stereotype starts changing, and when the doctor is sure that the state of the patient's muscular system will allow to maintain the regenerated mobility. Only a systematic treatment, such as defanotherapy, can secure this algorithm of SD treating.

Of all the multiple SD classifications, offered by many authors, the clinical classification by V.D. Chakhlin (1973) seems to be the most rational one, by this theory all the forms of scoliosis are divided into four groups, according to the degree of column deformation. The SD of the first and the second degrees are functional, and the spinal column curvature determines and maintains the regional progressive muscular disbalance.

Children with the first degree scoliosis have a minimal spinal curvature (less than 10 degrees) and it usually forms in the state of slackness (standing or sitting) and disappears in flexion or extension. Regional progressive muscular disbalance is characterized by a spasm or tonic muscles shortening (lateroflexors and rotators) on the concave side of scoliosis. At that, the local hypermobility could not be determined.

We have treated 108 patients with this pathology. Except for the previously mentioned scoliosis manifestations, all the patients we have been treating turned to have a one-sided local defense on the side of cervicooccipital joint and cervicothorocal junction. 6 patients were ascertained to have defense location in the place of cervicothoracal junction, which was ipsilateral by the cervicohead joint level. 50% of patients had the local defense of multipartite muscle beams at the level of the sixth thoracal vertebra, and with the rest of the patients - at the level of the twelfth. In the region of sacroiliac articulation the presence of local muscular defense was determined again in all the cases. 102 patients were determined to have fascial-muscular rigidity of ishiocrural muscles, 19 patients - in four-head hip muscle, 65% of patients - increase of motional volume in ankle joint, 72 patients - the pathological changes in podogram.

The course of treating the aforenamed patients was planned in the following way: 3 sessions of impulse impact on all the parts of the column, which manifest the presence of hypomobility, with further 7-15 sessions of postisometric relaxation on the pathologically changed muscles, and also daily APPE.

In a month the checkup showed that 72 persons were able to keep their column in an optimal state, the rest underwent an additional session of traction-impulse impact, the patients with muscular pathology made correctional exercises on the muscles, APPE should be made during 3 months. In 3 months the checkup showed only 4 patients, of those who had undergone the course, to have pathological changes.

In the presence of II degree scoliosis regional progressive muscular disbalance is not so explicit (moderately explicit, both tonic muscles shortening and phase muscles relaxation in the corresponding parts of the column). This is a permanent and fixed scoliosis, but considerably reduced in flexion and extention, and especially - in lateroflexion in the opposite direction. In the presence of this scoliosis degree a distinct muscular asymmetry is determined, but there is no thorax deformation. As in the presence of lateroflexion into analogous side the bearing curves considerably, the muscular shortening still predominates over relaxation.

For II degree scoliosis, as well as for I degree scoliosis, multiple functional blockages of spinal-motor segments, manifesting themselves mainly in rotation and lateroflexion, rarely - in flexion and extention, are characteristic. The patients with II degree scoliosis were not detected to have a singe case of pathology in any muscle or a group of muscles, that is why the treatment of patients with the second degree scoliosis is to be held by means of the impact both on osteoligamentary spinal apparatus and on the compulsory with compulsory muscles postisometric relaxation and APPE.

The plan of treatment for the patients of this group was the following: 3 sessions of impact by traction-impulse method, 1-3 courses of PIR on the muscles in the state of FMR and 6-8 months of APPE.

In the last 3 years in our clinic 126 patients with II degree scoliosis were observed, 103 of which were entirely cured and 21 were recorded to have a stable improvement and only 2 of the patients remained in the same state, though all the input data, both clinic and radiologic, gave a strong hope of positive treatment results.

It is noteworthy that after the first session of traction-impulse impact by dint of specially selected elements of APPE the patients undergoing the treatment succeeded in achieving optimal state of the column. After this their people were taught to make the exercises correctly and explained the reasons and mechanisms of paravertebral muscles "reeducation", demonstrated the photos of the patients with IV degree scoliosis, all these was done to persuade them in the necessity of making APPE.

The aforecited statistics could be different, if the patients, who had ignored the doctor's recommendations in further treatment, were included into it.

The observation of the dynamics of treating for the III degree scoliosis, which is characterized by a more explicit stable column deformation, thoracal with the presence of pelvis deformation and regional progressive muscular disbalance with the presence of the regions of explicit hypertrophy on some paravertebral regions and hypotrophy on the other, is of great interest. In the radiograms of the patients of this group an explicit deformation of vertebra bodies can be determined. After the first-second session of traction-impulse impact most of the patients of this group were discovered to have scoliotic arch extension by 30-70%, but as the disbalanced paravertebral muscles are not able to retain the regenerated elements of the column, everything recovers the old level. In this group the treatment turned to be efficient only for 32% of patients, and the progress was achieved in half a year.

After a session some patients were noted to have common state deterioration, which negatively influenced the patients and their people's will to make the exercises, and, according to the laws of logic and the practical results, the progress in treatment is impossible without it. Those patients and their people, who have overcome the barrier, had had good results. These patients spent over an hour and a half on the exercises a day, their common state is good, scoliotic arch radius has extended, the muscular groups in the state of hypotrophy and hypertrophy are gradually recovering the normal state.

The experience, obtained by the doctors of our clinic in the process of treating the patients with III degree scoliosis, shows that an out-patient treatment on the first stage ( the first 2-3 weeks) is not preferable, as the elimination of a nonoptimal and chronic MS in most cases causes pains in muscles, joints, the common state becomes worse during the treatment, so, it is better to held this period of treatment in a dispensary, sanatorium, in the place were a daily doctor's control can be provided. In an exclusive case an out-patient treatment is possible, but it should be preceded by a good psychological training both of the patient and his people. The developed traction-impulse impact is a most effective method of osteoligamentary spinal structures rehabilitation, with the speed of which the reparation processes in muscles and joints do not keep up, which in many cases leads to exacerbation, which is possible to stop by additional symptomatic treatment. Carrying out scoliosis treatment, it is necessary to remember that scoliosis treatment will never be a success, if the following principles of defanotherapy are not conformed:

1. the pathologic changes in the form of sublucation in the upper part of the column and sacroiliac joint should be eliminated, and such changes are characteristic of practically any patient suffering from this disease;
2. it is always necessary to pay attention to the state of the pelvis upper aperture axe: pelvis axe may be not horizontal but, as a result of vertebral pathology, - oblique, which may be the real cause of lower extremity shortening. In this case a shoemaker should take part in the treatment;
3. before eliminating the cause of spinal hypomobility, it is necessary to make certain that the patient's muscular system is able to retain the regenerated elements of motor stereotype in physiological state, that is why the quantity of manipulations on the column should be minimal. That is why the regeneration of mobility is to be started only from one spinal-motor segment in one part of the column, and then consolidate the results achieved due to APPE, and only then to continue the manipulations in other parts of the column, if they are necessary;
4. it is not worth while expecting a durable effect, if the functions of the muscles in the state of FMR are not regenerated;
5. in scoliosis treatment the most laborious and important part of the work is not the manipulations but the informational and educational work with the patient and his people. The most important stage in achievement of good results of treatment is disposing the patient to daily trainings, if this part of the work is disregarded, it is useless to expect satisfactory results;
6. during the first 2-3 sessions of treatment the patient tries to achieve the optimal state ( the slope lowered from the acanthi of the second neck vertebra should pass through the coccyx) with the help of side pressing movements of the hands. During this time the doctor should teach the patient to strain the groups of paravertebral muscles, which would provide the optimal state of the spinal column;
7. till the patient is not able to hold his spinal column in the its optimal state, he should stay under the doctors observation, then the correctional impact on the column may be made once in a month or three months. The duration of the treatment depends on the scoliosis form and degree, the extent of paravertebral muscles hypotophy presence. Making APPE should last during the whole period of his trunk growth, and the manipulations - twice or thrice a year.

Indications and contra-indications for defanoyherapy.

Except for the above-mentioned, the methodology on offer can treat a vide range of diseases connected with functional deviations of osteomuscular system and column ( miofascial and reflex syndromes, radiculopathy, neuropathy, arthrosis of large joints). Defanotherapy can successfully treat functional deviations of internal organs of vertebral genesis (vertebrocardiology, chronic disease of alimentary tract, lungs, liver, uterus, urinary bladder). This methodology is especially efficient for prophylactic diagnostic checking, both individual and mass, with further treatment. Palpation diagnostics according to the local defense allows to detect pathological changes in the column at precocious stages.

Contra-indications for defanotherapy could be divided into absolute and relative. Disc myelipathy, vascular radicular-spinal syndrome with extremities paresis can be traced to the absolute. The method is also contra-indicated in the presence of tumours, inflammatory diseasesof column and spinal cord, Bekhterev disease, an acute form of osteoparosis, constitutional hypermobility. In the presence of scoliosis, which has developed in the presence of Ellers-Danlas syndrome, hemocistinury or Marphan syndrome the method is contra-indicated because of joint apparatus functional inferiority. To the relative contra-indications we can trace the presence of scoliosis of the third or a further degree, Scheierman-Mau disease of the third degree, intervertebral disc hernias at the stage of secvestration, though some elements of defanotherapy still may be indicated, excluding traction-impulse impact on the hernia zone.

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