Modern ideas about the mechanisms of physiological and therapeutic action of physical factors. Mechanisms of action of physical factors (physiotherapy procedures)
4. Mechanisms of action of physical rehabilitation factors
General mechanisms of action physical factors must be considered from the standpoint of interrelated reflex and humoral influences on the body. Their primary action is carried out through the skin, its receptor apparatus, the vascular system and is associated with a change in the physicochemical processes in the skin, and, therefore, the implementation of the action of physical factors on the whole organism and the therapeutic effect has a number of features.
In the mechanism of action of a physical factor on the body, three groups of effects are distinguished: physicochemical, physiological and therapeutic.
The physicochemical effect of a physiotherapeutic factor on the body is associated with molecular changes in tissues during its use. It is based on the absorption of energy and its transformation inside the cell into the energy of biological processes. In this regard, physical, chemical and structural transformations occur in the tissues, which form the primary basis for the reactive response of complex functional systems of the body.
The physiological effect is based on reflex and neurohumoral mechanisms. Electrical, temperature, mechanical, chemical, radiation and other irritations inherent in physical factors, exerting an effect on the skin, cause reactions of its receptor apparatus and blood vessels in the form of a change in the excitability threshold of receptors and the tone of the vessels of the microvasculature (skin-vasomotor reflexes). Afferent impulses from sensory nerve fibers through interneurons activate motor neurons anterior horns spinal cord with the subsequent formation of effector impulse flows that propagate to various bodies with corresponding segmental innervation. Primary reflex reactions of the nerve endings of the skin are closely intertwined with humoral changes resulting from physical and chemical processes. nervous excitement. They are also a source of nervous afferent impulses, and not only during the period of the factor (primary effect), but also after the cessation of such a factor for several minutes, hours, and even days (trace effect). The main humoral (chemical changes) in the skin itself are reduced to the formation of biologically active substances (histamine, acetylcholine, serotonin, kinins, free radicals), which, entering the blood, cause changes in the lumen of capillaries and blood flow in them, improve transcapillary metabolism, which enhances diffusion of gases and other substances, tissue metabolism. With convergence to the central neurons of afferent impulse flows from visceral conductors, the activation of neurosecretion of releasing factors by the hypothalamus occurs, the production of hormones by the pituitary gland, followed by stimulation of the synthesis of hormones and prostaglandins. Homeostasis, or more correctly, homeokinesis in the body is determined by the "triangle of homeostasis" - the nervous, immune and endocrine systems.
The therapeutic effect is formed on the basis of the body's integral response to the physiotherapeutic effect. It can be non-specific or specific, which is determined by the characteristics operating factor.
The nonspecific effect is associated with an increase in the activity of the pituitary-adrenocorticotropic system. Catecholamines and glucocorticoids entering the bloodstream increase the affinity of adrenoreceptors, modulate inflammation and immunity.
Specific effect(for example, analgesic), taking into account the initial state of the body, is observed in diseases of the peripheral nerves under the influence of diadynamic or sinusoidally modulated currents. For electrical stimulation of denervated muscles are more suitable impulse currents low frequency. The anti-inflammatory effect is most pronounced with UHF and magnetotherapy. To a large extent, the influence of physical factors is realized through the known skin-visceral, ionic, etc. reflexes. Phases are distinguished in the reflex response: irritation, activation and development of compensatory-adaptive mechanisms, such as increased regeneration with increased nonspecific resistance organism. Wherein important role play biologically active substances (BAS): neuropeptides (substance P and b-endorphins), eicosanoids (prostaglandins, in particular, E2 and F2a, B4 leukotrienes), mediators (histamine, serotonin, norepinephrine, acetylcholine, adenosine), products of lipid peroxidation (LPO), cytokines, nitric oxide, released into the interstitium through the vascular endothelium. Moreover, substance P determines nociceptive, and b-endorphins - antinociceptive sensitivity, with the activation of leukocytes in the first case and fibroblasts - in the second. Prostaglandin F2a - increases the permeability of the cell plasmolemma, activates the axonal transport of trophogens, increases oxygen consumption, modulates the intensity of inflammation, and prostaglandin E2, on the contrary, has an anabolic effect, activates the proliferation and maturation of granulation tissue.
The influence of a physical factor on an organism is essentially determined by its initial state. Therefore, in the doctor's tactics, it is especially important to determine the indications and choose the method of physiotherapy.
Recovery processes in organs and tissues are realized through inflammation, the intensity of which is largely determined by the reactivity of the organism. In turn, reactivity forms the body's stress response, the severity of which depends on the balance regulatory systems and antisystem. With eustress, there is a favorable outcome and uncomplicated healing after injury. On the contrary, distress with increased and decreased reactions causes an imbalance in regulatory mechanisms, the development of a disadaptation syndrome, and, ultimately, an unfavorable outcome or complicated healing. Hence, the impact must be adequate and it must be carried out, first of all, in order to optimize the recovery processes, taking into account the “optimality of the disease” proposed by us, which provides for measures aimed at bringing the disease to such a course in which a favorable outcome is observed. The principle of disease optimality is based on evolution-selected and genetically fixed disease mechanisms as mechanisms of recovery. Violations in the optimality of the disease are violations in the mechanisms of recovery, but not the "pathological" nature of these mechanisms. This is the individualization of treatment. This task is difficult, since it provides for the allocation of uncomplicated and complicated forms of the disease and, on this basis, the construction of treatment tactics. This approach to rehabilitation treatment and to treatment in general is promising and deserves attention. With severe inflammation against the background of hyperreactivity, it is necessary to reduce it. In this case, magneto-, UHF therapy and so on. With mild inflammatory processes against the background of hyporeactivity, on the contrary, it is necessary to influence their intensification, which indicates the expediency of using ultrasound, ultraviolet and laser radiation, microwave therapy, oxygen barotherapy.
Physical factors cause a variety of physiological responses that can be used with therapeutic purpose. Reactions occur, as a rule, according to the “activation-stabilization-addiction” scheme (adaptation with the mobilization of the compensatory-adaptive capabilities of the body - “adaptation therapy”). Moreover, the activation of any system is accompanied in parallel by an increase in the anti-system.
Therefore, it is very important to highlight the primary direction of influences (the first phase is the primary effect) and, taking into account this direction, develop indications for the treatment of patients. The direction of the trace effect (second phase - secondary effect) reflects the reserve capacity of the organism. Changes in microcirculation observed under the influence of physical factors form a therapeutic effect. However, the ways of formation of this mechanism are different for different physical factors. Significant are those chemical changes in the skin, blood and tissues that occur as a result of the penetration of chemical components through intact skin. mineral waters. Many of them also affect vascular reception and vascular tone, platelet aggregation, oxyhemoglobin dissociation, and blood oxygen capacity.
Special meaning in the mechanism therapeutic action physical factors has a change in the sensitivity of vascular receptors, especially especially sensitive chemoreceptors of the carotid and aortic zones. From the receptor zones, reflexes arise that change the tone of arterial and venous vessels, blood pressure, heart rate, excitability of the vasomotor and respiratory centers. A decrease in the sensitivity of vascular adrenoreceptors has been proven when using radon procedures and carbon dioxide baths, photoinactivation of skin receptors is observed during light therapy. Primary physico-chemical and vascular reactions are played out in the skin - important body immunogenesis. The totality of metabolic, morphological and vascular changes in the skin, neurohumoral and hormonal changes provides a restructuring of the body's immunological reactivity. Local physical action, which is the initial trigger, is converted into a chemical one, which, in turn, is transformed into a single neuro-reflex and humoral process involving various body systems in responses.
Therapeutic effects during physiotherapy, depending on the factor and its dose, can be distinguished as follows:
1. immunomodulation (hyposensitization, immunostimulation);
2. analgesia, by creating a new dominant in the brain, increasing the threshold of conduction and excitability of peripheral nerves and improving microcirculation, relieving spasm and edema in the lesion;
3. myorelaxation and myostimulation (direct effect on muscle tissue or indirectly through activation of the receptor apparatus);
4. increase or decrease in blood clotting;
5. hyperplasia and defibrolization through changes in microcirculation, metabolic processes and cell activity;
6. increase or decrease functional activity CNS, autonomic nervous system.
5. Indications and contraindications for physiotherapy
Indications for physiotherapy
Without a correct understanding of the syndromic-pathogenetic and clinical-functional approaches to the use of rehabilitation physical factors, indications and contraindications for their use, which are usually built on the basis of syndromes, cannot be assessed.
Physiotherapeutic methods can be aimed at the prevention and treatment of diseases in the composition rehabilitation activities.
1. For preventive purposes, resort, climatic and mechanical factors are currently most widely used: thalasso, speleo, and aerotherapy, some types of hydrotherapy (showers, baths), heliotherapy and (UV, exercise therapy and massage. Over time, Apparently, magnetic and microwave therapy will find application.
2. In the treatment of the main clinical syndromes: general inflammatory changes; intoxication; painful; broncho-obstructive; the presence of fluid in the pleural cavity; some cardiac arrhythmias; respiratory, vascular, cardiac, hepatic, kidney failure I-II Art.; hypertensive; hypotensive; thrombophlebitic; phlebothrombosis; dyspeptic; stool disorders; jaundice; exocrine pancreatic insufficiency; hepatic and renal colic; dysuric syndrome; nephrotic; urinary; convulsive; muscular-tonic; Raynaud; dysfunction of the joints; spinal deformities, defiguration of the joints (including the syndrome of increased production synovial fluid); skin; violations of the integrity of tissues; allergic; anemic; hyperglycemic; hyperthyroid; hypothyroid; obesity menopausal; cephalgic; encephalopathy; encephalomyelopathy; hypothalamic; polyneuropathy; neuropathy; dyscirculatory encephalopathy; vestibular; meningeal; liquor hypertension; dyskinetic (spastic and atonic); edematous; cerebroischemic; atrophic; asthenic; neurotic (asthenoneurotic, neurosis-like); vegetative-vascular dystonia; radicular; radicular-vascular; reflex.
3. For diseases and conditions:
3.1. Traumatic injuries.
3.2. Inflammatory diseases.
3.3. Metabolic-dystrophic diseases.
3.4. Functional disorders CNS and autonomic system.
3.5. Secretion disorders in organs.
3.6. Motor disorders of the gastrointestinal tract.
Contraindications for physiotherapy
According to syndromic-pathogenetic and clinical-functional signs, contraindications (general (absolute) and relative) to the use of physical rehabilitation factors are also built.
General (absolute) contraindications:
1. Hyperthermic syndrome ( feverish state patient at a body temperature above 38 ° C), which is associated with the occurrence of endogenous heat under the influence of physical factors. However, cold, as a physical factor, is shown in this case.
2. Hemorrhagic, hemolytic, myeloplastic syndromes, taking into account the antispastic, activating and fibrinolytic effects of physical factors.
3. Epileptic syndrome (due to the activating influence of physical factors).
4. Cardiac, vascular, respiratory, renal, liver failure with decompensation. Physiotherapeutic treatment is aimed primarily at mobilizing the body's reserves, which in this case are depleted.
5. Cachexia syndrome.
The nosological principle of contraindications is preserved in the following areas of medicine:
1. Oncology and hematology (malignant neoplasms and systemic diseases blood). All physiotherapeutic factors are energetic and increase metabolism in the body, which is contraindicated in tumor process.
2. Narcology. Narcotic state And alcohol intoxication serve as a contraindication due to the impossibility of dosing physiotherapeutic procedures according to the patient's feelings, as well as their unmotivated behavior, which can lead to tragic consequences.
3. Obstetrics (pregnancy of the second half: physiological - after 26 weeks; pathological - over 24 weeks). Physical factors have a load effect on the body, which can lead to a threat of termination of pregnancy.
4. Resuscitation (acute emergency severe conditions with infectious diseases, acute period of some diseases of internal organs, for example, myocardial infarction, cerebral stroke, etc.).
Currently, the number of general contraindications is decreasing. Quite a lot of facts have been accumulated on the effectiveness of treating tuberculosis with the help of intraorganic tubazide electrophoresis, dimethyl sulfoxide electrophoresis, magnetic laser therapy and other methods, which makes it possible to remove this disease as absolute contraindication to physiotherapy.
6. Dosage of physical factors
The category of "measures" is the leading one in physiotherapy and determines the doctor's tactics depending on the reactivity of the organism and the phase of the disease. In the acute period of the disease, predominantly low-intensity physical factors are used on segmental reflex zones. On the contrary, in the subacute and chronic phase of the disease, the intensity of the factor is increased and directly affects the pathological focus. For example, in the first week of pneumonia, low-intensity UHF EP (up to 20 W) is prescribed, from the second week - high intensity (40-70 W). General UVR with good body reactivity is prescribed according to the main scheme, for weakened patients - for slow, and physically strong - for accelerated. The impact of a physical factor of low force is accompanied by unsharp changes in the functions of organs belonging to the same metamer of the body as the irritated skin surface, while the impact of a greater force is accompanied by significant changes.
The basis of dosing physical factors are:
1. Sensations of the patient: warmth, vibration, tingling, tingling.
2. Duration of the procedure: the duration of the procedure can be from several minutes (light therapy) to several hours (magnetotherapy).
3. Number of procedures: from 5-6 with UHF, up to 20 with galvanization, which can be carried out daily, every other day or for 2 days with a break for the third.
4. The value of the physical factor: power, specific current density, etc. Moreover, the parameters of the physical factor are selected individually: for example, UVR - depending on the biodose, electrical stimulation - based on the results of electrodiagnostics, and the method of drinking mineral water - according to the state of gastric secretion.
The cardinal sign of inadequate physiotherapy is exacerbation pathological process with the formation of a maladjustment reaction.
In chronic diseases against the background of reduced reactivity of the patient's body, recovery can occur through an exacerbation of the process at the initial stages of treatment, which, on the contrary, reflects the development of the adaptation syndrome and should not be regarded as a complication.
Inadequate response to treatment may be general or local.
At general reaction, proceeding according to the type of vegetative-vascular syndrome, there is a deterioration in well-being, increased irritability, fatigue, decreased performance, sleep disturbance, excessive sweating; there is a change in the temperature curve, lability of the pulse and blood pressure, exacerbation of concomitant chronic diseases.
With a focal (local) reaction observed when exposed to a pathological focus, collar area, cervical sympathetic nodes, eyes or with an endonasal technique, a violation of cerebral hemodynamics, headaches, dizziness, swelling of the nasal mucosa, persistent local hyperemia, irritation, itching are characteristic.
Spoke) and the imposition of a plaster bandage. From the second or third day include exercise therapy, massage, physiotherapy. Ability to work is restored in 1.5-2 months. 2.2 Features physiotherapy exercises for fractures of fingers Therapeutic Physical Culture is prescribed to patients from the very first days of immobilization. Exercises are performed for the fingers, as well as in the elbow and shoulder joints. Exercises for...
current state sick. Principle complex treatment physical factors. Involvement of several organs and systems in the pathological process necessitates integrated use medical and physical factors. Complex physiotherapy must be adequate for the patient, commensurate with him both in terms of sequential and parallel use of therapies and ...
Stages of treatment - all this allows you to carry out optimal rehabilitation an elderly person by restoring it motor functions. 2. Studying the influence of physical therapy on the elderly in the rehabilitation system 2.1 Organization and conduct of the study The hypothesis that we put forward sounds in the following way: if you pick up certain exercises, for people ...
ABSTRACT
General characteristics of therapeutic physical factors
Donetsk 2009
Introduction
1. Physical and chemical characteristics of therapeutic factors
2. Physiotherapy equipment
3. Methods of physiotherapy
5. General indications to physical therapy
Introduction
Physiotherapy(from the Greek words. nature and heal) a science that studies the effect on the human body of physical environmental factors and their use for therapeutic and prophylactic purposes.
When studying general physiotherapy It is advisable to sequentially pay attention to the following sections:
1. Physical and chemical characteristics of the studied factor.
2. Devices that generate this factor.
3.Methods and technique of the procedure.
4. The mechanism of action of the physical factor on the body.
5.Indications for the use of physical factors.
6. Contraindications.
7. Dosage of the physical factor.
In accordance with the specified plan, information is provided on each method of physiotherapy treatment and rehabilitation of patients.
1. Physico-chemical characteristics of therapeutic factors
The physical factors used in physiotherapy are divided into natural (water, climate, mud, etc.) and preformed, obtained by artificial means(electrotherapy, ultrasound, etc.). They are classified by physical characteristics in the following way
1.Low voltage direct currents:
a) galvanization and medicinal electrophoresis;
b) impulse currents: diadynamic therapy and diadynamophoresis; electrosleep; electrical stimulation; short-pulse electroanalgesia; amplipulse therapy (rectified mode) and amplipulsforesis; interference therapy.
2.Alternating currents:
a) low and audio frequency and low voltage: amplipulse therapy (variable mode); fluctuation;
b) overtone and high frequency and high voltage: darsonvalization; overtone frequency currents (TNFC).
3.Electric field:
a) ultrahigh frequency therapy (UHF);
b) franklinization;
c) air ionization.
4.Magnetic field:
a) low-frequency magnetotherapy;
b) inductothermy - a high frequency alternating magnetic field (PEMPVCH).
5.Electromagnetic radiation:
a) microwave therapy (UHF therapy): centimeter wave (CMW) and decimeter wave (UHF) therapy;
b) extremely high frequency therapy (EHF-therapy): millimeter wave (MMW) therapy;
c) light therapy: infrared, visible, ultraviolet, monochromatic coherent (laser) and polychromatic incoherent polarized (pilsr-) radiation.
6.Mechanical vibrations:
a) massage, b) vibrotherapy, c) ultrasound, d) traction.
7.Water (hydrotherapy and balneotherapy).
8. Temperature factor (thermotherapy) :
a) heat therapy (therapeutic mud, peat, paraffin, ozocerite);
b) cold treatment (cryotherapy).
9. Air (barotherapy).
IN practical medicine continues to use the previously proposed electrotherapy classifications:
1. Treatment with direct currents of low voltage: galvanization and electrophoresis; diadynamic therapy and DDT-phoresis; electrical stimulation; electrosleep, etc.
2. Treatment with alternating currents of low and audio frequency and low voltage: amplipulse therapy (variable mode); fluctuorization.
3. Treatment with high frequency and high voltage alternating currents, and electromagnetic field: darsonvalization; inductothermy; UHF therapy; microwave therapy; EHF-therapy.
4. High intensity electric field treatment: franklinization; air ionization.
2. Physiotherapy equipment
At present, physiotherapy equipment is being improved; enterprises of the military complex are connected to its production as part of the conversion. There are three directions in the creation of physiotherapy equipment.
Firstly, complex complexes for laser therapy, magnetoturbotrons, and tracomputers for spinal traction are produced, which, as a rule, are installed in specialized departments of rehabilitation hospitals.
Secondly, equipment for hospitals (UHF, microwave, etc.) is traditionally produced.
Thirdly, an important trend is the creation of compact, safe, portable semiconductor devices that can be used not only in hospitals, but also in domestic conditions.
Information about the most widely used physiotherapy devices and complexes at present is given in the relevant sections of this publication.
3. Methods of physiotherapy
Developed and implemented in clinical practice methods:
1.Are common(according to Vermel, collar according to Shcherbak, four-chamber baths, general UVR, franklinization, etc.).
2.Local(transverse, longitudinal, tangential (oblique), focal, perifocal).
3.Influences on reflex-segmental zones with a site of metameric innervation. The significance of reflexogenic zones and the resulting reactions are covered in the works of physiotherapists A.E. Shcherbak, A.R. Kirichinsky and others.
4.Impact on the Zakharyin-Ged zones.
5.Effects on active skin points, which are widely used in reflexology. Doctors are increasingly turning to this technique. For its implementation, a lot of special equipment for reflexology has been created.
Physiotherapy techniques are divided into surface nye (skin) and abdominal(nasal, rectal, vaginal, oral, ear, intravascular), for which special electrodes are provided.
Depending on the density of contact with the body surface, the techniques are divided into contact And effluvial(an air gap is provided between the body and the electrode).
According to the technique of performing the technique, there are stable (the electrode is fixed) and labile (the electrode is movable).
4. Mechanisms of action of physical factors
In the mechanism of action of a physical factor on the body, three groups of effects are distinguished: physicochemical, physiological, and therapeutic.
Physical and chemical component of action physiotherapeutic factor on the body is associated with molecular changes in tissues during its use. Describing physiological and rehabilitation effects it should be noted that the reflex principle and the neurohumoral mechanism are generally recognized. Afferent impulses from sensory nerve fibers through the intercalary neurons activate the motor neurons of the anterior horns of the spinal cord, followed by the formation of effector impulse flows that propagate to various organs that have the corresponding segmental innervation. Homeostasis in the body is determined "triangle of homeostasis"- nervous, immune and endocrine systems. The response of the body to the physiotherapeutic effect is integral, and it forms curative effect, which may be non-specific or specific (depending on the exposure factor).
Non-specific effect associated with increased activity of the pituitary-adrenocorticotropic system. Catecholamines and glucocorticoids entering the bloodstream increase the affinity of adrenoreceptors, modulate inflammation and immunity.
Specific effect(for example, analgesic), taking into account the initial state of the body, is observed in diseases of the peripheral nerves under the influence of diadynamic or sinusoidally modulated currents. For electrical stimulation of denervated muscles, pulsed low-frequency currents are more suitable. The anti-inflammatory effect is most pronounced with UHF therapy. The influence of the physical factor is realized through the known south-visceral, ionic, etc. reflexes. In the reflex response, phases are distinguished: irritation, activation and development of compensatory-adaptive mechanisms, such as increased regeneration with an increase in nonspecific resistance of the organism. In this case, biologically active substances (BAS) play an important role.
The influence of a physical factor on an organism is essentially determined by its initial state. Therefore, in the tactics of a doctor, it is especially important to determine the indications and choose the method of physiotherapy and physical rehabilitation.
Recovery processes in organs and tissues are realized through inflammation, the intensity of which is largely determined by the reactivity of the organism. In turn, reactivity forms the body's stress response, the severity of which depends on the balance of regulatory systems and antisystems. With eustress, there is a favorable outcome and uncomplicated healing after injury. On the contrary, distress with increased and decreased reactions causes an imbalance in regulatory mechanisms, the development of a disadaptation syndrome, and, ultimately, an unfavorable outcome or complicated healing. Hence, the impact of rehabilitation methods must be carried out, first of all, with the aim of optimizing the recovery processes, providing for measures aimed at bringing the disease to a course in which a favorable outcome is observed. This is the individualization of treatment and rehabilitation of patients. This task is difficult because it provides for the allocation of uncomplicated and complicated forms of the disease on this basis of building tactics of treatment and rehabilitation. This approach to physiotherapy and rehabilitation treatment is generally promising and deserves attention. With inflammation against the background of hyperreactivity, it is necessary to reduce it. In this case, UHF, magnetotherapy, etc. are indicated. In inflammatory processes against the background of hyporeactivity, on the contrary, it is necessary to influence their increase, which indicates the expediency of using: ultrasound, ultraviolet and laser radiation, microwave therapy, oxygen barotherapy and massage.
The effect on the body of various therapeutic physical factors develops more or less similarly, and it must be considered based on the most important principles of the functioning of living systems, in particular, on the principle of the unity of the organism and the external environment. The universal law of life is the adaptation (adaptation) of the body to changing environmental conditions in order to maintain homeostasis. This process is provided by a complex system of adaptive reactions, the basis of which is the unconditioned reflex. The body's response to the action of therapeutic physical factors, which are complex physical and chemical stimuli that bring energy (substance, information) into it and cause changes in it, is also a systemic adaptive reaction. The structure, features and severity of this reaction depend both on the physical nature and dosage of the factor, and on the initial functional state, individual qualities of the organism and the nature of the pathological process.
Physical factors are both means of both non-specific and specific action. It is the latter that causes special value physiotherapeutic influences, makes it possible, along with the general stimulation of protective and compensatory-adaptive reactions, to differentially influence the disturbed functions of the body, various pathogenetic and sanogenetic mechanisms, individual symptoms of the disease.
The chain of events occurring in the body after the application of a physical factor can be conditionally divided into three main stages: physical, physico-chemical, biological.
During physical stage the energy of the acting factor is transferred to the biological system, tissues, cells and their environment. The interaction of physical factors with the body is accompanied by reflection, transmission, dispersion and absorption of energy. Only the absorbed part of the energy has an effect on the body. Different tissues of the human body have an unequal (selective) ability to absorb physical energy. So, the energy of the UHF electric field is more absorbed by tissues with dielectric properties (bone, fat), and the absorption of microwaves, on the contrary, is mainly observed in tissues with a high content of water and electrolytes - muscle, blood, lymph, etc. The penetration depth is no less important. , or the level of energy absorption in the body. As is known, physiotherapeutic factors differ significantly in this indicator: some of them penetrate a few millimeters and are completely absorbed by the skin, while others penetrate the entire interelectrode space. Each physical factor also has its own mechanism of energy absorption. An illustration of what has been said can be data on the absorption and heating of various tissues when using certain physiotherapeutic methods. All these differences, in general, serve as the basis for the formation of specific features of the action of individual physiotherapeutic factors already at the physical stage.
The absorption of energy is accompanied by the appearance of physical and chemical shifts. Distribution of heat in individual cells. And their environment. They make up physico-chemical stage the action of physical factors on the body. The most studied primary effects are heat generation (tissue heating), changes in pH, concentration and ratio of ions in cells and tissues, formation of free forms of substances, generation of free radicals, changes in the spatial structure (conformation) of biopolymers, primarily proteins. Among the others possible mechanisms primary action physical factors should be called a change physical and chemical properties water, polarization and bioelectret effects, changes in the electrical properties of cells, the release of biologically active substances (prostaglandins, cytokines, nitric oxide, mediators, etc.). In general, as a result of the action of physiotherapeutic factors, various physical and chemical forms, capable of entering into metabolic reactions, or physicochemical changes occur that affect the course of both physiological and pathological processes in the body. Consequently, physical and chemical changes are a kind of trigger mechanism for converting the energy of a physical factor into a biologically significant reaction of the body.
The consequences of physicochemical shifts depend on their nature, biological significance, localization of exposure, morpho-functional specialization of the tissues in which they occur. Physico-chemical changes in the skin, subcutaneous fat, muscle tissue mainly determine the local effect of physical factors. If they happen in endocrine organs, then to a large extent determine the humoral component of the action of therapeutic physical factors. The predominant absorption of energy by nerve formations (receptors, nerve fibers, brain structures, etc.) and the physicochemical changes occurring in them are the basis for the formation of the body's reflex reaction to the use of physical factors. In this case, the reactions of these structures to physical factors proceed according to the laws of sensory physiology.
It is important to keep in mind that many physical and chemical effects can be inherent in one physical factor, and the use of various physiotherapeutic methods can cause similar primary shifts. This primarily determines the universal mechanism of action of therapeutic physical factors, the unity of the general and specific in their effect on the body, the similarity and differences in indications and contraindications for the use of physiotherapeutic methods.
The third stage is biological. It is a set of direct and reflex changes in organs and tissues as a result of the absorption of physical energy by the biological systems of the body. Allocate local, reflex-segmental And general (generalized) body reactions with their many components.
Local changes occur in tissues that have absorbed the energy of the physical factor. They are expressed in changes in metabolism, regional blood circulation and microcirculation, diffusion processes, mitotic activity of cells and their functional state, formation of free radicals, biologically active substances, etc. Local shifts lead to the creation of a new level of tissue trophism, the activation of local protective reactions, and contribute to the restoration of relationships disturbed by the disease in them. The same shifts, but occurring in receptors, neurovascular plexuses and peripheral nerves, serve as a source of nervous and humoral afferentation - the basis for the formation of body reactions of a systemic nature.
An important role in the local reaction belongs to the stimulation by physical factors of the function of antagonist cells (fat, plasma, enterochromaffin, etc.). This is one of the mechanisms for maintaining regional homeostasis and deploying protective reactions aimed at eliminating local damage. In addition, due to the biologically active substances synthesized by these cells (prostaglandins, plasmakinins, cytokines, substance P, nitric oxide) and mediators (histamine, norepinephrine, acetylcholine, serotonin), antagonist cells are involved in the formation of not only local reactions, but also humoral shifts.
Due to local shifts that are a source of prolonged irritation, as well as due to direct physicochemical changes in nerve receptors and other nerve formations, in response to the physiotherapeutic effect, a general response of the body is formed. It is, as already emphasized, systemic in nature and has an adaptive-compensatory orientation. The leading component of this holistic reaction of the body is a reflex act, the nervous and humoral links of which are closely interconnected. It should be emphasized that the close relationship of local and general reactions is largely ensured due to the peculiarities of the structure and functions of the skin, which is entrance gate for most physiotherapeutic factors.
Schematically, this reaction can be represented as follows. The excitation of extero- and interoreceptors that occurs under the influence of physical factors along afferent pathways reaches mainly those parts of the central nervous system (CNS) that control the adaptive mechanisms of the body (subcortical nuclei, limbic-reticular complex, hypothalamus). Nervous afferentation and humoral shifts, the nature of which depends on the nature and parameters of physical factors, cause changes in the functional state of these nerve centers. This is manifested in the formation (due to convergence and summation of afferent signals) of a stream of efferent impulses that trigger specific homeostatic reactions. Their main feature is that they develop according to previously established physiological mechanisms and are aimed at restoring the balance disturbed by a physical factor, and in conditions of pathology --for restoration functions disturbed by the disease and existing shifts, increased reactivity and immune protection organism, strengthening of sanogenetic mechanisms, stimulation of compensatory-adaptive processes. Homeostatic regulation under the action of physical factors is provided by various mechanisms and functional systems with the leading role of the central nervous system, universal principles the structural organization of which determines the unity of the processes of development of adaptive reactions of the organism.
Efferent impulses coming from the nerve centers reach the internal organs, including the glands. internal secretion, and involves them in the general adaptive reaction of the body. This is accompanied by dynamic shifts in the activity of various internal organs, general metabolic and trophic changes, and mobilization of the body's resources. And although many organs and systems take part in the formation of the general reaction of the body, the greatest shifts occur in the area of the pathological focus, which is of great therapeutic importance and is well interpreted from the standpoint of A.A. Ukhtomsky.
Participation in the adaptive reaction of all organs and systems is observed mainly after extensive or intensive physiotherapy procedures, as well as after exposure to special zones(acupuncture points, collar zone, Zakharyin-Ged zones, etc.). Limited physiotherapeutic effects are usually accompanied by dynamic changes. In organs and tissues belonging to the same metamer as the irritated skin surface. These shifts are realized by the type of segmental (metameric) reactions.
In the reaction of the body to the physiotherapeutic effects of the cerebral cortex takes an active part. Conditioned stimuli, combined with the unconditional, which is the physiotherapeutic method, can significantly change its effect on the body, develop in case course application new functional relationships between the nervous system and the physiological systems regulated by it, which also affects the therapeutic effect. Consequently, the reflex reaction during physiotherapeutic procedures is conditionally unconditional. The main proof of this is the possibility of the formation of conditioned reflex connections in response to physiotherapy. According to special studies and numerous clinical observations, after several physiotherapeutic procedures, the physiological effect characteristic of this impact, is also detected when the device is turned off.
The implementation of both local and general reactions to physiotherapy, especially during course treatment, requires energy and plastic support. Mobilization observed during physiotherapy energy resources and plastic reserves of the body, providing stimulated functions, protective and adaptive and compensatory processes- an important component of the systemic adaptive response of the body. To a large extent, it is implemented due to the adaptive synthesis of enzymes. The result of these processes will be a new coordination of metabolism and an increase in the functionality of the body. The humoral system and the endocrine glands play an important role in the energy and plastic supply of the changes caused by physical factors. In the reaction of the body during physiotherapeutic influences, they are included due to various mechanisms, including due to direct action physical factor on the specific activity of the endocrine organs.
Definition and subject matterphysiotherapy.
Mechanisms for the formation of body reactions
on physical factors.
Basic principles therapeutic use
physical factors.
CLASSIFICATION OF METHODS
PHYSIOTHERAPY
Physiotherapy
- a field of medical science that studies the effect on the bodynatural and artificial physical factors applied
for the treatment of the sick and the improvement of the population.
The term "physiotherapy" comes from the Greek words φυσι ζ (Greek.
- nature) and ϑεραπεια (therapy, treatment) and in literal translation
means the treatment of patients with natural (physical) factors.
Physiotherapy as a field of human knowledge has all the attributes
sciences: subject, categories, object, method and basic
patterns.
The subject of study of physiotherapy are therapeutic physical factors.
The effect of various physical factors on the bodyother sciences are also considered (electromagnetobiology,
photobiology, bioclimatology, hydrogeology, hygiene, ecology
and etc.).
Physiotherapy studies the properties of those therapeutic physical factors,
which are used to treat patients.
Natural healing factors, conditions for their formation and
rational use, as well as resort resources
are combined into an independent section of physiotherapy - resort
therapy, which is an integral part of developmental science
resorts - balneology.
Categories of Physiotherapy
A set of concepts united by a commonorigin (physical form of movement
matter), makes up the categories of physiotherapy -
therapeutic physical factor,
physical treatment,
physiotherapy procedure.
Criteria for the specific action of factors:
distinct effect on the target organ;choice of forms of energy appropriate
the nature of ion channels in cell membranes;
rapid development of the effect with minimal
energy costs.
Therapeutic physical factors
Therapeutic physical factor (currents, fields, radiation, mineralwater, climate, therapeutic mud) - the physical form of movement
matter, which determines the therapeutic nature of the impact on
various organs and systems of the body.
By origin, therapeutic physical factors are divided into two
groups - artificial and natural.
Natural and artificial healing factors consist of
unique combinations of various physical factors are:
electrotherapeutic, magnetic therapy, mechanotherapy,
phototherapy, climatotherapy, balneotherapy,
mud therapy, thermotherapy, hydrotherapy, radiotherapy
(Ulaschik, 2008).
1. Methods based on the use of electric currents of various parameters(constant, variable pulse)::
galvanization,
medicinal electrophoresis,
electrosleep,
transcerebral and short-pulse electroanalgesia,
diadynamic therapy,
amplipulse therapy,
interference therapy,
electrical stimulation,
fluctuation,
local darsonvalization,
ultratonotherapy.
Physical method of treatment - a set of methods for applying a specific therapeutic physical factor
There are four main groups of physicalmethods of treatment (Ponomarenko G.N., 2006).
Modulation methods for typical pathological
processes.
systemotropic methods.
Organotropic methods.
Functional state modulation methods
organism.
Methodology of the physiotherapy procedure
- a set of techniques (operations)practical use of a particular
physical method of treatment.
The object of study of physical therapy
is the person affectedphysical factors with medical and health-improving
purpose.
The results of such an impact can be assessed
directly during the procedure or
indirectly, by extrapolating data
experiment on animals, or
help mathematical modeling medical
physical effect on the body.
Physiotherapy method - basic for scientific knowledge - dialectical-materialistic
It combines morphofunctional assessment methodsthe effect of therapeutic physical factors on tissues with
clinical methods for assessing the condition of patients with
various diseases
The evaluation of the results obtained is carried out at
using the methods of dialectical logic - analysis,
synthesis, abstraction, induction, deduction,
formalization, etc.
Physiotherapy is closely related to the fundamental
sciences (biophysics, biochemistry, normal and
pathological physiology, immunology, etc.) and
clinical disciplines.
MECHANISMS OF FORMATION OF ORGANISM REACTIONS TO THERAPEUTIC PHYSICAL FACTORS
The therapeutic effect of any physical factor is determineda combination of effects developing under its influence. And them
formation and development is determined by:
specific properties of the physical factor, which are based on
are the features of the distribution of its energy in time and
space;
physical (electrical, magnetic, mechanical,
thermophyaic, etc.) properties of "target" tissues, which determine the absorption of the energy of a given factor;
the presence of selective sensitivity of the body to a given
a factor that determines the low thresholds of his sensory perception;
functional reserves of adaptation and reactivity of the body.
Reactions of the body in the formation of the therapeutic effects of physical factors:
local,reflex-segmental and
generalized (general) reactions of the body.
Various systems of the body that are subordinate to each other participate in their provision.
Local reactions appear in a limited area of the body and arise due to
activation of afferites of the somatosensory system and factors of the local vascular
regulation.
The mechanisms of their formation depend on the form of energy that is characteristic
each of them (electrical, magnetic, light, mechanical and thermal).
The mechanisms are activated through specific receptors and the most sensitive
biological structures, receivers of mechanical and light energy, mechanoreceptors and photoreceptors, as well as structures that selectively perceive
electromagnetic and thermal factors (nerve and muscle fibers,
thermomechanosensitive skin fibers).
Reactions to mechanical factors
depend on their parameters and proceed according to the lawssensory physiology:
the amplitude of afferent responses depends non-linearly
on the intensity of the physical factor,
the frequency selectivity of such reactions is due to spatial and structural features
receptor apparatuses, and they themselves are formed in
within the first second from the start of the action
factor a.
Thermal factors affect
on thermomechanically sensitive structures of the skin, and electromagnetic - on excitablefabrics.
They are able to modulate the impulse activity of nerve fibers.
The resulting reactions do not have a nonlinear dependence on the intensity and
factor frequencies and develop over time.
There are changes in the tone of arterioles and the diameter of capillaries and venules.
microcirculation. Such local effects are realized both through the axon reflex and through the release of biologically active substances (bradykinin,
prostaglandins, substance P, cytokines, nitric oxide) and mediators (norepinephrine,
acetylcholine, histamine, serotonin and adenosine), as well as changes in ion balance
tissues - hyperionia). Released free histamine molecules through H 2 histamine receptors mononuclear phagocytes
inhibit the secretion of chemotactic factors, the synthesis
macrophages of the complement system. Following this
a decrease in the secretion of inflammatory mediators activates
proliferation and maturation of granulation tissue
hotbed of inflammation. Has similar effects
prostaglandin E 2, the mechanism of action of which on the system of cyclic nucleotides has not yet been elucidated
end. Macrophages and labrocytes migrating into the skin
activate cellular immunity of the skin and non-specific
factors of its bactericidal system. Acetylcholine and other cholinomimetic agents
(for example, prostaglandin realizes its action
at 26 Introduction to physiotherapy various cells
through cholinergic receptors associated with the system
phosphotidylinositides and cGMP. Arising from
this increase in the permeability of the plasmalemma
cells, activation of axonal transport
trophogens and increased oxygen consumption
change the metabolism and trophism of tissues in the area
energy absorption of therapeutic physical
factor a. In addition, biologically active
compounds have local effector
impact on local impact
free nerve endings and nervous
conductors. Thus, in addition to various "targets" of the effects of therapeutic
physical factors, the mechanisms of their primary
perception. They are based on differences in absorption mechanisms
energy of physical factors.
Features of those entering the central nervous system signal
impulse flows cause a specific focus
unconditioned reflex reactions of each organ.
Such heterogeneity of the primary reactions of the body to physical
factors with different forms of energy are also manifested in the following
stages of formation of generalized responses of the body.
somatic, visceral and autonomic reflexes.
They lead to shifts in the ionic balance of tissues and have a modulating effect.
on streams of impulse activity ascending to supraspinal structures.
Afferent impulses from sensory nerve fibers through intercalary
neurons activates the motor neurons of the anterior horns of the spinal cord with
subsequent formation of effector impulse flows, which
apply to various organs that have a corresponding segmental
innervation. Along with them, through back roots enter the spinal cord
impulse signals by autonomic nerve fibers, which close in the peripheral autonomic ganglia and have a pronounced trophic effect
on the tissue of the metamere, which belongs to this segment of the spinal cord.
Reflex reactions occur as a result
Interaction of visceral and somatic afferentimpulse streams and their switching to different effectors
occurs at the level of spinal, bulbar and cortical structures.
Irradiation of excitation to neighboring areas of the brain
causes both the strengthening of existing and the formation of new
complexly organized reflex reactions. Responsible managers
signals to different effectors can be implemented by
simple divergence of downward impulse flows into various
effectors.
Reflex reactions
Generalized reactions are formed as a result of the spread of ascendingimpulse flows from the anterior horns of the spinal cord to the overlying sections
brain, as well as under the direct influence of therapeutic physical
factors on subcortical structures that conduct afferent pathways and endocrine glands. Coming to the overlying parts of the central nervous system
impulse streams are modally unambiguous and are processed by intercalary and
intermediate neurons associated with somatic and visceral
efferent conductors.
The mechanism of formation of the response of the ensemble of neurons of the central structures
It is based on convergence to central neuronsafferent impulse flows from visceral and somatic
conductors with their subsequent summation.
Mechanisms of integration of somatic and visceral afferent
signals are similar and differ only in quantitative
convergence features. It manifests itself in the activation
neurosecretion of releasing factors by the hypothalamus and the production
tropic hormones by the pituitary gland with subsequent correction of the level
blood peptide hormones (by activating their secretion), as well as
synthesis stimulation steroid hormones and prostaglandins. IN
As a result of such neurohumoral processes,
coordinated changes in functional activity and metabolism
in various body tissues.
General adaptive reactions of the body, which are diffuse in nature.
The severity of the body's responses and the degree of participation in them of variouslinks of neuroendocrine regulation is determined by the number and area
energy absorption. At the same time, it is traditionally believed that with an increase in
the intensity of the factor, there is a sequential inclusion of local,
segmental reflex and generalized reactions that develop according to
universal mechanisms for regulating the functions of internal organs, and in this sense
non-specific. They aim to increase general resistance organism and
increase in the functional reserves of its adaptation. However, each medicinal
a physical factor can also have a specific (inherent only
him) action.
Generalized reactions
Generalized reactionsThe emerging generalized reactions are associated with cooperative processes,
developing in active biological environments, which include primarily
excitable tissues. Responses are formed in this case due to free
energy stored in macroergs of cells of various tissues, the value of which is significantly greater than the energy of acting physical factors. brought by them to
biological structures, energy serves as a kind of "trigger" for redistribution
free energy of cells and tissues, significantly changing their metabolism and
functional properties, that is, it carries the features of "informational"
impact. Such reactions develop mainly with local action on
biological communication channels (zones of skin projection of afferent conductors,
located in the underlying tissues and internal organs, motor points,
autonomic ganglia and acupuncture points), which have deterministic connections with
various body systems.
Specific and non-specific components of the mechanism of formation of therapeutic effects
Specific and non-specific componentsmechanism for the formation of therapeutic effects
manifest in functional neurohumoral shifts
(biophysical, biochemical, immunological, etc.).
They lead to increased reactivity and resilience
organism, increase the level of its mobilization
functional reserves and restore broken
disease of the adaptation system.
Nonspecific reactions of the body are manifested in an increase in the activity of the pituitary-adrenocortical system with
subsequent release of tropic hormones and activation
Lez internal secretion.
Glucocorticoids and catecholamines entering the blood
increase the affinity of adrenergic receptors in various tissues, and
hydrocortisone limits the exudative phase of inflammation and
causes immunosuppression.
Physiodiagnostics
The most common of these are electrodiagnostics andits variety is electroodontodiagnostics,
diagnostic photoerythema,
study of the electrical activity of the skin (the so-called galvanic skin response - GSR),
methods of electropuncture diagnostics
Laws of physiotherapy
Law is a form of universality (Engels F.), which expresses generalrelations inherent in all phenomena of a given class
The therapeutic effect of the physical factor is determined by the combination
interrelated processes developing under its action.
The law of heterogeneity of physiotherapy - multimodal therapeutic
physical factors have heterogeneous perceiving structures
(targets), molecular, cellular and systemic mechanisms of therapeutic
actions.
CLASSIFICATION OF PHYSIOTHERAPY METHODS
1. Methods based on the use of electricalcurrents of various parameters (direct, variable
pulsed): galvanization, drug electrophoresis,
electrosleep, transcerebral and short-pulse
electroanalgesia, diadynamic therapy,
amplipulse therapy, interference therapy,
electrostimulation, fluctuorization, local
darsonvalization, ultratonotherapy).
2. Methods based on the use of electrical
fields: franklinization, ultrahigh-frequency therapy,
infitoterapiya.
3. Methods based on the use of a variety of
magnetic fields: magnetotherapy, inductothermy.
CLASSIFICATION OF PHYSIOTHERAPY METHODS
4. Methods based on the use of microwave electromagnetic fields:decimeter and centimeter therapy, extremely high frequency therapy, terahertz
therapy.
5. Usage based methods electromagnetic oscillations optical
range: therapeutic use of infrared, visible, UV and laser
radiation.
6. Methods based on the use of mechanical vibrations: vibration therapy,
ultraphonotherapy.
7. Methods based on the use of fresh water, mineral waters and their
artificial analogues: hydrotherapy, balneotherapy.
CLASSIFICATION OF PHYSIOTHERAPY METHODS
8. Methods based on the use of heated (thermotherapy) media: treatmentparaffin, ozocerite, naftalan, therapeutic mud, sand, clay.
9. Methods based on the use of a modified or special air environment:
inhalation therapy, barotherapy, aeroionotherapy, climatotherapy.
10. Combined physiotherapeutic methods based on simultaneous
the use of several therapeutic physical factors from one or different
groups: inductothermoelectrophoresis, vacuum darsonvalization, magnetic laser therapy and
others
Syndromic-pathogenetic classification of physiotherapeutic methods based on their division according to the dominant therapeutic
action (G.N. Ponomarenko, 2000).Analgesic methods:
1. Methods of central influence
2. Methods of peripheral exposure
Methods for treating inflammation:
1. Alternative-exudative phase
2. Proliferative phase
3. Reparative regeneration
Methods of preferential influence on the central nervous system:
1. Sedatives
2. Psychostimulants
3. Tonic Methods of preferential influence on the peripheral
nervous system:
1. Anesthetics
2. Neurostimulating
3. Trofostimulating
4. Irritating free nerve endings
Methods of influence on the muscular system:
1. Myostimulating
2. Muscle relaxants
Methods of influence mainly on the heart and blood vessels:
1. Cardiotonic
2. Hypotensive
3. Vasodilator and antispasmodic
4. Vasoconstrictors
5. Lymphatic drainage (decongestant) Methods of influence mainly on the blood system:
1. Hypercoagulants
2. Hypocoagulants
3. Hemostimulating
4. Hemodestructive
Methods of influence mainly on the respiratory tract:
1. Bronchodilators
2. Mucokinetic
3. Strengthening alveolocapillary transport Methods of exposure to the skin and connective tissue:
1. Melanin-stimulating and photosensitizing
2. Enveloping
3. Astringents
4. Antipruritic
5. Diaphoretic
6. Keratolytic
7. Defibrosing
8. Modulating connective tissue metabolism Methods of influence on the genitourinary system:
1. Diuretics
2. Correcting erectile dysfunction
3. Stimulating reproductive function
Methods of influence on the endocrine system:
1. Stimulating the hypothalamus and pituitary gland
2. Stimulating the thyroid gland
3. Adrenal stimulants
4. Stimulating the pancreas Metabolic correction methods:
1. Enzyme stimulating
2. Plastic
3. Ion-correcting
4. Vitamin-stimulating
Methods for modulating immunity and non-specific resistance:
1. Immunostimulating
2. Immunosuppressive
3. Hyposensitizing
Methods of exposure to viruses, bacteria and fungi:
1. Antiviral
2. Bactericidal and mycocidal Methods of influence on the gastrointestinal tract:
1. Stimulating the secretory function of the stomach
2. Weakening the secretory function of the stomach
3. Enhancing intestinal motility
4. Weakening intestinal motility
5. Cholagogue Methods of treatment of injuries, wounds and burns:
1. Stimulating the healing of wounds and injuries
2. Anti-burn
Methods of treatment of malignant neoplasms:
1. Cancer-destructive
2. Cytolytic
Currently, Ponomarenko is actively finalizing the above classification.
Classification of combined physiotherapy methods
1. Combined methods of drug electrophoresis and galvanization:vacuum electrophoresis
Aeroelectrophoresis
Electrophonophoresis
Cryoelectrophoresis
Inductothermoelectrophoresis
Galvanoinductothermy
Galvanic mud treatment
Hydrogalvanic baths
Galvanoacupuncture 2. Combined methods of impulse therapy:
Electroacupuncture
Diadynamoinductothermy
vacuum electropuncture
3. Combined phototherapy methods:
Combined use of infrared, visible and UV rays
Magnetic laser therapy
MIL therapy
Laserphoresis
Phonolaser therapy
Photovacuum therapy 4. Combined hydrotherapy methods:
Vibration baths
Whirlpool baths
Underwater shower massage
Combined baths (carbon dioxide-radon, pearl-radon, sulfide-radon, etc.)
Mud baths
laser shower 5. Combined methods of mud therapy:
Galvanized mud
Mud electrophoresis
Diadynamic mud therapy
Pelophonotherapy
Amplipulse mud treatment
Mud baths
Mud inductothermy
Mud inductothermoelectric 6. Combined methods of ultrasound therapy:
Electrophonophoresis
Phonodiadynamophoresis
Phonoamplipulsphoresis
Magnetophonophoresis
Vacuumphonotherapy 7. Combined methods of high-frequency
therapy:
Vacuumdarsonvalization
Mud inductothermy
Inductothermoelectrophoresis
8. Combined methods of magnetotherapy:
Magnetophoresis drugs
Vibromagnetotherapy
Pelomagnetotherapy
Cryomagnetotherapy
MAIN PRINCIPLES OF THE THERAPEUTIC USE OF PHYSICAL FACTORS
Rational use of therapeutic physicalfactors in a particular patient suggests
adherence to a strictly differentiated choice of species
energy used and specific methods of conducting
procedures, etiological and pathogenetic
the validity of the application of this physical
factor, the nature of the main clinical manifestations,
individual characteristics of the course of the disease,
initial functional state of the organism and
specificity of the therapeutic effect of the chosen factor. The principle of unity of the etiological, pathogenetic
and symptomatic physiotherapy.
For subacute and chronic inflammatory diseases
physiotherapy procedures should be aimed at
resolution of the pathological process, elimination of its residual
manifestations and normalization of impaired functions of various
organs and systems. Availability pain syndrome demands it
relief during the first two or three procedures, since before
disappearance pain absorbable and
anti-inflammatory therapy is less effective. At the core
this principle is the close relationship caused
therapeutic physical factor of general, segmental-reflex
and local reactions.
The principle of adequacy of impacts
- compliance of the dose of the physical factor and the method of its applicationseverity and phase of the pathological process, the features of its
clinical manifestations, comorbidities and general
state of the body.
The principle of individual treatment with physical factors
Principle individual treatment physical factorswhen using physical factors, the physiotherapist must
consider:
age, sex and constitution of the patient;
the presence of concomitant diseases;
the presence of individual contraindications for the use of a particular
physical factor;
the reactivity of the body and the degree of training of adaptive-compensatory
mechanisms;
biorhythmic activity of the main body functions.
At the same time, the absence of a pronounced therapeutic effect after the first
procedures is not a basis for canceling or replacing one
physical factor to others.
An indispensable condition for the individualization of physiotherapy is the creation
positive psycho-emotional mood in patients.
The principle of course treatment with physical factors
The optimal therapeutic effect of most physical factors occurs inas a result of course treatment.
The duration is 6-8 for some nosological forms, 8-12 for others,
less often 14-20 procedures.
In this case, the morphological and functional changes that occur after the
initial procedure, are deepened and fixed by subsequent ones. Depending on the
the dynamics of clinical manifestations of the pathological process of the procedure is carried out
daily or every 1-2 days.
The summation of the therapeutic effects of physical factors provides a long-term
aftereffect of the course of physiotherapy, which continues after its completion.
A long course of treatment with one physical factor leads to
adaptation of the body and significantly reduces the effectiveness of its therapeutic action.
To assess the duration of the course, it is necessary, in addition to the subjective assessment
patient, also take into account the dynamics of objective indicators of his condition.
The principle of complex use of therapeutic factors
comes in two main forms - combination andcombination of physical factors. Combined
treatment involves the simultaneous exposure of several
physical factors on
pathological focus. At combined treatment physical factors
are used
consecutively at different time intervals. Application
this principle
limited: not all physical factors are compatible with each other
The principle of optimal treatment with physical factors
The principle of optimal treatment with physical factorsPhysical factors have different therapeutic efficacy
in the treatment of a particular disease.
The parameters of the therapeutic factor and the method of its application should be
optimal, i.e. match the character and phase as much as possible
pathological process.
In the acute period of the disease, mainly low-intensity
physical factors on segmental-metameric zones.
In the subacute and chronic phases, the intensity of the factor increases and
often act directly on the pathological focus.
So, for example, in the serous-alternative phase of inflammation,
ultraviolet radiation in increasing erythemal doses (3-10 biodoses),
and in reparative-regenerative - in suberythemal (1/4-1/2 biodoses).
Finally, general ultraviolet irradiation with good reactivity
the patient is prescribed according to the main scheme, in weakened patients - according to
a slow scheme, and for physically strong ones - according to an accelerated one.
Principle of small doses
based on manifestation specific action medicalphysical factors only when used in small doses;
at large
intensity of exposure specific reactions are replaced
non-specific
effects.
The principle of dynamic treatment by physical factors
The principle of dynamic physical therapyfactors
Physiotherapy should be appropriate for the current state
the patient, constant correction of the parameters of the applied physical factors during the entire period of treatment of the patient,
correspond to the phase of the pathological process and the state
patient, change the intensity and frequency of the physical
factor, localization, area and duration of its
effects, along with the inclusion in the complex of treatment
additional therapeutic physical factors.
Such variation contributes to a decrease in the patient's adaptation to the influencing physical factors, which significantly reduces them. clinical efficacy.
The principle of complex treatment with physical factors
The principle of complex treatment with physical factorsThe polysystem nature of the pathological process dictates the need
complex use of therapeutic physical factors.
It comes in two main forms: combined and
combined.
Combined treatment involves the simultaneous effect on
pathological focus by several physical factors.
In combined treatment, they are used sequentially with
different time intervals, reaching 1-2 days or
changing courses.
High efficiency of complex treatment with physical factors
based on their synergy, potentiation, manifestation of new
therapeutic effects, as well as an increase in the duration
effects of physical factors.
The principle of succession
is to take into account the nature andeffectiveness of previous treatment.
Repeated courses of therapy are carried out through
certain period of time:
for mud therapy this interval is 6 months,
for balneotherapy - 4 months,
for electromechanical methods - 2 months.
The principle of the correct appointment of physiotherapy procedures
The principle of the correct appointment of physiotherapy proceduresReasonable and rational use
physical factors in the complex of therapeutic
events
Manifestations of adverse reactions from pathologically altered organs that may occur with illiterate
Manifestations of adverse reactions frompathologically altered organs that may occur
with illiterate appointment of physical factors
The cardinal sign of inadequate physiotherapy is exacerbation
pathological process and the formation of a patient's maladjustment reaction. Such
the reaction may be predominantly general (without significant changes in
affected organ or system) or local (focal).
With a general reaction proceeding according to the type of vegetative-vascular syndrome,
there are adverse changes in well-being, an increase in
irritability, fatigue, decreased performance, sleep disturbance,
change in temperature curve, excessive sweating, pulse lability,
blood pressure, etc. Exacerbations of pathological
manifestations in associated foci
General contraindications for physiotherapy:
malignant neoplasms,systemic blood diseases,
sharp general exhaustion of the patient (cachexia),
hypertension stage III,
sharp severe atherosclerosis cerebral vessels,
diseases of the cardiovascular system in the stage of decompensation,
bleeding or tendency to them,
the general serious condition of the patient,
febrile state (body temperature of the patient over 38 ° C),
active pulmonary tuberculosis,
epilepsy with frequent seizures,
hysteria with severe convulsive seizures,
psychoses with the phenomena of psychomotor excitement.
Thank you for attention!
Vasily Mikhailovich Bogolyubov Gennady Nikolaevich Ponomarenko
GENERAL PHYSIOTHERAPYTextbook for medical students
Therapeutic physical groups
Depending on the types of energy and the types of its carriers,various groups of therapeutic physical
Introduction to physiotherapy 9 factors (Bogolyubov V.M., Ponomarenko G.N.,
1996), according to which the sections of physiotherapy are defined:
electrotherapy, magnetotherapy, phototherapy, hydrotherapy,
thermotherapy, etc.
The place of physiotherapy in the provision of health resort services. Fundamentals of the interaction of the body with physical factors
In sanatorium practice, along with natural healing resources wide application find methods of hardware physiotherapy.
Physiotherapy (Greek physis - nature, thewpeia - care, treatment) is a medical discipline that studies the effect on the body of physical factors used to treat patients, prevent diseases and medical rehabilitation.
Since the subject of study of this medical science is any therapeutic physical factors (see figure), balneology and physiotherapy have much in common in the field of therapeutic use of natural physical factors. At the same time, balneology does not specifically consider hardware methods of treatment, and physiotherapy does not study balneology, the organization of balneology, and a number of other balneological areas.
Numerous methods of physiotherapy are based on the action of physical stimuli that represent the natural environment of a person (fresh, heat, cold, mechanical impact, various forms electricity).
Physical apparatus methods of treatment at resorts are used as an addition to the main therapy. They have the ability to potentiate the action of natural healing factors, significantly accelerate the rehabilitation process, reduce consumption medicines. Balneologists, without obvious indications, usually try not to prescribe physiotherapeutic procedures, focusing on natural treatments in treatment. natural factors. However, in some cases, due to the rapid development of health-improving technologies, the creation and implementation of new methods of treatment, artificial factors (for example, artificial speleotherapy (in specially equipped rooms), barotherapy, detensor methods, monitor bowel cleansing, SPA technologies) are used in resorts. more active than natural ones.
The most pronounced therapeutic effect of most physical factors occurs as a result of a course of treatment. Its duration is 6 - 12, rarely 14 - 20 procedures. The summation of the therapeutic effects of each procedure provides an aftereffect for two to four months, and in combination with natural healing factors (balneotherapy, mud, climate) for 6 to 12 months.
The mechanism of action of physical factors
In the most general form The mechanism of action of physical factors can be represented as follows. The body absorbs the energy of the acting factor as a physical body. In this phase, all processes obey physical laws, which determine the depth of penetration of the active factor into the body, the type of tissues in which most energy is absorbed and primary effects of absorption occur (formation of heat, free radicals of excited molecules, etc.).
Along with the primary, physical, absorption of the energy of the acting factor in the tissues, complex and less studied processes of transformation of the energy of the physical factor into biological processes. There is an excitation of receptors, nerves or other excitable tissues, a change in the ratio of ions and the pH environment, which is usual for tissues, and the formation of biologically active compounds. Local changes in the state of tissues spread through nervous and humoral pathways, affect various systems and neuroendocrine regulation. The result of the action of physical factors are non-specific and specific reactions of the body.
