APPLICATION OF PHYSICAL THERAPY IN PATIENTS WITH LUMBAR OSTEOCHONDROSIS

Abstract

Introduction. Osteochondrosis of the spine is a process in which the intervertebral discs gradually wear out, their elasticity decreases, and the structure is disturbed. Due to their thinning (often uneven), the nerve roots coming out of the spinal cord are increasingly compressed. This is manifested by attacks of pain during physical exertion or changing the position of the body. And since the roots innervate a number of internal organs, the pain can be felt in them as well. The male population is the most prone one to osteochondrosis. The reasons that cause changes in the intervertebral discs have not been fully studied, but they are certainly related to the disruption of blood circulation and metabolism in the disc. The most probable risk factors include: genetic predisposition, infections, intoxications, excess body weight, improper nutrition, hypodynamia, unfavorable conditions of static (carrying loads, prolonged stay in a standing or sitting position) and dynamic (frequent jerky movements with turns, bending and stretching trunk) loads on the spine, age changes, spinal injuries, severe spinal deformities (kyphosis, scoliosis), foot deformities, weak development of the musculoskeletal system, pregnancy, smoking.

The aim of the study – to find the causes that cause changes in the intervertebral discs, to apply physical therapy (types of stretching) for patients with lumbar osteochondrosis.

The main part. There are four stages of development of osteochondrosis. At the first stage, the dehydration of the nucleus pulposus begins. This leads to a decrease in the standing height of the disc. Cracks appear in the fibrous ring, but the pathological process does not go beyond the intervertebral disc. In the second stage, as a result of the decrease in the standing height of the disc, the points of attachment of muscles and ligaments belonging to two adjacent vertebrae converge, so the muscles and ligaments sag. This can lead to excessive mobility of two vertebrae relative to each other, that is, instability of the vertebral-motor segment is formed. Displacement of the vertebrae relative to each other with the formation of spondylolisthesis is characteristic. At the third stage, protrusions are formed, i.e., the displacement of discs without breaking through the fibrous ring and prolapse, when it is accompanied by the exit of part of the pulp core beyond its borders, are noted. The articular apparatus of the vertebral-motor segment also suffers. Subluxations occur in the intervertebral joints, and spondyloarthrosis forms in places of greatest stress. At the fourth stage, marginal bone growths appear on the adjacent surfaces of the vertebral bodies - osteophytes (spondylosis), which cause microtraumatization of the nerve root. Fibrous ankylosis processes begin in the intervertebral discs and joints, which leads to almost complete immobility of the vertebral-motor segment.

Conclusions. The clinical picture of osteochondrosis of the spine is characterized by a chronic course of the disease with different durations of periods of exacerbation and remission. The main syndromes are pain (cervicalgia, thoracalgia, lumbago), neurological (reflex, radicular), vertebrogenic and instability syndrome.