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manipulation.

Manipulation it is recommended to spend in postimmobilizatsionnom the period. Manipulation sessions begin with correction kraniosakralno - go the mechanism on Sutherland W. G [64].

Often meeting at the given contingent of patients vertebralnye nayorushenija in segments CO-Cl, С1-С2, L4-L5, L5-S1 and S1-S2 eliminate with ispolzoyovaniem receptions applied kineziologii on Smith With.

A and Shafer J. [92]. For elimination miofastsialnyh «trigger points» in muscles of an anticnemion and foot (Simons D. G., Travell J. G [98]) use the "soft" technics «Z T» (tension, traction, torsion).

Further spend rhythmic traction mobilisation and mobilisation to rotation talocrural and podtarainogo joints, joint SHopara, mobilizayotsiju pljusnefalangovyh and and interphalanx joints of fingers of the injured foot, and also postisometric and postretsiproknuju a relaxation of muscles goyoleni and stops on G.A.Ivanichsvu [28].

The final stage spends the way developed by us manuyoalnoj therapies of contractures of joints of extremities. 1 Іриводим its description.

• the Way of therapy of contractures of joints of extremities (the demand for the invention №2003135902/038638, a priority from 10.02.2003).

The essence of the given way of manipulation consists that after isometric work of muscles amazed and kontrlateralnoj the extremities, carrying out movement in the direction opposite to a direction ogyoranichenija of movements in the amazed joint, greatest possible intenyosivnosti with use of respiratory and oculomotor synkineses, the patient relaxs muscles of the amazed extremity, activates muscles - antagonists kongrlateralyjuj extremities and carries out the forced movement in the direction coinciding with a direction of restriction of movements in the amazed joint.

The doctor one arm fixes at this time proximal, another an arm grasps a distal segment of an extremity as it is possible further from the amazed joint and, operating with it as the lever, by means of pressure of muscles of the case osuyoshchestvljaet smooth movement in a restriction direction under the continuous control over degree of a pliability of tissues own muscular oshchushcheyoniem, and by means of reduction of muscles of an arm carries out rhythmic koleyobatelnye movements in the amazed joint of the patient in a direction perpendicular a long axis of an extremity with amplitude of 3-5 mm.

The offered way of manipulation combines advantages of methods of rhythmic mobilisation of joints and a postisometric relaxation of muscles of extremities that provides its high efficiency at treatment of contractures of joints.

Advantages of an offered way are safety, legyokost performance and painlessness of procedure that allows to use hundred both in stationary, and in out-patient conditions.

The combination of isometric work of muscles amazed and kontrlateralyonoj with the subsequent manual influence allows to reach extremities reyolaksatsii and analgesias of muscles of an extremity to spend correction of the changed dynamic stereotype local and regionarnoj musculations, to carry out therapeutic influence on the amazed joint and para-articular tissues.

Use respiratory, oculomotor and muscular (with kontralayoteralnoj an extremity) sinkinszy raises efficiency of isometric work of muscles and the subsequent relaxation of muscles of the amazed extremity.

Rhythmic oscillatory influence on the amazed joint allows to eliminate skladoki an articulate capsule, promotes rupture of intraarticulate solderings.

The given technique at correct performance does not lead to any complications and practically has no contraindications.

Carry out an offered way of manipulation as follows:

For augmentation of an angle of a plantar flexion of foot of the patient have in position sitting on a massage table so that knee joints were on the brink of a table. Anticnemions of the patient thus are almost in vertiyokalnom position, knees are incurvated to an angle 100 ° for the purpose of a relaxation ikroyonozhnoj muscles.

The left arm the doctor keeps an anticnemion of the amazed extremity of the patient in a starting position, and the right arm has on a dorsum stoyopy as it is possible further from an ankle joint and fixes foot in polozheyonii the greatest possible plantar flexion in an ankle joint as it is shown on fig. 15.

Fig. 15. Use of a way of therapy of contractures of joints of extremities at оіраничении a plantar flexion in an ankle joint. A starting position. An explanation in the text.

The patient makes a deep inspiration with a breath holding and carries out the maximum isometric reduction of muscles amazed and kontrlateral -

Ache extremities, making efforts to realisation of a back flexion in golenoyostopnyh joints. Thus the patient fixes a look in a direction upwards. poyosle fatigues of the reduced muscles of the amazed extremity, the patient makes a deep smooth exhalation with a breath holding, translates a look in a downward direction, relaxs muscles of the amazed extremity and reduces muscles kontralateralnoj extremities, carrying out forced podoshyovennoe a flexion in an ankle joint.

The doctor the left arm continues to fix at this time an anticnemion porazhenyonoj extremities of the patient in a starting position, and the right arm, zahvatyvajuyoshchej a distal part of foot of the amazed extremity of the patient, operating with it as the lever, by means of pressure of muscles of the case carries out smooth poyodoshvennoe a flexion in an ankle joint under the continuous control over degree of a pliability of tissues own muscular sensation, and posredyostvom reductions of muscles of the right arm carries out rhythmic kolebatelyonye movements with amplitude of 3-5 mm in the amazed ankle joint of the patient in a perpendicular direction as the ego is shown on fig. 16.

Fig. 16. A way of contractures of extremities flexion restriction in a joint.

Use

Therapies

Joints

At

The plantar

The talocrural

To odds

sirovannaja a plantar flexion. An explanation in the text.

Treatment sessions spend daily to greatest possible vosstayonovlenija joint functions.

At restriction of a back extension in an ankle joint of the patient stack on a massage table in position on a back. The left arm the doctor priyozhimaet to a table an anticnemion of the amazed extremity of the patient, and the right arm raspoyolagaet on a plantar surface of foot in area pljusnefalangovyh joints also fixes foot of the patient in position of the greatest possible back extension in an ankle joint as it is shown on fig. 17.

Fig. 17. Use of a way of therapy of contractures of joints of extremities at ograyonichenii a back flexion in an ankle joint. A starting position. Объяснс* nie in the text.

The patient makes a deep inspiration with a breath holding and carries out the maximum isometric reduction of muscles amazed and kontrlateralyonoj extremities, making efforts to realisation of a plantar flexion in ankle joints. Thus the patient fixes a look in caudal nayopravlenii.

After fatigue of the reduced muscles of the amazed extremity, the patient makes a deep smooth exhalation with a breath holding, translates a look in a cranial direction, relaxs muscles of the amazed extremity and soyokrashchaet muscles kontrlateralnoj extremities, carrying out the forced back flexion in an ankle joint.

The doctor the left arm continues to fix at this time an anticnemion to a table, the right arm grasps forward department of foot of the amazed extremity patsiyoenta and, operating with it as the lever, by means of pressure of muscles of the case osushcheyostvljaet a smooth back flexion in an ankle joint under the continuous control over degree of a pliability of tissues own muscular oshchushche -

ni¾m, and by means of reduction of muscles of the right arm carries out rhythmic oscillatory movements with amplitude of 3-5 mm in the amazed ankle joint of the patient in a perpendicular direction as it is shown on fig. 18.

Fig. 18. Use of a way of therapy of contractures of joints of extremities at ogyoranichenii a back flexion in an ankle joint. Forced back flek this. An explanation in the text.


4.4.4.

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Scientific source Ivanov PETER VALENTINOVICH. OPTIMIZATION of TACTICS of SURGICAL TREATMENT And POSTOPERATIVE AFTERTREATMENT of PATIENTS With CALCANEUS FRACTURES. The dissertation on competition of a scientific degree of the candidate of medical sciences. Kazan -.

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