A set of physical therapy exercises for various chronic diseases. Therapeutic exercise for various diseases of the spine

Changes in bones, muscles, and ligaments often lead to numerous painful symptoms. Physical therapy is used for treatment and prevention. Doctors prescribe complexes of therapeutic exercises as a means of helping to improve mobility, relieve pain, and reduce the need for surgical operations. For example, physical therapy for osteochondrosis cervical spine spine strengthens muscles, relieves pain, eliminates vertebral immobility, improves blood flow. This treatment method allows people with a variety of diagnoses to recover from illness and improve their quality of life.

The importance of physical therapy

Movement is of great importance for health.

Physical activity is important for:

• Preventing obesity;
• Prevention of heart and vascular diseases;
• Strengthening bones and muscles;
• Warnings of arthrosis;
• Eliminate the threat of surgical operations.

Movement helps maintain a healthy balance in the body. But physical therapy and sports physical education differ in the nature and purpose of movements. Therapeutic exercises are designed to have a healing effect on diseased organs and systems. They are prescribed only by a doctor using the exact dosage.

People knew about the importance of physical activity back in ancient times. Doctors of ancient China used breathing exercises as a healing method, and Indian doctors used hatha yoga back in the second millennium BC. Famous physicians of the past - Hippocrates and Ibn Sina - described such types of physiotherapy as massage and gymnastics.

Modern doctors have long known that exercise therapy can be more effective than surgery in many situations.

For example:

• Lower back pain. Physiotherapy is more effective and cost-effective than injections or surgery;
• Therapeutic gymnastics is more effective than all other methods of treatment for rheumatism of the meniscus and arthrosis of the knee joint;
• Therapeutic exercise for the spine allows you to do without surgery;
• Exercise therapy is very effective for gastrointestinal diseases;
• Nothing, better than exercise, does not contribute to rehabilitation after operations and childbirth.

Therapeutic exercises always include exercises designed specifically for a specific condition.

Illness or injury

Exercises are done as an addition to daily physical activity. In addition to the therapeutic effect, they improve coordination, flexibility, and posture.

Exercises may include stretching to relieve pressure on joints, core muscles in the back, abdomen, and thighs, weight lifting to strengthen muscles, walking, and water aerobics.

Exercise therapy is excellent for helping athletes recover from injuries, as well as prevent future injuries. Therapeutic exercises relieve pain in soft tissues, increase muscle strength, improve flexibility, expand range of motion. Therapeutic gymnastics is the most modern method of rehabilitation after surgical operations, including caesarean section and natural childbirth. Special training prevents the occurrence of adhesions and promotes rapid recovery elasticity of fabrics.

Therapeutic exercises significantly improve the quality of life in serious chronic diseases such as spinal stenosis, arthritis and Parkinson's disease. The training program is developed individually for each patient, depending on age, nature of the disease and degree of physical fitness.

In some patients, diseases of several systems at once lead to a condition close to disability.

• Stroke;
• Spinal cord injuries;
• Cardiovascular diseases.

Such patients are observed the whole team specialists. The physiotherapist is an essential member of the team. He develops exercise therapy that includes strength training, mobility training, walking up and down stairs, and getting into and out of a wheelchair. Eat special exercises on using a wheelchair.

Physical therapy is necessary for children after serious injuries and those suffering from cerebral palsy. Physical activity thought out by a physiotherapist promotes the child’s growth and development, ensures correct movements, and increases endurance.

Classes for children and adults are held at many clinics and sanatoriums. Professional support is provided by the Center for Sports Medicine and Physical Therapy.

Changes in the spine - cartilage and intervertebral discs - are a very common condition. Almost every middle-aged person suffers from a disease called osteochondrosis. Sedentary work, physical inactivity, carrying heavy loads - everything affects the “main axis” of the human body – the spine. People experience neck and lower back pain. Sometimes the pain is excruciating and interferes with normal movements and peaceful life. Therapeutic exercise for spinal osteochondrosis is one of the most effective healing techniques.

• Sitting on a chair with a straight back, bow your head alternately to both shoulders;
• Slowly turn your head from side to side;
• Touch your chest with the edge of your chin;
• Place your elbow on the table and forcefully press your temple against your palm.

All exercises in this series must be performed at least ten times in each direction.

Physical therapists encourage patients to regularly strengthen the muscles that surround the chest.

A number of exercises are suggested:

• Lie with your back up. Place your palms on your hips. Lifting up top part torso, maintain this position for as long as possible. Bottom part fix your back on the floor, breathe evenly.
• Repeat 1, placing your hands at the back of your head.
• Do the first thing, spreading your arms like wings.
• Lying with your back up, raise your upper body, spread your arms to the sides, clench and unclench your fists.
• Lying on your stomach, make smooth upward and sideways movements (imitation of swimming).
• Repeat exercise 5, but perform circular movements with your hands.

• Lying on your stomach, alternately slowly raise and lower your straight legs;
• Raise one leg to the maximum height (the pelvis should be motionless) and hold in this position for 3-5 seconds. Repeat with the other leg.
• Lying on your stomach, raise both legs up, spread, connect and lower both legs together.
• Raise both legs and hold in this position for as long as possible.

When intervertebral discs become displaced, the ring that holds the vertebra ruptures. This condition is called intervertebral hernia. Most often, hernias form in the lumbar region. Therapeutic exercise for a herniated spine is designed to relieve severe pain symptoms, stretch the spinal column, and strengthen the muscles of the back and abs. All movements of this complex are smooth; jumps or side turns are excluded. Training in a state of exacerbation cannot be carried out. In remission, physiotherapists advise exercising twice a day, 3-5 exercises.

Approximate complex:

• Lying on your stomach, bend your legs, grab your ankles with your hands and pull them towards your neck.
• Lying on your stomach, bend your neck and upper torso back.
• Bend forward while kneeling. The head and palms should touch the floor.
• "Bridge".
• Lying on your back, bend your legs and pull your toes towards your neck. Keep your arms motionless at your sides.

Physical therapy for spinal hernia lumbar region implies caution. At pain you need to stop gymnastics immediately.

Scoliosis

Another serious problem of the spine is scoliosis. In everyday life it is called “curvature of the spine.” Most often, signs of scoliosis are observed already in childhood. school age. In addition to ugly posture, the pathology is unpleasant because it progresses, disrupts breathing and the normal blood supply to organs. How older child or a teenager, the more the spine bends. You can straighten your back with exercise therapy.

Physical therapy for scoliosis varies depending on the severity of the disease. In the first and second degrees, gymnastics helps to significantly straighten the spinal column or completely eliminate scoliosis. In the third or fourth degree, exercise therapy can only restrain the development of curvature.

The usual complex contains the following exercises:

• Standing, press your back straight against the wall and step back from the wall a few steps, maintaining a vertical position of your spine.
• Make a few warm-up exercises standing with a straight back - swinging your arms, turning your torso, squats.
• Lying on your back, take turns bending your knees towards your stomach.
• Lying on your back with your knees bent, raise your pelvis and bend your upper body.
• Lying on your stomach, raise your torso and legs with support on your palms.
• Lying on your back, do a “scissors” with your legs.
• Lying on your stomach. Raise both legs together and hold them there for as long as possible.
• Lying on your stomach, bend your upper body forward.

Exercise therapy to help sore knees

Even young people often suffer from arthrosis of the knee joint. For the elderly, this disease becomes a real disaster - it is impossible to go up and down the stairs, get out of the car, or just get up and sit down. Therapeutic exercises are one of the main ways to combat arthrosis. Precisely struggle, because the patient’s task is to prevent arthrosis from taking over his body. It is necessary to constantly force the sore joints to move.

Training methods are elementary:

• lying on your back, bend your knees;
• hold a rolled towel under your knee;
• holding onto the table, bend your leg at the knee back, pulling it with your hand;
• press the ball against the wall with your back and squat while holding it.

You can perform knee bending and extension using an expander.

Physical activity for the treatment of respiratory diseases

For acute and chronic diseases of the respiratory system, physical therapy also comes to the rescue. Sets of exercises include diaphragm training, simple gymnastics arms and legs, a system of deep breaths and exhalations. In acute inflammatory diseases, exercise therapy helps remove mucus from the lungs and bronchi and clear the lungs. For chronic diseases, for example, bronchial asthma, breathing with the help of the diaphragm, increased articulation of vowels and consonants is used, sport games, walking.

The body of a pregnant woman is an amazing laboratory in which new chemical reactions and new changes occur every day. Therapeutic exercise during pregnancy helps improve blood flow and provide all organs and the growing fetus with oxygen, reduces back pain and stress on the spine and legs, and prevents constipation. Physical activity tones the muscles, making them elastic, which is important for childbirth.

It is important to start training in the first trimester, when changes in the body are still minor. At this time, aerobics, brisk walking, swimming, dancing to pleasant music are useful.

Classic training for pregnant women is the Kegel exercise. This is a contraction of the pelvic floor muscles, strengthening them. Doctors recommend similar training before and after childbirth to quickly return the body to normal.

In the second trimester, jogging and sitting exercises with light dumbbells can be added to these types of physical education.

In the last three months, dumbbells are excluded, but you can continue walking and swimming, as well as some yoga poses that do not require much physical effort.

Any treatment complexes must be prescribed by a doctor and practiced with the help of specialist trainers. In big cities there are no problems with sports medicine centers. In rural areas, opportunities are limited. But it can be adjusted medical complex in specialized literature or on the Internet by typing “physical therapy: video.” Articles by high-level specialists on the latest methods of exercise therapy are published in the international scientific journal “Therapeutic Physical Education and Sports Medicine.”

The heart ensures the movement of blood through the vessels. However, only the force of contraction of the left ventricle is sufficient for this, and in the process of blood circulation a large role belongs to extracardiac (extracardiac) factors. There is negative pressure (below atmospheric pressure) in the jugular and iliac veins, and blood moves towards the heart due to the suction force of the chest cavity during inhalation.

The increase in the volume of the thoracic cavity during inhalation creates greater negative pressure inside the cavity than in the vena cava, and this promotes the movement of blood towards the heart. Blood flow in veins abdominal cavity provides another important extracardiac factor - the pressor function of the diaphragm. When contracted during inhalation, it flattens and descends, enlarging the thoracic cavity and simultaneously reducing the abdominal cavity; at the same time, intra-abdominal pressure increases, which ensures the movement of blood to the heart. When you exhale, the diaphragm relaxes and rises, accordingly the volume of the abdominal cavity increases, the pressure in it drops and blood from lower limbs moves into the inferior vena cava.

When performing passive and active exercises the muscles compress the veins and the valves in the veins move the blood towards the heart. This mechanism of blood flow in the veins is called the “muscle pump.”

By doing physical exercise the pulse quickens, blood pressure rises, the amount of circulating blood and the number of functioning capillaries in the skeletal muscles and in the myocardium.

Therapeutic exercises for diseases of the cardiovascular system, maximally activating the effect of extracardiac circulatory factors, contribute to the normalization of impaired functions.

Exercise therapy is widely used for diseases of the circulatory system in the acute period during recovery and, in reality, as a factor in maintenance therapy.

• acute phase of rheumatism, endo- and myocarditis;
• severe disturbances of the rhythm and conduction system of the heart;
• acute heart failure (pulse more than 104-108 beats/min, severe shortness of breath, pulmonary edema);
• stage III circulatory failure.

Exercise therapy for myocardial infarction

Myocardial infarction is focal or multiple necrosis of the heart muscle caused by acute coronary insufficiency. The necrotic tissue is subsequently replaced by a scar. During a heart attack, severe pain appears in the heart area, increased heart rate, decreased blood pressure, suffocation, and drowsiness. An electrocardiogram (ECG) determines the location of the infarction and its severity. In the first 3 days, body temperature rises, leukocytosis appears and ESR rises.

In accordance with the WHO classification and recommendations of the Cardiology Research Center of the Russian Academy of Medical Sciences, there are four functional classes of severity of the condition of patients who have suffered a myocardial infarction, as well as those suffering from coronary heart disease (without a history of a heart attack).

Functional class I - ordinary physical activity (walking, climbing stairs) does not cause heart pain; pain may occur with heavy loads.

Functional class II - pain occurs when walking, climbing stairs, in cold weather, during emotional stress, after sleep (in the first hours). The motor activity of patients is somewhat limited.

III functional class - pain appears when normal walking on level ground at a distance of 200-400 m, when climbing stairs to one floor. The possibility of physical activity is noticeably limited.

IV functional class - pain occurs with the slightest physical activity, i.e. the patient is not able to perform any physical work.

Patients with small-, large-focal and transmural uncomplicated infarction are classified as severity classes I-III. Class IV includes patients with severe complications: angina at rest, heart failure, rhythm and conduction disorders, thromboendocarditis.

The Cardiological Research Center of the Russian Academy of Medical Sciences has developed comprehensive program rehabilitation of patients with a heart attack at the stage of inpatient treatment and, together with the Russian Scientific Center for Rehabilitation and Balneology (Central Institute of Balneology and Physiotherapy - until 1992) - at the stages of outpatient and sanatorium treatment.

Physical rehabilitation of patients with myocardial infarction is divided into three phases (stages):

The first stage is treatment in a hospital in the acute period of illness until clinical recovery begins.

The second stage is post-hospital (readaptation) in a rehabilitation center, sanatorium, or clinic. The recovery period begins from the moment of discharge from the hospital and lasts until return to work.

The third stage is supportive - in a cardiological clinic, clinic, medical and physical education clinic. In this phase, rehabilitation continues and ability to work is restored.

The first stage is sick leave

Tasks and exercise therapy:

• prevention of possible complications caused by weakening of heart function, disruption of the blood coagulation system, significant limitation of motor activity due to bed rest (thromb-embolism, congestive pneumonia, intestinal atony, muscle weakness, etc.);
• improvement of functional status of cardio-vascular system the impact of physical exercise, mainly for training peripheral circulation, training orthostatic stability;
• restoration of simple motor skills, adaptation to simple everyday stress, prevention of hypokinesia and kinesia (hypokinetic syndrome);
• creating positive emotions.

• acute heart failure - heart rate (HR) more than 104 beats/min; severe shortness of breath, pulmonary edema;
• shock, arrhythmias;
• severe pain, body temperature above 38°C;
• negative dynamics of ECG indicators.

Forms of exercise therapy. The main form is therapeutic exercises at the end of this stage - dosed walking, walking up the stairs, massage.

In case of an uncomplicated heart attack, classes begin on the 2-3rd day, when the main signs of an acute heart attack subside.

The timing of the start of classes and the gradual increase in load are strictly individual and depend on the nature of the heart attack and the severity of post-infarction angina.

The physical rehabilitation program, taking into account the severity class and day of illness at the first stage of treatment in the hospital, is presented in Table. 4. The period of hospital stay is conventionally divided into four stages, which are divided into sub-stages (a, b, c) for a more differentiated approach in choosing the load. The severity class and transfer of the patient from one stage to another is determined by the attending physician.

The physical rehabilitation program for patients with myocardial infarction during the hospital phase is built taking into account the patient’s belonging to one of 4 classes of severity of the condition. The severity class is determined on the 2-3rd day of illness after the elimination of pain and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias. This program provides for the assignment to the patient of one or another nature and volume of physical activity of a domestic nature, a training regime in the form of therapeutic exercises, leisure activities in different terms depending on whether it belongs to one or another gravity class. The entire period of the stationary stage of rehabilitation is divided into four stages with a division of characterizing the daily level of loads and ensuring their gradual increase.

Stage I covers the period the patient is on bed rest. Physical activity to the extent of step “a” is allowed after the pain syndrome and severe complications of the acute period have been eliminated and is usually limited to one day.

Indications for transferring the patient to stage “b” (even while the patient is on bed rest):

• pain relief;
• elimination of severe complications on the 1st-2nd day of the disease with an uncomplicated course.

Contra-indications for transferring the patient to stage “b”:

• persistence of angina attacks (up to 2-4 per day);
• pronounced signs of circulatory failure in the form of sinus tachycardia (up to 100 or more per minute);
• severe shortness of breath at rest or when the slightest movement;
• a large number of congestive wheezing in the lungs;

Table 4. Physical rehabilitation program for patients with myocardial infarction during the hospital phase

Activity level	Household loads	Physiotherapy	Leisure	Day of start of rehabilitation depending on the severity class of the disease
				I	II	III	IV
l a	Turning on your side, moving your limbs, using a bedpan with the help of staff, washing while lying on your side; stay in bed with the head of the bed raised 2-3 times a day for up to 10 minutes	--	Using headphones	1st	1st	1st	1st
1 b	The same + sitting down with the help of a sister on the bed, legs dangling, for 5-10 minutes (1st sitting under the supervision of a physical therapy instructor) 2-3 times a day; shaving, brushing teeth, washing; defecation while sitting on a bedside toilet	Therapeutic gymnastics complex No. 1	Same + reading	2nd	2nd	2-3rd	3rd
II a	The same + more active (20 minutes each) sitting on the edge of the bed, legs dangling (2-3 times a day). Eating while sitting. Transferring to a chair and performing the same amount of daily activities while sitting on a chair		Also + reception of close relatives, if the patient is not in the intensive care unit	3-4th	5-6th	6-7th	7-8th
				but not before the coronary scar T begins to form on the ECG
II b	The same + walking around the ward, eating while sitting at the table, washing feet with outside help	Therapeutic gymnastics complex No. 2 (sitting, individual)	Board games, embroidery, drawing at the table, etc.	4-5th*	6-7th*	7-8th*	9-10th*
III a	The same household loads, sitting without restrictions, going out into the corridor, using a common toilet, walking along the corridor from 50 to 200 m in 2-3 steps			6-10th*	8-13th**	9-15th**	Ind.
III b	Walking along the corridor without restrictions, mastering one flight of stairs, later one floor of stairs, full self-service, taking a shower	Complex of therapeutic exercises No. 3 (sitting and standing, group classes in the “weak” group)	Board games, embroidery, drawing at the table, etc. + group activities. Using a public telephone and receiving visitors	11-15th*	14-16th**	16-18th**	Ind.
IVa	The same + going for a walk, walking at a pace of 70-80 steps per minute for a distance of 500-600m	Therapeutic gymnastics complex Nt 4 (sitting and standing, group exercises in a “strong” group)		16-20th*	17-20th**	19-21st**
IV b	The same + walking along the street for a distance of 1-1.5 km at a pace of 80-90 steps per minute in 2 steps			21-26th*	21-30th**	22-32nd**
IV century	The same + walking outside for a distance of 2-3 km in 2-3 steps at a pace of 80-100 steps per minute at an optimal pace for the patient. Bicycle ergometry			Until the 30th	31-45th**	33-45th**

Note. When transferring a patient to each subsequent level of activity, one should be guided by the criteria for expanding the regimen: in patients 60 years of age and older or who suffered from arterial hypertension or diabetes mellitus before a real myocardial infarction (regardless of age):

* the specified period is increased by 2 days;
** the specified period is increased by 3-4 days.

• attacks of cardiac asthma or pulmonary edema;
• complex severe rhythm disturbances provoked by physical activity or leading to hemodynamic disturbances (for example, frequent paroxysms of the tachysystolic form of atrial fibrillation)
• tendency to develop collapse.

With the transfer of the patient to step “b”, he is prescribed Therapeutic gymnastics Complex No. 1. The main purpose of this complex is to combat hypokinesia in the conditions of bed rest prescribed to the patient and prepare him for the earliest possible dilation physical activity. The use of therapeutic exercises in the first days of myocardial infarction plays an important psychotherapeutic role. Classes are conducted by a physical therapy instructor with the patient lying down, individually with each person. The timing of therapeutic exercises and its volume are determined collectively: by the cardiologist observing the patient, physical therapy doctor and instructor. The beginning of therapeutic exercises precedes the patient’s first sitting down. Actually, step “b” involves joining the above activity by sitting down in bed, dangling your legs, with the help of a sister for 5-10 minutes 2-3 times a day. The first sitting down is carried out under the guidance of a physical therapy instructor, who must explain to the patient the need to observe a strict sequence of movements of the limbs and torso when moving from horizontal position in a sitting position, physically help the patient at the stage of lifting the upper body and lowering the limbs, and carry out dynamic clinical monitoring of the patient’s reaction to this load. Therapeutic gymnastics ensures a gradual expansion of the patient’s physical activity regime.

Therapeutic gymnastics complex No. 1 includes light exercises for the distal limbs, isometric stress large muscle groups lower limbs and torso, relaxation exercises, breathing. The pace of the exercises is slow, subordinate to the patient’s breathing. The depth of breathing in the first days is not recorded, as this can cause pain in the heart, dizziness and fear during subsequent exercises. The instructor, if necessary, helps the patient in performing the exercises. Each movement ends with relaxation of the working muscles. After completing each exercise, a pause is provided for relaxation and passive rest. The total duration of rest breaks is 50-30% of the time spent on the entire lesson.

During exercise, you should monitor the patient's pulse. When the pulse rate increases by more than 15-20 beats, pause to rest. After 2-3 days of successful implementation of the complex and improvement of the patient’s condition, it can be recommended to repeat this complex in the afternoon in a shortened version. Duration of classes - 10-12 minutes.

We present approximate complexes therapeutic exercises for patients with myocardial infarction who are undergoing hospital treatment and who comply with the rehabilitation program (see Table 4).

Therapeutic gymnastics complex No. 1
(IP - lying down)

1. Dorsal and plantar flexion of the feet. Breathing is arbitrary (6-8 times).
2. Flexion and extension of the fingers. Breathing is arbitrary (6-8 times).
3. Bend your arms to your shoulders, elbows to the side - inhale, lower your arms along your body - exhale (2-3 times).
4. Hands along the body, turn your palms up - inhale. Raising your arms forward - up, palms down, pull them to your knees, raising your head, tensing the muscles of your torso and legs - exhale. When doing therapeutic exercises for the first time, you should not raise your head in this exercise (2-3 times).
5. Take 2-3 calm breaths and relax.
6. Alternately bending the legs while sliding along the bed. Breathing is voluntary. From the second lesson, bend the legs as if riding a bicycle (one leg is bent), but without lifting the feet from the bed (4-6 times).
7. Arms along the body, legs straightened and slightly apart. Turn your hands with your palms up, move them a little, at the same time turn your feet outward - inhale. Turn your hands palms down, feet inward - exhale. At the 3-4th lesson, move your arms so as to feel the tension in the shoulder joints (4-6 times).
8. Legs bent in knee joints, lower onto the bed to the right, then to the left (swaying of the knees). Breathing is arbitrary (4-6 times).
9. Legs are bent at the knees. Raise your right hand up - inhale; stretch right hand to the left knee - exhale. Do the same with your left hand to your right knee (4-5 times).
10. Straighten your legs. Move your right arm to the side, turn your head in the same direction, at the same time move your left leg to the side on the bed - inhale, return them to their previous position - exhale. Do the same with your left hand and right foot. The exercise can be complicated by combining leg abduction with leg lifting (3-5 times).
11. Calm breathing. Relax.
12. Bend your arms in elbow joints, fingers clenched into fists, rotation of the hands in the wrist joints with simultaneous rotation of the feet. Breathing is arbitrary (8-10 times).
13. Legs are bent at the knees. Raise your right leg up, bend it, return to IP. Do the same with the other leg. Breathing is voluntary. The exercise is included in the complex no earlier than after 2-3 sessions (4-6 times).
14. Legs are straightened and slightly spread, arms along the body. Right hand on the head - inhale; touch the opposite edge of the bed with your right hand - exhale. The same with the left hand (3-4 times).
15. Hands along the body. Squeeze your buttocks together, simultaneously straining your leg muscles, relax them (4-5 times). Breathing is voluntary.
16. When you inhale, raise your arms up, and when you exhale, lower them (2-3 times).

Criteria for the adequacy of this complex of therapeutic exercises: increased heart rate at the height of the load and in the first 3 minutes after it - by no more than 20 beats, breathing - by no more than 6-9 per minute, increased systolic pressure - by 20-40 mm Hg. Art., diastolic - by 10-12 mm Hg. Art. (compared to the original) or a decrease in blood pressure by 10 beats/min, a decrease in blood pressure by no more than 10 mm Hg. Art.

The occurrence of an attack of angina pectoris, arrhythmia, sudden shortness of breath, tachycardia with a slow return to the initial heart rate, sudden changes in blood pressure (mainly its decrease), severe weakness and a feeling of discomfort, pallor of the skin, acrocyanosis indicate an unfavorable reaction to physical activity. In these cases, further loading should be temporarily suspended.

Stage II includes the volume of physical activity of the patient during the ward period - before he goes out into the corridor.

At this stage of activity, the patient performs therapeutic exercises in the same volume (therapeutic exercises complex No. 1), lying on his back, but the number of exercises increases.

If there is an adequate response to this amount of physical activity, the patient is transferred to step “b” and he is allowed to walk first around the bed, then around the ward, sit down at the table, and eat food while sitting at the table. The patient is prescribed complex of therapeutic exercises No. 2, which is also performed individually under the guidance of an instructor. The main purpose of the complex is to prevent physical inactivity, gentle training of the cardiorespiratory system, and prepare the patient for free walking along the corridor and climbing stairs. The pace of the exercises is regulated by the instructor, especially in the first 2-3 lessons. Therapeutic gymnastics complex No. 2 is performed in the supine - sitting - lying position. The number of exercises performed while sitting gradually increases. Movements in the distal parts of the limbs are gradually replaced by movements in the proximal parts, which involves larger muscle groups. Additional effort is introduced into leg exercises. Each change in body position is followed by passive rest.

Therapeutic gymnastics complex No. 2
IP - sitting

1. Lean against the back of a chair, hands on your knees, do not strain. Hands to your shoulders, spread your elbows to the sides - inhale, lower your hands to your knees - exhale (4-5 times).
2. Roll from heels to toes with legs apart, simultaneously clench and unclench your fingers into fists (10-15 times). Breathing is voluntary.
3. Hands forward, up - inhale, lower your hands down through the sides - exhale (2-3 times).
4. Sliding your legs forward and backward on the floor without lifting your feet off the floor (6-8 times). Breathing is voluntary.
5. Spread your arms to the sides - inhale, hands on your knees, tilt your torso forward - exhale (3-5 times).
6. Sitting on the edge of a chair, move your right arm and left leg to the side - inhale. Lower your arm and bend your leg - exhale. Do the same in the other direction (6-8 times).
7. Sitting on a chair, lower your arm along your body. Raising your right shoulder up, simultaneously lower your left shoulder down. Then change the position of the shoulders (3-5 times). Breathing is voluntary.
8. Spread your arms to the sides - inhale, with your hands pull your right knee to your chest and lower it - exhale. Do the same, pulling your left knee to your chest (4-6 times).
9. Sitting on the edge of a chair, place your hands on your belt. Relax your torso, bring your elbows and shoulders forward, lower your head to your chest. While inhaling, straighten up, spread your elbows and shoulders, bend your back, turn your head to the right. Relax, head on chest. Continuing to do the exercise, turn your head to the left - exhale (4-6 times).
10. Calm breathing (2-3 times).

Therapeutic gymnastics complex No. 3 - group classes
IP - sitting, standing

1. Alternating tension of the muscles of the arms and legs, followed by their relaxation (2-3 times). Breathing is voluntary.
2. Hands to shoulders, elbows to the side - inhale. Hands on knees - exhale (3-4 times).
3. Roll your feet from heel to toe, simultaneously squeezing your fingers into fists (12-15 times). Breathing is voluntary.
4. Sliding the legs along the floor with the movement of the arms, as when walking (15-17 times). Breathing is voluntary.
5. Right hand to the side - inhale. With your right hand, touch your left leg, straightening it forward - exhale. Left hand to the side - inhale. With your left hand, touch your right leg, straightening it forward - exhale (6-8 times).
6. Hands on the belt. Turn the body to the right and left (8-10 times). Breathing is voluntary. Rest - walk around the hall, do breathing exercises while moving - raise your arms up (inhale), lower them to the sides (exhale).
7. IP - sitting on the edge of a chair, clasp your fingers together. Stretch your arms up, bend in the lumbar spine (inhale), lower your arms down - exhale (6-7 times).
8. IP - the same as in exercise 7, but lean your hands on the seat of a chair, straighten your legs forward. Alternate movements with straight legs up and down (6-8 times). Breathing is voluntary.
9. IP - the same. Hands to the sides - inhale, hands down - exhale (2-3 times).
10. IP - the same. Hands to the sides - inhale, with your hands pull your right knee to your chest - exhale. Hands to the sides - inhale. Using your hands, pull your left knee to your chest - exhale (8-10 times).
11. IP - sitting on the edge of a chair, hands on your knees. Hands up - inhale, bend your torso forward - exhale (3-4 times). Rest - walk around the hall.
12. IP - sitting on the edge of a chair, lean against the back of the chair, spread your arms and legs to the sides - inhale. Sit straight, bend your legs - exhale (4-6 times).
13. IP - sitting on a chair, leaning against its back. Bend to the sides, trying to touch the floor with your hand (4-6 times). Breathing is voluntary.
14. IP - sitting on the edge of a chair, right hand forward, up - inhale. Right arm back, down with the torso turning behind the arm, head following the movement of the arm - exhale. The same in the other direction (3-4 times).
15. IP - the same. Hands on the belt. Circular movements of the legs on the floor, changing the direction of movement (8-10 times). Rest - walk around the hall.
16. IP - sitting on a chair, leaning against its back, hands on the belt, back relaxed, round, head lowered. Arms to the sides, bend over, moving away from the back of the chair - inhale, return to IP, exhale (3-4 times).
17. IP - sitting, hands on knees. Tilts of the head forward, backward, forward, to the left - rotation of the head. Repeat 2-3 times each series of movements.
18. IP - the same. Hands forward, up - inhale. Hands down through the sides - exhale (2-3 times).
19. IP - sitting, hands on knees, legs apart. Calm breathing (2-3 times).

Therapeutic gymnastics complex No. 4 - group classes
IP - sitting, standing

1. IP - sitting on a chair. Hands to shoulders - inhale, lower your hands down - exhale (4-5 times).
2. IP - the same. Roll your feet from heel to toe, spreading your legs to the sides, while clenching your fingers into fists, while performing these movements, bend your arms alternately at the elbow joints (15-20 times). Breathing is voluntary.
3. IP - the same, hands locked. Hands up, legs straight (do not lift up!) - inhale. Hands lower, legs bent - exhale (4-5 times).
4. IP - sitting on the edge of a chair. Sliding the legs along the floor with the movement of the arms, as when walking (10-12 times). Breathing is voluntary.
5. IP - the same. Stretch your hands up, get up from the chair - inhale. Sit down - exhale (6-8 times). Rest - walk around the hall, perform breathing exercises while moving (2-3 times).
6. IP - standing behind the back of a chair, feet shoulder-width apart, hands to shoulders. Rotation in the shoulder joints in one direction and the other (10-15 times). Breathing is voluntary.
7. IP - the same, hands on the belt. Right hand forward, up - inhale. Hands back, down (circle with arms with torso turned) - exhale (4-6 times).
8. IP - standing behind the back of a chair, feet wider than shoulder width, hands on the back of the chair. Transferring the weight of the body from foot to foot, bending the legs alternately at the knees (6-8 times). Breathing is voluntary.
9. IP - standing sideways to the back of the chair. Swing the leg back and forth (8-10 times). Breathing is voluntary. Rest - walk around the hall.
10. IP - standing behind the back of a chair, hands on the back of the chair. Roll from heel to toe, bending and arching your back when moving to your heels, do not bend your arms (8-10 times). Breathing is voluntary.
11. IP - standing behind the back of a chair. Hands up - inhale. Bend forward, hands on the chair seat - exhale (6-8 times).
12. IP - standing with your back to the back of the chair at a distance of half a step. Turn the body to the right and left with your hands touching the back of the chair (8-10 times).
13. IP - standing in front of the chair seat. Place your right leg straight on the seat. Hands up - inhale. Bend your leg at the knee, forward, hands on your knee - exhale. The same - with the other leg (6-8 times). Rest.
14. IP - standing behind the back of a chair, legs together, hands on the belt. Move your right leg to the side on your toes, your left arm up - inhale. Tilt to the right side - exhale. The same - in the other direction (6-8 times).
15. IP - the same. Rise up on your toes - inhale. Sit down and straighten up - exhale (5-6 times).
16. IP - standing, legs together, arms along the body. Hands up through the sides - inhale. Hands down through the sides - exhale (3-4 times).
17. IP - the same, hands on the belt. Rotate the body clockwise and counterclockwise (8-10 times).
18. IP - the same. Free abduction of arms to the right - to the left (6-8 times). Breathing is voluntary.
19. IP - sit astride a chair, hands on the back of the chair. Alternately raising your legs forward up without bending back (6-8 times). Breathing is voluntary.
20. IP - the same. Hands up - inhale. Place your hands behind the back of the chair, relax your torso muscles - exhale (2-3 times).
21. IP - the same. Torso rotation. Breathing is voluntary. Change the direction of movements (4-6 times). Rest - walk around the hall.
22. IP - sitting on the edge of a chair. Hands to the sides - inhale. Pull your knee to your chest with your hands - exhale. The same - pulling up the other knee (6-8 times).
23. IP - the same. Lean against the back of the chair, spread your arms and legs to the sides - inhale. Sit up straight - exhale (6-8 times).
24. IP - sitting, hands on knees. Hands slide over the body - inhale, return to initial position- exhale (2-3 times).
25. IP - the same. Tilt the head to the right, left, forward, backward - rotate the head (8-10 times). Relaxation.

Particular attention should be paid to the patient’s well-being and his reaction to the load. If there are complaints of discomfort (chest pain, shortness of breath, fatigue, etc.), it is necessary to stop or reduce the load, reduce the number of repetitions and additionally introduce breathing exercises.

In patients of classes I and II of severity, an increase in heart rate during exercise up to 120 beats per minute is permissible. Before discharge, the threshold power of work that the patient can perform should be determined.

The second stage is post-hospital

The recovery period begins from the moment of discharge from the hospital and for an uncomplicated heart attack lasts two months. In the first month of the recovery period, it is most effective to continue rehabilitation in a cardiological sanatorium, which has been tested since 1988. Patients with an uncomplicated heart attack are sent to the sanatorium if they are in satisfactory condition, capable of self-care, and have achieved the ability to walk up to 1 km and climb 1-2 flights of stairs without any discomfort.

Patients enter the sanatorium on the 12-17th day, in total after 20-30 days, i.e. in the first month of the recovery period.

Based on the results of an exercise test, patients sent to a sanatorium are divided into three classes:

1st class - performance 700 kgm/min or more,
2nd class - performance 500-700 kgm/min,
3rd class - performance 300-500 kgm/min.

Tasks and exercise therapy:

• restoration of physical performance, elimination of residual effects of hypokinesia, expansion of the functional capabilities of the cardiovascular system;
• increased physical activity; preparation for physical household and professional stress.

Contraindications to the use of exercise therapy:

• circulatory failure degree II and higher;
• chronic coronary insufficiency of functional class IV;
• severe disturbances of heart rhythm and conduction;
• recurrent course of myocardial infarction;
• aortic aneurysm, cardiac aneurysm with symptoms of heart failure.

Indications for exercises in the exercise therapy room of a polyclinic, medical and physical education dispensary:

• frequent attacks of angina, angina at rest, unstable angina, severe arrhythmias;
• circulatory failure above stage II;
• persistent arterial hypertension over 170/100 mm Hg;
• concomitant severe diabetes mellitus. It is allowed to practice therapeutic gymnastics at home using a lightweight complex.

Forms of exercise therapy: therapeutic exercises, dosed walking, walking on stairs, walks, exercises on general exercise equipment (exercise bike, treadmill etc.), elements of applied sports exercises and games according to simplified rules, occupational therapy, massage.

Therapeutic gymnastics classes are almost no different from those carried out in the hospital before discharge. Gradually increase the number of repetitions, speed up the pace; apply exercises to gymnastic wall, with objects (gymnastic sticks, dumbbells, inflatable balls).

With concomitant asthenic syndrome in the early post-hospital period, the general and special load in therapeutic exercises should be limited and at the same time, relaxation exercises should be used more widely.

The procedures are carried out in a group method, preferably without musical accompaniment. Lesson duration - 20-30 minutes.

The main means of training is walking up to 3500 m, at a pace of 100-110 steps per minute. During outdoor games, according to simplified rules, it is necessary to pause for rest every 7-15 minutes. The pulse rate should not exceed 110 beats/min, and for those taking beta blockers - 100-105 beats/min. Use natural factors of nature, air baths, moderate solar radiation, sleep in the air.

In the second month of recovery, patients are at home and monitored at the clinic. They do exercise therapy at a medical and physical education clinic (VFD), a clinic 3-5 times a week, or independently at home. When doing therapeutic exercises, training on an exercise bike, or a treadmill for 10 to 20 minutes at the end of the month, it is considered optimal to increase heart rate by 20-25 beats/min, but not more than 120 beats/min. In addition to therapeutic exercises, walking 2 times a day for 3-5 km is recommended; by the end of the month, accelerated walking for 2-3 minutes is acceptable with an increase in heart rate to 135-145 beats/min.

The third stage is supportive

Starts at 3-4 months. from the onset of the disease and continues throughout life.

Given that regular classes at the previous stage, physical performance approaches that of healthy peers, -700-900 kgm/min.

Tasks and exercise therapy:

• maintaining and increasing physical performance;
• secondary prevention of coronary artery disease and recurrent infarction.

Forms of exercise therapy: physical exercises are similar to those used in people with poor health and reduced physical performance. They use therapeutic exercises, walking, climbing the stairs to the 3rd-5th floor 2-3 times, training on general exercise equipment, sports games with simplified rules, massage.

The described physical therapy exercises for myocardial infarction can be used for other diseases of the cardiovascular system, but the transition time to higher loads is shorter.

Exercise therapy for coronary heart disease

Coronary heart disease is a common disease that manifests itself as angina pectoris - pain in the heart, behind the sternum, in the left arm, under the left shoulder blade. Pain occurs as a result of vasospasm and myocardial ischemia. Attacks of pain are provoked by negative emotions, smoking, alcohol abuse, physical and mental stress.

Tasks and exercise therapy:

• contribute to the regulation of the coordinated activity of all parts of the blood circulation and the development of reserve capabilities of the cardiovascular system;
• improve coronary and peripheral blood circulation, improve emotional state, increase and support physical performance;
• secondary prevention of ischemic heart disease.

P r o t i v e d i n c a t i o n :

• frequent attacks of angina pectoris,
• acute coronary circulatory disorders,
• heart failure above stage I,
• heart aneurysm,
• persistent heart rhythm disturbances.

Forms of exercise therapy: therapeutic exercises, dosed walking, physical exercises in water and swimming, massage; use of natural factors.

Exercise therapy is indicated in the period between attacks of angina:

• for mild attacks (on the 2-3rd day),
• during severe attacks (on the 6-8th day),
• in older people (after a moderate attack after 3-4 days).

The method of training is similar to that used in survivors of myocardial infarction (Table 5).

Exercise therapy for arterial hypertension

Arterial hypertension (AH) is a common disease characterized by increased blood pressure.

Combined national committee The USA on the prevention, detection, assessment and treatment of hypertension in patients 18 years of age and older offers the following classification of this disease (Table 6).

Table 5. Scheme of the therapeutic exercises procedure for patients with a mild form of chronic coronary heart disease (for the middle of the course of treatment)

	Section and contents of the procedure	Duration, min	Guidelines	Purpose of the procedure
I	IP-sitting. Exercise for small and medium muscle groups of the arms and legs, alternating with breathing	3 - 4	Don't hold your breath	Gradual involvement of the body in physical activity. Improving peripheral circulation
II	IP - sitting and standing. Exercise for arms, legs and body with gradual involvement of large muscle groups; for balance, coordination; exercises with low effort alternating with breathing	10	Follow correct execution exercises and the correct combination with breathing phases	Cardiovascular and respiratory systems, balance, movement coordination
III	IP - standing. Walking is normal: with gradual acceleration and deceleration of the pace, turns in motion; attention exercises. Switch to running at an average pace and walking	3 - 4	Do not hold your breath, combine it correctly with core exercises. Watch your posture	Further training of the cardiovascular system; improved posture
IV	IP - standing. A game. Ball relay race (elements of basketball)	5 - 6	Make sure you pass the ball correctly	Increasing the emotional tone of the patient, training coordination
V	IP - sitting. Exercises for arms and legs combined with breathing	3 - 4	Watch your breathing	Reducing overall physical activity, restoring calm breathing
Total		24 - 28

Table 6. Classification of blood pressure levels (VI revision, 1999)*

* US Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension for Persons 18 Years of Age and Over.

The World Health Organization has adopted the following classification of hypertension:

Stage I - increased blood pressure without involvement of target organs;

Stage II - increased blood pressure with involvement of target organs (heart, fundus, kidneys);

Stage III - increased blood pressure with damage to target organs (stroke, heart attack, renal failure, heart failure).

The task of exercise therapy is to help reduce blood pressure and prevent crises, improve the general condition of the patient.

Contra indications for prescribing exercise therapy:

• hypertensive crisis;
• increase in systolic pressure more than 180 mm Hg. Art. and diastolic - more than 110 mm Hg. Art.;
• heart failure degree II and higher.

Forms of exercise therapy: therapeutic exercises, dosed walking, general exercise equipment, physical exercises in the pool and therapeutic swimming, massage.

During a crisis, bed rest is prescribed and exercise therapy is not used. Therapeutic exercises are prescribed after the pressure has decreased and the complaints that occur during a crisis have disappeared.

In the first days, classes are conducted individually, and if improvement occurs, after 5-6 days in a group. They use general strengthening exercises, breathing exercises, balance exercises, coordination exercises, exercises with objects, on apparatus. Turns; tilting the head and body is done with caution.

During the non-crisis period, patients should exercise in the same way as patients with coronary heart disease, the load power is 55-85% of the maximum that the patient is able to perform.

Exercise therapy for chronic heart failure

Circulatory failure is not a specific disease, but a complex of symptoms that occurs with heart valve defects, myocardial damage, and arrhythmias.

In case of heart failure, the stroke and minute volumes of the heart decrease, the pulse quickens, arterial pressure decreases and venous pressure increases, blood flow slows down, swelling, cyanosis, and shortness of breath appear.

There are three stages of chronic heart failure.

At stage I, at rest and during normal work and household loads, there are no signs of circulatory disorders. With increased stress, shortness of breath occurs, the pulse quickens and a feeling of fatigue appears, sometimes swelling in the legs appears in the evening.

Exercise therapy in the first half of the course of treatment is aimed at stimulating extracardiac circulatory factors. In the second half, the loads gradually increase from 50% of the threshold power to 75-80% in order to train the heart muscle. The density of classes is increased from 40-50 to 60-70%. All starting positions, exercises with objects, apparatus, and on apparatus are used. Include exercises to develop strength, sedentary games, and walking.

Lesson duration - 25-30 minutes.

Stage II is characterized by signs of insufficiency at rest.

At stage IIa, the liver enlarges, congestion in the lungs, moderate swelling in the legs. In case of circulatory insufficiency at the Pa stage, therapeutic exercises increase the effect of medications. General strengthening exercises are used in alternation with static breathing, at a slow pace, at the beginning of the course of treatment - in a lying position, later - sitting and standing, at an average pace, with a decrease breathing exercises in the ward mode, walking is added. Lesson duration - 10-15 minutes.

Stage II b is characterized by a significant enlargement of the liver, pronounced edema, shortness of breath and rapid heartbeat occur with minor movements. Such patients in the hospital are on extended bed rest. In case of circulatory failure stage II b, exercises are used for small and medium muscle groups, passive, active with help at a slow pace.

The duration of the lesson is 10-12 minutes, 2-3 times a day.

At stage III of chronic heart failure, congestion with accumulation of fluid (ascites) in the serous cavities and persistent changes in the heart, liver, kidneys and other organs are significantly pronounced. Therapeutic exercises are contraindicated.

Physical performance is reduced from 350-450 kgm/min in stage I to almost complete absence in stage III.

Exercise therapy for heart defects

Mitral disease is manifested by narrowing (stenosis) of the left atrium-ventricular orifice (mitral) and/or insufficiency of the left atrium of the ventricular valve. Mitral stenosis or a combination of stenosis and valve insufficiency is a serious disease. Acquired heart defects are formed during rheumatism. In the acute stage, patients are on bed rest. During the period of extended bed rest, therapeutic exercises begin to be used. Active exercises are used in combination with breathing exercises, at a slow pace, without effort, for 10-15 days. The next 2-3 weeks. patients on a ward basis are prescribed therapeutic exercises similar to those used for stage II circulatory failure. After 6-8 months. After discharge from the hospital, classes in health groups are permissible, and for students - in a special or preparatory group.

Therapeutic gymnastics differs from professional physical education in that its exercises are not so intense and are aimed at rehabilitating the patient. It helps develop endurance, increase strength, and strengthen the body. This is important for recovery and leading a healthy lifestyle in the future. The advantage of physical therapy, or exercise therapy, is the absence side effects. Health-improving gymnastics, on the contrary, restores the damaged organ.

What is therapeutic exercises

This is a physical activity consisting of a set of exercises aimed at restoring the health of an adult or child with neurological, cardiological, rheumatological, traumatological and other problems. Therapeutic exercise is necessary to relieve pain, increase motor activity and improve coordination of movements. In addition to rehabilitation, it is used in medicine to restore emotional and mental state, and also as a prevention of many diseases.

Peculiarities

The main difference between gymnastics is the static nature of the exercises. They are performed slowly in order to achieve the desired healing effect under tension. The exercises are targeted in nature, i.e. aimed at restoring the functioning of a specific organ. In case of serious illness, gymnastics is carried out under the supervision of a physical therapy instructor in a special room. Can be used for some exercises Sports Equipment: traction boards, couches, abdominal benches, fitball.

What is the main therapeutic method of exercise therapy?

The main methods of exercise therapy are specially selected physical exercises, with the help of which a specific disease is treated. In fact, this is the main task health program. The name of a specific exercise therapy technique includes the pathological condition or disease for which it is indicated. Osteoarthritis of the hip joint, for example, is recommended to be treated morning exercises.

Indications

The list of indications for the use of physical therapy includes a large number of diseases of the musculoskeletal system, nervous, cardiovascular and other systems. In each case it is selected individual program, which will allow you to influence the diseased organ.Overall, therapeutic Physical Culture shown when:

• curvature of the spine;
• paralysis;
• rehabilitation after surgery;
• orthopedic diseases;
• post-traumatic recovery;
• neurological diseases;
• paresis, manifested by weakening of organs;
• diseases of the heart and blood vessels.

Means and forms of exercise therapy

Exercise therapy refers to the current therapeutic factors that are used to rehabilitate the patient. This list includes:

• walking;
• gymnastics in water;
• swimming;
• training on simulators;
• climbing;
• gentle acrobatics.

A form of physical therapy is a type of training organization within which methods and means of exercise therapy are implemented. They are used not one at a time, but in combination to achieve greater effect. The main forms of physical therapy are:

• hydrokinesitherapy;
• morning hygiene exercises;
• applied sports exercises;
• short-distance tourism;
• outdoor and sports games;
• industrial gymnastics;
• walks;
• health running;
• occupational therapy;
• living skills and walking training;
• health path;

Types of therapeutic exercises

Gymnastics exercises are divided into types according to different criteria. According to the method of implementation, they can be individual or group, and according to the degree of activity - passive and active. In the first case, the patient experiences virtually no tension when performing it, and the movements themselves are performed by the instructor. Active movements can be done by the patient himself. According to other criteria, the following types of gymnastics are distinguished:

1. Static and dynamic. The first involves holding a position for a certain amount of time. Dynamic - involve performing a series of movements.
2. For stretching and relaxation. They help relieve muscle fatigue.
3. Respiratory. Indicated for diseases of the respiratory system. Such exercises have a beneficial effect on all tissues and systems. One of the well-known breathing exercises systems is the complex developed by singer A.N. Strelnikova.
4. Corrective – their task is to correct postural disorders and improve the health of the spine.

Exercise therapy complexes for various diseases

The specific exercise system depends on what disease the patient has and what needs to be restored. Gymnastics should involve the organ that is the cause of the pathological condition and discomfort. Treatment is often carried out with the inclusion of various forms and means of physical therapy. For example, for osteochondrosis of the lumbar, thoracic or cervical spine, morning and industrial exercises are indicated.

For osteochondrosis of the spine

The emphasis in the treatment of spinal osteochondrosis is on strengthening the entire muscular corset of the back. Just a few simple but effective exercises from Dr. Bubnovsky’s gymnastics will help with this:

1. Lying with your back up, place your palms on the sides of your thighs. Next, raise your upper body and try to hold it for several seconds. Do it five times.
2. Repeat the previous movement, but with your hands on the back of your head, and then with your hands spread to the sides (5 rubles each).
3. Then, in the same position, try to raise your legs as high as possible, while fixing them at the top point (8 p.).
4. Follow the previous step, but spread your feet at the top and then bring them back.

For spinal hernia

Even in the acute period, with a herniated intervertebral disc, you can perform several simple movements. The complex will help reduce the intensity of pain and improve your condition. The movements themselves do not cause any unpleasant sensations. If they occur, you should consult a doctor and stop exercising until then. If you feel well, you can perform the following exercises:

1. Lie on your back, straighten your legs. Next, simultaneously press your chin to your chest and pull your toes towards you (up to 10 repetitions).
2. Get on all fours and walk like this for about 3-4 minutes.
3. In the same position, try to stretch your right arm and left leg at the same time, holding them for a couple of seconds, and then do the same, but for the opposite limbs (ten times for each leg).
4. Again, arch your back on all fours and reach your head with your knee. Repeat the same on the other leg 8-10 times.

For scoliosis

Gymnastics is useful for crooked posture. It helps to straighten the spine to some extent and prevent it from becoming even more deformed. The complex of therapeutic exercises should be performed daily, using a slow pace. The delay in the extreme position should not be too long. When finished, just lie on a cotton roll for about a quarter of an hour. The set of exercise therapy exercises itself is as follows:

1. Lie on your back, place your hands behind the back of your head. Then, as you inhale, spread your elbows to the sides, and as you exhale, bring them back. 10-12 times.
2. In the same starting position, alternately bend/extend your legs, pressing them to your stomach (repeat up to 12 times).
3. Lie on your stomach, place one hand on the back of your head, and the other on your chest on the curved side of the curvature. Next, while inhaling, straighten your torso, and while exhaling, take the starting position. Repeat up to two dozen times.

For joints

To get rid of pain and restore joint mobility, you can regularly perform the complex. Along with proper nutrition, exercises gradually restore their function and prevent the condition from starting. Movements should be smooth. During breaks, you can even massage your joints for better blood circulation in the area. The complex includes exercises for specific joints.

1. For elbows. Relax your shoulders, clench your hands into fists, then rotate your forearms in different directions - away from you and towards you, five repetitions.
2. Shoulder joints. Straighten your arms, rotate them forward and backward several times simultaneously or discordantly.
3. Hip joints. Place your hands on your belt, then rotate your hips in one direction and the other, trying to engage only your pelvis (five times in each direction).
4. Knees. Bend your legs slightly, place your hands on your hips just above your knee joints. Make circular movements with your knees 8-10 times.

For hemorrhoids

The purpose of physical education for internal or external hemorrhoids is to return muscle tone anal sphincter and activation of blood flow in this area. This relieves constipation and eliminates venous congestion. You can do the following exercises:

1. Scissors. Take a lying position on your back, raise your legs to an angle of approximately 45 degrees. Next, separate the limbs, and then cross them, performing scissor-type movements (start with 20 seconds, gradually increasing).
2. Lifting. Remain in the same position, lift your pelvis from it, hold for a couple of seconds, and lower. Do up to 8 repetitions.
3. Walking on the buttocks. Sit on the floor, stretch your legs. Tighten the muscles of one buttock, move it forward, repeat the same with the second. “Walk” first forward and then back in the same way (10 + 10 movements).

For prostatitis

“Walking on the buttocks” also helps to prevent and improve the condition of prostatitis. From others simple exercises you can perform the following movements:

1. Stand up straight, and as you exhale, bring one leg forward, bending your knee to an angle of 90 degrees so that your thigh is parallel to the floor. Next, move your leg back, maintaining the same angle at the knee. 8 reps.
2. Lie with your stomach down, arms extended along your body. Lift your legs slightly off the floor, and then perform crossing movements with them, as with classic “scissors.” Up to 10 times.
3. Lying on your stomach, raise your legs and perform circular movements with them like riding a bicycle (no more than 5 minutes).

Breathing exercises for VSD

Helps reduce the symptoms of VSD (vegetative-vascular dystonia) breathing exercises. Her exercises are very simple and accessible to everyone. You should start with a small load, and then gradually increase it. They are done like this:

1. Rhythmic breathing. You need to do it through your nose, inhaling air at a normal pace. Then you can complicate the exercise by inhaling in jerks, counting to three. Exhale should be through the mouth.
2. Chest breathing. Hands must be placed on the waist. Next, inhale as much as possible through your nose, expand your chest, and then exhale all the air.
3. Breathing into a paper bag. Suitable for severe attacks of vegetative-vascular dystonia. To perform this, press a paper bag tightly to your nose and cheeks, and then breathe rhythmically into it for 2 minutes. Continue until the attack stops.

Exercise therapy for neurological diseases

Complex treatment of neurological diseases is also not complete without physical therapy. Regular implementation of special programs is important to speed up recovery processes. Their technique is as follows:

1. Start by walking in a circle for 1-2 minutes, changing direction periodically.
2. Then do the same, but walk alternately on your toes and heels.
3. Stand up straight, stretch your arms along your body, relax. Then alternately raise your right and left arms up at a speed of approximately 60-120 times per minute.
4. Place your feet shoulder-width apart. Stretch your arms forward, squeeze your fingers at a speed of up to 120 times per minute.
5. Place your legs a little narrower, do a squat as you inhale, and rise up as you exhale. Do another 4-5 reps.
6. Stand on your toes, then lower on your heels, do another 5-6 times.

Postoperative gymnastics

It is impossible to create a universal set of therapeutic exercises that would be suitable after any operation. The complex is determined by the doctor depending on the organ undergoing surgery. In general, after surgery it is recommended to do exercises that the patient should have mastered before the procedure. It is allowed to begin physical therapy exercises approximately 1-2 hours after the patient recovers from anesthesia. These include:

1. Exercises to help educate the patient proper breathing.
2. Mode light gymnastics, the exercises of which involve small muscles, lasting 3-5 minutes and frequency 3-4 times a day.
3. More intense physical activity from the 2nd day after surgery, represented by therapeutic exercises, which are determined based on the disease.

Contraindications

Not in all cases physical exercise are useful. Performing exercises is strictly prohibited if you have:

• signs of exacerbation of diseases;
• elevated temperature;
• pregnancy in women or recent surgery - according to indications;
• lung and heart diseases;
• bleeding;
• oncological diseases;
• severe mental disorders;
• thrombosis;
• intoxication, infectious and inflammatory processes.

Video

(exercise therapy) is a therapeutic method, the main means of which are physical exercises used for therapeutic and therapeutic purposes for injuries and various diseases. Exercise therapy, along with the main task (restoration of impaired functions), develops reaction speed, strength, endurance, dexterity, coordination and helps to quickly return to social and work activities after illness. Exercise therapy is used in combination with a properly organized regimen in clinical, outpatient, sanatorium and resort practice and at home.

Physical exercise changes: primarily affects the central nervous system, causing a change in the mobility of nervous processes in the cerebral cortex; correct the functions of the main body systems (breathing, etc.), metabolic processes; contribute to their compensation; influence the emotional state of the patient, distract from thoughts about the disease, and cause a feeling of cheerfulness and confidence.

Rice. 1. Different kinds exercises:
1 - passive;
2 - active with projectiles;
3 - active on the gymnastic wall.

Rice. 2. Basic exercises to strengthen muscles abdominal wall in a standing position.

Exercise therapy is indicated for open and closed fractures, soft tissue injuries for faster healing, callus formation, contractures of various origins, polyarthritis, . Widely used during operations on the abdominal, thoracic cavities, etc. (pre- and postoperative gymnastics) as a means of preventing various postoperative complications (intestinal atony, restriction of movement in the joints, etc.) and combating them. Physical exercise improves the nutrition of the heart muscle and enhances its contractile function. Exercise therapy is used in the initial stages of circulatory failure, myocarditis in the subacute and chronic periods, myocardial infarction, hypotensive conditions; for vascular diseases of the extremities: obliterating lesions of the arteries, chronic and varicose veins veins Therapeutic exercise is indicated for lung diseases (pneumonia, pleurisy, bronchial asthma, etc.); stomach and intestines (colitis, enterocolitis), with prolapse of the stomach and other internal organs, constipation, diseases of the liver and biliary tract; for metabolic and endocrine diseases (obesity, ); diseases of the female genital area (chronic inflammatory processes, prolapse of the walls, incorrect positions uterus, menstrual disorders). Exercise therapy is used in the postpartum and periods. Physical exercises are widely used for diseases and injuries of the central and peripheral nervous system. Exercise therapy is indicated as a method of rehabilitation therapy for paralysis and paresis caused by impaired cerebral circulation, with the consequences of diseases of the nervous system (meningitis, vestibular function disorders and neuroses). Exercise therapy is widely used in the complex treatment of various pathologies in children (diseases of the cardiovascular and respiratory systems, etc.). Exercise therapy is especially indicated as a therapeutic and prophylactic agent for defects and diseases of the musculoskeletal system in children (postural disorders, etc.).

The main means of physical therapy - sets of physical exercises - are divided into gymnastic, sports-applied (, etc.), mobile, etc. They are used in combination with natural factors (air, water, sun), which are most fully used in spa treatment. Of the complex of remedies, gymnastic exercises in the form of therapeutic exercises are most often prescribed. When prescribed to a patient independent studies At home, special recommendations for self-control are given. Gymnastic exercises classified: a) according to anatomical principle - for small muscle groups (hands, feet, face), medium (muscles of the neck, arms, legs, muscles), large (muscles of the thigh, abdomen, back); b) by activity (Fig. 1) - passive and active; the latter can be free, lightweight (in water, on sliding surface etc.), with effort, for relaxation, etc.; c) according to the specific principle - respiratory, preparatory, corrective, in throwing, balance, resistance, with apparatus, crawling, climbing, jumping, jumping, hanging and resting, etc.

Therapeutic gymnastics for children - see Gymnastics, for young children.

Rice. 3. Basic exercises to strengthen the abdominal muscles in a sitting position.

Rice. 4. Basic exercises to strengthen the muscles of the abdominal wall in a lying position.

Rice. 5. Therapeutic exercises for gynecological diseases in the prone position.

Physical exercises are used in the form of general and special training. Objectives of general training: strengthening the body, improving the functions of basic systems. Special training is aimed at restoring impaired functions. To carry out the tasks of special training, certain groups of exercises are selected. For example, to strengthen the abdominal muscles, exercises are used in standing, sitting and lying positions (Fig. 2-4); to improve blood circulation in the pelvic area - while lying on your stomach (Fig. 5).

The condition for the effectiveness of exercise therapy is long-term, systematic, regular training with gradual increase loads both in each procedure and throughout the entire course of treatment; taking into account the individual characteristics of the patient: age, profession, physical activity, characteristics of the course of the disease. Exercise therapy is used in the form of a therapeutic gymnastics procedure - individually or in groups (in a ward, a therapeutic gymnastics room or in an open area), pre- and postoperative gymnastics; self-study of patients performing tasks; morning hygienic gymnastics(cm. ). An additional form of influence is (see). In addition, near (see), dosed ascents (see), skiing, skating, rowing, swimming, games are used.

Methodological principles of classes: the load is dosed accordingly physical abilities patient, general strengthening exercises should alternate with breathing and special ones. The amount of load in the exercises depends on the starting position, duration of the procedure, number of repetitions of the exercises, tempo, range of movements, their complexity, degree of effort in the exercise, use of equipment, and combination with breathing exercises.

The methodological management of exercise therapy is carried out by medical and physical education clinics, which include exercise therapy rooms with a staff of specialist doctors and exercise therapy instructors.

Exercise therapy classes in the conditions of a paramedic-midwife station are conducted only by an instructor (methodologist) of physical therapy or a paramedic with special training. Therapeutic gymnastics rooms must have gymnastic bench, wall, horizontal ladder, sticks, clubs, dumbbells, balls, etc.

SET OF EXERCISES FOR DISEASES

OF CARDIO-VASCULAR SYSTEM

I.p. – main stand. Feet together, arms down.

As you inhale, move your right hand forward - up;

As you exhale, lower your hand. The pace is average. Repeat 2-3 times with each hand.

I.p. - stand with your legs apart, hands on your belt.

Rise on your toes, move your arms back, stick out the abdominal wall - inhale, lower yourself onto your feet, bring your elbows forward, draw in the abdominal wall - exhale.

Repeat 4 – 6 times.

I.p. – lying on your back, arms bent at the elbows and resting on them.

Bend your fingers and toes at the same time, then straighten.

Repeat 6-7 times. The pace is slow. Breathing is free.

I.p. - the same, arms along the body. Slide your palms along the body up to the armpits - inhale, return to the starting position - exhale. Repeat 4 times. The pace is slow.

IP - the same, arms are bent at the elbows and rest on them. Simultaneously move your hands and feet towards you, then away from you. Repeat 5-7 times. The pace is slow. Breathing is free.

Diaphragmatic breathing. Repeat 4 times.

I.p. - lying on your stomach. Move your legs alternately on the floor of your foot 6-8 counts towards you, bringing the bending in the knee and hip joints to a right angle, and also 6-8 counts away from you. Repeat 6 times. The pace is slow. Breathing is free.

I.p. - Same. Bend your legs at the knee joints and place your feet towards your buttocks, hands on your waist. Place your knees to the right, hand in front of you to the left, and the same in the other direction. Repeat 6-7 times. The pace is slow.

I.p. - Same. " Bike". 3 sets of 10 times. The pace is average. Breathing is voluntary.

I.p. - lying on its side “Pendulum”. 12 times. The same on the other side. Breathing is voluntary.

I.p. – emphasis, kneeling. Alternately raising the arm up while simultaneously lifting the opposite leg up. 6 times. Breathing is voluntary.

I.p. - Same. Head forward up, bend at the waist - inhale, round your back - exhale. 6 times.

Relaxation exercises.

SET OF EXERCISES

FOR RESPIRATORY ORGAN DISEASE

I.p. - standing. Slowly raise your arms up through your sides - inhale,

IP - standing, feet shoulder-width apart, hands on chest, fingers forward. Pulling the elbows back - inhale, bend forward with a stepwise exhalation and push-like pressing of the hands on the ribs with the pronunciation of the sound “oo-oo-oo”.

I.p. – standing, feet shoulder-width apart, hands clasped, arms down. Hands up - inhale, bend your hands between your knees - exhale while pronouncing the sounds “uh-uh-h”.

I.p. - standing, left hand on the chest, right on the stomach.

Chest breathing. 5 times

Abdominal breathing. 5 times

Mixed breathing. 5 times

Inhale through the nose and exhale noisily through the mouth.

IP - standing, arms along the body. Hands up, bend over - inhale.

Wrap your arms around your chest and exhale for a long time.

IP - lying on your back. Diaphragmatic breathing. 5 times

IP - lying on your back. The arms are bent at the elbows. Legs bent at the knees, right leg on the knee. Alternate relaxation of arms and legs. 7 times.

IP - lying on your back. In the starting position – inhale, pulling the knee to the chest – exhale. 6-8 times.

IP - lying on your back. After a deep inhalation, as you exhale, alternately perform circular movements with your leg in hip joint. Leg lift 45 degrees. 12 times.

IP - lying on your side. In the starting position - inhale, pulling the knee to the chest for a long time - exhale 8 times.

I.p. - Emphasis, kneeling. Head forward up, bend at the waist - inhale, round the back - exhale onto the chest. 6 times.

SET OF EXERCISES

IN THE EVENT OF POSTURAL VIOLATION

I.p. - lying on your back. Flexion and extension of the feet 12 times.

Circular movement of the feet, alternately in each direction 12 times.

I.p. – lying on your back, legs apart, arms along the body.

On the count of 1-2, lean on the back of your head, arms, buttocks, bend over, inhale.

I.p. - exhale. Repeat 6-8 times.

I.p. – lying on your back, legs bent at the knees, arms along the body

On the count of 1-2, leaning on your back, lift your pelvis off the floor - inhale.

I.p. - exhale. Repeat 10 times.

I.p. - lying on your back, legs bent at the knees, arms along the body.

I.p. - inhale. Raise your shoulders forward, pull your left leg towards your chest -

exhalation. The same with the other leg. Repeat 8 times.

I.p. – lying on your back, legs bent at the knees, hands behind your head.

I.p. - inhale. Bend forward with your right elbow and touch your left knee -

inhale. The same with the other hand. Repeat until you feel tired.

I.p. - lying on your back, hands behind your head, legs bent at the knees.

I.p. - inhale. Lift your shoulders, touching your lower back to the floor, tilt to the left -

exhalation. The same in the other direction. Repeat 7 times.

I.p. - lying on the right side, left leg wrapped behind the right leg,

perform swings with your left leg, counting 10, three approaches. Breathing is voluntary.

IP - lying on your stomach, hands at your chin.

I.p. - inhale. Pull your left knee towards your left elbow, exhale.

The same in the other direction. Repeat 10 times.

I.p. - lying on your stomach, hands behind your head.

I.p. - inhale, on the count of 5 - springy bends back, arching in the lower back.

Repeat 5 times.

IP - lying on your stomach, arms to the sides, legs apart. On the count of 1-3 springy

moving your arms back and up. Repeat 6-8 times. Breathing is voluntary.

I.p. lying on your stomach, holding a gymnastic stick with your hands in front of you.

On the count of 1-2, spring back movements, 3 - hold the stick at the top,

4- I.p. relax, exhale. Repeat 6-8 times.

I.p. – emphasis, kneeling. Bend at the waist, inhale, round your back,

exhalation. Repeat 8 times.

I.p. lying on your stomach, traction of the spine. Diaphragmatic breathing.

SET OF BASIC exercise therapy exercises

TO IMPROVE VISION

Horizontal eye movement: right - left.

Movement of the eyeballs: vertically up – down.

Circular eye movements: clockwise and in the opposite direction.

Intense squeezing and unclenching of the eyes at a fast pace.

Eye movements diagonally: squint your eyes to the lower left corner, then move your gaze upward in a straight line. Likewise in the opposite direction.

Bringing the eyes to the nose. To do this, place your finger on the bridge of your nose and look at it - your eyes will easily “connect”.

Frequent blinking of the eyes.

Eye work "at a distance". Go to the window, look carefully at a close, clearly visible detail; a branch of a tree growing outside the window, or a scratch on the glass. You can stick a tiny circle of paper on the glass. Then look into the distance, trying to see the most distant objects.

Each exercise should be repeated at least 6 times in each direction.

EXERCISES TO PREVENT MYOPIA

Leaning back, take a deep breath, then, leaning forward, exhale.

Lean back in your chair, close your eyelids, close your eyes tightly, open your eyelids.

Hands on your waist, turn your head to the right, look at the elbow of your right hand; turn your head to the left, look at the elbow of your left hand, return to the starting position.

Raise your eyes to the top, make them circular motion clockwise, then counterclockwise.

Hands forward, look at the tips of your fingers, raise your hands up - inhale, follow the movement of your hands with your eyes without raising your head, lower your hands - exhale.

GYMNASTICS FOR TIRED EYES

Take a deep breath, closing your eyes as tightly as possible. Tighten the muscles of your neck, face,

heads. Hold your breath for 2-3 seconds, then quickly exhale, opening your eyes wide as you exhale. Repeat 5 times.

Close your eyes, massage the brow ridges and the lower parts of the eye sockets with circular

movements - from the nose to the temples.

Close your eyes, relax your eyebrows. Rotate your eyeballs from left to right and right to left.

Put thumb hands at a distance of 25 - 30 cm from the eyes, look with both eyes at the end of the finger for 3-5 seconds, close one eye for 3-5 seconds, then look with both eyes again, close the other eye. Repeat 10 times.

Place your fingertips on your temples, squeezing them lightly. Blink quickly and lightly 10 times.

Close your eyes and relax, taking 2-3 deep breaths. Repeat 3 times

SET OF EXERCISES FOR FLAT FOOT

Sitting, legs bent at the knees at a right angle, hands on the knees. Raise your toes and lower them. Repeat 10 - 20 times. The pace is average, breathing is free.

I.p. Same. Raise your heels and lower them. Repeat 10-20 times. The pace is average, breathing is free.

I.p. Same. The legs are connected. Spread your legs apart and bring them together, without lifting your legs off the floor. Repeat 10-20 times. The pace is average, breathing is free.

I.p. Same. Spread your heels and bring them together without lifting your feet off the floor. Repeat 10-20 times. Medium pace, free breathing.

I.p. Same. Simultaneously raise the toe of your right foot and the heel of your left foot and vice versa.

Repeat 10-20 times. The pace is average, breathing is free.

1. I.p. Same. Without lifting your feet from the floor, simultaneously spread your toes to the sides, then

heels. Then return to the starting position. Repeat 10-20 times. The pace is average, breathing is arbitrary.

1. I.p. Same. Underfoot gymnastic stick. Roll your feet from toes to heels and back in the opposite direction for 1 minute. While rolling your feet, press them tightly against the stick. Repeat 10-20 times. The pace is average, breathing is free.

   I.p. Same. The feet are connected by a stick under the arches. Spread your feet, rolling

stick forward, bring it together. Repeat 10-20 times. Medium pace, free breathing

I.p. Same. There is a rubber ball under the feet. Roll the ball from toes to heels and back for one minute. When rolling the ball, try to keep your feet pressed tightly against the ball. Medium pace, free breathing.

1. Walk in place with your fingers bent 15-20 times.

Walk with your toes curled on the outer edge of your feet.

Walk on your heels for 15-20 seconds. Walking on toes for 15-020 seconds.

1. I.p. The leg is bent at the knee, resting on the edge of the stool. 1. With your right hand, lower your little finger down, with your left hand, raise your ring finger up, then vice versa. In this way, work all fingers 5 times each. 2. Holding your heel with your left hand, raise your fingers with your right hand and lower them down 4-6 times. 3. Using the fingers of both hands, knead and rub the heel, massage the foot on all sides, from toe to ankle joint. Finally, massage the entire leg from the ankle to the groin area.

SET OF EXERCISES FOR TREATMENT OF SCOLIOSIS

I.p. lying on your back - hands on the back of your head. Raising your elbows to the sides - inhale,

reduction - exhale.

I.p. - lying on your back. Alternating flexion legs to stomach - exhale. I.p. - inhale.

I.p. – lying on your back, legs bent at the knee joints. Raising the pelvis, arching the thoracic spine

I.p. - lying on your back. Stretching one hand up, and the other on the side of the convexity and curvature - to the side - inhale, I.p. - exhale. 4-6 times.

IP - lying on your stomach. Raising the torso, trying to bend the thoracic spine - inhale, I.p. - exhale. 4-5 times.

I.p. - lying on your stomach, one hand on the back of your head, the other on your chest on the curved side of the curvature. Extension of the torso - inhale. I.p. - exhale. 4-5 times.

I.p. - lying on your stomach, arms along your body, palms down. We raise our legs one at a time simultaneously with our torso, leaning on our hands - inhale, etc. - exhale. 6-6 times.

IP - lying on your stomach. Abduction of the leg to the side on the convex side of the curvature of the lumbar spine and subsequent return to IP. Breathing is voluntary. 4 – 5 times.

I.p. - lying on your side, on a cotton roll on the convex side of the curvature of the thoracic spine. We put our hand behind our head - inhale, lower it - exhale. The pace is slow. 5-6 times.

I.p. - Support while kneeling. At the same time we pull right leg and left hand - inhale,

I.p. – exhale; the same with the other arm and leg. Repeat 5-6 times.

1. I.p. - Support while kneeling. Bend your arms at the elbow joints until they touch the floor. Breathing is voluntary. Repeat 5-6 times.

Simultaneously raising your hands up - inhale, lower your hands - exhale.

NOTE;

The set of basic exercises is repeated daily, the pace of the exercises is slow, a short delay in the movement in the extreme position is recommended.

1. After therapeutic exercises, resting in a position lying on your side on a cotton roll is useful. 15 – 20 minutes.