Natural factors were used for medicinal purposes (especially hydrotherapy and sun therapy) in the countries of the Ancient East, Greece and Rome. Physical factors have affected man throughout his evolution; therefore, physiotherapeutic procedures have a more physiological effect on the body than many drugs.
Physiotherapeutic procedures cause both non-specific and specific responses of the body. The latter are due to the peculiarities of the acting factor and the pathological process and provide the main therapeutic effect. The choice of a factor, its dose and method of application, as well as a combination of several factors, is determined by the form and stage of the disease and the state of the organism. The variety of factors and methods used in physiotherapy determines the possibility of an individualized effect on the body and a directed influence on the pathological process without negative side effects.
Physiotherapy is one of the safest treatments available today.
Additional element of treatment; it is extremely rare to alleviate the patient's condition with the help of physiotherapy alone. Most often, physiotherapy is used as an addition to the main method of treatment, and it happens that the doctor prescribes it either out of hopelessness, or according to the principle "the more procedures, the better."
Therefore, I will briefly talk only about those physiotherapy procedures that are most actively used today in the treatment of diseases of the spine or they are the most useful from my point of view.
Laser Therapy (Laser Therapy)
Laser therapy is a relatively new method of treatment that has managed to become widespread. Laser devices are now, probably, in any hospital and any polyclinic. Moreover, many patients, having read advertising articles about the benefits of laser therapy, buy laser devices for home use. Unfortunately, most of the patients remain dissatisfied with the result of laser therapy, not having received the 100% healing promised by advertising. Here again we are faced with a situation where expectations exceed the capabilities of the method. A person sometimes expects results that laser therapy cannot give in principle.
To understand what can still be achieved with the help of laser therapy, you need to know how it affects the patient's body.
Laser therapy is the use for therapeutic purposes of a special enhanced light beam, consisting of ultraviolet, infrared and red radiation spectra. It is believed that laser exposure has anti-inflammatory, anti-edematous, analgesic effects and stimulates metabolism. Taking into account these properties of laser radiation, two methods of laser therapy have been developed:
local effect directly on diseased joints and damaged parts of the spine;
laser irradiation of the cubital vein area.
The first technique used (together with other methods of therapy) for the treatment of true osteochondrosis, osteoporosis, humeroscapular periarthritis, ulnar epicondylitis, ankylosing spondylitis, various arthrosis, in the complex therapy of disc herniation and for inflamed joints in patients with psoriatic arthritis.
Second technique used in the complex therapy of ankylosing spondylitis, psoriatic or rheumatoid arthritis. It is believed that when a laser emitter inserted into a vein or placed on the area of the vein irradiates the blood passing through the vein, the properties of this blood change, as a result of which the immunity of a sick person increases and his metabolism normalizes. In reality, such an effect helps about half of the sick. The course of treatment usually consists of 15 sessions.
Laser therapy is a good and fairly safe method of treatment (in the absence of contraindications), but still one cannot expect to cure a serious disease with laser alone. Laser therapy is precisely an additional method of treatment as part of complex therapy.
Contraindications to the use of a laser are tumor diseases, blood diseases, hyperthyroidism, infectious diseases, exhaustion, bleeding, myocardial infarction, stroke, tuberculosis, liver cirrhosis, hypertensive crisis.
Cryotherapy
In recent years, for the treatment of diseases of the joints, special cryogenic installations have been used that affect the body with ultra-low temperatures.
There are two main methods of cryotherapy: dry cryotherapy (exposure to ultra-low temperature air, in particular the use of cryosauna) and liquid cryotherapy - exposure to the affected joint or back area with a jet of liquid nitrogen under pressure. According to my observations, in diseases of the cervical spine and joints, liquid cryotherapy is much more effective than exposure to dry cold.
By acting on the affected joint or back area with a jet of liquid nitrogen, you can achieve a pronounced response of the body: increased blood circulation and improved metabolism, reduced swelling of the joint, relieve muscle spasm and reduce pain. The course of treatment includes 10-12 procedures performed daily or every other day.
Liquid nitrogen therapy gives a particularly good effect in acute and chronic painful spasm of the back muscles, arthrosis of the shoulder and knee joints, ankylosing spondylitis, and slightly less strong in case of disc herniation and rheumatoid or psoriatic arthritis. This, according to my observations, is one of the best physiotherapy procedures for the treatment of these diseases.
In addition, by acting with liquid nitrogen on the collar zone, it is possible to normalize high blood pressure along the way and facilitate breathing in case of bronchitis or bronchial asthma (with the exception of cold asthma).
In addition, with the right effect, cryotherapy with liquid nitrogen has almost no contraindications and can be used to treat elderly, debilitated patients. It cannot be used only for Raynaud's syndrome, some arrhythmias, and immediately after a heart attack or stroke. But many contraindications to other methods of physiotherapy do not apply to cryotherapy with liquid nitrogen: cryotherapy can be used even by those who have benign oncological diseases (such as fibroids, mastopathy, etc.) and thyroid diseases (in particular, nodes).
Unlike cryotherapy with liquid nitrogen, dry cryotherapy (cryosauna) has less local effect on individual inflamed joints. The scope of cryosaunas is mainly those joint diseases that require a general effect on the entire body: these are rheumatoid and psoriatic arthritis with a total lesion of all joints or with a lesion of a very large group of joints.
Electromyostimulation of muscles
Electromyostimulation is the effect on muscles with the help of pulsed currents of various frequencies. The procedure helps to restore muscle contractility and strength, as well as stimulate and revitalize damaged nerves. It makes sense to use electromyostimulation with general muscle hypotonia, osteoporosis and during the recovery period after spinal surgery.
In general, you need to understand that although, in general, electromyostimulation has a good effect on the spine, it is still more of a “gymnastics for the lazy” - the device “pumps” the muscles, and the person lies and rests. At the same time, naturally, it will not be possible to obtain the degree of muscle loading that gymnastics itself can give to the patient. So it is good to use electromyostimulation rather as an addition to gymnastics, but not instead of it. In addition, electrical muscle stimulation has serious contraindications: these are rheumatic, oncological and acute infectious diseases, bleeding, myocardial infarction, stroke, thrombophlebitis, hypertensive crisis. In addition, electrical stimulation of the muscles of the thoracic spine can cause interruptions in the activity of the heart: arrhythmia and tachycardia.
Magnetotherapy
Magnetic field treatment (magnetotherapy) is based on well-known physical laws. When a conductor (blood) moves in an inhomogeneous magnetic field or stationary structures (muscles, nerves) are affected by a magnetic field, so-called ring currents are formed in them. This phenomenon is used for non-contact electrical stimulation of muscles, improving blood circulation and metabolism in certain areas of tissues. It is believed that exposure to a magnetic field leads to a decrease in tissue edema and inflammation.
Magnetotherapy is used in the complex treatment of arthrosis of large joints, arthrosis of the intervertebral joints, osteochondrosis, osteoporosis, Forestier's disease and Scheuermann's disease. Some authors suggest the use of magnetotherapy in the treatment of disc herniation, but experience shows that such treatment often leads to an increase in nerve edema and increased radicular pain. From my observations, I note that in chronic back diseases, the method rarely meets expectations.
Contraindications to the appointment of magnetic therapy are oncological diseases, a tendency to bleeding, acute myocardial infarction and stroke, pregnancy, inflammatory diseases with fever, significantly reduced blood pressure, thrombophlebitis, as well as local suppuration, until they are opened surgically.
Medicinal electrophoresis
The method is based on the ability of an electric current to conduct various medicinal substances through the skin into the body. During electrophoresis, a wet gauze cloth moistened with a medicinal solution of a certain concentration is applied to the skin over a diseased arm joint or a damaged segment of the spine. Electrodes are placed over the napkins, to which a weak electric current is applied. Under the influence of electricity, medicinal substances begin to actively penetrate the skin to the diseased joint or damaged spine.
As a result, the part of the body treated with electrophoresis receives a double therapeutic effect: both from electrical impulses and from drugs administered in this way.
Medicinal electrophoresis is actively used in complex therapy in the treatment of disc herniation, arthrosis of the intervertebral joints, true osteochondrosis, acute muscle spasm, arthrosis of large joints, as well as for the treatment of ulnar epicondylitis, humeroscapular periarthritis. At the same time, novocaine, analgin and lidase are usually brought to the joints using electrophoresis, and diphenhydramine, novocaine, caripazim and magnesia are usually applied to inflamed neck muscles or a damaged segment of the spine.
Contraindications to electrophoresis are oncological diseases, myocardial infarction, pregnancy, stroke, inflammatory diseases with fever, sharply increased blood pressure, thrombophlebitis, bleeding, local suppuration.
Thermal treatment (ozokeritotherapy, paraffin therapy, mud therapy)
For thermal effects on the body, substances are used that can retain heat for a long time, slowly and gradually giving it to the patient's body: paraffin (oil distillation product), ozocerite (mountain wax), therapeutic mud (silt, peat, pseudovolcanic). In addition to the temperature effect, such heat carriers also have a chemical effect on the patient's body: during the procedure, biologically active substances and inorganic salts penetrate the body through the skin, which improve metabolism and blood circulation.
It makes sense to use thermal treatment for osteochondrosis, osteoporosis, arthrosis of the joints of the spine, chronic stiffness of the back muscles, Scheuermann's disease, Forestier's disease and Bechterew's disease (without exacerbation, when blood counts are normal), arthrosis of the joints, ulnar epicondylitis, humeroscapular periarthritis, as well as calm course of rheumatoid and psoriatic arthritis.
Contraindications to thermotherapy are acute inflammatory diseases, oncological diseases, blood diseases, inflammatory diseases of the kidneys, bleeding, purulent lesions of the body, hepatitis.
Of the options for thermal treatment, therapeutic mud deserves a detailed description. Unlike paraffin and ozokerite therapy, therapeutic mud can be used at home, since pharmacies now offer a fairly large selection of mud preparations.
The main method of mud therapy is application, when therapeutic mud of a certain temperature is applied to the affected area of the back. Here is a way to prepare such an application: therapeutic mud is diluted with water and heated to a temperature of 60 ° C. Then the hot mud is mixed with unheated mud, reaching a temperature of 38-42 ° C, and a layer 2-3 cm thick is applied to the affected area of the back. The mud mixture is covered with compress paper or oilcloth and a blanket on top. The exposure time is 20-30 minutes. The procedures are carried out every other day, the course of treatment is 10-12 procedures.
I considered only a part of the physiotherapeutic methods of treatment, I mentioned exactly those of them that are most often used for diseases of the spine. For those of you who want to learn more about physical therapy, just go to the medical book store and select the appropriate literature. For example, physiotherapeutic procedures are described in great detail in the book by A. A. Ushakov “Guide to Practical Physiotherapy”.
Attention! the information on the site is not a medical diagnosis, or a guide to action and is for informational purposes only.
Modern methods of physiotherapy allow treating diseases with minimal side effects and a low risk of complications. Their diversity is explained by the rapid development of technology and the desire to improve the quality of medical care. The international scientific community is interested in improving the health of the population.
In developed countries, the problem of complete recovery and rehabilitation of patients after serious injuries and massive surgical interventions is particularly acute. In this regard, new methods are being developed in physiotherapy that most fully affect diseased organs and systems. Among the most active medical scientific communities working in this direction, it is worth noting the doctors of the Russian Federation, the EU, the USA and Israel.
The development of physiotherapy in Russia
On the territory of Russia, physiotherapy has been carried out since the time of Peter I. Then sanatoriums were created in which the principles of aerotherapy and the beneficial effects of mineral waters were used. Currently, electrophoresis, magnetotherapy, ozocerite and exposure to the body with laser beams are considered the most progressive methods.
The developments of Russian scientists are especially effective for solving problems in the field of pediatrics. Since most traditional methods of treatment are not suitable for children, there was a need to invent new methods. Due to the high level of safety, physiotherapy has attracted attention.
Electrophoresis is very popular. It is carried out as an independent procedure or in combination with the introduction of drugs. For people with limited mobility, they invented mobile devices ("Potok-1", "Potok-2" and others). They can be used at home, allowing physiotherapy to be carried out by the patient's relatives or by himself. This expands the possibilities for treatment and rehabilitation. This method is suitable for patients with pathologies in the field of pulmonology (chronic bronchitis, bronchiectasis, bronchial asthma), the musculoskeletal system and dentistry.
In children's sanatoriums, physiotherapy is widely used as a preventive procedure. Especially often in these conditions, ozokerite is used. It is prescribed to patients with pathologies in the field of gastroenterology. For adults, this technique is suitable for the treatment of gout on an outpatient basis. At home, such procedures are not carried out.
Magnetotherapy is used for injuries of the musculoskeletal system, as well as for pathologies in the field of gynecology. It allows you to accelerate tissue regeneration, relieve pain, stop the process of inflammation, restore joint mobility and function of the affected organs. To achieve a positive effect, you need to carry out several procedures performed daily or according to an individual schedule. The course can be repeated 1-2 months after its completion.
Modern developments of scientists have made it possible to apply the technique at home.
For this, mobile portable devices ("Almag" and its various configurations) were invented. They are used by patients independently under the outpatient supervision of a physician. This gives patients the opportunity to be treated in comfortable conditions, providing a positive emotional background and speeding up recovery.
The latest techniques used in the USA
The United States of America has been developing new physiotherapy techniques as a separate scientific field since 1947. There are a large number of professional communities in the country that annually discuss the prospects for the development of the field and modern developments used to provide medical care. At the same time, technological inventions are constantly introduced into the daily work of hospitals.
More than 80 programs for accreditation of physiotherapists and rehabilitation doctors have been developed in the USA. This direction is currently developing especially rapidly, which proves its promise and effectiveness. For this reason, over the past 10 years, many new methods and ways of influencing pathological processes in the body have been discovered.
Since there is a large number of disabled people in the country, which is growing year by year, new methods of physiotherapy are being developed specifically for the rehabilitation of such patients and increasing their quality of life. For this, the most modern methods are used, which include mechanical methods. With the help of them, the patient often returns to working capacity and mobility.
The latest development of American scientists in this area is robotic therapy.
This is a new word in physiotherapy, which refers to the use of high-tech devices to ensure human mobility and complete restoration of limb functions. The technique is especially relevant for people with damage to the musculoskeletal system, as well as disorders in the field of neurology. A novelty in this industry is the Lokomat apparatus. It is used to get rid of paralysis by “reminding” muscle and brain cells of how the movement took place before the development of the disease, which triggers activity in them again.
Physiotherapy in Europe
Rehabilitation procedures and physiotherapy are singled out as a separate industry in all EU countries. But in Denmark and Malta they are not recognized as an independent branch of medicine. At the same time, methods of influence are developed in accordance with the laws and traditions of the state. The training of doctors lasts 4-6 years, while the possibility of obtaining a doctoral degree remains.
Innovative modern physiotherapy is widespread in Hungary, Germany and Poland. These countries offer affordable and high-tech treatment, for which people come from abroad. The latest techniques include:
- kinesitherapy - movement treatment that resembles physiotherapy exercises, but is more effective with lower risks (an actual way to recover from strokes and heart attacks);
- kinesio taping - modern physiotherapy of muscle pathologies (motor disorders, paresis, paralysis) using teips (adhesive tapes), which fix damaged areas, which allows you to adjust the speed of restoration of mobility and load on the diseased organ;
- psychotherapy using devices that control the functioning of the brain - allows you to get rid of psychogenic diseases, as well as find the cause of their appearance and eliminate it.
Clinical guidelines in European countries necessarily include physiotherapy techniques. This allows you to speed up the rehabilitation of patients after suffering a pathology, and also improves the quality of life of people. In addition to modern methods of influence, massage, manual therapy, acupuncture, balneotherapy and other traditional and non-traditional types of treatment are widely used.
Israeli methods of physiotherapy
Modern methods of physiotherapy in Israeli medicine are based on the use of internal reserves of the body. This allows you to minimize the harmful effects and stabilize the results, which last longer. This takes into account not only the well-being, but also the wishes of the patient regarding the chosen treatment.
Devices for home physiotherapy are especially popular. They were invented in Israel a huge amount. The most popular are:
- Handy Cure - combines the properties of magnetic and laser therapy, relieving pain and inflammation, can be used in dentistry and cosmetology, as well as in diseases of the musculoskeletal system.
- Cure-EX - is used to treat nail fungus, is available in a convenient clothespin form.
- Vireo is an innovative device that uses photo exposure to activate regenerative processes that heal trophic ulcers, bedsores, relieve dermatosis and psoriasis, kill microbes and improve microcirculation in tissues.
An individual approach to the patient and the possibility of independent physiotherapy allows you to quickly and comfortably get rid of the disease. This is especially important for people who are unable to visit the clinic on a daily basis or who have mobility difficulties.
What common?
Physiotherapists all over the world agree that new methods of treatment should be more accessible to all segments of the population. Therefore, portable devices for home use are invented, and the methods themselves are included in state guarantee programs. This allows patients with any income and mobility to use modern technologies to the fullest to get rid of diseases.
Physiotherapy methods are used in many areas of medicine, which makes them universal. In this way, treatment is carried out in the presence of pathologies in the field of urology, dentistry, dermatology, pulmonology, neurology and the musculoskeletal system. The versatility of physiotherapy allows the use of one device for a variety of diseases. This saves money for both patients and clinics.
In almost all countries, physiotherapy is singled out as an independent science. This gives it the opportunity to develop and improve technology. Scientists around the world are working to make the techniques more modern and efficient. This will help raise the level of general health of the population, as well as return lost functions to the disabled, and significantly improve their quality of life.
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Basic methods of physiotherapy
To achieve a therapeutic effect in physiotherapy, there are various possibilities for the impact of therapeutic physical factors on the body:- locally - the impact directly on the pathological focus;
- segmental-reflex - impact on reflexogenic zones and areas of segmental-metameric innervation;
- generalized (general effect) - the effect on the whole organism of a general tonic or sedative nature, as well as in order to increase the nonspecific resistance of the organism (immunity).
According to the nature of the location relative to the surface of the patient's body of electrodes, inductors, emitters or other generators of physical factors of influence, the following physiotherapeutic methods have been identified.
Contact technique - exposure to a preformed physical factor, in which the electrode, inductor or emitter is in direct contact with the surface of the patient's body.
Remote technique - the impact of an external physical factor, in which the electrode, inductor or emitter is located at a certain distance from the surface of the patient's body.
Stable method - the impact of a physical factor in which the electrode, inductor or emitter is located at a certain place of the patient's body motionless (with the contact method) or affect the corresponding part of the body (with the remote method) during the entire procedure.
Labile technique is the impact of a physical factor in which the electrode, inductor or emitter is moved during the procedure along a certain trajectory along the surface of the patient's body by contact or remotely.
Longitudinal technique - exposure in which electrodes, inductors or emitters are located along the pathological focus, body or limbs of the patient during the entire procedure.
Transverse technique - during the entire procedure, electrodes, inductors or emitters are located across the pathological focus, body or limbs of the patient and directed towards each other.
General principles for the use of therapeutic physical factors
The rational use of preformed physical factors involves a differentiated choice of the type of energy used and specific procedures for conducting procedures. There are general principles for the use of physical factors for therapeutic and prophylactic purposes.The principle of an individual approach is the use of physical factors, taking into account the age, gender, constitutional characteristics of the patient, the severity of the condition, the presence of concomitant diseases, individual contraindications and the degree of training of adaptive-compensatory mechanisms.
The principle of the optimal appointment of physical factors is a physical factor, the method of its application and parameters should correspond as much as possible to the nature and phase of the pathological process.
In the presence of pain, it is necessary to stop it during the first 2-3 procedures.
In the acute and subacute periods of the disease, it is necessary to apply factors that mainly affect the etiology and pathogenesis of the disease and symptomatic therapy.
In the recovery period of the disease, it is necessary to use factors aimed at replacing dead tissue areas with tissue of the same structure (restitution) and granulation tissue (regeneration), as well as the use of factors that provide full or partial compensation for lost functions (compensation), and physical factors that have a general tonic effect. action and supporting nonspecific resistance of the organism (immunity).
In the acute period of the disease, low-intensity physical factors are applied directly to the pathological focus; high-intensity factors - on segmental-reflexogenic zones.
In the subacute period and in the chronic course of the disease, the intensity of factors applied topically to the pathological focus increases.
The absence of a pronounced therapeutic effect after the first procedures is not a reason to cancel this factor or replace it with another physical factor.
The principle of course treatment is necessary to achieve the most pronounced therapeutic effect and ensure a long aftereffect of a course of physiotherapy.
Prolonged use of the same physical factor leads to addiction (adaptation to the factor), which significantly reduces the effectiveness of its therapeutic action.
Taking into account the long aftereffect of therapeutic physical factors, repeated courses of treatment are possible only after the effects of the previous treatment have decreased. The summation of therapeutic effects and the aftereffect of preformed physical factors range from 1 to 4 months, and natural physical factors - from 6 to 12 months.
The principle of complex treatment with physical factors is based on synergism, potentiation and obtaining new therapeutic effects when using combined (simultaneous exposure to the pathological focus by several physical factors) and combined (successive use of various physical factors at different time intervals or successive courses) exposure to therapeutic physical factors .
Physical methods of treatment are used against the background of basic drug therapy; they are in addition to it, but in no case replace drug therapy.
Epifanov V.A.
Physiotherapy I
Physiotherapy
Physiotherapy (Greek physis nature + therapeia; synonym: physical, physical therapy,) - a field of medicine that studies the physiological and therapeutic effects of natural and artificially created physical factors and develops methods for using them for preventive and therapeutic purposes; a set of physical methods of treatment and their practical application. With stable angina pectoris, postinfarction cardiosclerosis I and II functional classes with circulatory failure not higher than stage I and without cardiac arrhythmias, general contrast baths are prescribed: the patient is immersed in a pool of warm (38 °) fresh water for 3 min, then it goes into a pool of cool water (28°) for 1 min while performing active . Three transitions to the procedure are recommended, which ends with a cool bath (by the middle of the course, its temperature is lowered to 26-25 °). Total for the course 12-15 baths, per week - 4-5 baths. In post-infarction cardiosclerosis and after coronary artery bypass surgery (starting from the 30-35th day), foot contrast baths are used (with a temperature of 38 and 28 °, from the second half of the course - 40 and 20 °): a total of 12-15 baths per course. For the treatment of patients with a painless form of coronary heart disease, cardiosclerosis, which can manifest itself as heart failure and heart rhythm disturbances, balneotherapy and hydrotherapy are used. When choosing the type of treatment, methods of its implementation, determining the degree of violation of the functional state of the cardiovascular system according to the results of tests with physical activity, as well as the nature of cardiac arrhythmias, is of decisive importance. Hypertonic disease. When choosing the F. method, one should take into account not only the stage of the disease, but also the variant of hemodynamic disorders (hyperkinetic or hypokinetic). In the hyperkinetic variant, to reduce the increased sympathetic activity of the hypothalamic centers, central electroanalgesia, galvanotherapy and medicinal, low-frequency magnetic field, microwave therapy, negatively charged electroaerosols are used. In the treatment of patients with stage I and II hypertension without frequent vascular crises, significant cardiac arrhythmias and circulatory failure not higher than stage I, balneotherapy is widely used: carbonic, radon, hydrogen sulfide, sodium chloride, iodine-bromine, arsenic-containing, as well as nitrogen baths. The temperature of all baths is 35-36°, except for sodium chloride baths (35-34°). take every other day, 4-5 baths per week, for a course of 10-12 baths. Patients with stage IIB hypertension in combination with coronary heart disease, as well as with circulatory failure not higher than stage IIA, use 2- and 4-chamber baths or dry carbonic baths (temperature 28 °, duration 15-20 min, for a course of 10-12 baths). In hypertension stage I and II without signs of coronary and heart failure, cardiac arrhythmias, hydrotherapy is used: coniferous, pearl, oxygen baths, wet wraps and healing showers, incl. underwater shower-massage, as well as sauna treatments. Cardiopsychoneurosis. In order to influence arterial hyper- and hypotension, cardialgia, disturbed heart rhythm, electrosleep is used, drug electrophoresis (, anaprilin) is carried out according to the method of general exposure or the collar method; in the hypotensive type, caffeine-bromo-electrophoresis is used: in severe asthenic syndrome, a galvanic anode collar according to Shcherbak. In the cardiac type of the disease with severe cardialgia, novocaine electrophoresis is prescribed according to the segmental method, darsonvalization of the heart area, ultraviolet in an erythemal dose or heart area. Carbonic, sodium chloride, iodine-bromine baths are prescribed for hypotensive type of the disease and severe asthenic syndrome; radon, nitrogen baths - for hypertensive, cardiac, incl. arrhythmic, symptom complexes and a pronounced predominance of the process of hypersympathicotonia, insomnia; hydrogen sulfide baths - with hypertensive and cardiac types with relatively balanced nervous processes and without signs of hypersympathicotonia and cardiac arrhythmias. Hydrotherapy in the form of therapeutic showers (rain, circular, Scottish, underwater shower-massage), dry and wet wraps, contrast, pearl, coniferous baths are used for all types of diseases. In violation of the heart rhythm, a pronounced predominance of excitation processes, do not use circular and Scottish showers, as well as contrast baths. Myocarditis cardiosclerosis(consequences of rheumatic and infectious-allergic myocarditis) in patients with circulatory failure not higher than stage I, cardialgia, incl. with mild heart rhythm disturbances, is an indication for balneotherapy in the form of general carbonic, radon, sodium chloride and iodine-bromine baths, and in the absence of heart rhythm disturbances, hydrogen sulfide baths. In patients with severe mitral stenosis or after commissurotomy, preference should be given to carbon dioxide baths. In such patients, inhalations of aero- or electric aerosols are used, to improve immunogenesis in order to prevent exacerbations, inductothermy is performed on the adrenal region (at the level of Th X -L IV). Physiotherapy for nonspecific respiratory diseases aimed at eliminating inflammation, achieving faster resorption of the inflammatory focus, preventing the transition of an acute inflammatory process to, improving the function of external respiration, especially bronchial conduction, lymph and blood circulation of the bronchopulmonary system, restoring impaired immune status, providing a hyposensitizing effect, training thermoadaptive mechanisms. pneumonia(acute, prolonged, chronic). In the complex treatment of acute pneumonia, electromagnetic fields of ultra-high, ultra-high, extremely high and high frequencies, variable low-frequency magnetic fields, ultraviolet irradiation, electroaerosol therapy, applications of paraffin, ozocerite, and therapeutic mud are most widely used. In the first days of the disease, exposure to the UHF electric field on the chest is prescribed in continuous (with a power of 40-100 Tue) or impulse (4.5-6 Tue) modes. Also recommended are inhalations of antibiotics, phytoncides, bronchodilators, alkaline solutions, herbal decoctions with expectorant action, erythemal ultraviolet irradiation of the chest (usually in separate fields) according to the affected lobe of the lung, one field daily. Irradiation intensity 2 to 4 biodoses; 4-5 exposures are prescribed per course. In the period of resolution of the process and resorption of the inflammatory focus, microwave therapy is prescribed to the area of the lesion or lower lobes of the lungs. According to the same principle, inductothermia is carried out using low-thermal and thermal doses, mainly for central and radical pneumonia (in the absence of coronary heart disease and hypertension), as well as microwave therapy or UHF therapy (especially in pulsed mode). In the same period of the disease, magnetic therapy is carried out using a low-frequency (50 Hz) magnetic field in continuous or intermittent modes, which favorably affects the functions of the cardiovascular system, causing the advantage of this method in the treatment of patients with concomitant cardiovascular pathology. Contraindications for magnetic therapy are severe, hemoptysis, diseases accompanied by a tendency to bleeding. To improve the resorption of the inflammatory focus and eliminate bronchospasm, pain, and difficult sputum discharge, electrophoresis of calcium, magnesium, heparin, aminofillin, aloe extract, ascorbic acid, lysozyme is used. At the same time, one (100-150 cm 2) are located in the interscapular region, the second - taking into account the localization of the focus of inflammation. A good effect (including at the stage of infiltration) is given by the use against the background of pharmacotherapy (and others), galvanization of the chest (20-40 min), which is carried out with intravenous drip after 1/2 - 2/3 of the volume of the solution has been consumed, and with intramuscular injection - after 1-1 1/2 h after injection. This increases the concentration of the drug in the inflammatory focus. In the period of resolution of the process and resorption of the inflammatory focus, aerosol therapy with expectorant, mucolytic, tonic drugs, as well as applications of ozocerite, paraffin, silt and peat mud are used. On the 2-3rd week. you can prescribe climatotherapeutic procedures (day stay on the veranda, air baths). All F. methods are combined with exercise therapy, massage. In the treatment of prolonged pneumonia or residual effects of acute pneumonia, hardening methods (water wiping, dousing, showers), (in a sanatorium or rehabilitation department), general UV irradiation, expectorant, mucolytic and restorative drugs, as well as sodium chloride, turpentine , "dry" carbon dioxide baths according to generally accepted methods. The principles of treatment of exacerbation of chronic pneumonia are the same as the treatment of acute pneumonia. In the stage of remission, spa treatment is widely used: climatotherapy (Climatotherapy) ,
heliotherapy (Heliotherapy) ,
thalassotherapy (thalassotherapy) ,
as well as gymnastics (Gymnastics) and in the pool, various methods of hydro- and balneotherapy. Chronical bronchitis. With an exacerbation of the disease, the presence of an active inflammatory process, the same methods are used as in the treatment of acute pneumonia. Particular attention is paid to the drainage function of the bronchi, to improve which electroaerosol therapy is used using bronchodilator mixtures, mineral waters, proteolytic enzymes, etimizol, glucocorticoid hormones, and herbal decoctions. The same methods are used in the chronic course of the process, outside the stage of exacerbation. In the treatment of chronic obstructive bronchitis, as well as bronchial asthma, electromagnetic fields of high and ultrahigh frequency are used when localizing the impact on the projection area of the adrenal glands, amplipulse therapy (Amplipulse therapy) .
Bronchial asthma. In order to block pathological impulses from the bronchopulmonary system during amplipulse therapy, the impact is also carried out on the region of the cervical sympathetic nodes. With bronchospastic syndrome, they are successfully used, which, as a rule, act alternately on 3 fields (2-3 min for each): paravertebral, on the area of VI-VII and VII-VIII intercostal zones and subclavian zones. If bronchospastic is caused by psychoneurological reactions or is accompanied by functional disorders of the central and autonomic nervous systems, the use of electrosleep is effective (with the orbito-occipital location of the electrodes). For the same purpose, a galvanic collar, electrophoresis of calcium, bromine is used on the collar zone. Patients with pulmonary hypertension, pulmonary heart disease are recommended "dry" carbon dioxide baths. Mitigation of the symptoms of obstructive bronchitis can be achieved with the help of vibration therapy. To improve pulmonary ventilation and gas exchange in patients with respiratory failure of I-III degree, transcutaneous electrical stimulation (Electrical stimulation) of the diaphragmatic can be used. In order to increase the overall resistance of the body in patients with chronic nonspecific lung diseases, desensitization in case of allergic phenomena, UV irradiation of the chest with suberythemal doses is prescribed. Patients with chronic bronchitis with minimal activity of the inflammatory process are treated with mud ,
imposing sulfide silt or peat mud on the back surface of the chest with the capture of the projection zone of the adrenal glands. Outside the stage of exacerbation, balneotherapy (“dry” and aqueous carbonic, radon, turpentine baths), heat treatment in baths, incl. in sauna. In the stage of remission, patients with chronic nonspecific lung diseases are referred for sanatorium treatment in a familiar climate (local sanatoriums) or a dry warm climate (Southern coast of Crimea), or middle mountains (Kislovodsk, Issyk-Kul resort area, etc.). Physiotherapy for diseases of the musculoskeletal system usually complements other types of treatment, but in some cases becomes the leading treatment method, an alternative to drug therapy. Arthritis. In brucellosis arthritis with a pronounced exudative component in the subacute stage, UV irradiation of the affected joints is prescribed (no more than two at a time) after 1-2 days (with an increase of 1-2 biodoses); only 3-4 irradiations of each joint. With the predominance of proliferative changes in the affected joints and periarticular tissues, ultrasound, hydrocortisone are used (also not more than 2 joints at the same time, on average 5-6 min per joint), for a course of 10-12 procedures daily or every other day. Patients with chronic brucellosis arthritis are prescribed balneotherapy: hydrogen sulfide, sodium chloride, iodine-bromine and radon baths, as well as (applications in the form of trousers, half-trousers - for damage to the joints of the lower extremities, in the form of a jacket, half-jacket - for damage to the joints of the upper extremities), therapeutic exercises and massage. With gonorrheal arthritis, even against the background of acute events, you can use UV irradiation in erythemal doses after 2-3 days (with the addition of 1-2 biodoses), only 3-4 irradiations of each affected joint. In the future, with exudative-proliferative changes in the joints, UHF therapy is prescribed (power 30-40 Tue, duration of daily procedures 10-15 min. 10-12 procedures per course). With the predominance of proliferative and fibro-destructive changes, inductothermy and microwave therapy are used on the affected and lumbar region. In the chronic course of arthritis with pain syndrome, joint contractures, treatment with pulsed currents is prescribed (Pulsed currents) .
With exacerbation of gouty arthritis, UV irradiation of the affected joint has an anti-inflammatory and analgesic effect, and UHF therapy is also advisable. At an early stage of reactive arthritis, UV irradiation of the joints in erythemal doses is indicated after 1-2 days with an increase of 1-2 biodoses (for a course of 3-5 sessions), as well as UHF or microwave therapy. With the predominance of arthralgia, ultrasound is used, hydrocortisone ulgraphonophoresis on the affected joints (but 3-5 min for each joint every other day, 6-10 procedures per course). With minimal activity of the process, therapeutic exercises, massage, radon, sodium chloride baths with a duration of 10-12 min every other day, for a course of 10-12 baths. In the remission phase, mud therapy, calcium and salicylate electrophoresis, and general UV irradiation are carried out. In rheumatoid arthritis, a pronounced therapeutic effect is exerted by high-frequency electric currents (HF therapy, or) on the Th X -L II segments and on the joints; you can also use microwave therapy or UV irradiation. If there are contraindications for these methods of treatment, electrophoresis of acetylsalicylic acid (0.5-1% solution), analgin (2-5% solution), sodium salicylate (2-5% solution), novocaine (5% solution), and with degenerative changes in the joints - electrophoresis of hyaluronidase, lidase, ronidase in a 1% solution of novocaine. A good effect is the use of ultrasound on the area of the joints and paravertebral in patients with predominantly proliferative changes in the joints. With minimal activity of the process and severe arthralgia, proliferative phenomena, contractures, amplipulse and diadynamic therapy are indicated. ,
as well as diadynamophoresis of analgesic drugs. Balneo-mud treatment is also widely used, incl. radon, hydrogen sulfide, sodium chloride, iodine-bromine baths. On the inflammatory process in the spine and joints in Bechterew's disease, a pronounced effect is exerted by HF and microwave therapy on the Th X -L II segments, as well as on the region of the spine and joints. In the inactive phase and with minimal activity of the process, hydrocortisone ultraphonophoresis is also performed paravertebral and on the affected joints. With a pronounced spastic state of muscles, contractures, pain syndrome, amplipulse therapy and diadynamic therapy, electrophoresis of novocaine (2-5% solution) and iodine (potassium iodide 1-5% solution) are used according to the general method, on the spine and on the affected joints (duration 15- twenty min, for a course of 15-20 procedures). Also shown are applications of dimexide (50% aqueous solution), as well as heparin (250 U / ml), analgin (0.025 g/ml), hydrocortisone (0.75 mg/ml), nicotinic acid (0.4 mg/ml), therapeutic and massage. Of the balneotherapeutic procedures, radon and hydrogen sulfide baths are of the greatest importance; with a pronounced violation of the function of the musculoskeletal system, mud therapy is indicated, as well as applications of paraffin and ozocerite, therapeutic exercises and massage. With the activation of the inflammatory process, it is advisable to prescribe HF therapy (inductothermy) and microwave therapy on the Th X -L II segments. In case of traumatic arthritis, from the second day after, UHF therapy is used, from the 1-6th day - HF therapy (inductothermy) and microwave therapy. With severe arthralgia, from the 2-3rd day, UV irradiation of the joint in an erythemal dose is used, as well as amplipulse therapy, diadynamic therapy and interference currents (100-200 Hz). In order to normalize micro-circulation and reduce edema, it is possible to use an alternating magnetic field (50 Hz) in continuous or intermittent mode. On the 5th-7th day, an ultrasonic effect on the joint is shown, and in case of manifestations of synovitis, hydrocortisone ultraphonophoresis is indicated. In order to resolve the exudate and prevent the development of contractures, electrophoresis of novocaine (2-5% solution), potassium iodide (3-5% solution), lidase, hyaluronidase is performed. At the final stage, applications of mud, paraffin and ozocerite are used, as well as hydrogen sulfide, slag, sodium chloride, iodine-bromine baths in combination with massage, therapeutic exercises and mechanotherapy. Diseases of the periarticular tissues. With periarthritis, which is often combined with tendovaginitis, UV irradiation of the joint is indicated, irradiation with a solar lamp or infrared rays (20-30 min 1-2 times a day daily, total 8-10 procedures). A good therapeutic effect in traumatic periarthritis is given by paraffin applications. In subacute periarthritis, iodine-novocaine electrophoresis is indicated, as well as electronoresis of lidase, ronidase, hyaluronidase, the use of ultrasound and ultraphonophoresis of medicinal substances (, eufillin, gangleron, etc.). In the treatment of periarthritis, low-frequency currents are widely used - amplipulse therapy, diadynamic therapy with localization both on the joint area and paravertebral. Of the balneotherapeutic procedures, radon and hydrogen sulfide baths are shown, with pronounced contractures - mud therapy, applications of paraffin and ozocerite. With heel spurs, ultraphonophoresis of hydrocortisone, analgin on the heel area is used (8-10 min daily, only 10-12 procedures), electrophoresis of lidase, ronidase, iodine (5% solution) and novocaine (5% solution). To stop the pain syndrome, amplipulse therapy and analgin (5% solution), novocaine (2-5% solution) with a solution of adrenaline at a dilution of 1: 1000, UHF and microwave therapy are used. In the case of attachment of neuritis of the branches of the tibial or sural nerve, UV irradiation of the lateral surfaces of the foot and the back of the leg is used. After subsiding of acute manifestations, paraffin applications are prescribed. Physiotherapeutic treatment of osteoarthritis is aimed at unloading the affected joints, improving metabolism, blood circulation in the joint tissues, and reducing the effects of reactive synovitis. In the initial stages of the disease, when synovitis is absent or mild, HF therapy (inductothermia) and microwave therapy on the joint area, ultrasound and ultraphonophoresis of medicinal substances (analgin, hydrocortisone) are used daily or every other day. A pronounced analgesic effect is exerted by low frequency - and diadynamic therapy, as well as diadynamic electrophoresis of novocaine, analgin, etc. Electrophoresis on the joint area of analgin (2-5% solution), sodium salicylate (2-5% solution), novocaine (0, 25-2% solution) in combination with adrenaline (1:1000). With exacerbation of secondary synovitis and severe movement disorders, UV irradiation, UHF therapy, and exposure to an alternating magnetic field are performed. After that, radon, sodium chloride and iodine-bromine baths, general and chamber hydrogen sulfide baths are prescribed, mud therapy, paraffin, ozokerite applications, massage and therapeutic exercises, mechanotherapy are widely used. The basic principles and methods of physiotherapeutic treatment of osteochondrosis of the spine correspond to those for osteoarthritis, differing only in some features of the methods of using physical factors, depending on the localization of the pathological process. Usually they act on the corresponding spine or paravertebral. Thus, ultrasonic exposure and ultraphonophoresis of medicinal substances (one of the most effective therapeutic methods for this pathology) are carried out only paravertebral. The more acute the pain syndrome, the less should be the impact of microwave therapy, amplipulse therapy, diadynamic therapy. should be carried out according to the “lightweight” technique, especially on the cervical spine. The physiotherapy complex must include therapeutic exercises (see Therapeutic physical culture) ,
Massage ,
manual therapy (manual therapy) .
In the treatment of this pathology, a special place is occupied by the so-called extension therapy - underwater static and dynamic orthotraction, or underwater spine, in mineral water. Especially shown is dynamic orthotraction, which, in addition to decompression, has a training effect on the ligamentous-muscular spine, increasing its corset function, improves the locomotor function of the articular apparatus. The tasks of physiotherapeutic treatment and rehabilitation of patients operated on the joints include, first of all, reducing the intensity of the pain syndrome, regeneration processes, preventing the development of inflammatory infectious processes, and restoring the locomotor function of the musculoskeletal system as fully as possible. From the first days, UV irradiation is carried out, incl. wound surface and postoperative suture. An important factor in the early stages is UHF therapy; a solux lamp is also used. To reduce pain, iodine-novocaine-electrophoresis is indicated. It is advisable to prescribe amplipulse therapy and diadynamic therapy paravertebral to the corresponding segment of the spine; in the early stages, an alternating magnetic field is also used (50 Hz) on the affected joint. Ultrasound, electrophoresis of lidase, ronidase are used to prevent ankylosis and contractures. With the development of a purulent inflammatory process after the evacuation of the exudate from the joint cavity, erythemal UV irradiation of the joint is performed, and in the case of the formation of a fistulous tract, hypererythemic irradiation of its mouth. With sluggish repair processes, the effect of ultrasound on the fistulous mouth is shown. During this period, UHF therapy, darsonvalization of the wound surface, and franklinization are also used. Copper and zinc electrophoresis is used as an irritant for sluggish regeneration processes. The treatment complex must include massage, which is advisable to start already in the early stages (the so-called percussion, soft, absorbable massage). After 2 weeks after subsiding of acute phenomena, therapeutic exercises, mechanotherapy in combination with radon, hydrogen sulfide, sodium chloride baths are prescribed; in the formation of contractures - mud therapy, applications of paraffin and ozocerite, therapeutic exercises in the pool, neuromuscular stimulation. Physiotherapy for diseases of the digestive system. With reflux esophagitis, amplipulse therapy has a good effect, because. sinusoidal modulated currents have an anti-inflammatory, analgesic trophic effect, affect the secretion and motility of the stomach and the functions of other digestive organs, improve blood circulation in tissues. In the presence of a pronounced pain syndrome, electrophoresis of ganglioblocking agents, in particular gangleron, is indicated. Patients with reflux esophagitis with concomitant peptic ulcer of the stomach and duodenum, severe hypersecretory disorders and disorders of the functional state of the liver are recommended microwave therapy (460 MHz). You can also use the UHF electromagnetic field from the Ekran-2 device. Due to the increased neurovegetative excitability, patients with diseases of the esophagus are shown electric sleep procedures. For the same purpose, galvanization of the collar zone according to Shcherbak is prescribed. Applications of sulfide silt or peat mud are effective on the epigastric region and the lower part of the sternum, as well as segmentally, especially in combination with drinking mineral water and diet therapy. Physiotherapy is contraindicated in patients with severe reflux esophagitis, complicated by strictures, ulcers, bleeding from the esophagus, with suspected benign and malignant esophagitis. Amplipulse therapy, microwave electromagnetic field (460 MHz). The use of ultrasound is also shown, usually after 1-2 h after taking liquid food (milk, jelly, liquid porridge, pureed soup without bread). The method of ultraphonophoresis of medicinal substances, in particular hydrocortisone, is also common. The use of high-frequency therapy (inductothermy) is effective. Amplipulse therapy, which has a pronounced effect, is prescribed for pain syndrome; with concomitant damage to the liver, microwave therapy is indicated, and the pancreas - amplipulse therapy. For gastritis with increased secretion, it is advisable to use amplipulse therapy and microwave electromagnetic field; with this form is not recommended, tk. it causes a pronounced stimulation of the glucocorticoid function of the adrenal glands, which is often accompanied by an exacerbation of the disease. In chronic gastritis with severe pain syndrome, perigastritis, concomitant lesions of other digestive organs, mud therapy (sulfide silt, peat, sapropelic mud) is indicated in the form of applications on the stomach area and segmentally by 10-20 min in one day. Elderly patients, for whom mud therapy is stressful, can be recommended electrophoresis of therapeutic mud or a mud preparation of gumizol. In all cases, it is desirable to combine F. with mineral water drinking and diet therapy. Physiotherapy is contraindicated in exacerbation of chronic gastritis, the presence of a single polyp of the mucous membrane or polyposis of the stomach, as well as patients with rigid antral gastritis. Peptic ulcer of the stomach and duodenum. A good effect is exerted by the action of low-frequency currents according to the method of electrosleep, especially in the presence of pronounced neurotic phenomena, sleep disorders, and metabolism. Amplipulse therapy is recommended for patients with severe pain syndrome, concomitant diseases of the liver and intestines with a slowdown in its motor function. In the absence of devices for amplipulse therapy, diadynamic currents can be used. Galvanization has not lost its significance, during which an electrode connected to the positive pole is applied to the region of the stomach or pyloroduodenal region, the other - to the region of the lower thoracic spine. Due to the fact that patients with peptic ulcer often do not tolerate the ingestion of a number of drugs, it is advisable to use drug electrophoresis, primarily novocaine (2-5% solution), which relieves pain well. With increased excitability of the nervous system and sleep disturbance, a general bromine electrophoresis (5% sodium bromide solution) is indicated; using galvanic current, it can be injected into ganglion blockers (1% benzohexonium solution, 0.1% ganglerone solution); trophic effect is exerted by electrophoresis of various microelements - copper, zinc and other substances. A pronounced antiulcer effect has a domestic analogue of leu-enkephalin - dalargin, which is also recommended to be administered by electrophoresis. The use of an alternating magnetic field and ultrasound is also effective. To enhance the effect of ultrasound, it is combined with mud applications. Among the methods of F. peptic ulcer of the stomach and duodenum, one of the leading places is occupied by mud therapy. Therapeutic mud (3-4 kg) is applied to the epigastric region and segmentally. In the presence of concomitant diseases of the liver or gallbladder, mud is also applied to the region of the right hypochondrium, and in case of intestinal diseases - to the whole and segmentally. Applications of silt and firth mud are prescribed at a temperature of 38-40 °, acid peat and sapropelic mud - 42-44 °. The presence of an open ulcer or a symptom of a "niche" in X-ray examination is not a contraindication for mud therapy, as well as a single profuse bleeding that occurred a year ago or more. Indications for mud therapy can be expanded when mud is applied not to the stomach area, but to the collar zone, which is most innervationally connected with the central nervous system. At the same time, mud applications with a total area of 800-1200 cm 2 impose on the back and side surface of the neck and shoulder girdle in the cervical and two upper thoracic skin segments. This technique can be recommended for patients with duodenal ulcer in the presence of large ulcers localized in the duodenal bulb, with severe pain, as well as for patients with a history of gastric bleeding. Such patients should be prescribed mainly "sparing" methods of F., incl. not having a pronounced local thermal effect: an alternating magnetic field, an electromagnetic microwave field on the thyroid gland, sinusoidal modulated currents on the cervical sympathetic nodes. In case of poor tolerance of mud applications, galvanic mud or mud phoresis can be applied using sinusoidal modulated currents. In the absence of therapeutic mud, you can use it, which is applied to the epigastric region and segmentally. When F. is used, exacerbations are possible, more often after 5-6 excessively “loading” procedures (muds of high temperatures, high concentration baths, electric current of great strength, etc.) or when taking several procedures within one day. In these cases, it is necessary to reduce the strength and duration of exposure, skip one or two procedures and resume them only after the pain syndrome and other signs of exacerbation subside. Contraindications for F.: a sharp peptic ulcer, motor insufficiency of the stomach caused by stenosis of its output part, ulcers to other organs, a tendency to bleeding from an ulcer, suspicion of its malignancy. Diseases of the operated stomach. The expediency of early use of F. after surgery on the stomach - after 8-10-14 days, is proved. it contributes to the rehabilitation of operated patients and the prevention of the development of diseases of the operated stomach. Usually, F. procedures are used for such patients according to “sparing” methods, i.e. in small doses, every other day, without prescribing several procedures during the day. Use galvanization, calcium electrophoresis (5% calcium chloride solution). For the purpose of a more complete functional recovery of the pancreas and prevention of the development of postoperative pancreatitis, electrophoresis of protease inhibitors, in particular contrical a and Gordox, is recommended. It is possible to prescribe microwave therapy to the area of the stomach or thyroid gland, an alternating magnetic field or HF therapy (inductothermia) to the area of the stomach. Therapeutic mud (sulfide, silt, peat, sapropel) is advisable to apply in the early stages - after 2-3 weeks. after stomach surgery. Elderly patients, sharply weakened, use galvanic mud, mud electrophoresis. Such thermal factors, as well as ozokerite, are not recommended for patients in the early stages after surgery, because. they can cause complications. It is more effective to use these methods in combination with balneological procedures. The complex of treatment also includes drinking mineral waters, exercise therapy, massage of the collar zone, climate therapy; be sure to follow the diet. Indications for F.: conditions after resection of the stomach, suturing of a perforated ulcer, organ-preserving operations in combination with vagotomy, selective proximal vagotomy with the presence of asthenic syndrome, so-called small stomach syndrome, dumping and hypoglycemic syndromes of mild and moderate severity. Contraindications: surgery for ulcerative bleeding, but without removing the ulcer itself; bleeding in the postoperative period and other surgical complications, operations and general contraindications. Not completely healed postoperative and increased (up to 30-40 mm/h) ESR is not a contraindication for F. Treatment of patients with late postoperative syndromes or the so-called diseases of the operated stomach is carried out taking into account the type of operation and the nature of the complications that have occurred. Patients after surgery for suturing a perforated ulcer of the stomach or duodenum should be treated according to the same principles as non-operated patients with peptic ulcer, but it is necessary to use physical factors that have a thermal effect more carefully. The use of F. is indicated for patients who have undergone stomach surgery in the past with the presence of dumping and hypoglycemic syndromes of mild and moderate severity, gastritis, hepatitis, cholecystitis, pancreatitis, reflux esophagitis, etc. However, it is not carried out in patients with deep asthenia, nutritional decline, anemia, non-healing postoperative fistulas, afferent loop syndrome, peptic ulcer of the jejunum or anastomosis, severe dumping syndrome, exacerbation of chronic pancreatitis. chronic hepatitis. The most favorable effect is exerted by moderately thermal or non-thermal factors, incl. mud applications on the area of the right hypochondrium and segmentally. Sulfide silt and sapropelic muds are used, as well as peat applications. Applications of paraffin and ozocerite can also be used as thermal factors. Elderly patients and those for whom mud therapy is stressful can be recommended galvanic mud, mud electrophoresis on the liver area. HF therapy (inductothermy), as well as (combination of mud therapy and inductothermy) approaches mud therapy in terms of efficiency. Effective is the UHF electromagnetic field on the liver area, as well as sinusoidal modulated currents (amplipulse therapy). They also use an alternating magnetic field, an electromagnetic field of microwave (460 MHz) on the liver area according to standard methods. Ultrasonic exposure is carried out on the area of the right hypochondrium and paravertebral in the area of Th V-IX . Galvanization, magnesium electrophoresis (10% magnesium sulfate solution), electrophoresis of the protease inhibitor aminocaproic acid are also used. Physiotherapy is contraindicated in patients with chronic aggressive and cholestatic hepatitis, persistent hepatitis in the acute phase, cirrhosis of the liver with ascites, jaundice of any origin, tumors, liver echinococcus and cachexia. Physiotherapy is successfully used in the rehabilitation treatment of patients with residual effects of viral hepatitis. One of the main methods of complex therapy for this disease is drinking mineral waters; general radon baths are shown (concentrations 20-40 nCi/l), coniferous, coniferous-radon, carbonic, carbonic-hydrogen sulfide baths with a hydrogen sulfide content of 10 mg/l. Therapeutic mud can only be used as applications on the right hypochondrium (temperature 37-38°C) in a short course (2-3 times a week, 6-8 procedures in total). More shows galvanic mud at a low current density and duration of the procedure up to 20 min. Locally, on the liver area, an UHF electric field, HF, microwave electromagnetic fields can be applied; to reduce asthenia, which is dominant in the picture of the disease, it is advisable to use electrosleep, effects on the collar zone (galvanic current, microwave therapy, etc.). Physiotherapeutic methods are contraindicated in patients with residual effects of viral hepatitis in the active phase. Chronic cholecystitis. The use of F. is aimed at reducing inflammation in the gallbladder and biliary tract, improving the functional state of the liver, the physicochemical properties of bile, and normalizing the motor function of the gallbladder. These goals are most consistent with the use of drinking mineral waters, physiotherapy and balneotherapy procedures, incl. mud therapy, which, depending on the form and severity of cholecystitis, the presence of concomitant diseases and the individual characteristics of patients, can be modified. Patients tolerate galvanic mud more easily; mud pressing electrophoresis or mud solution can also be used. Of the thermal factors, you can use ozocerite applications, preferably in combination with drinking water and balneotherapy. High-frequency and UHF electromagnetic fields have a good effect on the area of the liver and gallbladder. Electrophoresis of 10% magnesium sulfate solution, 5% novocaine solution is used. It is possible to combine the effect of HF therapy and electrophoresis of a mixture of magnesium sulfate and nicotinic acid on the liver area. microwave therapy (2375 MHz) on the liver area is used in a low-thermal dosage. In the hypotonic form of concomitant dyskinesia of the gallbladder, low-intensity ultrasound (0.2 W / cm 2), and in the hypertonic form - a higher intensity (0.8-1 W / cm 2). Galvanization, sinusoidal modulated currents (amplipulse therapy), microwave therapy, an alternating magnetic field are prescribed according to the same methods as in chronic hepatitis. In chronic cholecystitis, F., carried out in remission, has the best effect. With the appearance of pain in the right hypochondrium, increased pain during percussion and palpation of the gallbladder area, an increase in hyperesthesia zones and other signs of exacerbation, it is advisable to reduce the duration of the procedures, skip one or two of them, and with a more significant increase in pain, dyspepsia, and fever , a change in the blood picture should be interrupted for several days. Patients with chronic calculous cholecystitis deserve special attention, in which the use of F. can lead to an increase in the motor function of the gallbladder, migration of the stone, its infringement in the bile ducts and an attack of hepatic colic. In this regard, physiotherapeutic methods of treatment are contraindicated for such patients, as well as in severe cholecystitis with frequent exacerbations and the presence of active infection and complications (purulent cholecystitis, gallbladder empyema, active, jaundice). Chronic cholangitis. Given the presence of infection in the biliary tract, thermal factors (mud treatment, etc.) are not advisable to use. The anti-inflammatory effect is exerted by the UHF electromagnetic field, microwave therapy, amplipulse therapy using sparing methods. It is advisable to combine F. with antibacterial therapy, drinking mineral water, and an appropriate diet. F.'s use is contraindicated in case of a sharp exacerbation of cholangitis, stenosis of the major duodenal papilla, and jaundice. Postcholecystectomy syndrome. The treatment of patients with nostcholecystectomy syndrome presents significant difficulties. To prevent it, it is important to apply F. in the early stages, 8-10-14 days after the operation. The most effective is complex treatment, which includes, in addition to physiotherapeutic methods, drinking mineral water, balneotherapy, exercise therapy, and massage. Of the physiotherapeutic methods, amplipulse therapy, microwave therapy, an alternating magnetic field, ultrasound in a pulsed mode on the liver area and on the right rear at the level of Th VI -Th X paravertebral are recommended. UHF and microwave therapy, galvanization, drug electrophoresis, which are applied both to the liver area and to the collar zone, have anti-inflammatory and analgesic effects. Electrosleep is also prescribed. Mud therapy (applications of sulfide silt, sapropel or peat mud on the right hypochondrium) is very effective after 2-3 weeks. after cholecystectomy. Chronic pancreatitis. It is advisable for patients with pain syndrome to carry out electrophoresis of a 5-10% solution of novocaine on the area of the pancreas. For severe pain, sparing techniques should be used. Procedures with a pronounced thermal effect (UHF and HF therapy, etc.) should be prescribed with caution, because they can exacerbate the disease and increase pain. In this regard, they are used in athermic or oligothermal dosage. (intensity 0.4-0.6 W / cm 2) is carried out, respectively, the projection of the pancreas on the anterior abdominal wall. In the presence of pain syndrome, diadynamic therapy is also indicated. A beneficial effect in chronic pancreatitis is provided by amplipulse therapy, microwave therapy (power 25-35 Tue) to a greater extent than amplipulse therapy increases the production of enzymes and bicarbonates, therefore it is indicated for patients with a moderate increase in the activity of pancreatic juice enzymes, and the microwave electromagnetic field can be recommended for patients who have a decrease in the amount of pancreatic juice and the content of enzymes in it. The presence of concomitant cholecystitis is an indication for magnesium electrophoresis. Applications of sulfide silt, peat and sapropelic mud are also used on the left upper half of the abdomen and segmentally. Mud treatment is carried out very carefully, taking a break at the first signs of exacerbation (increased pain, dyspepsia, etc.). The risk of exacerbation is less with the use of galvanic mud. F. should be combined with drinking mineral waters, baths (carbonic, radon, sodium chloride, etc.) and dietary nutrition. chronic colitis. One of the most effective methods of F. is HF therapy (inductothermy). Microwave therapy, UHF electromagnetic field (pulse or continuous), amplipulse therapy are recommended. Diadynamic currents are also used. With pain syndrome, electrophoresis of novocaine (2.5% solution), platyfillin (0.2% solution) or galvanization of the intestinal area has a good effect. Sometimes phototherapy procedures are effective: irradiation with a solux lamp, local and general UV irradiation. An important therapeutic factor in chronic colitis is mud therapy (applications of sulfide silt, peat and sapropelic mud on the abdomen and segmentally); also appoint mud solution electrophoresis, mud inductothermia. With an exacerbation of the disease, the duration and frequency of physiotherapy procedures are reduced or they are temporarily canceled; sometimes antibiotics are prescribed in combination with antihistamines. F.'s efficiency at chronic colitis increases in a complex with a diet, drinking of mineral waters, water procedures. Physiotherapy in diseases of the nervous system. As a rule, in the treatment of neurological diseases, both local and segmental and general effects of physical factors are used. For example, local exposure (ultrasound, exercise therapy, massage, mud therapy, etc.) leads to accelerated regeneration of nerve fibers, protects against ischemia, edema, and improves the motor function of the limb. With segmental exposure, in addition to a direct effect on (injuries and diseases of the spinal cord, condition after removal of a benign tumor, cysts, etc.), compensatory capabilities develop through intact, but previously inactivated nerve structures of the damaged limb, which leads to an improvement in spinal circulation and activity. motor neurons. Through the use of baths, heliotherapy, climatotherapy, the overall effect of physical factors on the body is carried out. In this case, afferent signaling (stimuli), specific for one or another effect, comes in a continuous stream from the peripheral parts to the central nervous system. Complex treatment affects not only the local focus, but also the cortical and subcortical-stem levels, causing a number of vasomotor-hormonal shifts (hormones). Due to the extensive influence of F. on various processes and functions of the body, physical methods of treatment are widely used in neurology for preventive, therapeutic, and rehabilitation purposes. For example, F.'s use in the initial stages of insufficiency of blood supply to the brain or discirculatory encephalopathy helps to prevent the development of more severe manifestations of cerebral vascular insufficiency. With neurosis with visceral manifestations, vibration disease, initial manifestations of diseases of the peripheral, autonomic nervous system, atherosclerosis of cerebral vessels, arterial hypertension, drug electrophoresis is used according to various methods (reflex-segmental, transcerebral, according to the method of general effect, on vegetative formations, etc.). Widespread exposure to pulsed currents (according to the method of electrosleep), UHF electric field, as well as spa treatment for neuroses. General mineral baths improve microcirculation, the functions of the endocrine glands, prevent dystrophic changes in nerve cells and vascular walls, peripheral nerves, and therefore staying at climatic and balneotherapeutic resorts is indicated, for example, after transient cerebral ischemia, in the stage of remission of chronic recurrent diseases of the peripheral nervous system. systems in connection with osteochondrosis of the spine, etc. As part of the treatment of diseases of the peripheral nervous system (traumatic, infectious, allergic, toxic, vertebrogenic origin), in order to combat pain (headaches, phantom pains, causalgia, neuralgia), short-pulse, diadynamic, sinusoidal modulated currents, ultrasound, ultraphonophoresis, laser irradiation are used. and other physical factors, as well as their combination. In order to improve cerebral circulation, brain metabolism, aggregation properties of blood in the early after ischemic disorders of cerebral circulation (mild and moderate strokes), electrophoresis of the so-called antiplatelet agents, amino acids, an alternating magnetic field, microwave and UHF therapy, hydrogen sulfide, iodine-bromine, carbonic (including "dry"), nitrogen, nitrogen-radon and other baths. In injuries and diseases of the spinal cord, where vascular disorders play an important role, along with these methods, eufillin electrophoresis, amplipulse therapy, high-frequency therapy, mud therapy are used, which not only improves blood circulation in the spinal cord, but also trains spinal compensation mechanisms, contributing to the involvement of inactivated motor neurons, as in cases of activation of the so-called silent neurons during strokes. In the late periods of neurological diseases, along with the use of psychological, social, labor factors, F methods are also used to rehabilitate patients. Exposure to physical factors can be used even in the acute period of vascular, traumatic diseases of the brain or spinal cord, peripheral nervous system in order to prevent contractures, bedsores , the appearance of synkinesis (exercise therapy, massage, electrical stimulation, etc.). In the early recovery period, the range of F. methods expands: drug electrophoresis, amplipulse therapy, UHF and microwave therapy are prescribed, and after 4-10 weeks. artificial mineral baths. In the late and residual periods of the disease, spa treatment is used - mineral baths, mud applications, climatoheliotherapy, etc. Physical methods of treatment are also used before and after stereotaxic operations for parkinsonism (, amplipulse therapy, microwave therapy, levodopa electrophoresis, hydrogen sulfide, radon baths); with progressive muscular dystrophies (ultrasound, diadynamic therapy, amplipulse therapy, drug electrophoresis, exercise therapy, mud applications, etc.); syringomyelia (radon, radon steam baths); with myasthenia gravis (exercise therapy, electrophoresis, UV irradiation, baths); multiple sclerosis (hydrocortisone ultraphonophoresis, mineral baths, ultrasound, UHF therapy); after removal of benign tumors of the spinal cord (baths, exercise therapy, massage); after reconstructive operations on the vessels of the brain in case of injuries, vascular diseases (microwave therapy, amplipulse therapy, exercise therapy in the pool, oxygen, "dry" carbon dioxide baths); after removal of the disk and reconstructive operations on the nerves and plexuses (ultrasound, amplipulse therapy, mud therapy, exercise therapy, massage, electrical stimulation, etc.). Contraindications for F. in neurological diseases: acute period of the disease, progredient forms of infectious diseases of the central nervous system, tumors of the brain and peripheral nerves, with frequent seizures, psychosis and cachexia. Physiotherapy for diseases of the female genital organs. In gynecology, F. is used for the purpose of hemostasis, regulation of the menstrual cycle, elimination of vegetative-vascular disorders, elimination (reduction) of the inflammatory process, pain, adhesions, and for the prevention of complications after operations. In the absence of urgent indications, the optimal time for the first physiotherapeutic procedure is the 5-7th day of the menstrual cycle, when negative general and focal responses of the body are least likely; it is expedient to carry out procedures daily, because. rarer impacts are less effective. During menstruation, F. is not interrupted, replacing only intravaginal effects with intrarectal or extracavitary (cutaneous) effects. With an increase in menstrual blood loss during F., it is advisable to reduce the intensity of the physical factor; if this does not help, then F. is stopped and the patient is examined to exclude fibroids, internal endometriosis (adenomyosis) and other diseases of the uterus. It is also important to take into account the course of F., which in gynecological patients continues on average: after mud therapy 6 months, ozokerite therapy - 4-5 months, mineral baths and irrigation - 4 months, electrotherapy - 2 months. Due to the aftereffect period, the long-term results of F., as a rule, are more favorable than the immediate ones. A repeated course of the same physiotherapeutic procedures is justified only when the previous one was effective, and the interval between courses should not be less than the aftereffect period. During the entire course of F. and the period of its aftereffect, women of reproductive age need careful attention. Menstrual irregularities. It is desirable that F. preceded hormonal treatment, tk. this will either avoid it or carry it out in smaller doses. With bleeding during puberty (the so-called juvenile bleeding), if they are associated with an acute infectious disease (, tonsillitis, etc.), endonasal calcium electrophoresis according to Kassil is performed; if irregular menstrual-like discharge against the background of hyperestrogenism precedes, electrophoresis of novocaine is prescribed to the zone of the upper cervical sympathetic ganglia (with increased sensitivity to novocaine, galvanization of this zone is possible). With frequent juvenile bleeding against the background of moderate or low estrogenic activity, a selection massage of the paravertebral zones at the level of the lower thoracic and cingulate vertebrae is indicated. In girls over 15 years old with genital infantilism, a hemostatic effect can be achieved by causing mammary-uterine, which provides the muscles of the uterus by galvanizing the mammary glands or vibrating nipple massage. Bleeding during puberty of central genesis can be eliminated by electrophoresis of novocaine in the area of the upper cervical sympathetic ganglia or (if novocaine is intolerant) by excitation of the mammary-uterine reflex. In case of mastopathy, the effect of physical factors on the mammary glands is contraindicated, and therefore such patients undergo galvanization of the zone of the upper cervical sympathetic ganglia. With peripheral (ovarian) genesis of dysfunctional uterine bleeding and hyperestrogenism, electrical stimulation of the cervix with low-frequency impulse currents is most effective, electrophoresis of novocaine on the area of the upper cervical sympathetic ganglia or (if this drug is intolerant) its galvanization is also indicated. With some violations of the menstrual cycle without bleeding (hypergonadotropic and hyperprolactinemia), it is advisable to refrain from F.. With emotional-neurotic and vegetative-vascular disorders, aerotherapy is carried out), after the exclusion of hyperestrogenism - heliotherapy, thalassotherapy, manual massage of the collar zone, dousing, rain. With previously transferred inflammatory diseases of the brain, coniferous, pearl, iodine-bromine baths, galvanization of the cervico-facial zone according to Kellat (to normalize cerebral circulation) are advisable. With vegetative-vascular, metabolic and trophic disorders, after exclusion of hyperestrogenism, carbonic baths are possible, and if it is present, radon and nitrogen-radon baths and vaginal irrigation; endonasal galvanization according to Kassil is effective. With hypoestrogenia of central origin, hydrogen sulfide baths and vaginal irrigations, arsenic baths and vaginal baths, as well as carbon dioxide, turpentine or nitrogen baths are used; copper electrophoresis is effective. In case of hyperestrogenism with insufficiency of the luteal phase of the menstrual cycle and especially anovulation, the use of ozokerite, hydrogen sulfide, arsenic, carbonic, nitrogen, highly concentrated sodium chloride waters, turpentine baths, mountain climate, ultrasound, vibration and gynecological massage, high-frequency therapy (inductothermy), copper electrophoresis is contraindicated . Recommended electrophoresis of iodine, in case of insufficiency of the luteal phase - iodine and (or) zinc; radon and iodine-bromine baths and vaginal irrigation. In case of menstrual irregularities, sanatorium-resort treatment, treatment in local sanatoriums, sanatoriums-dispensaries are usually indicated. Climacteric and post-castration syndromes- indications for aerotherapy and hydrotherapy (including at home - dousing, washing, rain shower, coniferous, sage, contrast foot baths). If they are ineffective, central or endonasal galvanization of the cervicofacial, collar zones is indicated. Treatment is also recommended in sanatoriums, local sanatoriums, as well as in the resorts of the southern coast of Crimea (in the non-hot season) and the Baltic states. Bleeding in the menopause can be eliminated by F. only after the exclusion of signs of a malignant process (the methods are the same as during puberty). Benign and hyperplastic processes usually subject to surgical treatment. In other cases, radon and iodine-bromine baths, galvanization, diadynamic therapy, amplipulse therapy, fluctuorization, an alternating magnetic field, as well as drug electrophoresis are prescribed, excluding. Local effects can be localized both on the upper half of the body (excluding the mammary glands), and in the suprapubic, inguinal, hypogastric, lumbosacral regions or on the thighs. With uterine myoma against the background of prolonged endocrine disorders, iodine-bromine baths or endonasal galvanization are prescribed; with myoma, which was preceded by chronic inflammatory gynecological diseases or intrauterine interventions, radon baths, electrophoresis of iodine or iodine and zinc are indicated. The same F. methods are used for le treatment of endometriosis, as well as after operations for uterine fibroids and endometriosis. With mastopathy, iodine-bromine baths and iodine electrophoresis are prescribed (only for the pelvic organs). With benign hyperplastic processes in the endometrium, F. concomitant gynecological diseases is contraindicated, as well as spa treatment. Treatment of genital infantilism provides for aerotherapy, heliotherapy, thalassotherapy, hydrotherapy. The more pronounced the morphological (reduction in the size of the uterus) and functional (decrease in the estrogenic activity of the ovaries) inferiority of the reproductive system, the more soft and gentle the F should be. mud, ozocerite, hydrogen sulfide mineral waters; HF therapy (inductothermia) is also possible. If the size of the uterus is slightly reduced, but there is a pronounced ovary, it is advisable to use sodium chloride waters, copper electrophoresis, vibration massage, as well as carbon dioxide and nitrogen waters, high-frequency therapy (inductothermy) using a vaginal applicator, vibration massage of the paravertebral zones in the region of the lower thoracic segments of the spinal brain. Inflammatory diseases. In case of vulvovaginitis in children, general UV irradiation, irradiation of palatine tonsils, posterior pharyngeal wall and external genital organs with UV rays are sequentially carried out on the same day. At home, warm sitz baths with chamomile infusion are useful. With bartholinitis, the focus is affected by UV radiation, UHF and microwave electric fields. Physiotherapy of inflammatory diseases of the uterus, appendages, pelvic peritoneum and fiber in the acute stage is possible only if the process is limited and stabilized. Conduct UV irradiation of the abdomen and lumbosacral region, low-frequency magnetotherapy, microwave therapy. In the subacute stage of the disease, the same physical factors are used, and in the presence of uterine fibroids or endometriosis, electrophoresis of acetylsalicylic acid, magnesium, zinc, and calcium is used. In chronic inflammatory diseases, a prerequisite for F. is to determine the initial hormonal function of the ovaries, so that, for example, in case of hyperestrogenism, procedures that increase the estrogen of the ovaries are not prescribed. With endometritis, therapeutic mud is used (in the form of panties, vaginal tampons); hydrogen sulfide baths and vaginal irrigation, microwave therapy, low-frequency alternating magnetic field, electrophoresis of acetylsalicylic acid, magnesium, zinc. With salpingoophoritis (salpingitis), peri- and parametritis during the period of exacerbation, low-frequency magnetotherapy is indicated, and for intense pain, microwave therapy. Patients with uterine myoma, endometriosis, mastopathy undergo electrophoresis of medicinal substances recommended in the subacute stage of these diseases; in pain syndrome, diadynamic or sinusoidal modulated currents are effective, as well as (in patients with neurocirculatory dystonia); transcutaneous electrical nerve stimulation, ultrasound therapy are indicated. Patients of reproductive age with obstruction of the fallopian tubes and peritubar adhesions leading to infertility, as well as adhesions in the pelvis with a fixed retroversion of the uterus, are shown ultrasound therapy, turpentine baths, iodine electrophoresis, after clinically cured tuberculosis of the genitals - interference currents, and after gonorrhea - hydrogen sulfide baths and vaginal irrigation, in addition, patients under 30 years old - HF therapy (inductothermy), therapeutic ozokerite,. With residual (residual) manifestations of chronic salpingo-oophoritis (mainly in the form of chronic pelvic pain), the same F. is carried out as during an exacerbation of the disease, and emotional-neurotic and other secondary functional disorders are eliminated (reduced) with the help of hydrotherapy, iodine-bromine baths, galvanization (endonasal, as well as collar or cervicofacial zones). F. is indicated for functional tubal infertility: patients with hypertonicity of the fallopian tubes are prescribed magnesium electrophoresis or radon baths and irrigation; with discoordination of contractile activity - galvanization of the endonasal or collar zone; in the absence or decrease in the contractile activity of the fallopian tubes - their electrical stimulation or hydrogen sulfide baths and vaginal irrigation. Early recovery F. after gynecological operations is necessary for all patients (except those operated on for malignant tumors, cystomas). It should be started from the first (but not later than the third) day after the operation, i.e. before adhesion of tissues in the small pelvis, preceding adhesion formation. Low-frequency magnetotherapy is effective, less - UHF-therapy. After reconstructive operations on the fallopian tubes, their electrical stimulation is advisable. In all cases, it is advisable to start F. with extracavitary (cutaneous) procedures, and only after adequate reactions to 3-6 such effects, move on to intracavitary. Physiotherapy in obstetrics. For preventive purposes, pregnant women are shown aero- and at home, general UV irradiation. After the artificial termination of the first pregnancy, copper electrophoresis is indicated, which begins after 1-2 h after surgery and continue in the outpatient setting. With the threat of miscarriage, endonasal galvanization, transcutaneous electrical nerve stimulation, magnesium electrophoresis and uterine electrorelaxation are used to reduce the contractile activity of the uterus. With early toxicosis of pregnant women (excluding indomitable vomiting), central electroanalgesia is effective, with late toxicosis it is advisable only for nephropathy of the I degree of severity; carry out central electroanalgesia or galvanization of the collar zone; with a pronounced immunoallergic component, microwave therapy is most adequate (impact on), with placental insufficiency, transcutaneous electrical nerve stimulation. Restorative F. after late toxicosis includes central electroanalgesia, galvanization of the collar zone, or endonasal galvanization. With nipple cracks in a puerperal, ultrasound therapy is most effective. Lactostasis can be eliminated by UV radiation of the mammary glands, but F. lactational mastitis is not effective enough. For prophylactic purposes, starting from the 2nd day. after surgery on the perineum in childbirth, the sutures are exposed to UV radiation or a helium-neon laser, and starting from the 3rd day. after caesarean section, local UV radiation is performed. With adequate responses, up to 4 procedures per day can be performed, influencing the same factor on one zone (for example, endonasal galvanization), one factor on different zones (UV irradiation of the mammary glands and perineum), or different factors on different zones; influences by various factors on one zone should be refrained from. Physiotherapy in urology. Patients with pyelonephritis are prescribed drinking mineral water, sodium chloride and carbon dioxide baths, amplipulse therapy, microwave therapy, ultrasound, UHF therapy, direct current. Most often, the complex of treatment includes drinking mineral water, a mineral bath and one of the named physical factors. After surgery for urinary tract stones and acute pyelonephritis, F. is prescribed at different times - from 10 days or more - depending on the nature of the course of the postoperative period and the activity of inflammation. F. is contraindicated in primary and secondary pyelonephritis in the phase of active inflammation, the terminal stage of chronic pyelonephritis, polycystic kidney disease, decompensated hydronephrosis. Microwave therapy is also contraindicated in coral stones of the kidneys, stones of the pelvis and calices of the kidneys. Patients with acute cystitis are treated with UHF therapy, irradiation of the bladder area with an infrared lamp, sodium chloride baths or sitz baths from fresh water at a temperature of 37 °, paraffin (ozocerite) applications locally or on the lumbar region. With moderate inflammation, ultrasound is used, acting directly on the neck and anatomical triangle of the bladder vaginally or rectally. With hyperreflexia, detrusor hypertonicity, amplipulse therapy is prescribed both in its pure form and for gangleron electrophoresis. In the stage of remission of cystitis, mud rectal or vaginal tampons, mud "cowards", iodine-bromine, sodium chloride, carbonic baths are used. Contraindications for F. in patients with cystitis are oxalates and precipitate with an acid reaction of urine, drinking alkaline bicarbonate sodium or calcium waters is indicated. With phosphate stones that form in alkaline urine, drinking carbonic-hydrocarbonate calcium-magnesium waters is shown, which lowers the pH of the urine. Drinking mineral water is not indicated in violation of the passage of urine, prostate adenoma, insufficiency of kidney function and the cardiovascular system. When the calculus is located in the ureter at any level, drinking mineral water, high-frequency therapy (inductothermy), and amplipulse therapy are consistently used. After taking mineral water in 30-40 minutes, inductothermia is carried out in the projection of the location of the calculus in the ureter on the back or abdominal wall. Immediately after this, amplipulse therapy is prescribed, placing one electrode in the projection area on the lower back, and the second in the suprapubic region at the projection site of the lower third of the ureter. Instead of inductothermy, microwave therapy and sodium chloride baths can be used. When the calculus is located in the lower third of the ureter, the treatment complex includes drinking mineral water, sodium chloride baths and ultrasound (they act vaginally or rectally at the site of the calculus projection). Complex F. is not indicated for stones larger than 10 mm in diameter, acute pyelonephritis, significant anatomical and functional changes in the kidneys and ureter on the side of the lesion, cicatricial narrowing of the ureter below the location of the stone. In the treatment of patients with chronic prostatitis, mud therapy in the form of panties and tampons, hydrogen sulfide baths and microclysters are used. turpentine baths, ultrasound, amplipulse therapy, laser, low-frequency magnetic field, UHF and microwave electric fields. Contraindications for F. in these patients are acute inflammatory diseases of the rectum and prostate, rectum, anal fissures, acute hemorrhoids, and prostate. For the use of ultrasound prostate adenoma is not a contraindication. Physiotherapy in pediatrics. Even in the presence of irreversible changes, the early use of F. in combination with educational and other measures helps the child adapt to life due to the large compensatory capabilities of the growing organism. In connection with the anatomical and physiological characteristics of the child's body (increased nervous system, delicate, richly vascularized, with a large resorptive capacity; high water content in the tissues and the resulting large deep-seated organs exposed to electric current, etc.), the dosage of F. methods and the duration course of treatment should be less, the younger the child. Thus, the biodose should be determined at intervals of 15 With and check in 6-8 h; current density for young children should not exceed 0.02 mA/cm2, for preschoolers - 0.03 mA/cm2; electric field can be applied with an output power of up to 30 Tue; number of procedures per course up to 10, etc. In pediatrics, UV radiation, water and heat treatment are most widely used as the most biologically adequate, as well as impulse effects that reduce the energy load on the body. Most often F.'s methods apply at the following diseases of children. Newborns with diseases of the skin, navel (diaper rash, omphalitis) are prescribed short air baths in combination with local irradiation with a Minin lamp, warm fresh baths with potassium permanganate, UV radiation, UHF electric field (3-4 procedures); with purulent omphalitis - a combination of an electric UHF field and UV radiation (5-6 procedures) in combination with antibiotics. For the treatment of phlegmon of newborns, acute hematogenous osteomyelitis, immediately after surgery, UV irradiation, UHF electric field, laser radiation, hemolytic disease - phototherapy (irradiation with blue light for 6-8 h per day with a break every hour, the course is 3-5 days). With the consequences of a birth injury (brachial plexus, clavicle,) an UHF electric field, irradiation with a Minin lamp, warm baths (for plexitis), then ozocerite applications, amplipulse therapy, iodine electrophoresis are used. In order to prevent and treat rickets, general long-wave UV irradiation or UV irradiation is carried out, starting from 1/6 - 1/4 of the biodose, gradually increasing to 1 1/2 -2 biodose by the end of the course of 15-20 exposures. It is impossible to combine UV irradiation with taking vitamin D preparations. Sodium chloride baths, massage are also recommended, and for skeletal deformities and muscle hypotension, ozocerite applications, HF therapy (inductothermia), calcium electrophoresis, sand baths. F.'s role at allergic diseases is especially great. diathesis, children's, neurodermatitis are often associated with food allergies. In the period of subsiding inflammatory manifestations, an alternating magnetic field is used segmentally and on lesions (12-15 procedures), warm medicinal baths (, series, etc.), in the presence of infiltration, skin itching - ozokerite applications, darsonvalization, ultrasound (oscillation frequency 2640 kHz), electrosleep, calcium electrophoresis. In the period of remission, general UV irradiation, radon, hydrogen sulfide, sodium chloride baths, mud therapy, drinking mineral waters, and thalassotherapy are used. For the treatment of bronchial asthma, asthmatic bronchitis and other respiratory allergies with, infectious-allergic forms in the period of subsidence and out of attacks, in combination with hyposensitization, electroaerosol inhalations of antispasmodics, amplipulse therapy, ultrasound, an alternating magnetic field, drug electrophoresis (eufillin, etc.) are prescribed for chest, electrosleep; with current endobronchitis - UHF electric field, microwave and high-frequency therapy, then electrophoresis: UV erythema, massage, therapeutic exercises. In the period of remission - baths (carbon dioxide, radon, chloride, sodium), electrosleep, histamine electrophoresis, exercise therapy, swimming. With pollinosis - endonasal intal electrophoresis, diphenhydramine, in the period preceding the flowering of plants, which reduces the severity of allergic manifestations. Acute respiratory diseases (, bronchitis,) in young children occur with significant violations of the general condition and external respiration. In the initial stage, they are pumped with heat-moist (oxygen, medicinal) inhalations, ozocerite "boots", UV irradiation of the feet, mustard wraps, and if the child is worried, warm baths. In older children - UV irradiation of the mucous membrane of the nasopharynx, UHF on the area of the paranasal sinuses. In the period of resolution of bronchopulmonary changes - inductothermia, UHF therapy, UV erythema, microwave therapy, ozokerite applications, drug electrophoresis (ascorbic acid, magnesium, calcium, mud solution, etc.), massage, therapeutic exercises. In remission and in the presence of residual effects - aerosol therapy, mineral baths, mud therapy, massage, hardening procedures, general UV irradiation. In chronic bronchopulmonary diseases in the period of exacerbation, the same F. methods as in acute ones; in the period of remission - sanatorium treatment. Diseases of the organs of support and movement (congenital hip, congenital, osteochondropathy, scoliosis, rheumatoid arthritis, trauma, etc. .
) require the widespread use of F. methods for the treatment and rehabilitation. In the period of subsiding inflammatory, dystrophic changes, subacute course, UV erythema, UHF electric field, amplipulse therapy, diadynamic therapy, microwave therapy, ultrasound, drug electrophoresis are used (in combination with orthopedic measures) , electrical stimulation, mineral baths, massage, hydrotherapy; in the period of remission, after corrective operations in the stages of recovery - sanatorium treatment, mud therapy, sea bathing,. In diseases of the nervous system (children's cerebral, consequences of neuroinfections, craniocerebral injuries, peripheral nerves, neuromuscular dystrophies, etc.), physiotherapy methods are of primary importance in rehabilitation treatment. In the period of subsiding inflammatory changes and with residual phenomena, warm baths, amplipulse therapy, UHF electric field, HF therapy (inductothermy), wool wraps, drug electrophoresis, electrical stimulation, mineral baths, UV irradiation, massage, exercise therapy are widely used; Spa treatment. With neurotic reactions, neuroses (, tics, etc.), therapeutic baths, electrosleep, endonasal galvanization, drug electrophoresis, and general UV irradiation are very effective. For the treatment of diseases of the ENT organs (otitis media, tonsillitis, rhinosinusitis, etc.), in the stage of subsiding acute inflammation or exacerbation of a chronic process, irradiation with a Minin lamp, UHF electric field, UV irradiation, inhalation, drug electrophoresis, ultraphonophoresis, then ozocerite applications are applied locally; in the period of remission - general UV irradiation, baths, mud therapy, climatotherapy. In diseases of the digestive system (, dyskinesia, gastroduodenitis, duodenal ulcer, colitis, etc.), liver and biliary tract (dyskinesia, cholecystitis, etc.), high-frequency therapy (inductothermy), drug electrophoresis, amplipulse therapy, diadynamic therapy, alternating magnetic field, ozocerite and mud applications, mineral water drinking, massage, exercise therapy; in the period of remission - sanatorium treatment. F. is also important in the prevention of diseases and the correction of risk factors. For example, in diseases of the cardiovascular system (myocarditis, arrhythmia, arterial cardiopathy, etc.), in order to prevent relapses and progression of the disease, mineral (carbon dioxide, hydrogen sulfide, bromine) baths, mud therapy, UV irradiation, electrosleep, drug electrophoresis are prescribed. For diseases of the urinary organs (chronic, cystitis,), metabolic diseases, balneotherapy methods are widely used - drinking mineral waters, mineral baths, applications of therapeutic mud in the period of remission, in the subacute stage - UHF electric field, microwave therapy on the projection area of the kidneys, amplipulse therapy , electrical stimulation - with hypotension of the ureters, megaureter. the field of clinical medicine that studies the healing properties of natural and artificially created physical factors and develops ways to use them (without destroying tissues) for the treatment and prevention of diseases, as well as for medical rehabilitation; some physical factors (significantly increased air pressure, etc.) are studied not by F., but by other areas of medicine. 1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
The composition of physiotherapy includes such sections as electrotherapy, ultrasound treatment, phototherapy, climatotherapy, mechanotherapy, physical pharmacotherapy, hydrotherapy and thermotherapy.
Each of these sections includes a group of methods that are based on the action of certain physical factors.
The largest number of methods combines electrotherapy. It includes treatment methods based on the use of various types of electric current:
- constant current - galvanization;
- sinusoidal modulated currents - amplipulse therapy;
- constant pulsating currents with a frequency of 50 and 100 pulsations in 1 s - diadynamic currents;
- short-pulse currents of low frequency - electronarcosis, electrosleep;
- impulse currents of high frequency - darsonvalnization;
- methods based on the use of a constant electric field of high intensity - franklinization, etc.
also in electrotherapy includes:
- methods based on the action of a low-frequency alternating magnetic field - low-frequency magnetotherapy;
- electromagnetic fields of high frequency - inductotherapy;
- electromagnetic fields of ultrasonic frequency - UHF-therapy;
- microwave electromagnetic fields - microwave therapy.
Phototherapy combines methods using ultraviolet radiation, infrared radiation, visible radiation, i.e. electromagnetic oscillations of light and close to it ranges of waves.
Hydrotherapy combines methods based on the use of fresh water in the form of various showers, douches, rubdowns, wraps, partial and total baths, underwater shower-massage.
Balneotherapy is based on the use of baths of various gas and chemical composition.
Thermal treatment includes methods that use the heat of heated paraffin, ozocerite, sand, various pemoids (mud therapy), as well as Russian baths and saunas.
mechanotherapy combines methods based on the impact of mechanical energy:
- various types of massage;
- manual therapy (chiropractic);
- vibrotherapy;
- exposure to ultrasound;
- mechanotherapy with the use of various devices (simulators).
Physicopharmaceutical treatment combines methods of simultaneous impact on the body of physical factors and drugs. These include: drug electrophoresis, phonophoresis, electroaerosol therapy.
Physical factors have a reflex, humoral and directly physical and chemical effect on the tissues of the body.
It has now been proven that physical factors act mainly specifically. The specificity of this effect is determined by the type of exposure, the localization of exposure, the depth of penetration of this effect, the dose of exposure, and the type of tissue that is affected. Of great importance is the body's response to physiotherapy. Considering this response of the body, it is possible to correct, and sometimes even refuse, physiotherapy treatment for this (specific) patient.
In physiotherapy, various methodological methods for carrying out procedures have been developed. These can be general and local effects, effects on reflex-segmental zones, taking into account metameric pervation, on Zakharyin-Ged zones, biologically active skin points. In physiotherapy treatment, a wide range of therapeutically important reactions is manifested: analgesic, antispasmodic, anti-inflammatory, fibrinolytic effects. They manifest themselves against the background of activation or normalization of blood and lymph circulation, permeability of biological membranes, metabolism, functions of the nervous and endocrine systems.
With different methods of physiotherapy, these reactions are different, hence the choice of physiotherapy treatment (to obtain an analgesic effect in diseases of the peripheral nerves, diadynamic or sinusoidal modulated currents are used; to obtain an anti-inflammatory effect, UHF therapy, inductotherapy, etc. are used).
We must also not forget about the compatibility and sequence of physiotherapy procedures. It is allowed to use no more than two procedures in one day, including balneotherapy. Moreover, one of the procedures must necessarily be in the nature of a pronounced “local effect”. You can not take a cool shower after the mud, two different baths (soothing and exciting).
With antibacterial therapy, UHF ultrasound increases the body's sensitivity to antibiotics, so you can reduce the dose of the latter. Often, one physiotherapy procedure enhances the effect of another. For example, before iodine electrophoresis, mud applications enhance the therapeutic effect (traumatic diseases), or if an ultrasound session is performed before a radon bath, the therapeutic effect is enhanced (joint diseases).
The most pronounced therapeutic effect is manifested 1.5-3 months after physiotherapy. Therefore, caution is necessary in conducting repeated courses of treatment.
Contraindications to the use of physiotherapy: a state of severe exhaustion, a tendency to bleeding, blood diseases, malignant neoplasms, pronounced manifestations of systemic organ failure (cardiovascular insufficiency, respiratory failure, impaired renal function).