The value of exercise therapy for juveniles. Rules, forms and types of monitoring the effectiveness of physical therapy. Treatment of juvenile idiopathic arthritis

Juvenile arthritis is classified as an autoimmune disease in children. The inflammatory process is localized in the synovial membrane of the joints. We will talk about the danger of this disease, the reasons for its occurrence, the characteristics of the course and treatment of the disease in the article.

What is juvenile arthritis?

Juvenile rheumatoid arthritis is a chronic disease in which inflammation of the synovial membrane of the joints occurs in children and adolescents (under the age of 16 years). The disease has an unclear etinology and a rather complex pathogenesis. In most cases, the disease progresses steadily. As a result, other organs are also involved in the inflammatory process. Quite often, the result of juvenile arthritis is the child’s disability.

Official world statistics indicate that a pathology such as juvenile arthritis occurs in pediatrics with a frequency of 0.6%.

Peculiarities

Research conducted by scientists and doctors has shown that juvenile arthritis:

almost never diagnosed in children aged from birth to two years;
girls suffer from this disease approximately twice as often as boys;
in 50% of cases, children who were treated for juvenile arthritis in childhood lose their ability to work in adolescence;
about 10% of patients with this diagnosis become disabled and cannot lead a full life.

Classification

Modern medicine identifies several main types of juvenile rheumatoid arthritis:

System. Another name for the pathology is Still's disease. Steadily progressing arthritis, during the development of which damage to vital organs is also observed - the gastrointestinal tract, heart muscle, lymph nodes, etc. Rashes appear on the patient’s skin, and the body temperature remains elevated for a long time.
Oligoarthritis. The second name of the disease is juvenile arthritis. Already in the first months of the onset and development of the pathology, several joints (from one to five) are affected. At the same time, the child experiences the development of other pathologies not related to joints. In 90% of cases, oligoarthritis is diagnosed in girls aged 10 to 16 years.
Polyarthritis. A form of the disease in which the disease affects more than five joints. In 90% of cases, the joints of the arms and legs, neck, and back of the head are affected. Girls suffer from this pathology many times more often than boys.
Post-traumatic arthritis. Develops after injuries. The disease primarily affects the spinal column, bones, tendons and joints. This form of pathology is most often diagnosed in boys under the age of 8 years.

Juvenile idiopathic arthritis is not a type of disease. This means that the causes of arthritis in a child cannot be identified.

Depending on the clinical and anatomical features, doctors distinguish the following forms of juvenile arthritis:

articular (manifests in the form of polyarthritis or oligoarthritis);
articular-visceral (the pathology is characterized by symptoms of Still's disease and allergic septic syndrome);
with limited visceritis (the disease affects not only the joints, but also other organs - the cardiovascular, bronchopulmonary system, etc.).

Degrees

During diagnosis, the doctor has the opportunity not only to identify pathology, but also to determine the degree of the disease. It is divided according to the activity of the inflammatory process into:

3 - high;
2 - average;
1 - low;
0 - stage of remission.

Depending on the degree of the disease, as well as the severity of the main symptoms, the doctor selects the appropriate treatment.

Causes

Juvenile rheumatoid arthritis is a pathology that is based on a hereditary predisposition. Negative environmental factors, as well as various infections, have recently become of no small importance.

Hereditary predisposition to pathology is confirmed by family cases of detection of this disease.

The mechanism for the development of the disease and its rapid progression can be triggered by:

viral or bacterial infections suffered by the child;
joint injuries;
frequent hypothermia;
vaccination performed against the background of acute respiratory viral infection (vaccinations against measles, rubella, mumps, influenza, and other infections can cause complications in the form of juvenile arthritis in children).

Medicine knows of cases where juvenile arthritis in children was diagnosed after vaccination against hepatitis B.

Some doctors believe that this disease can occur against the background of damage to the child’s body by various intestinal infections, certain types of streptococci, and mycoplasma. Official medicine does not recognize these assumptions.

Other causes that can cause juvenile arthritis:

hyperactivity of the immune system (as a result of which self-destruction of joint tissue occurs);
prolonged exposure to direct sunlight;
non-compliance with the schedule and rules for preventive vaccinations.

Symptoms

Juvenile arthritis is a disease that has its own symptoms. Very rarely the disease is asymptomatic. In most cases, complaints are made of pain in the joints, swelling around them, and limited mobility. This symptomatology is especially pronounced in the morning or after a short rest.

Young children most often do not pay attention to the main symptoms of the pathology and do not complain of pain.

Other symptoms of juvenile arthritis:

increased body temperature accompanied by fever;
loss of appetite followed by weight loss;
the appearance of a rash on the lower and upper extremities;
enlarged lymph nodes;
change in gait, lameness in one leg;
general malaise, lethargy, weakness in the body;
vision problems (red eyes, eye pain, loss of vision, inflammation);
increased irritability, frequent mood swings;
growth slowdown;

It is not uncommon for arthritis to lead to uneven development of joints, as a result of which a child may have different lengths of arms or legs.

Diagnostics

The process of diagnosing juvenile rheumatoid arthritis consists of several main steps.

History taking. It begins with a consultation with a highly specialized specialist - a rheumatologist, who conducts a survey of the patient, visually examines the affected joints, and records the main complaints and presenting symptoms of the disease in the child’s medical record.

Laboratory and hardware diagnostic methods. They are carried out to clarify the diagnosis and draw up a general picture of the disease. The main ones:

general and biochemical blood test;
general urine analysis;
blood test for infections;
blood test to determine antibodies that provoke the development of arthritis;
radiography (allows you to determine the presence of injuries and damage to joints, tissues, bones);
analysis of bone marrow samples;
CT and MRI, bone scanning (can detect changes in the structure of bone tissue).

Juvenile arthritis belongs to the category of diseases that can be confused with other pathologies. If the child does not have pronounced symptoms, then the doctor can clearly determine the diagnosis only by excluding diseases such as:

lupus;
infectious diseases;
malignant tumors;
Lyme disease.

Treatment

Immediately after juvenile arthritis is determined in a child, treatment should begin. It could be:

non-medicinal (conservative);
medicinal.

Certain types of therapy are selected depending on the speed of development of the pathology, which can be slow, moderate or rapid, the type of juvenile arthritis, as well as the degree of the disease.

Non-drug therapy

Special regime. If the disease worsens, the child’s physical activity should be reduced. It is prohibited to completely immobilize damaged joints due to the possibility of developing muscle atrophy and worsening osteoporosis. For moderate pain, a set of special physical exercises aimed at maintaining joint mobility is indicated. The following will be useful:

a ride on the bicycle;
walking in the fresh air;
swimming.

During any activity, you should avoid jumping, running, and active, excessively active games.

In addition, the patient is advised to sleep on a hard mattress with a low pillow, and self-control to maintain a straight posture while walking. Children diagnosed with juvenile arthritis should be exposed to the sun as little as possible.

Diet. Includes the inclusion in the diet of foods containing significant amounts of vitamin D and calcium. Most often, doctors recommend a protein diet with minimal consumption of fats and so-called “fast” carbohydrates.

Exercise therapy. Physical therapy is one of the main components of the treatment of juvenile arthritis. Sick children are recommended to perform special exercises daily to build muscle mass and increase joint movement.

Exercise therapy programs are compiled individually, taking into account the child’s physical capabilities, the stage of the disease and the rate of its progression.

Orthopedic correction. In some cases, patients are advised to wear special splints, splints, insoles or orthoses. The main feature of their use in juvenile arthritis is the intermittency of immobilization. During the day, such devices should be removed and put on several times in order to avoid muscle atrophy and stimulate muscle tissue during physical activity.

In severe forms of damage to the hip joints, according to the doctor's indications, walking on crutches is prescribed.

Modern medicine offers a traditional course of treatment, which includes:

Analgesics. Prescribed to reduce severe pain in severe forms of pathology. Most often, the doctor may recommend taking Aspirin and Indomethacin.
Anti-inflammatory drugs. To reduce the severity of the inflammatory process in the joints themselves and nearby tissues, organs affected by the disease.
Immunomodulators.
Vitamin complexes. Which necessarily include vitamins P, B, C.
Steroids. They are used to relieve pain, as well as reduce swelling in the affected joints.
Antibacterial agents. Antibiotics are indicated for patients in whom juvenile arthritis has developed against the background of various infectious diseases.
Non-steroidal anti-inflammatory drugs. Used only at the acute stage, strictly according to the doctor’s recommendations. The most popular for arthritis are Diclofenac, Nimesulide, Prednisolone, Ibuprofen.

It is worth remembering that almost all medications can cause adverse reactions, so their use by children is allowed only as prescribed by the attending physician.

In addition to all the treatment methods described above, children diagnosed with juvenile arthritis may be recommended:

therapeutic and preventive massage;
paraffin and ozokerite applications;
mud therapy;
UV irradiation, phonophoresis (using special medications).

In the most severe forms of rheumatoid arthritis, with joint deformation, prosthetics are indicated.

Forecast

In 50% of children diagnosed with juvenile rheumatoid arthritis, it is possible to achieve stable remission of the pathology and prevent its progression for several years. However, in some cases, persistent remission is replaced by a period of active exacerbation.

If the disease was diagnosed in a child at an early age, the likelihood of subsequent disability is quite high. Developing arthritis later in life reduces this risk.

The mortality rate among children suffering from juvenile arthritis is negligible. Lethal outcome is observed only in the most severe forms of the disease due to the lack of adequate treatment, as well as associated complications and additional infection.

Patients with this diagnosis should get used to the idea that the pathology will periodically remind itself throughout their lives. To minimize health risks, during exacerbations, children should undergo therapy as prescribed by a doctor, followed by professional rehabilitation.

Complications

In many cases, children diagnosed with juvenile rheumatoid arthritis, including those who have undergone adequate comprehensive treatment, develop all sorts of complications:

problems arise in the functioning of the cardiovascular system, as well as the gastrointestinal tract;
joint deformation occurs;
mobility of the limbs is limited (can be partial or complete);
vision deteriorates;
there is a slowdown in growth;
loss of motor ability, which in a short time leads to disability.

Prevention

To date, there is no specific prevention of juvenile arthritis, since medicine does not know the exact causes of this disease.

However, to reduce the risk of developing the disease you should:

if possible, reduce contact with patients with infectious diseases;
do not overcool;
get vaccinated in a timely manner and follow the rules for its implementation;
do not take any immunostimulants unless necessary and prescribed by a doctor;
lead a healthy lifestyle;
pay due attention to physical activity.

As you can see, juvenile rheumatoid arthritis is a rather dangerous disease that can lead to irreversible consequences and even disability. To avoid serious joint problems, children are advised to follow preventive measures. If an illness is detected, do not refuse complex treatment and supportive care.

Rheumatology is one of the fastest growing specialties, and successes in treating patients, including those with such a serious disease as juvenile idiopathic arthritis (JIA), are undeniable. Timely prescribed adequate basic therapy, including genetic engineering therapy, significantly reduces the activity of rheumatic disease, as a result, the condition of patients improves, the range of motion in the joints expands, which allows the child to lead an age-appropriate active lifestyle. Nevertheless, rehabilitation measures aimed at both improving the function of the affected joints and strengthening the child’s body as a whole and increasing his endurance are important for juvenile idiopathic arthritis. Therapeutic physical education (physical therapy) and other rehabilitation activities accustom the child to the need for constant exercise and help develop the correct stereotype of motor activity for life. However, at present there is not enough methodological literature devoted to the rehabilitation of children with rheumatic diseases; the available literature concerns mainly adult patients, so discussion of the problem is relevant and timely.

JIA is one of the most common and disabling rheumatic diseases in children. The incidence ranges from 2 to 16 per 100,000 children, and is more common in girls than boys. In the Russian Federation, the prevalence of JIA in children under 18 years of age reaches 62.3. The classification and nomenclature of JIA includes the identification of seven variants of the course of the disease (according to the classification of the International League of Associations for Rheumatology (ILAR)):

1) systemic arthritis;
2) polyarthritis: negative for rheumatoid factor (RF);
3) polyarthritis: positive for the Russian Federation;
4) oligoarthritis: a) persistent and b) spreading;
5) enthesitic arthritis;
6) psoriatic arthritis;
7) other arthritis that: a) does not meet any of the categories or b) meets the criteria of more than one category.

To date, the etiology of juvenile idiopathic arthritis remains unknown. The mechanism of development of the disease is based on the activation of cellular and humoral immunity, probably in response to the appearance of a foreign or altered self-antigen. As a result of complex interactions, activated T-lymphocytes, macrophages, fibroblasts, synoviocytes produce pro-inflammatory cytokines, causing a cascade of pathological changes with the development of progressive inflammation in the joint cavity. Uncontrolled reactions of the immune system lead to the development of acute immune inflammation with its transformation into chronic inflammation with the development of pannus and irreversible destruction of joint structures.

Articular syndrome is the leading symptom complex of all forms of idiopathic arthritis, and, from the point of view of rehabilitation, it should be assessed as a manifestation of maladaptation of the musculoskeletal system, in which the following typical pathomorphological processes are observed: inflammation, circulatory disorders, dystrophy and degeneration. As a result of these processes, pain, distortion, and deformation occur, leading to dysfunction of the joint. This pathological chain inevitably leads to a deterioration in the quality of life and disability of the child.

Rehabilitation, or restorative treatment of children, is a process that includes a set of measures. Rehabilitation measures are aimed at preserving the functionality of the affected joints and stabilizing the pathological process. In the rehabilitation of children, compliance with dietary recommendations is important; daily routine, physiotherapeutic methods of treatment; reflexology; Spa treatment.

Our publication focuses on kinesiotherapy methods, which occupy a central place in the physical rehabilitation of children with juvenile arthritis. By the term “kinesitherapy” we mean positional treatment (including orthotics), exercise therapy, massage, manual techniques, mechanical and occupational therapy.

Among the general recommendations, it should be noted that the child should sleep on a comfortable bed; an orthopedic mattress is preferable, not too soft, but not too hard. If the joints of the lower extremities and spine are affected, orthopedic shoes can be used, but, in any case, shoes with a hard back. Disability of our patients is often caused by damage to the joints of the hand. Therefore, it is necessary, with the help of doctors, exercise therapy methodologists, and parents, to form the correct stereotype of movements in the wrist joint to correct possible or existing ulnar deviation in it. So, you need to maintain a straight axis when performing all movements, including when performing physical therapy exercises (position on the edge of the palm), avoid positioning the hand towards the little finger. To prevent the formation of “swan neck” type deformities, it is recommended to reduce the load on the terminal phalanges - that is, a “cushion grip” is developed, thickened cone-shaped handles and pencils are used.

One of the key places in the rehabilitation of children with lesions of the musculoskeletal system is occupied by physical therapy. As a result of inflammation and painful sensations in the joints, a forced compensatory limitation of limb mobility occurs and, as a result, hypoxic and subsequently hypotrophic processes in the muscles. Exercises allow you to maintain and restore range of motion in affected joints, prevent the development of muscle wasting, and maintain muscle strength and endurance. Physical activity is a proven method of preventing osteoporosis, the risk of which is increased in patients with JIA. Also, exercise therapy in childhood stimulates psychomotor development, is an excellent means of distraction from illness, and is an element of psychotherapy.

When carrying out exercise therapy, the level of load is dosed individually depending on the functional and age capabilities of the child. It is advisable to carry out a set of exercises 2-3 times a day (by a methodologist and trained parents). The complex necessarily includes breathing exercises, as well as exercises for developing correct posture, strengthening the muscle corset, and activating large and small muscles of the limbs.

Exercise therapy has virtually no contraindications, with the exception of the period of high activity of JIA, accompanied by fever, other systemic manifestations of the process, severe pain, and pronounced humoral changes. In this situation, for the purpose of early prevention of the formation of contractures, the so-called. passive gymnastics, when work with joints is carried out by a physical therapy instructor or a trained parent; the range of motion in the joints is determined within the pain-free corridor. Passive gymnastics may also be necessary for young children if the child himself is not yet able to follow the instructions of the methodologist. The use of this method may be indicated in the case of active complicated uveitis in patients with JIA if joint development is necessary. According to individual indications, after performing a complex of passive gymnastics, treatment with a weighted position can be used.

Treatment with positioning using weights is also used in the presence of formed joint contractures. According to the method, the joint is brought to the “extreme” position in the direction of limited movement and a weight is fixed on it, the gravity vector of which coincides with the vector along which movement is limited. Depending on the age and condition of the patient, the lesson time ranges from 10 to 30 minutes 3-5 times a day. When performing this manipulation, a gradual slow passive stretching of the periarticular muscle-tendon apparatus occurs, which leads to an improvement in the motor function of the joint. However, according to the children's department of the Research Institute of Rheumatology, the use of weights (including “cuff traction”) has worked well for damage to the knee joint, but in the acute period it only worsens the condition of the elbow joint.

Orthosis is an important method of rehabilitation treatment for patients with JIA, the main goal of which is the correction of pathological deviations of the joints and the formation of their correct functional alignment. The use of orthoses during physical therapy exercises is especially effective for maintaining and consolidating the achieved results during the development of joints.

The orthosis mode and its use are selected individually in each case. Practice shows that the most “in demand” are orthoses for the wrist, knee, and ankle joints. If necessary, some orthoses can be worn at night.

It is recommended to wear a “Schanz collar” if the cervical spine is affected. The height of the treatment collar should be equal to the distance from the bottom to the top of the neck, that is, to the jaw in front and to the base of the skull at the back. It is recommended to wear the collar for a total of 1.5 to 3 hours a day, depending on the age and individual characteristics of the child.

The myofascial component has a certain significance in the formation of chronic pain syndrome and the development of pain contractures. Myofascial pain syndrome (MPS) is a myalgia manifested by local and/or referred pain, the source of which is the myofascial trigger point (MTP). MTT is a group of compacted, as if frozen muscle fibers, in which there is an area of intense pain. MTT is characterized by the presence of a constantly or not always palpable compaction (“cord” or “nodule”) within the muscle, as well as a sensory disorder, which most often manifests itself as pain. The mechanism for the appearance of MTT is believed to be irritation of sensitive nerve endings in joints, muscles and ligaments, which leads to chronic excitation of mechanoreceptors involved in the formation of pain, and physical and metabolic muscle tension occurs. The structure of muscle contraction changes, satellite trigger points are formed in the muscles that perform a compensatory function. An important part of stress is hypoxic (ischemic) damage. Trigger points can contribute to the formation of tendinosis due to disruption of the dynamics of muscle contraction, local overload of the tendon and the occurrence of relative hypoxia in these areas. This mechanism is also implemented in patients with JIA: when local pain occurs, the “muscle protection” mechanism is activated, and the resulting spasm leads to a decrease in motor activity. In a state of physical inactivity, conditions are created for ischemia of the muscular system, which is one of the prerequisites for the development of MBS. The pain syndrome can be “reflected” from spasmodic periarticular muscles and tendons: thus, according to our observations, when they are relaxed using manual techniques, pain in the joint area has a clear tendency to decrease. Manual influence on the area of the myofascial pain point in our patients leads to a pronounced softening of the dense cord and an increase in the pain threshold. It was also noted that with myofascial relaxation, in a large proportion of cases the severity of enthesopathies decreases. In order to correct the myofascial component of the pain syndrome, our patients use the post-isometric relaxation (PIR) method, as well as soft manual (osteopathic) techniques.

PIR is used in the presence of myalgic syndrome. By relaxing spasmed muscles, the ischemic component of the formation of MBS is eliminated, their blood supply is restored, and pain is reduced. In addition, PIR has proven itself well when working with joints in which restriction of movement has developed due to both severe pain and painless spasms of the periarticular muscles and tendons, as well as due to a decrease in the size of the joint space. The exercises are performed as follows: the patient moves towards the restriction to the “barrier”, then fixes the joint in this position for 1-2 minutes and relaxes the tension. The training regimen is selected individually and performed by a trained specialist.

In the case of multiple trigger points and the patient’s increased sensitivity to pain, it is possible to use osteopathic correction of myofascial tension. The actions are carried out with the lightest touches at the level of the muscle fascia, which makes it possible to achieve relaxation of the muscle-tendon system without causing pain. Typically, this technique is used 1-2 times, after which the patient is transferred to a combination of PIR + exercise therapy to establish positive feedback between one’s own work and the achieved result.

Osteopathic correction and PIR techniques are used both in the stage of remission and in the stage of clinical and laboratory exacerbation of the disease and can accelerate the reduction of pain, improve the well-being and motor function of the joints, and help prevent the formation of joint contractures. Unfortunately, these techniques are not always applicable to small joints of the hands and feet; they have proven themselves much better on large and medium-sized joints.

Manual massage is also included in the complex of rehabilitation measures for JIA. It prevents the increase in muscle hypotonia and malnutrition and is aimed at eliminating muscle imbalance in the periarticular muscles. Massage can be indicated at the stage of proliferative changes in the joints without exacerbation of the disease. Methods generally accepted in childhood are used. The joint area is not massaged. Massage is contraindicated for acute synovitis, febrile syndrome, serositis and visceritis, humoral activity above grade 1, and the presence of general contraindications (acute respiratory viral infections, skin diseases, etc.) is also taken into account.

Mechanotherapy is one of the methods of medical rehabilitation. It is based on the use of dosed movements performed by patients using special devices. The method is more suitable for older children. Contraindications for mechanotherapy are the presence of bone ankylosis, severe joint pain, severe muscle weakness, and impaired congruence of the articulating surfaces of bones.

Rehabilitation and treatment of our young patients is ultimately aimed at ensuring a high quality of their future life, adaptation to living conditions and future work. Occupational therapy, or “occupation therapy,” promotes integration into public life and socialization of children with juvenile arthritis. Occupational therapy is of great importance in cases of damage to the small joints of the fingers, allowing to slow down the progression of impairment of their motor functions. Modeling, beading, knitting, playing the piano, etc. are recommended. This method is also useful as a means of increasing general and mental tone, and allows the use of play techniques in younger children. Receiving the product of labor serves as an incentive for better performance of work and includes elements of competition and creativity. The correct stereotype of hand function developed in the process of occupational therapy is reinforced when performing everyday manipulations.

In conclusion, I would like to note that, despite all the successes of modern drug treatment of juvenile arthritis, physical methods of rehabilitation occupy an important place in the complex of patient management. The rehabilitation plan is drawn up individually, based on the problems of a particular patient, and not just on his diagnosis. Rehabilitation should be an activity not only for doctors and methodologists, but also for the patients themselves and their parents. The tactics of rehabilitation measures and the program should be drawn up together with them; with this approach, the patient becomes the central figure of rehabilitation treatment and an active participant in this process.

Literature

Konopelko O. Yu., Zholobova E. S., Rozvadovskaya O. S., Elyashevich V. Ya., Nikolaeva M. N. Etanercept in real clinical practice in the treatment of patients with active juvenile idiopathic arthritis) // Scientific and practical rheumatology. 2013, 51(1): 44-47.
Neroev V.V., Katargina L.A., Denisova E.V., Starikova A.V., Lyubimova N.V. The effectiveness of genetically engineered biological drugs in the treatment of uveitis associated with rheumatic diseases in children // Scientific and practical rheumatology. 2012, 53(4): 91-95.
Michels H., Nikishina I. P., Fedorov E. S., Salugina S. O. Genetic engineering biological therapy of juvenile arthritis // Scientific and practical rheumatology. 2011, no. 1, 78-93.
Zholobova E. S., Shakhbazyan I. E., Ulybina O. V. and others. Juvenile rheumatoid arthritis. Guide to pediatric rheumatology / Ed. N. A. Geppe, N. S. Podchernyaeva, G. A. Lyskina. M.: GEOTAR, 2011. P. 162-245.
Pediatric rheumatology: clinical recommendations for pediatricians / Ed. A. A. Baranova, E. I. Alekseeva. M.: Union of Pediatricians of Russia, 2011. 236 p.: ill.
Geppe N. A., Meleshkina A. V., Makarova M. R. and others. Physical rehabilitation of children with juvenile arthritis: a textbook for students of medical universities: local electronic publication. M.: Publishing house GBOU VPO First Moscow State Medical University named after. I. M. Sechenova, 2014.
Milyukova I. V., Evdokimova T. A. Therapeutic physical education: The newest reference book / Under the general. ed. prof. T. A. Evdokimova. St. Petersburg: Sova; M.: Eksmo Publishing House, 2003. 862 p.
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A. V. Meleshkina 1,Candidate of Medical Sciences
A. V. Bunin
N. A. Geppe,Doctor of Medical Sciences, Professor
S. N. Chebysheva,Candidate of Medical Sciences

GBOU VPO First Moscow State Medical University named after. I. M. Sechenova Ministry of Health of the Russian Federation, Moscow

Article publication date: 03/18/2014

Article updated date: 06/04/2019

Rheumatoid arthritis is characterized by joint deformation, limited mobility and the development of contractures (immobility). To reduce symptoms, treatment includes exercise therapy, massage, swimming and physiotherapy. Therapeutic exercise for rheumatoid arthritis is aimed at strengthening ligaments and muscles, increasing range of motion in joints and slowing down pathological reactions.

Indications and contraindications for physical education

Exercise therapy is indicated for almost all patients. With significant restrictions, it is possible to perform breathing exercises or positional treatment (more details -).

The main contraindications for prescribing physical education:

exacerbation of rheumatoid arthritis, accompanied by severe pain and inflammation;
systemic manifestations of the disease with serious damage to internal organs (vessels, kidneys, heart, lungs);
some concomitant chronic pathologies (infections, cardiovascular and respiratory failure).

Basic methods and stages of classes

All approaches to physical therapy for rheumatoid arthritis can be divided into three groups:

Individual classes are ideal for patients with the most severe stage of the disease, as well as for rehabilitation after surgical treatment.

Group classes are the most accessible and rational approach. Patients are grouped according to the degree of mobility limitation.

During consultations, patients are taught techniques and exercises that they can use at home.

The main condition for exercise therapy is regularity of classes and a systematic increase in load. Exercises should not be performed with force: after proper physical activity, the patient should experience an increase in strength and a decrease in stiffness.

During inpatient treatment, three periods of rehabilitation can be distinguished:

Preparatory, when the doctor teaches the patient relaxation and breathing techniques. The duration of these exercises is about 10 minutes, the duration of training is 1–2 days.

During the main period, a basic set of exercises is performed. Classes take place daily for two weeks, each lasting about half an hour.

The final stage is carried out before discharge: the doctor teaches the patient exercises that he can do at home.

Treatment by position

The “position” method of treating rheumatoid arthritis is also classified as exercise therapy and is used for severe lesions, when the patient is practically unable to move and is mainly in bed. It should also be carried out during periods of exacerbation of the disease.

What is its essence? The mattress on which the patient lies must be smooth and hard; it is advisable to use a special orthopedic one. The feet should have support; for this you can use either a moving headboard or a stand. You need to change your body position at least once an hour, if necessary with the help of another person.

If contractures begin to form, special splints (hard strips of plaster-impregnated bandages) are applied. If this is difficult to do, you can use rollers, weights and other devices. For example, if the hip joint is affected, a two-level mattress is made, allowing the leg to be extended in a relaxed position.

Hand exercises

In rheumatoid arthritis, the joints of the fingers are most often affected. Usually the hand takes on the characteristic appearance of a flipper, which leads to limited functionality and disability.

To reduce the strain rate it is advisable to:

do not move your fingers towards the little finger;
reduce the load on the fingertips;
when at rest, ensure the correct position of the hand;
write only with cone-shaped thickened pens;
perform everyday activities correctly: trying to ensure that the axis of movement in the joints does not deviate to the side;
at night, use orthoses - devices that limit mobility.

Here is one set of exercise therapy exercises for hand injuries:

Starting position: hands in front of you, next to each other. Alternately turn your palms up and down.

Place your hands on the table and raise and lower them first, and then only your fingers.

Stretch your hands clenched into fists forward. Rotate the brushes clockwise and counterclockwise.

Place your elbows on the table, clasp your palms, spread and bring your elbows together without lifting them from the surface.

Make up-down, left-right and circular movements with each finger in turn.

Touch each finger to the thumb, as if grasping something round.

Squeeze and unclench the soft ball in your hand, roll it over the surface.

Rotate your hands at the wrist joint, while trying to relax your palm.

Move your fingers along the stick from bottom to top.

Rub your palms together.

Each exercise should be performed 5–7 times, depending on the patient’s condition. There should be no pain during exercise.

Click on the picture to enlarge

Exercises for lesions of the shoulder girdle

Raise and lower your shoulders, make circular movements forward and backward.

Place your palms on your shoulders, alternately bringing your elbows forward.

Clasping your elbows with your palms, raise them and lower them.

Lying on your back, bend, raise and lower your straightened arms.

Place your hands on your belt and alternately place them behind your head.

Hug yourself.

During exercises, it is very important to maintain the correct breathing rhythm.

The above exercises are called dynamic, that is, related to the movement of the body in space. They are mainly aimed at restoring mobility and preventing contractures.

There is another type of load in which muscle work is not accompanied by movement of the limb, since it is fixed: isometric. Isometric exercise helps strengthen muscle fibers, even with severe mobility limitations. An example of such an exercise: lying on your back, press with straightened arms on the surface.

Leg exercises

Lying on your back, bend your leg at the knee joint without lifting the soles from the surface (sliding steps).

Exercise bike.

Move your legs bent at the knees to the sides and bring them back.

Swing with a straight leg while lying and standing, holding onto a support.

Circular movements in the hip joint with the leg bent at the knee.

Raising straight legs to the sides in a lying position.

Circular movements with a straight leg.

Isometric exercises are performed with the help of an assistant, who provides resistance and prevents the limb from moving.

Ankle exercises

With rheumatoid, it is not often affected, but its deformation quite quickly leads to limitation of movements and disability. To prevent contracture, it is recommended to perform the following complex:

While sitting, bend and straighten your feet and toes.

Roll from heel to toe and back.

Stand on your toes against a support.

Try to lift various objects from the floor with your toes.

Roll a stick or ball with your feet.

Walk across the stick, stepping on it with the middle part of the sole.

Make circular movements with your feet.

When performing any complex of therapeutic exercises, it is advisable to alternate isometric and dynamic exercises, breathe correctly, and at the end of the session, conduct a muscle relaxation session.

To increase the load, you can gradually increase the range of motion in the affected joints and the number of repetitions.

Exercises in water

Of all the sports, swimming is most suitable for the treatment of rheumatoid arthritis, since in water there is no stress on the joints due to the weight of the body. With a weight of 60 kg, completely immersed in water, a person feels only 7 kg. Therefore, exercises in the pool can be performed even by patients who practically do not move.

The intensity of the load is determined by the degree of immersion, which allows you to gradually restore motor activity. Higher water density requires greater effort to overcome resistance.

The temperature in the pool also has a positive effect: with thermal exposure, the pain syndrome is significantly reduced.

Contraindications to water activities:

open damage to the skin;
allergy to chlorine;
eye diseases (conjunctivitis);
lesions of the ear, nose and throat;
venereal diseases;
some chronic pathologies of other organs and systems.

In the pool you can perform the following complex:

Walking with straight and bent legs. It is advisable to spread your arms to the sides so as not to lose balance; if necessary, you can hold on to the support. The water level is adjusted depending on the required load.

Swing your legs back and forth, to the side, in circular movements.

Squats with legs wide apart (it is important to keep your back straight).

Having immersed yourself in water up to your neck, spread your straight arms to the sides and perform circular movements in the shoulder, elbow and wrist joints.

The swimming itself can be free or facilitated (using fins, special foam boards or inflatable objects). Depending on the goals pursued, you can increase the load on your legs or arms.

Functional motor test

Before the start of the rehabilitation period, the physical therapy doctor assesses the degree of damage to the patient’s motor system. To do this, you can use various tests, but the most popular is the functional motor study, which lasts only 5–6 minutes. The doctor asks the patient to perform various actions, for each of which a certain number of points is assigned. The test results allow you to objectively assess the dysfunction:

No functional limitations.
Maintaining professional ability to work.
The ability to work is completely lost.
Cannot take care of himself.

Based on the results obtained, patients are divided into groups and the optimal complex of exercise therapy is selected.

If you have rheumatoid arthritis, don’t give up on yourself. Start doing special exercises. Daily physical therapy exercises will tone your muscles, improve your well-being and increase your mobility. Before starting gymnastics, you should consult your doctor.

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Introduction

Sports medicine is part of general medical science, part of clinical medicine and includes everything that should ensure the improvement of the health and functional state of both healthy and sick people through physical activity. Therefore, the definition also mentions physical inactivity, the study of the influence of which is the prerogative of sports medicine. This is necessary, firstly, because it is impossible to study the effect of intense physical activity without simultaneously studying the effect of physical inactivity; secondly, because the number of people with the so-called detrained heart in modern society is growing and it is necessary to be able to dose them with physical activity; thirdly, because certain periods of artificially created physical inactivity in athletes can have a positive effect on the growth of sporting achievements in the future (A.G. Dembo).

It is also essential in the definition of sports medicine that it studies not only the positive, but also the negative effects of physical activity, which is possible with its irrational use. This understanding of sports medicine requires a revision of the concept of medical supervision. The official formulation reduced this concept only to the study of health and fitness in order to promote the intensive use of means and methods of physical education to improve health, physical improvement and achieve the best sports results. And this was true in the first stages of the development of the physical education movement in our country. The most acute and main problem of sports medicine at that time was the organization of medical supervision over those involved in physical culture and sports [Graevskaya N.D., 1995]. It was understood that the object of study, i.e. an athlete is always healthy, since sport and health are synonymous (A.G. Dembo). Therefore, at present we should talk not so much about medical control, but about a broad system of medical observations of athletes and people involved in recreational physical education.

1. Brief historical outline of the development of therapeutic physical culture and sports medicine

Development of physical therapy (physical therapy). In Russia, movements for therapeutic purposes began to be used in the 16th-17th centuries, and already in those days they used a combination of movements with thermal procedures for traumatic injuries. At the end of the 18th century. Many scientists and public figures (M.V. Lomonosov, A.P. Protasov, S.G. Zybelin, etc.) in their works developed the preventive direction in medicine, assigning a significant role to physical exercise in the fight for the health of the growing generation. Among the scientists of that time, the founder of the Russian therapeutic school, M.Ya., was well known. Mudrov, who advocated the use of physical exercise and labor for therapeutic purposes. N.I. Pirogov was also a supporter of this trend, recommending the use of special exercises after gunshot injuries.

A significant role in the dissemination of knowledge on therapeutic gymnastics (TG) and massage in Russia belongs to G.K. Solovyov, E.N. Zalesova and others.

In the works of P.F. Lesgaft provides scientific justification for the use of physical education means for therapeutic purposes, emphasizing the importance of their preventive value. However, under those conditions, LH, pursuing the goal of a comprehensive health-improving effect, could not find full development. It was used only in the form of mechanotherapy and corrective gymnastics.

Physical therapy was first introduced in sanatoriums and resorts in 1923-1924. In 1926 I.M. Sarkizov-Serazini (1887-1964) organized the first department of physical therapy, where most of the first doctors and candidates of science in this field were trained, among them V.N. Moshkov, V.K. Dobrovolsky, D.A. Vinokurov, K.N. Pribylov and others. Much credit for the development of exercise therapy belongs to the first People's Commissar of Health N.A. Semashko (1874--1949). On his recommendation, since the early 30s, exercise therapy departments and rooms have been opened in physiotherapeutic and trauma research institutes, exercise therapy departments in advanced training institutes for doctors and some medical universities, where methods of its use for various diseases have been developed.

The wealth of experience gained during the Great Patriotic War made it possible to significantly expand the scope of exercise therapy in the post-war period. Currently, physical exercises and massage as one of the main means of treatment are used in hospitals, sanatoriums, clinics, and resorts.

Increased attention to the role of the nervous system in the pathogenesis of diseases has created the prerequisites for the use of exercise therapy for such diseases of the cardiovascular system as hypertension, chronic coronary insufficiency and myocardial infarction (A.A. Leporsky, V.N. Moshkov, V.K. Dobrovolsky, I I. Khitrik, I. B. Temkin, etc.).

The development of surgery has raised the problem of dealing with postoperative complications with particular urgency. Despite the fact that medicine in the 30s-50s did not yet have experimental data on the negative effects of physical inactivity, many surgeons came to the conclusion that the main cause of most postoperative complications was abuse of rest. Analysis of the causes and mechanisms of complications in the first days after surgery, early postoperative gymnastics, improvement of its methods and evidence of the high effectiveness of exercise therapy have convincingly proven the advisability of using physical exercises, starting from the first hours after surgery (P.I. Dyakonov, P.A. Kupriyanov, V.K. Dobrovolsky and others).

An analysis of the effectiveness of exercise therapy in thoracic surgery showed that the success of the operation largely depends on the full use of physical exercises for therapeutic purposes. The PH technique was developed in detail both in the preoperative and postoperative periods (V.K. Dobrovolsky, E.I. Yankelevich, V.A. Epifanov, etc.).

The success of the use of physical exercises in traumatology, orthopedics, and neurosurgery is striking. Compensation and sometimes elimination of severe disorders of various functions after injuries to the musculoskeletal system, brain and spinal cord and peripheral nerves became possible only thanks to the timely and full use of exercise therapy in the complex treatment of victims (V.V. Gorinevskaya, E.F. Dreving, Z.M. Ataev, A.F. Kaptelin, V.A. Epifanov, V.L. Naidin, etc.).

The intensive development of abdominal surgery, joint surgery, urology, operative gynecology, and dental surgery has made it possible to significantly improve exercise therapy methods and expand the indications for their use (A.A. Sokolov, D.N. Atabekov, K.N. Pribylov, I.G. Vasilyeva, A.I. Zhuravleva, F.A. Yunusov, etc.).

A distinctive feature of the development of exercise therapy at the present stage is the increasing role of physical rehabilitation in the system of rehabilitation treatment of patients. This determined the main directions of exercise therapy: scientific justification and development of new methods of exercise therapy in the complex treatment of patients with diseases of the cardiovascular system, respiratory organs, diseases and injuries of the abdominal cavity and pelvic organs, with injuries and diseases of the central and peripheral nervous system, with diseases and injuries locomotor system, as well as after surgical interventions.

Scientific research is characterized by an in-depth study of the mechanism of action of differentiated methods of rehabilitation therapy (physical exercises, position correction, traction treatment, massage, etc.) in the treatment of patients at the stages of rehabilitation: inpatient - outpatient - sanatorium-resort after-care. The complex use of exercise therapy for various diseases and injuries is carried out on the basis of studying changes in the body's immune system and metabolism, testing the patient's physical performance using various methods of monitoring the functional state of the body during physical activity. Physical activity programs have been created, methods of medical supervision have been developed in the process of raising children (preschool age, schoolchildren) and students, and when the adult population engages in mass forms of physical education. The programs are based on an analysis of the mechanisms of adaptation of people of different gender, age, and professional background to physical activity of varying volume, intensity and direction, taking into account the level of physical performance, functional state and health criteria.

Exercise therapy occupies a worthy place in modern medicine, reflecting its preventive orientation and the task of fully restoring the health and working capacity of a sick person.

2. Development of medical supervision

One of the fundamental principles of the physical education system is its health-improving orientation. Medical control (MC) during physical exercise is intended to contribute to the implementation of this principle. VC is considered as a state system that ensures the correct use of physical culture and sports for the improvement of the population.

The theoretical foundations of VC in Russia were laid by the works of P.F. Lesgaft and V.V. Gorinevsky, and the first VK classrooms began to be created in the 20s at the Main Military School of Physical Education and the State Central Institute of Physical Culture. The first head of the department, and then the department of computer science, was V.V. Gorinevsky (1923).

In 1925, the first “Guide to Medical Control” was published (V.V. Gorinevsky, G.K. Birzin); a little later - other methodological developments and instructions.

The first extensive experience in medical support for mass competitions was gained at the 1st All-Union Spartakiad in 1928, when the indications and contraindications for physical exercise were first substantiated, and evaluation tables and standards were developed to take into account the effect of physical activity on the body.

In 1930, the Presidium of the Central Executive Committee of the USSR adopted a resolution, according to which the health authorities were entrusted with the management of the VK and sanitary supervision of places of physical exercise. This was the first state act that laid the fundamental foundations of the system of medical support for athletes and athletes - the implementation of the thesis of the first People's Commissar of Health N.A. Semashko: “Without medical supervision there is no Soviet physical education.”

The further development of VK is associated with the names of Z.P. Solovyova, B.A. Ivanovsky, V.E. Ignatieva and others. The introduction of the All-Union complex “Ready for Labor and Defense of the USSR” was the basis for the development of VC methods for mass examinations of athletes and athletes, the principles of rationing physical activity for people of different ages, gender and level of physical fitness. Systematic training of personnel began at the departments of medical institutes, VK laboratories were opened in different cities of the country, where scientific research institutes of physical education functioned (Moscow, Leningrad*, Kharkov, Tbilisi). By the beginning of the Great Patriotic War, a wide network of VC offices had been formed at sports facilities and educational institutions.

The leading role in the development of VC was played by the laboratory at the Central Research Institute of Physical Culture (TsNIIFK), led by S.P. Letunov, rightfully considered the founder of modern sports medicine. He not only formulated its methodology and main directions of research, but also laid the foundations for the leading branches of sports medicine. In the 40s, the first “healthy person clinic” was created at the Central Scientific Research Institute of Physical Culture - a hospital for athletes.

The development of VC as a scientific and practical discipline, its increasing role in solving problems of physical culture and sports led to the fact that in the early 70s the term “medical control” was replaced by the name “sports medicine”, which more broadly reflects the content of this section of scientific research . To date, a medical specialty has been defined - “physical therapy and sports medicine.”

In 1971 - 1985 was organized by the Research Institute of Medical Problems of Physical Culture of the Ministry of Health of the Ukrainian SSR (Kyiv). In 1986, the Institute of Medical and Biological Problems of Sports was separated from the All-Union Scientific Research Institute of Physical Education, in which a doping control center was opened.

With national teams in various sports, a new organizational form of work has emerged - complex scientific groups on VC, which include sports doctors, coaches and researchers.

Currently, there are 5 main areas in sports medicine (SM), which are represented both in elite sports, recreational physical education, in classes with children, and in VC for physical education according to state programs, in individual and group classes.

The main directions of the SM: 1) dispensary examination of the relevant contingents; 2) in-depth medical and biological examinations (IBI); 3) medical and pedagogical observations; 4) clinical issues of sports medicine; 5) medical support for sports competitions.

Each of these areas has its own characteristics and differs in methods and methodological approaches.

Scientific and practical aspects of SM concern not only sports, but also physical culture and physical education. Accumulating material about the range and variants of the so-called norm in different conditions of the organism’s existence, about its functional reserves and adaptive capabilities when increased demands are placed on it, about the borderline states between norm and pathology and early manifestations of functional disorders, often not yet recorded in clinical practice, SM made a significant contribution to the creation of the science of a healthy person, the theory of adaptation, and thereby to the development of many theoretical and clinical medical disciplines.

3. Characteristics of rheumatoid arthritis

Rheumatoid arthritis is one of the most common diseases, and its incidence has increased over the past 50-60 years.

The etiology of rheumatoid arthritis is unclear. The alleged connection with an infectious pathogen (mycoplasma, molecular components of microorganisms with antigenic properties, persistent viruses, primarily rubella and Epstein-Barr viruses) does not currently have sufficiently convincing justification.

It is most likely that various damaging factors of the internal and external environment (and more often their combination) lead to disruption of immune homeostasis with subsequent damage to connective tissue and its derivatives.

Some importance is attached to genetic factors.

Pathogenesis. One of the leading links in the development of the disease is a primary (congenital or acquired) defect of immunity, leading to a weakening of immune control and the occurrence of pathological immune (autoimmune) reactions. Perhaps the damaging effect of an unknown factor on the synovial membrane is important. Most often, in rheumatoid arthritis, antibodies are formed to the c-fragment (Fc) of immunoglobulin G - rheumatoid factor.

Autoantibodies and the immune complexes formed with their participation (antigen + immunoglobulin + rheumatoid factor + complement) cause a number of pathological reactions, often acquiring a chain (continuous) character. In this case, damage to cell lysosomes occurs with the release of active pro-inflammatory substances, stimulation of phagocytosis, activation of inflammatory mediators (kinins, serotonin, histamine, etc.), activation of the blood coagulation system. Such interconnected reactions take place primarily in the synovium, but also outside the joints, especially in the vessels. Thus, the disease often acquires a systemic character from the very beginning, which is not always clinically obvious.

Predisposing factors in the development of rheumatoid arthritis include constitutional and genetic characteristics of the body, disorders in the pituitary-adrenal system, and changes in neurotrophic processes.

Rathomorphology. In the initial period, damage to joint tissue is noted in the form of acute or subacute synovitis with pronounced exudative alterative changes (hyperemia, edema, infiltration of leukocytes, serous effusion into the joint cavity). The inflammatory process subsequently spreads to the joint capsule and soft tissues of the joints. Exudative changes are soon replaced by proliferative ones with the formation of microvilli, lymphoid infiltrates, a network of vessels, and granulations. The growing granulation tissue (the so-called pannus) penetrates the cartilage and destroys it, then the epiphyses of the bones are involved in the process. In the periarticular tissue, the fibrotic process often occurs with the formation of rheumatoid nodules.

The progression of the fibrosclerotic process leads to the development of subluxations and dislocations, contractures with limited joint function, and ankylosis (fibrous and then bone). Along with changes in joints, processes of disorganization of connective tissue and changes in blood vessels are observed in many organs and systems.

Clinic. In most cases, the disease begins acutely or subacutely.

As a rule, symmetrical damage to the proximal interphalangeal joints of the hands and feet is initially observed. Then larger joints are involved: wrist, ankle and, finally, knee, shoulder, hip. Often large joints are affected from the very beginning. There is a moderate enlargement of the joint, an increase in local temperature, hyperemia, and pain on palpation.

4. Rheumatoid arthritis and exercise

Special exercises can provide pain relief and strengthen the muscular system.

When your joints are stiff and painful, exercise is the last thing on your mind. However, with rheumatoid arthritis, regular exercise is one of the most effective ways to maintain joint mobility and overall tone.

· People who exercise live longer, regardless of whether they have rheumatoid arthritis or not.

· Regular exercise can actually reduce the pain of rheumatoid arthritis.

· Exercise strengthens bones. Thinning bone tissue becomes one of the most serious complications of rheumatoid arthritis, especially if you require regular steroid medications. Exercise helps strengthen bone tissue.

· Exercise maintains muscle strength.

· Regular exercise improves the functional activity of joints, reducing your dependence on others.

· People with rheumatoid arthritis who engage in exercise therapy feel better and are more able to overcome various life challenges.

How safe is exercise for rheumatoid arthritis?

Is exercise safe? Yes, certain types of exercise are appropriate for people with RA. There are three types of such exercises, including stretching, strength exercises and general strengthening exercises.

· Stretching exercises are the easiest to perform. They consist of stretching and holding various groups of joints and muscles in position for 10-30 seconds. Stretching exercises improve flexibility and are a daily part of any exercise program.

· Strength exercises involve muscles resisting loads. Exercises are performed both with and without weights. Resistance exercises strengthen the muscular system and increase range of motion.

· General strengthening physical exercises, or aerobics, improve the functioning of the cardiovascular system. Aerobics has many benefits! These exercises strengthen blood vessels, prevent disability, and improve mood and well-being. Low-impact exercises such as walking, swimming, cycling or using an elliptical machine are effective for people with rheumatoid arthritis. All these exercises improve heart function.

After the doctor analyzes your condition, you will begin to perform moderate-intensity exercises daily for 20-30 minutes for as long as you feel strong. It’s good to exercise as long as possible, but periodic exercise is still better than no exercise at all!

What exercises are contraindicated for rheumatoid arthritis?

What exercises should you avoid if you have rheumatoid arthritis? In general, you need to be careful when performing high-intensity exercise, such as:

· Jogging.

· Lifting weights.

This does not mean that these types of physical activity should be completely excluded. If you are interested in participating in these sports, consult your doctor.

Your rheumatologist will help you create an optimal exercise program. You will also need to take advice from a physical therapist. The physical therapist will determine the areas you need to work on, prescribe appropriate exercises, and indicate the intensity of the exercises.

Before you begin, you should make a plan with the help of your healthcare team, especially if you have other health problems.

By exercising regularly, you will realize the benefits of exercise and learn to control the progression of rheumatoid arthritis. As a result, both the functions of your joints and your general condition will improve.

5. Basic means of therapeutic physical culture

The main means of therapeutic physical culture are physical exercises and the natural forces of nature. Physical movements, as having a comprehensive impact on the sick body, systematically used for preventive and therapeutic purposes, represent the main and main therapeutic factor in physical therapy.

A feature of physical exercises used in physical therapy, which distinguishes them from movements used in work and everyday life, is their therapeutic, pedagogical orientation.

Among the physical exercises used in physical therapy, the dominant position is occupied by gymnastic exercises, applied exercises, games and sports exercises.

The unity of the entire process of treating a patient by means of physical therapy is carried out by the use of all its means, the influence of which on the body is closely intertwined in harmonious interaction, according to the basic principle of medicine - to treat the whole sick person, and not just one pathological process.

For this purpose, mainly gymnastic exercises are used for individual diseased areas of the body, which have a special effect and are widely used in surgery, orthopedics, gynecology, in the fight against obesity, etc., and exercises of the so-called medical gymnastics - active, passive to resistance exercises, mechanotherapy and massage.

Specific exercises are usually combined with exercises that affect the entire body. Of great importance in the overall impact on the body or on individual organs and systems, on peripheral blood circulation, etc. are breathing exercises, serial, preparatory exercises, exercises for coordination of movements, exercises in balance and resistance, hangs and supports, throwing exercises, jumping, as well as exercises with objects and on apparatus.

Physiotherapy exercises, to varying degrees, also use walking, running, climbing, swimming, all types of sports and applied exercises, walks, excursions, climbing and especially games, including sports.

The possibilities of physical therapy are not limited to these means. In a number of cases, any method, any event that can have a positive effect on restoring the function of a diseased organ, speed up regeneration processes, and contribute to solving the problem of returning the patient to work as quickly as possible has the right to be included in physical therapy.

The simplest methods of self-assessment of performance, fatigue, exhaustion and the use of physical education means for their targeted correction.

The scientific and technological revolution in modern production has significantly changed the structure of human professional activity. The level of physical activity has decreased significantly, and work has become predominantly mental in nature. However, automation of production, significantly influencing the content of labor and facilitating its physical side, at the same time sharply increased the requirements for the human operator, synthesizing in his activities many labor processes that were previously separated.

In addition, the professional activity of a modern person (both physical and especially mental) is almost always accompanied by some neuropsychic and emotional stress, often associated with physical inactivity, long-term maintenance of a forced monotonous working posture, with a high proportion of static physical activity, exposure to extreme factors, constituting the specifics of production conditions.

The concept of “performance” can be formulated as follows: a person’s ability to perform precisely defined specific work for a long time without reducing its quality and level of productivity. Each person’s performance is different and depends on age, health, physical strength, psychological attitude, work experience, and training.

The performance of work is preceded by the so-called pre-start or pre-work period, which ensures a certain psychological preparedness of the human body to perform a particular practical activity. The pre-working period is followed by a period of workability, during which all body functions associated with providing energy costs to perform work reach an optimal level. This is followed by a period of a stable state of high performance, during which the optimal mode of activity of all systems (nervous, circulatory, respiratory, etc.) that ensure the performance of work is established. In a state of fatigue (sometimes at the end of the working day), there is a period of “final rush” - increased performance, which is caused by the desire to finish work quickly and the emotional uplift in connection with the end of the shift and the anticipation of rest.

Fatigue is a physiological condition, reversible, in other words, normal for any organism (if, of course, it is compensated by rest).

If a person did not rest enough and began to work when fatigue had not yet passed, he may develop overwork. Overwork can be prevented by observing several prerequisites:

1. when starting any work, you need to get into it gradually;

2. in any type of activity it is necessary to observe a certain sequence and systematicity;

3. you should correctly alternate between different types of work, work and rest;

4. There must be a favorable attitude towards the work of both the person who works and society.

THEM. Sechenov found that the consequences of fatigue are eliminated faster if a person after work does not rest passively, but involves muscles that did not actively participate in the main work into an active state.

This principle underlies industrial gymnastics, which, unfortunately, is not carried out in all organizations. It consists of introductory gymnastics (at the beginning of the working day), physical education pause (during the working day) and restorative and preventive gymnastics (for post-work recovery). The most widespread are introductory gymnastics and physical education breaks. Introductory gymnastics is carried out for 5-7 minutes before starting work. A physical break should be taken 1.5-2 hours before the end of work, when fatigue is felt most acutely. The physical education break lasts 7-10 minutes. Restorative and preventive gymnastics is one of the main means of preventing occupational diseases. Along with general developmental exercises, it is necessary to use special breathing exercises.

Special studies have established that even with significant fatigue, one or two days of passive rest are enough, after which it plays a negative role, relaxing the body. And this is where physical education comes to the rescue. It is physical exercise that is considered by modern physiologists as a means of active recreation and restoration of the tone of the nervous system. For heavy physical labor associated with significant neuromuscular tension, gymnastic exercises with stretching elements, swimming, walking, and sports games that do not require significant muscle loads are preferable.

For mental workers, rest, on the contrary, should be aimed at strengthening the body, combating hypokinesia, and include significant muscle effort. This includes running, sports games, tourism, cycling, skiing, physical labor, and physical training classes. For people whose work takes place indoors, outdoor recreation is of particular importance - skiing, rowing, swimming in natural reservoirs, gardening and field work, outdoor sports games.

If the work involves monotony of operations (conveyor production), it is preferable to have recreational activities that are carried out at different paces, varied in their effect on the body and are emotional in content: sports games, attractions, dancing, rhythmic gymnastics, gardening work.

And women always need to pay great attention to strengthening the muscles of the torso, especially the abdominals and pelvic floor.

Unfortunately, cases of people becoming overworked have become more frequent. And such common attempts to explain this by a lack of time for leisure are just an excuse: a person’s non-working time accounts for more than 30% of the day. In addition, 104 days off with a 5-day work week means almost five additional annual vacations. How can one not recall the fair words of N.M. Amosov that we are increasingly sick not from a lack of food or comfort, but from their excess. In his opinion, only 1-2% of the population take their health seriously. It's a pity! After all, even very busy people, if they really want to, can always find time for active recreation. In short, to avoid overwork, you need to learn how to properly (actively) rest.

6. A set of physical therapy exercises

It is advisable to do the exercises in a spacious, ventilated room with a large wall mirror and a mat for exercises performed while lying down. The complex consists of several parts: warm-up, exercises lying on your back, lying on your stomach, and standing. Rest between exercises is done in the starting position (i.e., if the exercise is lying on your back, we also rest in this position, there is no need to get up or sit down).

1. Unloading the spine. All exercise therapy exercises traditionally begin with exercises to unload the spine. A classic exercise is walking on all fours. Duration of execution is 2-3 minutes.

We lie down on the mat on our backs. Back exercises are primarily designed to strengthen the abdominal muscles.

2. "Stretching" the spine. Lying on your back, stretch your heels “down” and the top of your head “up”. We perform 3-4 “extensions” for 10-15 seconds.

3. Bicycle. Lying on your back, hands behind your head or along your body, with your legs we make movements that imitate riding a bicycle. Important: most of the amplitude of leg movements should be “below” the body, there is no need to dangle your legs above your stomach, you need the straightened leg to alternately pass close to the floor. The pace of execution is average. We perform 2-3 approaches for 30-40 seconds.

4. Scissors. Lying on your back, arms behind your head or along your body, we perform cross horizontal and vertical leg swings. Important: it is advisable to perform horizontal swings closer to the floor. The pace of execution is average. We perform 2-3 approaches for 30-40 seconds.

Now we turn over onto our stomach. Abdominal exercises are mainly designed to strengthen various back muscles.

5. "Extension." Performed similarly to exercise 2, only on the stomach.

6. Swimming. Starting position: lying on your stomach, legs straight, head resting on the back of your hands. We bend in the lower back (head, upper torso, arms and legs raised, fulcrum - stomach). While holding this position, we perform movements that imitate breaststroke swimming:

Hands forward, legs spread apart,

Arms to the sides, legs together,

Hands to shoulders, legs still together, etc.

We perform 2-3 sets of 10-15 repetitions with a short rest between sets (5-10 seconds)

7. Scissors. Lying on your stomach, legs straight, head resting on the back of your hands. We raise our legs and perform cross horizontal and vertical leg swings. Important: when performing this exercise, your hips must be lifted off the floor. The pace of execution is average. We perform 2-3 approaches for 30-40 seconds.

8. Retention. Lying on your stomach, legs straight, head resting on the back of your hands. We raise our legs and upper torso, bending at the lower back (head, upper torso, arms and legs raised, fulcrum - stomach). Feet together, arms to the sides, palms turned up. We statically freeze in this position for 10-15 seconds. Important: it is advisable not to hold your breath; when performing this exercise, your hips must be lifted off the floor. We perform 3-4 repetitions with a short rest between repetitions (5-10 seconds).

Now let's get up.

9. Arm rotation. Exercise for scapula fixators. Standing in front of a mirror (controlling your posture), elbows to the side, fingers to your shoulders. Rotate your arms backwards (clockwise). Important: this exercise does not require a large amplitude of movement; on the contrary, the elbows should rotate in a small circle. The pace of execution is slow. We perform 2-3 approaches of 20-30 seconds with a short rest between approaches.

10. Squats. Exercise for posture. Standing in front of the mirror (controlling your posture), arms to the side, palms turned up. In this position, maintaining good posture, we stand on our toes, then squat, again on our toes and back to the starting position. We perform 5-10 such squats with a short rest. The pace of the exercise is slow.

Bibliography

rheumatoid therapeutic physical arthritis

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2. ZatsiorskyV. M. Fundamentals of sports metrology.-- M.: Physical culture and sport, 1979.--152p.

3. Theory and methodology of physical education volume 1 / Ed., Krutsevich T.Yu. - K.: Olympic Literature, 2003. - 424 p.

4. Theory and methodology of physical culture / Ed., Yu.F. Kuramshina, V.I. Popova. - SPb.: SPbGAFK im. P.F. Lesgafta, - 1999. - 374 p.

5. Sergeev, V.N. Do you know how to relax / V.N. Sergeev. - M.: Knowledge, 2001.

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