What modern therapy and how it differs from conventional physical therapy, is it possible to do through the pain, for whom therapeutic exercise should become a way of life, and why start the day with morning exercises, told Mednovosti Methodist physical therapy FSBI “Scientific research Institute of rheumatology named after V. A. Nasonova” Sergey kuzyakov, Olga Kondrashova.
Now there are many new Wellness techniques, such as, Pilates. But you are the representatives of a conservative system of exercise, which came to us from the Soviet past?
Olga. Pilates sounds more modern, and, of course, is used as a promotion move. There is even an anecdote. Meet two friends, asking each other who where in a hurry. One said that Pilates. “Super, you’re such a badass! – meets another. I LFK”. – “Physical therapy? Yes, you smell of mothballs!”. In the end both come to the same door.
Sergey.Pilates is the same exercise therapy. And even though the abbreviation is, indeed, preserved from the Soviet time, I can proudly say: “physical therapy”. Because there’s no other way to say. This medical and physical.
Olga. And culture.
Sergey. Modern gymnastics is a very complex discipline that is based on the physiology of muscular activity, neurophysiology, biomechanics . Using the methodology and concepts of physical therapy I can take apart any motor in the process – from ballet to yoga, to accurately determine the movement type, location, frequency, amplitude. As for the Pilates, its author, is engaged in martial arts, yoga, gymnastics has developed, which put on the feet of wounded soldiers during the first world war. Creative people, Joseph Pilates created a system that gives real results are very interesting, and many perceive it with pleasure. When I analyze this system, understand what the principles of exercise here are the same as in gymnastics. Many of the same elements we use in our practice. And of course we recommend: “for God’s sake, do Pilates”.
Olga. Key word “do”. Pilates, Nordic walking. The main thing – move!
And start the day with morning exercises?
Sergey. Morning hygienic gymnastics is the transition the body from sleep to wakefulness. Unfortunately, this concept is also altered. But for many people, especially for our patients is a vital thing! The highest level of inflammatory process is achieved from 3 to 5 o’clock in the morning the person feels stiffness, remove that can only gymnastics. And the sooner we do that, let’s get those on the immobilization of joints.
Who needs physical therapy? Or easier to say who doesn’t?
Sergey. It’s the most natural form of healing, so now the surge of the fitness movement. After 30 years in humans, every ten years there is one chronic disease. That is, 50 of them already, at least two. And the movement is a natural biological stimulator just in the body. 70% of our body consists of muscles, and if muscles are working actively occurring metabolic processes, and runs all: cardiovascular, nervous, endocrine system.
In medicine physical therapy is applicable everywhere, except in extreme cases when a person requires resuscitation and intensive therapy. For example, after a stroke or myocardial infarction to do on the second day. Of course, within certain limits. But, when the patient consciously turned his head, focusing on the turn – this is physical therapy. Even while on bedrest, you can perform isometric exercises, breathing exercises, exercises that support peristalsis.
But the most important thing physical therapy is still in diseases of the musculoskeletal system, when people from the pain of the fear and make a move and exacerbate his condition?
Sergey. The question here is not of the importance to be consistent. For example, after six months of rehabilitation, after heart disease, when the heart has adapted to new conditions, people may even quit gymnastics. And for the person with the disease of musculoskeletal system is a continuous process, every day he needs to roll uphill this Sisyphean stone. Do exercises that perform the draining function removes excess swelling in the joint, strengthen the temporarily weakened muscle. Some exercise is needed every day, some twice a week, but it all runs in cycles throughout life. It is a continuous process, like breathing.
For example, if a small (5-6 mm) of intervertebral hernia, if wisely used therapy from the point of view of a new dynamic stereotype, equipment movements, the person adapts well to this condition and avoids the onset of pain. In rheumatic diseases the main problem is that the place of attachment of muscle to bone begins to become inflamed, and this pain does not give to move actively. But everyone knows that if a joint is to close for six months in a cast, it will cease to function, without motion degenerative changes in the joint are very fast. And the pain just becomes the cast.
And people have to overcome this pain?
Sergey. In any case! Light pain during the exercise is permitted in ankylosing spondylitis. But this disease has its own characteristics, in particular, involves increased physical activity, including sport. It stimulates the body’s output, for example, endorphins and the hormone cortisol, which have a pronounced anti-inflammatory action. And in rheumatoid arthritis pain when you exercise can lead to its strengthening and the formation of contractures (when the muscle spazmiruyutsya, and movement is impossible). In this disease, many patients experience fear, and this is natural: when people a long time hurting, he is lost, trying not to do a lot of household traffic. And we must teach it this movement that will not harm him, to recommend those exercises that will allow you to change the condition inside the joint, inside the spine. That’s what gymnastics differs from conventional gymnastics.
That is, just find some exercises on the Internet is useless, and even dangerous?
Sergey. Yes. There are many different nuances – a little different turned the brush to the side, straightened her back, in a special way, left foot, and you get a lot of effort, for example, at the place of attachment of ligaments to the sacrum. To ordinary movement became health, you need to follow a number of conditions. First, it is necessary to know how a specific exercise works on a specific area of the body. Secondly, one must understand the structure of their pathology at the level of the muscles, ligaments, vertebral body. And third, learn exercises you still not on visual but on the physical level. This is achieved when a person performs exercises under the guidance of an instructor who shows up and corrects it during this movement.
Olga. Our work is plus, to a large extent creative – must be able to improvise, it is impossible to adjust one hard method at all. Every patient is different.
Sergey. And the task of the specialist of physical therapy to determine a person’s individual dose of stretching, heartfelt at its physical level, because everyone has their own level of barrier elastic cords. To obtain a therapeutic effect, you need a certain way to a certain force to pull, to strain a muscle or pull a ligament. Will not reach the receptors in the ligaments don’t work, chip away – get the pain.
In addition, when the disease the person for life, it must adapt. By changing the technique movement, moving, avoiding the sore spot, people may behave in society as if he doesn’t have this disease is to go to work, accomplish some household functions, workflows. And this he also needs someone to teach, and often to persuade. Unfortunately, the world experience shows that active patients only 10-15%, the rest are passive, and we need to motivate them to regular classes. And to debunk the depressing “I have nothing to help”. It turns out that the experts in physical therapy working at the intersection of three disciplines: clinical medicine, pedagogy and psychology.
Where are taught by experts in physical therapy?
Sergey. There are several possibilities. For example, refresher courses (a total of 288 hours) for nurses. Of course, this is not enough and requires a few years of practical work to gain experience, in order to experience the subtleties of this profession. In addition, in the institutions of physical education there is such a section, as adaptive physical education, which deals with issues of physical therapy. These professionals previously were widely used in medicine, now increasingly they put bureaucratic obstacles due to the lack of medical education. Although this specialty studying biomedical discipline level of anatomy, biomechanics, physiology of muscular activity. There are still doctors, physiotherapists, specialists with higher medical education.
Olga. But even in medical schools so don’t teach the same biomechanics as physical institutions, where it is in depth study for four years. They have more clinics and less physiology, that is, ideas about how to deliver the exercise, what number of reps.
Sergey. The problem is that we have no such class professionals in the West – the physiotherapists, who study and clinic, and methodology. Therefore, doctors and trainers should work together. But, unfortunately, not enough of the other is not, especially little left doctors.
Optimized? But them before the vast number of patients never seen.
Sergey. Unfortunately, today the availability of therapy to patients is very low. I worked for 20 years at the head of rheumatologic Institute, we have a large flow of patients. But if earlier we had 12 instructors, physiotherapists, now there are 4. If previously the patient was supposed to 15 treatments, now OMS allows only 7. For each procedure you have to fill out a piece of paper and God forbid you deviate from this norm. And on the periphery and in other hospitals, the reduction of offices and specialists in exercise therapy in General has assumed catastrophic dimensions. At the same time decreased activity of information exchange, there are fewer courses.
Olga. This optimization eventually turns into big losses. For example, in neurology rehabilitation has always been a shock link. If six months after a stroke the person is not recovered, then already the odds quite a bit. Now by the standards of the OMS patient with a stroke 14 days lying in the hospital, and then home. And relatives struggling for months that the patient was in a rehabilitation center, or started getting any treatment at the place of residence. But to speed up the process is possible only when it has the financial capacity, and they are not all.
How much are these services?
Sergey. Everywhere in different ways. For example, in the fitness club, the customer pays for a one-hour personal training with coach 2.5 thousand rubles. To pay rehabilitation center. Therefore, from fiscal medicine washed out by specialists, many successful instructors in clinics receive a small money, go to the gym.
And you for not considering it?
Olga. You know, for me this is the case when the same work and hobby. If the person is a professional who sees that really helps the patient, it is very stimulating, always want to learn to use something new. There is excitement, and even not so important, what is your salary, you work to help and see the result. The greatest gratitude from the man, when he, in particular, and thanks to your efforts, got up and went. That every time a small victory. And very nice to see long-term results of their work, thanks to the Internet. We can’t meet with went home patients, but they show their achievements on Skype: “Olga, how do you like me? I bent a knee” or “Look, I put my foot up on the step”. At such moments, I feel happy.