Healing Fitness. Physiotherapy exercises The method of using physiotherapy exercises for various deviations

4.5. But what about physical activity? And now, at the very end of our book, let's talk about physical activity, which we have not paid attention to at all. Yes, there are a large number of systems of physical exercises aimed at achieving harmony. They are very diverse

Physical activity Improving walking For the elderly, the most natural and suitable look physical activity - walking. Daily walks of 30 minutes can reduce coronary morbidity. Another important pattern: in old age, according to

Loads in exercise therapy The load should be optimal and correspond to the functional capabilities of the patient. For the dosage of the load, a number of factors should be taken into account that can increase or decrease it:

Physical activity It is impossible to restore the normal functioning of the organs, including the genital organs, without restoring the microcirculation of blood, lymph, and energy. And microcirculation cannot be restored without special exercises, massage, which, of course, must be carried out.

Physical activity Good digestion is impossible without physical activity. Bragg recommended that people with neglected health begin their wellness activities with walking. “Walking is the queen of exercise,” he said. – You must, starting small, daily

An analysis of the most dangerous types of diseases and the aging process showed that human health is determined by the state of the hereditary apparatus of cells. This apparatus controls synthesis, plastic processes and is subject to the control actions of hormones. Consequently, physical exercises that cause a "game" of hormones with a large release into the blood from the glands of the endocrine system have the maximum healing effect. Consider from this point of view the well-known types of health-improving physical culture.

Cyclic aerobics

One of the most popular types of recreational physical culture, which uses such cyclic exercises as running, walking, cycling, etc.

Physiology of cyclic exercises

Aerobic exercise is one of the most studied types of physical activity. A feature of these exercises is the participation in the movement of certain (same) muscle groups, which are sequentially tensed and relaxed. As oxygen consumption rises, heart rate (HR) and blood pressure (BP) increase. For example, with a heart rate of 150 beats / min, systolic blood pressure can be 150-190 mm Hg, and diastolic - 70-90 mm Hg.

At low speed (for example, running), only a small part of the muscle fibers of active muscles work. These muscle fibers have a large number of mitochondria, so they can oxidize fats - they are called oxidative muscle fibers. If muscle fibers with a low content of mitochondria are connected to work, then anaerobic glycolysis occurs in them, they are called glycolytic muscle fibers, i.e. lactic acid is formed in them from glycogen (lactate - La and hydrogen ions - H). Lactic acid penetrates oxidative muscle fibers and interferes with fat oxidation. Therefore, with an increase in speed, all muscle fibers switch to the oxidation of carbohydrates (lactate, glucose and glycogen). Scientists discovered this phenomenon back in the 20-30s. XX century; there were recommendations on the use of aerobic exercise to increase fat metabolism. Fat burning can occur during exercise if only oxidative muscle fibers with a normal blood supply are involved in the work.

However, research in the 1990s the last century showed that basically only those fats that accumulate in muscle fibers in the form of droplets are oxidized. The reserves of these fats are enough for 30-60 minutes of work. Subcutaneous fat does not have time to pass into the blood and muscle during the exercise. This process is essential only during recovery, when in 5-15 hours the spent glycogen and fat stores in muscle fibers are restored (resynthesized) either due to fat and carbohydrates entering the blood from food, or due to blood glucose and fat entering from the subcutaneous fat depot.

The concentration in the blood of hormones associated with the activity of the pituitary gland and the sympathetic nervous system (somatotropin, testosterone, adrenaline, norepinephrine, etc.) increases as mental stress increases. Mental stress especially increases with the combined action of several factors:

Increased muscle activity;

Acidification of the muscles to the extent that causes pain;

Achievement of maximum heart rate;

Achievement of the maximum respiratory rate.

The duration of an aerobic cyclic exercise depends on the set intensity, such as running speed. At the level of the anaerobic threshold, a person can continuously move for 20-30 minutes; while the heart rate is 140-170 beats / min or more - depending on the size of the heart and the level of aerobic capacity of the muscles. At the same time, the concentration of hormones increases slightly, but is in the range of 150-200% of the rest level. At extreme stress, the concentration of hormones can increase by 10 or more times.

Methodology for the use of aerobic exercises in health-improving physical culture

“Running from a heart attack” is the main goal of jogging (according to Cooper). In the literature on this topic, it is noted that running at low intensity (speed) - more precisely, up to the speed of the anaerobic threshold - is associated with fat oxidation, a more active work of the heart and blood vessels compared to rest. Further, based on the empirical law “function builds an organ”, the statement is made that aerobic exercise should improve the condition of the heart and blood vessels, as well as reduce the amount of fat in the body. However, studies of aerobic exercise over the past 30 years have not revealed a significant positive effect of aerobic exercise on the heart, blood vessels, and adipose tissue.

Training with a heart rate of 100-140 beats / min, when there is a maximum stroke volume of the heart (the largest blood ejection in one heartbeat - systole), can lead to dilatation, i.e. gradual elongation of myofibrils in its muscle fibers (namely, the number of sarcomeres in the myofibril increases). Therefore, at rest, the heart begins to eject more blood in one beat. Since the oxygen demand at rest remains the same, the resting heart rate decreases. This indicator is proposed to be recorded, assessing the state of health according to it. It is impossible to agree with this point of view, since an increase in the volume of the left ventricle is important for athletes, and for an ordinary person, the state of the endocrine and immune systems is important.

The vascular system is subjected to severe tests when running with a heart rate of 100-140 beats / min, since systolic blood pressure can increase to 160-190 mm Hg. Since with low-intensity running (walking) the concentration of hormones in the blood increases slightly, the process of healing blood vessels is very slow. For example, in a one-year experiment, with a three-time training session (1 hour per week), it was not possible to reduce high blood pressure. However, there is no doubt that after 3-5 years the pressure should normalize - this is confirmed by the practice of joggers.

Thus, the generally accepted method of using aerobic exercises is an ineffective means of improving the cardiovascular system and other systems and organs.

Well-trained athletes can afford to do 2-4 hour training sessions 3 times a week. A long duration of low-intensity aerobic exercise can be a very effective means of recovery. The fact is that as fatigue develops, mental stress increases, which means that hormones are released into the blood. Therefore, the preparation of amateur athletes for participation in marathon competitions can have a healing effect - you just need to follow the following rules:

You can not use running as a means of preparing for a marathon distance, as this leads to significant damage to the joints, ligaments and muscles. Instead of running, you should use brisk walking or cycling, skiing or roller skiing;

The method of using cyclic exercises for middle-aged and elderly people after a long break in physical education is well described, for example, in the works of K. Cooper and N.M. Amosov. These authors do not state the meaning of their recommendations, but the classes are built taking into account the general pedagogical principles of gradualness, activity and consciousness. It should be noted that both K. Cooper and N.M. Amosov, promoting their systems, after 20-40 years significantly changed their point of view on what was created by them. K. Cooper practically forbade the use of running as a means of recovery and recommends brisk walking and strength exercises in gyms for these purposes. N.M. Amosov, after he was diagnosed with heart rhythm disturbances and had an operation to implant a heart stimulator, spoke very negatively about his own healing system - the use of gymnastic exercises and walking. The change in views was caused by the accumulation of a large number of experimental data on the effect of running on the state of the musculoskeletal system, as well as on the insignificant effect of aerobic exercises on the morphostructure of vascular tissues, aging processes in the cardiovascular system.

Those who want to start physical exercises to restore lost physical conditions after prolonged hypokinesia should keep in mind that the state of the muscles can be changed to the required level quite quickly - in 3-6 months. But it is possible to change the state of ligaments, tendons and the structure of bones only in 1.5-3 years. Hence the principle of a gradual increase in the load on the musculoskeletal system. The norm for middle-aged and elderly people is daily continuous walking at a very fast pace (heart rate 100-120 beats / min) for 30 minutes. To fulfill this standard, it will take 2-3 months for almost any relatively healthy person. However, when forcing loads, problems inevitably arise with the joints of the legs - primarily the ankle and knee. Therefore, the duration of training sessions changes gradually - from 10 to 60 minutes during the year. Training sessions include walking at different speeds: for example, comfortable walking (rate 80-100 steps / min; distance - 100-200 m); very fast walking (tempo - 150-180 steps / min; distance - 20-50 m). In one lesson, the total duration of very fast walking gradually increases, but by the end of the year it should not be more than 30 minutes. The length of a single segment of very fast walking should not exceed 50 m, and the heart rate should not exceed 120 bpm. AT next year fast passage of a distance can be replaced by running, which in this case is used not only to improve the functional state of the cardiovascular system, but also to increase the load on the musculoskeletal system, improve its condition.

Thus, aerobic exercises are a low-effective means of health-improving training and can be used as an additional tool in health-improving physical culture classes. These exercises are the simplest and most convenient means of maintaining the musculoskeletal system in a normal state.

Gymnastic aerobics

Back in the 60s. 20th century health-improving system of gymnastic exercises was developed. At first, gymnastic aerobics was like a simplified version of rhythmic gymnastics, in which there were many exercises performed with a large amplitude, requiring great flexibility. The sets of exercises were developed taking into account the following requirements:

The average intensity of exercise should correspond to the aerobic mode of energy supply of muscle activity so that fat oxidation occurs predominantly;

The nature of performing exercises to music should correspond to the aesthetic needs of a person.

One of the creators of gymnastic aerobics, Jane Fonda, released many complexes on videotapes. For 10 years of testing the ideas of aerobics in practice, the following was revealed.

1. Aerobics two to three times a week (1.5-2 hours each) do not promote fat loss body. When doing aerobics, some exercises are replaced by others, that is, some muscles work first, and then others. Usually, changing exercises is associated with mild local fatigue, and therefore with slight local muscle acidification. In the case of acidification in the muscles, the oxidation of fats is stopped (inhibited) and the oxidation of carbohydrates (blood glucose or muscle glycogen) begins. Hence, in the process of doing aerobic gymnastics, fat oxidation cannot occur. A sharp decrease in the concentration of glucose in the blood by the end of the workout causes a very strong feeling of hunger after 30-60 minutes of recovery. It is almost impossible to fight him, so the student accepts writing. As a result, instead of oxidizing your own fats, fat is accumulated at the expense of carbohydrates and fats from food.

2. Intensive performance of exercises with a large amplitude is associated with the risk of sprains in the hip, shoulder and knee joints, with tucking of the feet. Especially often there are muscle injuries, tears of myofibrils or even whole muscle fibers - and not only in trained, but also very often in beginner athletes.

As a result, dance exercises began to be used instead of rhythmic gymnastics in aerobics. Restrictions were introduced into the rules for performing exercises in sports aerobics. For example, it is not allowed:

Perform sharp movements with a large amplitude;

Tilt forward with a straight torso and perform turns in this position;

Make sudden head movements (especially combine tilts with head turns);

Significantly extend the spine back;

Perform deep squats (the angle of flexion in the knee joints is less than 90 °);

In a kneeling position, relying on hands, perform swings with a leg laid aside;

Exercise the abdominal muscles by lifting straight legs.

Outwardly, such aerobics began to look more like rhythmic movements to music, i.e. dancing, in order to achieve heart rate at the level of the anaerobic threshold (130-160 beats / min). The duration of the training session is 60-90 minutes and includes groups of dance exercises, parterre strength gymnastics and stretching. When performing dance exercises, the heart rate of many practitioners often increases to 180-200 beats / min.

After 10 years, it again became clear that this complex does not cause changes in body weight. Therefore, new variants of gymnastic exercises began to be developed - such as step aerobics or slide aerobics. These types of exercises began to cause stronger sensations of local fatigue in the extensor muscles of the leg joints, which led to negative consequences- pain in the knee joints due to their excessive overload. However, the biggest drawback of these health systems is the lack of any serious theoretical and experimental justification.

ISOTON–health training system (local strength exercises)

Strength exercises can only be used by absolutely healthy people. There is no doubt that a system of exercises such as bodybuilding is an excellent means of preventing the main types of human diseases, since it stimulates the activity of the endocrine and immune systems (with the exclusion of overtraining). However, people with signs of atherosclerosis, diseases of the spine (osteochondrosis, sciatica), thrombophlebitis, etc. cannot afford bodybuilding. For most people, it is necessary to develop a gentle system of strength exercises, which should preserve all the positive that is contained in bodybuilding:

Stress, which causes an increase in the concentration of hormones in the blood;

Activation of anabolism processes in muscle tissue, formation of a muscular corset;

An increase in catabolism processes in all tissues (and especially in adipose tissue), which leads to the renewal of organelles, weight loss and treatment of the hereditary cell apparatus.

Principles and rules for constructing the ISOTON system

There are two ideas in the ISOTON system.

The first is that the main means of physical education for the majority of practically healthy people, which has the maximum health-improving efficiency, are power static-dynamic, or quasi-isotonic, exercises.

The second is the regular use of statodynamic exercises in human life, which creates conditions for increasing the adaptive reserves of the body and constantly maintains an increased vitality.

The implementation of ISOTON's ideas is achieved by observing the following principles and rules.

The principle of minimizing the rise in systolic blood pressure . It is clear that for persons with signs of atherosclerosis, it is contraindicated to perform exercises that cause an increase in blood pressure of more than 150 mm Hg. Therefore, when constructing a training session, the following requirements must be observed.

Warm up. Before the main part of the lesson, before performing strength exercises, it is necessary to achieve expansion of the arteries and arterioles with the help of a warm-up. In this case, peripheral resistance decreases, the work of the left ventricle of the heart is facilitated.

Exercise while lying down. In the standing position, the heart must pressurize the blood in the arteries and arterioles to such an extent that it overcomes the weight of the blood in the venous system and raises the blood to the level of the heart. Therefore, it is preferable to perform exercises in I.P. lying.

Involve the minimum number of muscles in a strength exercise. When performing dynamic exercises, tension and relaxation of the muscles facilitates the work of the heart. When performing strength exercises, with the participation of a large mass of muscles, when compression of blood vessels occurs, the work of the heart becomes more difficult. Therefore, in strength exercises, the minimum number of muscles should be involved - especially if they work in a static-dynamic mode.

Alternate exercises for muscles with a relatively large and small mass. When building a set of exercises, it is often necessary to use a large mass of muscles, which creates conditions for an increase in blood pressure. Therefore, performing the following exercise for muscles with low mass eliminates possible problems associated with an increase in blood pressure.

After each strength exercise or series of exercises, stretch. Stretching does not impose special requirements on the cardiovascular system, so the time of 10-40 seconds is enough to reduce activity and restore the cardiovascular system. At the same time, stretching the muscles stimulates protein synthesis in them.

Ultimate Stress Principle . When performing strength exercises in bodybuilding, the maximum stress stress is created by holding the breath, straining, and a sharp increase in blood pressure. This way of doing strength exercises in ISOTONE unacceptable, therefore, strength exercises are performed taking into account the following requirements.

Muscle tension intensity should be 10-50% of the maximum effort. Exercises are performed in a static-dynamic mode (without complete relaxation of the muscles).

It is forbidden to hold your breath e. With muscle contraction, a slow exhalation should be done, with inferior work - a short, medium-depth breath.

The duration of the exercise should be between 30 and 60 s. It is this time that is sufficient for a significant destruction of creatine phosphate molecules and moderate acidification of muscle fibers. Both of these factors are the main stimulators of protein synthesis in muscle fibers.

Exercise should be performed until severe pain–stress. Taking into account the requirements listed above creates such conditions for performing a strength exercise under which blood passes poorly through an unrelaxed muscle. This causes even in oxidative muscle fibers the development of anaerobic glycolysis. The accumulation of hydrogen ions leads first to a burning sensation in the muscles, and then to severe pain - stress.

Exercises for one muscle group are combined into a superset. When choosing an intensity of 30-50%, a strength exercise lasting 30-60 seconds may not cause significant acidification or sensation of pain. Therefore, after a short rest interval (20-60 s), the strength exercise should be repeated for the same muscle group. With the second and especially the third repetition, the sensation of pain appears earlier and becomes unbearable. It is this state that should be achieved - a state of severe stress.

The principle of the relationship between the training process and nutrition . Performing physical exercises leads to an increase in the processes of anabolism and catabolism in various tissues. Depending on the diet, it is possible to direct the course of adaptation processes in the desired direction: for example, increase muscle mass (the intake of complete protein is above the norm), reduce the mass of adipose tissue (the intake of carbohydrates and fats is below the norm).

Rules for selecting exercises for circuit training

1. Start with a large muscle group exercise to quickly increase the concentration of hormones in the blood.

2. Alternate exercises for large muscle groups with exercises for relatively small muscles (flexors of the hand, forearm, extensors of the shoulder, etc.); as a result, the average training intensity decreases.

3. Do not perform exercises first for the synergistic muscles, and then for the antagonist muscles of one limb - allow the biochemical processes in the tired muscles to proceed without your intervention.

4. Do not allow the heart rate to increase above the aerobic threshold - it is desirable that it be in the range of 90-120 beats / min.

5. Avoid holding your breath and straining; when contracting the muscles, exhale, while yielding work - a short breath. Compliance with this rule will ensure a minimal increase in systolic blood pressure.

6. Use mainly those exercises that need to be performed in ip. lying down or sitting - so you facilitate the work of the heart and vascular system, minimize the risk of a heart attack or stroke.

7. Remember that most practically healthy people have some kind of spinal injury (for example, osteochondrosis). In this regard, it is prohibited:

Perform swing (ballistic) movements of the limbs with a large amplitude and intensity;

Twist the spine in the cervical, thoracic and lumbar regions;

In i.p. lying on your back, rhythmically tear off the lumbar region from the floor.

8. Try to do exercises without sudden movements; Activate the antagonist muscles whenever possible.

Means of therapeutic physical culture

The main means in therapeutic physical culture are:

Physical exercise;

Natural factors (sun, air, water);

Massotherapy;

motor mode.

In addition, additional means are used: occupational therapy and mechanotherapy.

Occupational therapy refers to the restoration of impaired functions with the help of selectively selected labor processes.

Mechanotherapy is the restoration of lost functions with the help of special devices. It is mainly used to prevent and develop contractures (stiffness in the joints).

In sports practice, after damage to the musculoskeletal system, mechanotherapy can be used to increase the range of motion in the joints; to strengthen muscles, classes on various simulators are effective.

Therapeutic massage (classic, acupressure, segmental-reflex, apparatus, hydromassage) is used in combination with physical exercises in the process of both treatment and rehabilitation.

Classification and characteristics of physical exercises used in exercise therapy

Physical exercises used with therapeutic purpose, are divided into gymnastic, ideomotor, sports and applied, exercises in sending impulses to muscle contraction, dosed games, etc.

Gymnastic exercises. They are specially selected combinations of movements natural for a person, divided into elements. By applying gymnastic exercises, selectively influencing individual muscle groups or joints, one can improve the overall coordination of movements, restore and develop such physical qualities as strength, speed of movement and dexterity.

Gymnastic exercises are classified according to several main features: anatomical; on the basis of activity; the principle of using gymnastic objects and apparatus; by type and nature of performance.

According to the anatomical feature - exercises for the muscles of the neck, trunk, shoulder girdle, upper limbs, abdominals, pelvic floor, lower limbs.

On the basis of activity - active (performed by the patient himself), passive (performed by the exercise therapy instructor with the patient's willpower), active-passive exercises (performed by the patient himself with the help of an exercise therapy instructor).

According to the principle of using gymnastic objects and apparatus - exercises without the use of objects and apparatus; exercises with objects (gymnastic stick, rubber, tennis or volleyball, stuffed ball, clubs, dumbbells, expanders, rope, etc.); exercises on shells (gymnastic wall, inclined plane, gymnastic bench, rings, mechanotherapeutic equipment, uneven bars, crossbar, beam); exercises on simulators, etc.

According to the species characteristic and the nature of the performance - ordinal and drill, preparatory (introductory), corrective, for coordination of movements and in balance, in resistance, breathing, hanging, stops, jumps and jumps, rhythmoplastic exercises, etc.

Ordinal and drill exercises. They organize and discipline patients, developing the necessary motor skills (building, rebuilding, walking, turning on the spot, other exercises).

Preparatory (introductory) exercises. Prepare the body for the upcoming load.

Corrective exercises. They reduce posture defects, correct deformations of individual parts of the body. Often combined with passive correction (traction on an inclined plane, wearing a corset, massage). These include any movements performed from a certain starting position, which determines a strictly local impact. In this case, a combination of power stresses and stretching exercises is used. For example, with severe thoracic kyphosis (stoop), a corrective effect is exerted by physical exercises aimed at strengthening the back muscles, stretching and relaxing the pectoral muscles, as well as the muscles of the legs and feet.

Exercises for coordination and balance. They are used to train the vestibular apparatus (for hypertension, neurological and other diseases). Performed in the following starting positions: main stance, standing on a narrow support area, standing on one leg, on toes, with open and closed eyes; with and without items. Coordination exercises also include exercises that form household skills lost as a result of a particular disease: fastening buttons, lacing shoes, lighting matches, opening a lock with a key, etc. Sculpting, assembling children's pyramids, making patterns from mosaics, etc. are also widely used. . P.

Resistance exercises. They are used in the recovery training period of exercise therapy. Contribute to the strengthening of muscles, increase their elasticity; have a stimulating effect on the cardiovascular and respiratory systems, metabolism.

Breathing exercises (static, dynamic, drainage). Used in all forms of exercise therapy. beneficial effect on cardiovascular and respiratory systems, stimulate metabolic and digestive processes. Their calming effect is used in violation of the nervous regulation of various functions of the body, for faster recovery from fatigue, etc.

Static breathing exercises are performed in various initial positions (without movements of the legs, arms and torso); dynamic breathing exercises are performed in combination with the movements of the limbs and torso. Drainage exercises include breathing exercises specifically aimed at draining exudate from the bronchi; they are used in various diseases of the respiratory system. It is necessary to distinguish between respiratory drainage exercises and positional drainage (specially set positional initial positions, also aimed at outflow of exudate through the respiratory tract, according to the “gutter” principle).

Hangs, stops, jumps, jumps. Varieties of gymnastic exercises that are included in physical therapy classes during the recovery period. They are performed strictly in doses, under the supervision of an exercise therapy instructor.

rhythmic exercises. They are used at the sanatorium and outpatient stages of rehabilitation - for the final restoration of the function of the musculoskeletal system, as well as in the treatment of neuroses, diseases of the cardiovascular and other systems; are performed to musical accompaniment, with a given rhythm and tonality (depending on the functional state of the patient and the type of higher nervous activity).

Muscle stretching exercises (stretching). They are used to increase the elasticity of the musculoskeletal system and relax muscles. They also contribute to the restoration of muscle performance after physical exertion.

Exercises in water (hydrokinesitherapy). They are increasingly being used in exercise therapy. warm water pool or bath helps to relax muscles, soften soft tissues, increase their elasticity, reduce spasticity. In addition, water reduces the weight of the body and its individual parts, making it easier to exercise. Physical exercises in water and swimming are indicated for musculoskeletal injuries, osteochondrosis and spondylosis, posture disorders and scoliosis, paralysis and paresis and other suffering.

Ideomotor exercises are also used in exercise therapy (especially at the hospital stage). Performed mentally, they not only cause weak muscle contraction, but also improve their functional state, have a trophic effect. These exercises are used for paralysis and paresis, with prolonged immobilization, when the patient cannot actively perform exercises.

Isometric (static) exercises. The patient is invited to contract and relax the muscles of the immobilized joint while mentally imagining the movement being performed. These exercises are used when immobilizing limbs to prevent muscle atrophy, improve blood circulation and metabolism in them (for example, when applying a plaster cast to the thigh and knee joint, the patient actively contracts the quadriceps muscle of the thigh without making movements in the knee joint, etc.

Exercises on simulators are increasingly used in exercise therapy for the rehabilitation of patients and the disabled. The use of simulators allows you to accurately dose the load and develop the necessary physical qualities: endurance, muscle strength, etc. For training the cardiovascular system, the following are used: exercise bikes (leg and manual), rowing machines, treadmills (“treadmill”), a ski simulator, etc. To develop the strength of various muscle groups, there are various simulators: block, Kettler, David, etc. In our country, simulators of a new generation by Professor V.K. Zaitsev.

Sports-applied exercises. Of this group of exercises in exercise therapy, dosed walking, running, jumping are most often used; throwing and climbing; balance exercises; lifting and carrying weights; dosed rowing, skiing, skating, cycling, therapeutic swimming.

The use of applied sports exercises in exercise therapy contributes to the final restoration of the damaged organ and the body as a whole; educates patients with a conscious attitude to exercise therapy and self-confidence.

Dosed walking. It strengthens the muscles not only of the lower extremities, but of the whole organism due to the rhythmic alternation of their tension and relaxation. As a result, blood and lymph circulation, respiration, metabolism are improved, and there is a general strengthening effect on the body.

Dosed run. It evenly develops the muscles of the body, trains the cardiovascular and respiratory systems, improves metabolism and respiratory function. In therapeutic gymnastics classes, running is used for patients who are sufficiently trained for it with an individual dosage (with careful medical and pedagogical control).

Dosed jumps. Refers to short-term intense exercises used during the recovery period with an individual dosage (with pulse control).

Throwing exercises. They help to restore coordination of movements, improve joint mobility, develop the strength of the muscles of the limbs and trunk, and increase the speed of motor reactions. In therapeutic gymnastics classes are used stuffed balls, disks, balls with a loop, grenades.

Climbing on the gymnastic wall and rope. They help to increase mobility in the joints, develop the strength of the muscles of the trunk and limbs, and coordinate movements.

Balance exercises. They are used for lesions of the vestibular apparatus, for amputation of the lower limb, diseases and injuries of the nervous system.

Dosed rowing. In exercise therapy, it is used for the purpose of general training of the body, the development of rhythmic movements that contribute to the deepening of breathing, the development and strengthening of the muscles of the upper limbs and torso, and the mobility of the spine. An increase in intra-abdominal pressure during rowing has a positive effect on the digestion process and tissue metabolism.

The use of rowing in conditions of clean, ionized air saturated with water vapor has a healing effect on the body.

Rowing lessons are prescribed in a dosed form, indicating short pauses for rest and deep breathing (with medical and pedagogical control).

Dosed skiing. It activates the work of the muscles of the whole body, improves metabolism, the activity of the cardiovascular and respiratory systems, trains the vestibular apparatus, increases muscle tone, improves mood, and contributes to the normalization of the state of the nervous system.

Dosed skating. It trains the cardiovascular, respiratory and nervous systems, improves metabolism, develops coordination of movements, strengthens the vestibular apparatus. It is prescribed during the recovery period for well-trained people who can skate (with medical and pedagogical control).

Dosed therapeutic swimming. Increases heat transfer, improves metabolism, blood circulation and respiration, strengthens the muscles of the whole body, nervous system hardens the body.

Dosed cycling. It is used for general health purposes, to strengthen muscles and develop movements in the joints of the lower extremities; trains the cardiovascular and respiratory systems, the vestibular apparatus.

Exercises in sending impulses to muscle contraction (to performing movements) are used for paralysis and paresis, when active movements are absent or sharply weakened. It is recommended to combine the sending of impulses with passive movements - this helps to improve conduction along the centripetal and centrifugal nerves.

Dosed games (on the spot, sedentary, mobile and sports) are used in exercise therapy to educate the patient's determination, perseverance, ingenuity, dexterity, courage, discipline; have a positive effect on the activity of all organs and systems. Games are included in the classes at the stage of recovery. All types of games are carried out under medical and pedagogical control.

General requirements for the method of applying physical exercises in exercise therapy

Before the appointment of physical therapy classes, the tasks of using physical exercises are determined, the means and forms of classes are selected to solve them.

It is important to combine the general and local (local) effects of physical exercises on the patient's body, remembering that recovery largely depends on the general condition of the body.

The method of applying physical exercises in each case depends on the diagnosis, stage of the disease, functionality, individual characteristics of the patient (the level of his physical fitness, age, profession, presence of concomitant diseases), i.e. the principle of an individual approach is used.

In the exercise therapy methodology, it is necessary to adhere to other general pedagogical didactic principles: consciousness and activity, visibility, accessibility, systematicity, gradual increase in loads, regularity, cyclicality, novelty and diversity.

The principle of consciousness and activity. Only the conscious and active participation of the patient himself in the treatment process creates the necessary emotional background and psychological mood for him, which increases the effectiveness of exercise therapy.

The principle of visibility. When teaching patients to exercise, it is carried out with the help of visual perception (display). The demonstration of physical exercises makes the verbal explanation of the instructor more understandable and helps the patient to perform the exercises correctly.

The principle of accessibility. It is carried out on the basis of an assessment by a doctor or a methodologist of exercise therapy of the level of physical fitness of the patient and the clinical course of the disease.

The principle of systematicity. It is the basis of therapeutic and rehabilitation training during the rehabilitation period, which sometimes lasts for several months and even years. Only by systematically applying various means of rehabilitation, it is possible to ensure the optimal effect on the body for each patient, contributing to the improvement of its functional state.

The principle of gradualism. A gradual increase in physical activity - in terms of volume, intensity, the number of exercises performed, the number of repetitions, the degree of complexity of the exercises.

The principle of regularity. Regular use of physical exercises - daily or several times a day, in fractional doses.

The principle of cyclicity. Alternation in the process of employment of work and rest; inclusion of breathing exercises in the exercise therapy complex to change the density of the lesson.

The principle of novelty and diversity. In the process of training, 10-15% of physical exercises should be updated, and 85-90% should be repeated to consolidate the results of treatment. Quite often, patients and convalescents have an insufficient level of physical fitness, therefore, these principles should be especially carefully followed, otherwise exercise therapy can cause unwanted complications and deprive the patient of faith in the effectiveness of physical exercises in the treatment and rehabilitation processes.

In the exercise therapy methodology, the dosage of physical activity, taking into account the total volume and intensity, is important.

The intensity of physical exercises can be small, moderate and maximum (according to V.K. Dobrovolsky).

Low-intensity exercises include movements for small muscle groups, performed mainly at a slow pace; while physiological changes in the body are insignificant.

Moderate-intensity exercises include movements for medium and large muscle groups performed at a slow and medium pace: exercises on gymnastic equipment and simulators, weight-bearing exercises, walking, running, skiing, etc. These exercises make significant demands on the cardiovascular, respiratory and neuromuscular systems, causing significant physiological changes in the body, the recovery time of which varies (within tens of minutes).

Exercises of maximum intensity are characterized by the involvement of a large number of muscles in the work and a fast pace of movement: running at speed, significant loads on simulators, sports games, etc. At the same time, submaximal and maximum changes in heart rate and respiratory rate are observed. Recovery of the body lasts several hours and even days.

The dosage of physical activity depends on the nature of the disease, its stage, the functional state of various body systems (primarily cardiovascular and respiratory).

Methods for dosing physical activity in exercise therapy classes

The dosage of physical activity in physical therapy should be understood as the establishment of the total dose (value) of physical activity when using both one physical exercise and the whole complex (morning hygienic gymnastics, therapeutic exercises, etc.).

Physical activity should correspond to the functional capabilities of the patient, not reducing or, conversely, not exceeding them: in the first case, it will not give the desired therapeutic effect, in the second, it will worsen the patient's condition.

In physical therapy, the dosage of physical activity is carried out by choosing the initial positions of the body, selecting physical exercises, the duration of their implementation, the number of exercises in the complex and repetitions of each exercise, the pace and amplitude of movements, the degree of effort and complexity of movements, the ratio of general developmental and breathing exercises, the use of the emotional factor .

Starting position of the body. When doing physical exercises, it is an important element of load regulation.

In therapeutic physical culture, the choice of starting positions depends on the motor regimen prescribed by the doctor. There are three main starting positions - lying, sitting and standing. I.p. lying has the following options: lying on the back, on the stomach, on the side. I.p. sitting has the following options: sitting on a chair, sitting in bed, on the carpet - legs are straight; sitting in bed - legs lowered. I.p. standing has the following options: standing on all fours; main stance - without support and relying on crutches, sticks, walkers, bars, crossbar, gymnastic wall, chair back, etc. For diseases of the cardiovascular and respiratory systems, IP can be used. lying, reclining with a high position of the head, sitting and standing; in case of damage to the spine - i.p. lying on the back, on the stomach, standing on all fours, reclining, standing.

Selection of physical exercises. It is carried out taking into account the principle of gradualness - from simple to complex, as well as the characteristics of the course of the disease and the level of physical fitness of the patient.

Duration of exercise. It is determined by the actual time that the patient spends on their implementation; primarily depends on the degree of difficulty of the exercises.

The number of exercises in the complex and the number of repetitions of each exercise. It depends on the characteristics of the course of the disease, the nature and type of exercises included in this complex, the duration of their implementation. For example, the number of repetitions of exercises for small muscle groups may be greater than for large muscles.

The pace of movement. Can be slow, medium and fast. In a hospital, a slow and medium pace is used, at the outpatient and sanatorium stages of rehabilitation - slow, medium and fast.

Decreased or increased range of motion. Allows you to regulate physical activity.

The degree of effort during the execution of movements. Influences the magnitude of the load. In exercise therapy classes, it is necessary to gradually increase the load in the exercises as they master them and increase the functional capabilities of the body.

The degree of difficulty of movements. It also affects the load. In exercise therapy classes, it is necessary to gradually complicate the exercises as you master them and increase the functional capabilities of the body.

The ratio of general developmental and breathing exercises. Depends on the period of the disease. As you recover, the number of breathing exercises decreases and the number of general developmental exercises increases.

Using the emotional factor. It consists in evoking positive emotions in the patient during physical exercises, which increases the therapeutic effect and delays the onset of fatigue.

When dosing physical activity, the density of exercise therapy is also of great importance. It is determined by the ratio of the actual time of the exercise to the duration of the entire lesson. In exercise therapy classes, the density should be 50-60%; in sanatorium conditions, with a training motor mode, it can reach 75% or more.

By including breathing exercises and muscle relaxation exercises in classes, alternating exercises for different muscle groups, it is possible to maintain a high density of training and at the same time not cause fatigue in those involved.

Exercise therapy exercises have a therapeutic effect only with the correct, regular, long-term use of physical exercises. For these purposes, a methodology for conducting classes, indications and contraindications for their use, accounting for effectiveness, and hygienic requirements for places of employment have been developed.

There are general and private methods of exercise therapy. The general methodology of exercise therapy provides for the rules for conducting classes (procedures), the classification of physical exercises, the dosage of physical activity, the scheme for conducting classes at different periods of the course of treatment, the rules for constructing a separate lesson (procedure), forms of using exercise therapy, and schemes of movement modes. Private methods of exercise therapy are designed for a specific nosological form of the disease, injury and are individualized taking into account the etiology, pathogenesis, clinical features, age, and physical fitness of the patient. Special exercises for influencing the affected systems, organs must be combined with general strengthening, which provides general and special training.

Physical exercises are performed after they are explained or shown. In elderly patients with organic lesions of the central nervous system, a demonstration and a verbal explanation of the exercises should be combined. During classes, there should be a calm environment, the patient should not be distracted by extraneous conversations and other irritants.

Physical exercises should not increase pain, as pain reflexively causes vasospasm, stiffness of movements. Exercises that cause pain should be carried out after preliminary relaxation of the muscles, at the time of exhalation, in optimal starting positions. From the first days of training, the patient should be taught correct breathing and the ability to relax muscles. Relaxation is more easily achieved after vigorous muscular tension. With unilateral lesions of the limbs, relaxation training begins with a healthy limb. Musical accompaniment of classes increases their effectiveness.

The main means of exercise therapy are physical exercises and natural factors of nature. There are many physical exercises, and they affect the body in different ways.

Classification of physical exercises

Physical exercises in exercise therapy are divided into three groups: gymnastic, sports and applied and games.

Gymnastic exercises

Consists of combined movements. With their help, you can influence various body systems and individual muscle groups, joints, developing and restoring muscle strength, speed, coordination, etc. All exercises are divided into general developmental (general strengthening), special and respiratory (static and dynamic).

General strengthening exercises

It is used to improve and strengthen the body, increase physical performance and psycho-emotional tone, activate blood circulation, respiration. These exercises facilitate the therapeutic effect of special ones.

Special exercises

Selectively act on the musculoskeletal system. For example, on the spine - with its curvature, on the foot - with flat feet and trauma. For a healthy person, exercises for the body are general strengthening; with osteochondrosis, scoliosis, they are classified as special, since their action is aimed at solving the problems of treatment - increasing the mobility of the spine, correcting the spine, strengthening the muscles surrounding it. Leg exercises are general strengthening for healthy people, and after surgery on the lower extremities, trauma, paresis, joint diseases, these same exercises are classified as special. The same exercises, depending on the method of their application, can solve different problems. For example, extension and flexion in the knee or other joint in some cases is aimed at developing mobility, in others - to strengthen the muscles surrounding the joint (exercises with weights, resistance), in order to develop muscle-articular feeling (accurate reproduction of movement without visual control) . Usually, special exercises are used in combination with general developmental ones.

Gymnastic exercises are divided into groups:

• by anatomical sign;
• by the nature of the exercise;
• by species;
• on the basis of activity;
• on the basis of the objects and shells used.

According to the anatomical feature, the following exercises are distinguished:

• for small muscle groups (hands, feet, face);
• for medium muscle groups (neck, forearms, shoulder, lower leg, thigh);
• for large muscle groups (upper and lower limbs, torso),
• combined.

According to the nature of muscle contraction, exercises are divided into two groups:

• dynamic (isotonic);
• static (isometric).

Muscle contraction, in which it develops tension, but does not change its length, is called isometric (static). For example, when actively lifting the leg up from the initial position lying on the back, the patient performs dynamic work (lifting); while holding the leg raised up for some time, the work of the muscles is carried out in isometric mode (static work). Isometric exercises are effective for injuries during the period of immobilization.

The most commonly used dynamic exercises. In this case, periods of contraction alternate with periods of relaxation.

Other groups of exercises are also distinguished by their nature. For example, stretching exercises are used for joint stiffness.

By type, exercises are divided into exercises:

• in throwing,
• for coordination,
• for balance,
• in the resistance
• hangs and stops,
• climbing,
• corrective,
• respiratory,
• preparatory,
• ordinal.

Balance exercises are used to improve coordination of movements, improve posture, and also to restore this function in diseases of the central nervous system and vestibular apparatus. Corrective exercises are aimed at restoring the correct position of the spine, chest and lower extremities. Coordination exercises restore overall coordination of movements or individual segments of the body. They are used from different PIs with a different combination of movements of the arms and legs in different planes. Necessary for diseases and injuries of the central nervous system and after prolonged bed rest.

On the basis of activity, dynamic exercises are divided into the following:

• active,
• passive,
• for relaxation.

To facilitate the work of the flexor and extensor muscles of the arms and legs, exercises are carried out in the IP lying on the side opposite to the limb being exercised. To facilitate the work of the muscles of the foot, exercises are carried out in the PI on the side on the side of the exercised limb. To facilitate the work of the adductor and abductor muscles of the arms and legs, exercises are carried out in the PI on the back, abdomen.

To complicate the work of the flexor and extensor muscles of the arms and legs, exercises are performed in the IP lying on the back, stomach. To complicate the work of the adductor and abductor muscles of the arms and legs, exercises are carried out in the IP lying on the side opposite to the exercised limb.

To perform exercises with effort, the resistance provided by the instructor or a healthy limb is used.

Mentally imaginary (phantom), ideomotor exercises or exercises “in sending impulses to contraction” are performed mentally, used for injuries during the period of immobilization, peripheral paralysis, paresis.

Reflex exercises consist in influencing muscles that are distant from the trainees. For example, to strengthen the muscles of the pelvic girdle and thigh, exercises that strengthen the muscles of the shoulder girdle are used.

Passive exercises are called exercises performed with the help of an instructor, without the patient's willpower, in the absence of active muscle contraction. Passive exercises are used when the patient cannot perform an active movement, to prevent stiffness in the joints, to recreate the correct motor act (with paresis or paralysis of the limbs).

Relaxation exercises reduce muscle tone, create conditions for relaxation. Patients are taught "volitional" muscle relaxation using swing movements, shaking. Relaxation is alternated with dynamic and static exercises.

Depending on the gymnastic objects and apparatus used, exercises are divided into the following:

• exercises without objects and shells;
• exercises with objects and equipment (gymnastic sticks, dumbbells, maces, medicine balls, jump ropes, expanders, etc.);
• exercises on projectiles, simulators, mechanical devices.

Breathing exercises

All exercises are related to breathing. Breathing exercises are divided into the following:

• dynamic,
• static.

Dynamic breathing exercises are combined with the movements of the arms, shoulder girdle, torso; static (conditionally) are carried out with the participation of the diaphragm, intercostal muscles and abdominal muscles and are not combined with the movements of the limbs and torso.

When using breathing exercises, exhalation should be activated. With a static full type of breathing, all respiratory muscles (diaphragm, abdominal, intercostal muscles) participate in the process of inhalation and exhalation. Full breathing is the most physiological; during inhalation, the ribcage expands in the vertical direction due to the lowering of the diaphragm and in the anteroposterior and lateral directions as a result of the movement of the ribs up, forward and sideways.

Static breathing exercises include:

• breathing exercises:
  • the above described full type of breathing;
  • chest type of breathing;
  • diaphragmatic breathing;
• resistance exercises:
  • diaphragmatic breathing with resistance - the instructor's hands are located in the edge of the costal arch (closer to the middle of the chest);
  • diaphragmatic breathing with a bag of sand (0.5 to 1 kg) placed on the area of ​​the upper square of the abdomen;
  • upper thoracic bilateral breathing with overcoming resistance, which is carried out by the instructor, pressed with his hands in the subclavian region;
  • lower thoracic breathing with the participation of the diaphragm with resistance from the pressure of the instructor's hands in the region of the lower ribs;
  • upper thoracic breathing on the right with resistance when pressed by the hands of the instructor in the upper part of the chest;
  • use of inflatable toys, balls.

There are general and special breathing exercises. General breathing exercises improve lung ventilation and strengthen the major respiratory muscles. Special breathing exercises are used for lung diseases, paresis and paralysis of the respiratory muscles.

Drainage breathing exercises are called exercises that promote the outflow of discharge from the bronchi into the trachea, followed by sputum during coughing.

For a better outflow of discharge from the affected area, static and dynamic breathing exercises are used. Drainage exercises are carried out in initial positions lying on the stomach, on the back, on the side with the raised foot end of the bed, sitting, standing. The choice of starting position depends on the location of the lesion.

Sports and applied exercises

Applied sports exercises include walking, running, crawling and climbing, throwing and catching a ball, rowing, skiing, skating, cycling, health path (metered climbing), and hiking. Walking is most widely used - for a variety of diseases and almost all types and forms of exercise. The amount of physical activity during walking depends on the length of the path, the size of the steps, the pace of walking, the terrain and the complexity. Walking is used before the start of classes as a preparatory and organizing exercise. Walking can be complicated - on toes, on heels, walking in a cross step, in a semi-squat, with high knees. Special walking - on crutches, with a stick, on prostheses. It is used for lesions of the lower extremities. Walking speed is divided into: slow - 60-80 steps per minute, medium - 80-100 steps per minute, fast - 100-120 steps per minute and very fast - 120-140 steps per minute.

Games

Games are divided into four groups of increasing load:

• in place;
• sedentary;
• mobile;
• sports.

In exercise therapy, croquet, bowling alley, towns, relay races, table tennis, badminton, volleyball, tennis and elements of other sports games (basketball, football, handball, water polo) are used. Sports games are widely used in the conditions of sanatorium treatment and are carried out according to general lightweight rules with the selection of partners with the same physical fitness.

Gymnastic exercises with specially selected musical accompaniment should be used in group morning and therapeutic exercises. This favorably affects the state of the nervous, cardiovascular and respiratory systems, and metabolism.

Dance elements and dance steps should also be included in the procedures.

Physical exercises in the water and swimming in the pool at a water temperature of 25-27 ° C are effective in the treatment of diseases of the vascular system, respiratory organs, metabolism, nervous system, damage to the musculoskeletal system during the period of persistent remission of a chronic disease. Exercises at a water temperature of 34-36 ° C are appropriate for patients with spastic paresis.

In exercise therapy, mechanical devices and simulators of local (local) and general action are used. To develop joints with limited movements in them and strengthen weakened muscles in patients with diseases and consequences of injuries of the musculoskeletal system, exercises on local action mechanical devices are prescribed - as an addition to therapeutic exercises.

Simulators and mechanical devices of general action - exercise bikes, a rowing machine, a treadmill and others - are prescribed for diseases of the cardiovascular, respiratory systems, exogenous-constitutional obesity and other diseases in the compensation stage.

Dosage of physical activity

Dosage in exercise therapy is the total amount of physical activity that the patient receives during the procedure).

The load should be optimal and correspond to the functional capabilities of the patient. For the dosage of the load, a number of factors should be taken into account that affect the magnitude of the load, increasing or decreasing it with:

1. Starting positions lying, sitting - lighten the load, standing - increase.
2. The size and number of muscle groups. The inclusion of small groups (feet, hands) - reduces the load; exercises for large muscles - increase.
3. Range of motion: the larger, the greater the load.
4. The number of repetitions of the same exercise: increasing it increases the load.
5. Execution rate: slow, medium, fast.
6. Rhythmic execution of exercises facilitates the load.
7. The requirement for accuracy in performing exercises: first increases the load, later, when automatism is developed, it decreases.
8. Exercises that are difficult for coordination - increase the load, so they are not included in the first days.
9. Relaxation exercises and static breathing exercises - reduce the load: the more breathing exercises, the less the load. Their ratio to general strengthening and special can be 1:1; 1:2; 1:3; 1:4; 1:5.
10. Positive emotions in the classroom in a playful way help to endure the load more easily.
11. Different degree of effort of the patient when performing exercises: changes the load.
12. The principle of load dissipation with the alternation of different muscle groups: allows you to choose the optimal load.
13. The use of items and shells affects not only the increase, but also the decrease in the load.

The total physical load in the lesson depends on the intensity, duration, density and volume of it. The intensity corresponds to a certain level of its threshold value: from 30-40% at the beginning and 80-90% at the end of treatment. To determine the intensity threshold, the performance of loads on a bicycle ergometer with increasing power from 50 to 500 kgm/m and more up to the tolerance limit is used. The duration of the load corresponds to the time of classes. The concept of load density refers to the time spent on the actual exercise, and is expressed as a percentage of the total time of the session. The volume of workload is the total work that is done in the lesson. Uniform performance of exercises without interruptions in a lesson is referred to as a streaming method, while the total physical load is determined by the intensity and duration of classes. With the interval (separate) method with pauses between exercises, the load depends on the density of classes.

Movement mode(activity mode) is a system of those physical activities that the patient performs during the day and throughout the course of treatment.

Strict bed rest is prescribed for seriously ill patients. To prevent complications, exercises in static, breathing, passive exercises and light massage are used.

Extended bed rest is prescribed for general satisfactory condition. Allow transitions to a sitting position in bed from 5 to 40 minutes several times a day. Apply therapeutic exercises with a small dosage of physical activity with an allowable increase in heart rate by 12 beats / min.

The ward mode includes a sitting position up to 50% during the day, movement around the department at a walking pace of 60 steps per minute for a distance of up to 100-150 m, therapeutic exercises for up to 20-25 minutes, with an increase in heart rate after exercise by 18-24 beats ./min.

In free mode, in addition to the ward, they include moving up the stairs from the 1st to the 3rd floor, walking around the territory at a pace of 60-80 steps per minute for a distance of up to 1 km, with rest every 150-200 m. Therapeutic exercises are prescribed 1 time per day in the gym, the duration of the lesson is 25-30 minutes, with an increase in heart rate after it by 30-32 bpm.

The pulse rate in the classroom should be no more than 108 beats / min for adults and 120 beats / min for children.

In sanatorium-resort conditions, sparing, sparing-training and training modes are used.

The sparing mode corresponds basically to the free mode in the hospital, with the permission to walk up to 3 km with a rest every 20-30 minutes, games, bathing (if prepared and hardened).

A sparing training regime allows for moderate physical activity: walking up to 4 km in 1 hour, walking, skiing at an air temperature of at least 10-12 ° C, boating in combination with rowing 20-30 m, sports games with facilitated conditions for their implementation.

The training mode is used in cases where there are no pronounced deviations in the functions of various organs and systems. Running, sports games according to the general rules are allowed.

Forms and Methods physiotherapy exercises

The system of certain physical exercises is a form of exercise therapy; these are therapeutic exercises, morning hygienic exercises, self-study of patients on the recommendation of a doctor, instructor; dosed walking, health path, physical exercises in the water and swimming, skiing, rowing, exercises on simulators, mechanical devices, games (volleyball, badminton, tennis), towns. in addition to physical exercises, exercise therapy includes massage, hardening with air and water, occupational therapy, ray therapy (horseback riding).

Hygienic gymnastics is intended for sick and healthy people. Carrying it out in the morning after a night's sleep is called morning hygienic gymnastics, it helps to remove the processes of inhibition, the appearance of cheerfulness.

Therapeutic gymnastics is the most common form of using physical exercises for the purpose of treatment and rehabilitation. The ability to purposefully influence the restoration of damaged organs and systems with the help of various exercises determines the role of this form in the exercise therapy system. Classes (procedures) are carried out individually for seriously ill patients, by small group (3-5 people) and group (8-15 people) methods. The groups unite patients according to nosology, i.e. with the same disease on the localization of the injury. It is wrong to combine patients with different diseases into one group.

Each lesson is built according to a specific plan and consists of three sections: preparatory (introductory), main and final. The introductory section provides for preparation for the implementation of special exercises, gradually includes in the load. The duration of the section takes 10-20% of the time of the entire lesson.

In the main section of the lesson, they solve the problems of treatment and rehabilitation and use special exercises in alternation with restorative ones. Section duration: - 60-80% of the total class time.

In the final section, the load is gradually reduced.

Physical activity is controlled and regulated by observing the body's responses. Heart rate control is simple and affordable. Graphic image changes in its frequency during exercise is called the physiological load curve. The greatest rise in heart rate and maximum load is usually achieved in the middle of the session - this is a one-peak curve. In a number of diseases, after an increased load, it is necessary to apply a decrease in it, and then increase it again; in these cases, the curve may have several vertices. You should also count the pulse 3-5 minutes after class.

The density of classes is very important, i.e. the time of the actual exercise, expressed as a percentage of the total time of the lesson. In inpatients, the density gradually increases from 20-25 to 50%. In sanatorium-and-spa treatment on a training regimen in groups of general physical training a density of 80-90% is acceptable. Individual self-study supplements the therapeutic exercises conducted by the instructor, and can subsequently be carried out only independently with periodic visits to the instructor for instructions.

The gymnastic method, carried out in therapeutic gymnastics, is most widely used. The game method complements it when working with children.

The sports method is used to a limited extent and mainly in sanatorium practice.

When using exercise therapy, one should follow the principles of training, taking into account the therapeutic and educational objectives of the method.

1. Individualization in the method and dosage, taking into account the characteristics of the disease and the general condition of the patient.
2. The systematic and consistent use of physical exercises. They start with simple exercises and move on to complex exercises, including 2 simple and 1 difficult new exercises in each lesson.
3. The regularity of the impact.
4. The duration of the sessions ensures the effectiveness of the treatment.
5. The gradual increase in physical activity during treatment to provide a training effect.
6. Variety and novelty in the selection of exercises are achieved by updating them by 10-15% with the repetition of 85-90% of the previous ones to consolidate the results of treatment.
7. Moderate, continuous or fractional loads - it is more expedient to use than reinforced ones.
8. Compliance with the cyclical alternation of exercises with rest.
9. The principle of comprehensiveness - provides for the impact not only on the affected organ or system, but on the whole organism.
10. The visibility and accessibility of exercises is especially necessary in classes with lesions of the central nervous system, with children, the elderly.
11. Conscious and active participation of the patient - is achieved by skillful explanation and selection of exercises.

To conduct exercise therapy, a lesson plan (procedure) is drawn up, which indicates the sections, the content of the sections, dosage, target setting (section tasks) and guidelines (Table 3).

table 3

The scheme does not list the exercises, but indicates which of the existing ones in the classification should be used. In accordance with the scheme, they make up a set of exercises - indicating the starting positions, a description of the exercise, its dosage (number of repetitions or duration in minutes) and guidelines(if necessary for individual exercises).

The course of application of exercise therapy is divided into periods: introductory, main and final (or the beginning, middle and end of the course of treatment). Accordingly, for each period, schemes and sets of exercises are made.

An approximate set of physical exercises for circulatory insufficiency of the 1st degree

1. IP - sitting on a chair, hands on hips. Calm breathing of a static character (3-4 times).
2. IP - sitting, hands on knees. Extension of the arms g of the wrist joint (6-8 times).
3. IP - sitting. Dorsiflexion of the feet in the ankle joint (6-8 times).
4. IP - sitting, hands down. Hands to the sides - inhale, lower - exhale (4-5 times).
5. IP is the same. Throwing straight arms forward, to the sides, lower (5-6 times).
6. IP - sitting. Alternately lifting the hips. Draw in the stomach while adducting the hips (5-6 times).
7. IP - stsdya. Take your hands to the sides - inhale, lower - exhale (4-5 times).
8. IP - sitting, hands are fixed on the back of the chair. Bending the back without taking your hands off. When bending - inhale, when bending - exhale.
9. IP - sitting, hold on to the seat with your hands, legs extended. Breeding and bringing straight legs with sliding feet on the floor (6-8 times).
10. IP - sitting, hands on the chin. Spread your elbows to the side - inhale, bring your shoulders, squeeze chest and slightly tilt the body - exhale (4-5 times).
11. IP - sitting, hands on hips, legs apart shoulder width apart. Tilts of the body alternately to the right - to the left on the exhale. When straightening - inhale (3-4 times).
12. IP - sitting, arms lowered, raising arms to the sides up - inhale, lowering - exhale (3-4 times).
13. IP - sitting on a chair, hands on hips. Exercise in raising, lowering, retracting back and bringing forward the shoulder girdle (6-8 times).
14. IP - sitting on the edge of a chair, hold on to the seat with your hands. Imitation of the movements of a cyclist with sliding feet on the floor (10-12 times).
15. IP - sitting. Calm breathing of a static character (3-4 times).
16. IP - sitting. Raising the arms to the sides, up - inhale, lower - exhale (3-5 times).
17. IP - sitting. Circular movements in the wrist joints (5-6 times in both directions).
18. IP - sitting. Rolling feet from toes to heel (5-6 times).

Indications, contraindications and risk factors in physiotherapy exercises

Physiotherapy shown at any age in almost all diseases, injuries and their consequences, It is widely used:

• in the clinic of internal diseases;
• in neurology and neurosurgery;
• in traumatology and orthopedics;
• after surgical treatment of diseases of internal organs;
• in pediatrics;
• in obstetrics and gynecology;
• in phthisiology;
• in psychiatry;
• in ophthalmology - with uncomplicated myopia;
• in oncology - in patients without metastases after radical treatment.

The list of contraindications is very small and mainly concerns the initial period of the acute stage of the disease or exacerbation of chronic diseases, the acute period of injury, with indications for surgical intervention, with bleeding.

General contraindications to the appointment of exercise therapy:

• acute infectious and inflammatory diseases with high body temperature and general intoxication;
• acute period of the disease and its progressive course;
• malignant neoplasms before their radical treatment, malignant neoplasms with metastases;
• severe oligophrenia (dementia) and mental illness with a sharply impaired intellect;
• the presence of a foreign body near large vessels and nerve trunks;
• acute disorders of the coronary and cerebral circulation;
• acute thrombosis and embolism;
• increase in cardiovascular insufficiency with decompensation of blood circulation and respiration;
• bleeding;
• the general serious condition of the patient;
• pronounced pain syndrome;
• negative dynamics of the ECG, indicating a deterioration in coronary circulation;
• atrioventricular block.

Temporary contraindications to the appointment of exercise therapy:

• exacerbation of chronic diseases;
• complication during the course of the disease;
• intercurrent diseases of an infectious or inflammatory nature;
• acute injuries;
• the appearance of signs indicating the progression of the disease and the deterioration of the patient's condition;
• vascular crisis (hypertonic, hypotonic or normal blood pressure);
• violation of the rhythm of heart contractions: sinus tachycardia (over 100 beats / min), bradycardia (less than 50 beats / min), an attack of paroxysmal or atrial fibrillation, extrasystoles with a frequency of more than 1:10.

To risk factors, in which damage to the osteoarticular apparatus may occur, include:

• severe osteoporosis in the elderly, especially in women;
• significant effort on the part of the patient with fragile callus after fractures of the bones of the extremities, in patients with spastic paralysis with impaired pain sensitivity.

Caution should be observed after fractures to prevent the occurrence of a false joint, arthrosis. With an aneurysm of the thoracic or abdominal aorta, exercises with effort, resistance should not be used. Physiotherapy exercises can be an independent method of treatment, rehabilitation and prevention of diseases, as well as exercise therapy is well combined with all types of drug treatment, physiotherapy, mud therapy, before and after surgery.

Before the appointment of therapeutic physical culture, the tasks of using physical exercises are determined, means and forms are selected to solve these problems. To do all this correctly, it is necessary to take into account the phase of the development of the disease, the reaction of the body to it, the state of all organs and systems not involved in the disease process, the patient's mental reaction to the disease and his other individual characteristics.

In all cases, it is important to observe the principle of combining the general and local effects of physical exercises, remembering that recovery largely depends on the general condition of the patient's body.

Each physical exercise used in therapeutic physical culture has a restorative, supportive or prophylactic effect on the patient. Therefore, when prescribing therapeutic physical culture, it is necessary to determine (in addition to medical indications) the direction of its use: in order to restore impaired functions, maintain them and health in general, or to prevent diseases, their complications and other deviations in health.

Based general provisions therapeutic physical culture, various private methods are built, reflecting the originality of the pathophysiological and clinical manifestations of the disease in an individual patient or a group of patients, compiled according to a nosological sign. The main principles of the application of therapeutic physical culture are the integrity of the body (the unity of mental and physical), the unity of the environment and the body (social and biological), the unity of form and function, general and local, treatment and prevention (V. N. Moshkov, 1984).

The methodology of therapeutic physical culture should be based on general pedagogical (didactic) principles. Its effectiveness is possible only with the active attitude of the patient to classes. The methodologist's explanation of the prospect of accelerating the recovery of impaired functions under the influence of physical exercises increases the patient's interest in them.

The principle of visualization in teaching movements is carried out not only through visual sensations, but also with the help of other senses. Demonstration of physical exercises confirms the explanation and helps the practitioner to perform them correctly.

The principle of accessibility depends on the assessment by a doctor or methodologist clinical manifestation disease and the level of physical fitness of the patient.

The healing effect of therapeutic physical culture is the result of the implementation of the principle of systematic training, built taking into account the gradualness and sequence of exercises. Classes begin with simple and easy exercises known to the patient. As its functionality grows, more complex exercises are assigned (with strict consideration of the body's reaction). Classes are held daily, sometimes several times a day, at a certain dosage, in combination with the prescribed daily routine.

The principle of an individual approach involves taking into account gender, age, fitness level, the general condition of the patient, the course of the underlying and concomitant diseases.

Along with didactic principles, the optimal dosing of therapeutic physical culture means is of great importance - establishing the total dose (value) of physical activity when using both one exercise and any complex (morning exercises, therapeutic exercises, walking, etc.) (In . N. Moshkov).

Physical activity should be adequate to the functional capabilities of the patient. An excessively small or large load will not have a sufficient therapeutic effect. The load is dosed by the choice of starting positions, the selection of exercises, the number of general developmental and breathing exercises, their duration, the number of repetitions of each exercise, the pace, the amplitude of movements, the degree of force tension, the complexity of movements, their rhythm, the emotionality of classes, their density.

In therapeutic physical culture, the choice of starting positions depends on the motor regimen prescribed by the doctor. There are three main starting positions: lying (on your back, on your stomach, on your side), sitting (in bed, on a chair, on a carpet with straight legs, sitting in bed or on a chair with your legs down), standing (on all fours - knee - carpal, on half-fours - knee-elbow, standing without support, relying on crutches, sticks, walkers, bars, crossbar, gymnastic wall, back of a chair, etc.). For example, in diseases of the cardiovascular and respiratory systems, you can perform exercises in the prone position, reclining with your head held high, sitting, standing; with diseases of the digestive system - sitting, lying on your back, standing; with injuries of the spine - lying on the back and on the stomach, standing on all fours, reclining, standing.

The selection of physical exercises and the determination of their duration is carried out taking into account the principle of gradualness (from easy to difficult, from simple to complex), as well as the characteristics of the patient's personality and the course of the disease.

The duration of physical exercises is determined by the actual time spent by the patient on their implementation. It depends on the complexity of the exercises, the number of exercises in the complex, the individual reaction of the patient's body to the load.

The number of repetitions of each exercise depends on the characteristics of the course of the disease, the number, nature and type of exercises included in this complex, the duration of their implementation. The number of repetitions of exercises for small muscle groups may be greater than for large ones.

The pace of movement may vary. Distinguish between slow, medium and fast pace. In a hospital, exercises are usually performed at a slow and medium pace, at the outpatient and sanatorium stages of rehabilitation - at a slow, medium and fast pace.

Reducing or increasing the amplitude (range) of movements also allows you to adjust the physical load.

The degree of force tension during the performance of movements depends on volitional tension, the use of weights, resistance, or a combination of them. Weighting can be carried out by the weight of one's own body, the weight of objects, the weight or resistance of a partner.

The degree of complexity of movements also affects the magnitude of the load. It is necessary to complicate the exercises gradually, as they master them, and also as the functional capabilities of the body grow.

The rhythm of movements, or the system of their alternation, has a great influence on performance. Properly selected rhythm of movements delays the onset of fatigue. The rhythm of movements helps to reduce the load on the nervous system due to the development of automatism.

The number of general developmental and breathing exercises in a lesson depends on the period and nature of the disease. As the recovery progresses, the proportion of these exercises decreases due to the introduction of special exercises. In some cases, for example, in diseases of the respiratory system, digestion or in the postoperative period, these exercises are special.

The use of the emotional factor consists in creating positive emotions in the patient during physical exercises. This increases the therapeutic effect of classes and delays the onset of fatigue.

Of great importance for dosing physical activity is the density of the lesson. It is determined by the ratio of the duration of the actual exercise to the duration of the entire session. In therapeutic physical culture, the load density reaches 25--30%. Basically, it depends on the duration of the breaks between individual exercises. In therapeutic and health-improving physical culture, the density of the load increases significantly.

The dosage of the load in therapeutic physical culture is very important, since the therapeutic effect of physical exercises largely depends on it. An overdose can cause a deterioration in the condition, and an insufficient load does not give the desired effect. Only in accordance with the patient's condition and his capabilities, physical activity can optimally change the functions of various body systems and have a therapeutic effect.

Physical activity is dosed depending on the tasks of this period of treatment, manifestations of the disease, functionality and age of the patient. It is far from always necessary to strive for great physical exertion. Health-improving and therapeutic effect in many diseases is achieved by special physical exercises with moderate physical activity. For example, improvement in peripheral circulation can be obtained by using exercises for small muscle groups and breathing exercises, which are classified as low-intensity exercises.

You can change the physical load in various methodological techniques, since it depends on many factors. The main of them is the volume of muscle groups involved in the movement, the number and nature of physical exercises: pace, amplitude of movement, degree of muscle tension.

You can increase or decrease physical activity by increasing or decreasing the number of repetitions of each exercise and changing the nature of their implementation.

Specially selected starting positions allow you to regulate the impact of physical exercises. Some of them in themselves cause physiological changes, as they require muscular efforts of a static nature. For example, in the sitting position, the heart rate increases by 5--8%, and in the standing position - by 10--20% compared to the prone position.

The alternation of muscle loads, when exercises for one muscle group are replaced by exercises for another group, and exercises with a large muscle load alternate with exercises that require little muscle effort, or with breathing exercises and relaxation exercises, prevents premature fatigue and provides an opportunity for a long, without long rest breaks to do physical exercise.

Physical activity is also regulated by the degree of complexity of the exercises. Exercises that are difficult to coordinate can cause tension in muscles not involved in movement, thereby increasing the load.

The intensity of physical exercises can be small, moderate, large and maximum (V. K. Dobrovolsky). Low-intensity exercises include exercises involving the movement of small and medium muscle groups, performed at a slow and medium pace, static breathing exercises and muscle relaxation exercises. Starting positions should not cause large static stresses and make it difficult to perform exercises. Physiological changes during the performance of these exercises are insignificant: a slight change in heart rate, a moderate increase in the maximum and a decrease in the minimum blood pressure, slowing down and deepening of breathing.

Exercises of moderate intensity involve the movement of medium (at a medium and fast pace) and large (at a slow and medium pace) muscle groups. Dynamic breathing exercises, exercises with objects and small weights, walking at a slow and medium pace, sedentary games are used. When performing these exercises, the heart rate increases slightly, the maximum arterial and pulse pressure moderately increases, and pulmonary ventilation increases. The duration of the recovery period is several minutes.

Exercises of high intensity are characterized by the simultaneous inclusion of a large number of muscle groups in the work, the performance of movements at an average and fast pace. These include exercises on gymnastic equipment, with weights, brisk walking, running, jumping, outdoor and sports games, skiing, etc. All of them place significant demands on the nervous, cardiovascular and respiratory systems: they cause an increase in heart rate, increase in maximum arterial and pulse pressure, increased metabolism. The duration of the recovery period is over 10 minutes.

Exercises of maximum intensity are rarely used in therapeutic physical culture. Such exercises with maximum load include, for example, speed running. When they are performed, oxygen debt arises, so the activity of the cardiovascular and respiratory systems is significantly enhanced.

It is necessary to dose general and local physical activity. The total load consists of the body's energy costs for the performance of muscle work in all physical exercises. The correspondence of its capabilities to the patient can be judged by outward signs fatigue and reactions of the cardiovascular and respiratory systems - the dynamics of heart rate and respiration. Local physical activity has mainly local effects. An example of such a load is exercises to restore the movement of paralyzed muscles.

Passive movements and exercises performed with help have little overall effect, so they must be dosed by the degree of local influence. In some cases, local loads, for example, exercises to strengthen the muscles of the body with compression fractures, are dosed both according to the general and local effects (according to heart rate and the degree of muscle fatigue) on the patient's body. For a more accurate assessment of the general and local load, the subjective sensations of the patient are also taken into account.

Depending on the tasks in different periods of treatment, there are three main options (both general and local) for the dosage of loads: therapeutic, tonic (supportive), and training.

Therapeutic dosage is used in cases where it is necessary first of all to have a therapeutic effect on the affected system or organ, to form compensation, to prevent complications. At the same time, the total physical load in classes is usually small and increases slightly from lesson to lesson. When the condition worsens, it decreases. Local physical activity consists of special exercises and may be small (for example, in initial period treatment of patients bronchial asthma or with neuritis of the facial nerve) or moderate (for example, in the treatment of fractures during the period of immobilization). Signs of general fatigue may not be observed, although fatigue of individual muscle groups is often noted. Physiological changes in the cardiovascular and respiratory systems are not very pronounced.

Tonic (maintenance) dosage is used in a satisfactory condition of the patient with prolonged immobilization, chronic diseases with an undulating course, after the end of rehabilitation treatment with the maximum possible therapeutic effect. General and local physical activity depends on the functionality of the organism as a whole, a separate affected organ or system. They should stimulate the functions of the main systems, i.e., have a tonic effect and support results achieved treatment. Physical exercise of moderate or high intensity is used. Feature This variant of the dosage of loads is that they do not increase during the course of therapeutic physical culture. The lesson should not tire the patient, but cause a feeling of cheerfulness, a surge of strength, and an improvement in mood.

The training dosage is used during the recovery period and during the period of rehabilitation treatment, when it is necessary to normalize all the functions of the patient's body, increase its performance or achieve a high degree of compensation. Physical loads during the performance of both general developmental and special exercises are increased from lesson to lesson due to various methodological techniques and are dosed in such a way as to cause fatigue. Physiological changes in the activity of the main systems, as a rule, are significant, but depend on the disease and the patient's condition. A training effect in certain periods of the disease can also be exerted by exercises of moderate intensity with a gradually increasing dosage. To determine the amount of physical activity that has a training effect, various tests are carried out. So, in diseases of the cardiovascular system, the maximum allowable physical activity is determined using a tolerance test; the value of the axial load in diaphyseal fractures - using the pressure of the injured immobilized leg on the scales until the onset of pain (80% of the value obtained - the optimal load); training effect to increase muscle strength has a load of 50% of the maximum.