Melnychenko L. Efficiency of combined traction in medical rehabilitation of patients with myofascial pain syndrome of lumbar localization

The dissertation presents a theoretical generalization and a solution of the actual scientific problem of increasing the efficiency of rehabilitation of chronic vertebrogenic myofascial pain syndrome patients with lumbar localization based on the complex analysis of the features of the clinic of the vertebro-neurological syndrome, the results of questionnaire scales, instrumental, neuroimaging study by the application of complex rehabilitation with a combined traction of the spine. It is known that insufficiently studied are clinical forms of combination of chronic nonspecific mechanical low back pain with myofascial pain syndrome with significant degenerative-dystrophic changes in the spine and the absence of neurological symptomatology of root damage. The requirement of successful treatment and rehabilitation of patients with chronic vertebrogenic myofascial pain syndromes of the lumbar localization is a using of complex integrated approach with multimodal influence and taking into account pathomorphology and function of vertebral-motor segments, clinic and static-dynamic disorders, state of muscular imbalances, localization and severity of myofascial dysfunction with the involvement of. For the study data of 149 patients with vertebrogenic myofascial pain syndrome of lumbar localization aged 20 to 60 years old were taken, duration of the last exacerbation ranged from 3,5 to 7 months (average duration 5,2±0,1 months). To evaluate the treatment efficacy, all patients were divided by randomization method into control (69 person) and main (80 person) groups that were identical in age and sex. Duration of the disease from the beginning to the last exacerbation ranged from 1 to 9 years (average duration 3,5±0,2 years). The study did not include patients with cauda equine syndrome, hernia sequestration, spondylodiscitis, instability of lumbar segments, deforming spondylosis with block by the osteophytes, spondylolisthesis, spinal fractures, and osteoporosis. Before the treatment the clinical vertebroneurological and functional status of patients according to clinical, biomechanical, instrumental (MRI, myotonometry) research and rehabilitation scales (VAS, McGill, SF-36) was studied. All patients of the control and main groups prescribed medication blockades, apparatus physiotherapy (low frequency electrotherapy by sinusoidal currents), massage, post-isometric relaxation, ischemic compression, medication (alflutop, meloxicam), kinesotherapy (therapeutic corrective physical exercises), fixation of the lumbar spine with corset. Complex rehabilitation was carried out individually, depending on the revealed clinical vertebroneurological manifestations of the disease (clinic, pain syndrome, state of motor function of the spine, muscle strength and muscle tension, myofascial dysfunction), MRI results. The treatment of patients in the main group included using of a combined traction on the device developed for this.