Gresko I. Mechanisms of development, diagnosis and treatment of motor stereotype disorders in patients with lumbar osteochondrosis

The objects – motor stereotype in patients with lumbar osteochondrosis with myotonic reactions of the muscles of the lumbar-pelvic region was selected; the purpose – improving of diagnosis and treatment of motor stereotype disorders in patients with lumbar osteochondrosis on the basis of clinical and radiological study of the mechanisms of their development; methods – a) clinical: 1) study of orthopedic status with assessment of the position of paired anthropometric points; spinal configurations in the frontal and sagittal planes; the patient’s reaction to palpation of the trigger points of the lumbar-pelvic region; general mobility of the spine using the test «fingers-floor», mobility of the thoracic and lumbar spine by the method Sсhober, the volume of movements in the hip joints by the neutral 0-pass method; the functional state of the flexor and extensor muscles of the lumbar spine, pelvis and thigh with the study of their tone, strength and endurance; 2) study of motor stereotype according to the results of tests of active motor control of the muscles of the lumbar-pelvic region and tests that simulate the performance of daily movements; 3) questioning patients with self-assessment of their functional status;b) radiological; c) statistical; results – аccording to the results of clinical studies, the predominance of asymmetric location of the studied anthropometric landmarks in the static position and during dynamic loads not only on the right and left, but also in the upper and lower half of the torso of patients was revealed. The results of palpation of the trigger points of the lumbar-pelvic region allowed to establish that the most painful were the trigger points of the lower lumbar-pelvic region. The mobility of the spine as a whole according to the results of the test «fingers–floor» was limited due to myofixation of the lumbar spine. The functional state of the muscles was characterized by increased tone, decreased strength and endurance of all studied muscles. The results of testing active motor control of the muscles of the lumbar-pelvic region revealed the implementation of pathological motor patterns. Compensatory mechanisms have been identified by tests that simulate daily loads. The results of self-assessment of patients of their functional state revealed that the intensity of lumbar pain, the level of disability reflected severe functional disorders in the musculoskeletal system; levels of kinesiophobia and fear and anxiety associated with the expectation of pain were high.The results of a comparative analysis of the study of lumbar spondylograms of the general group of patients with osteochondrosis of the spine with motor stereotype and the group of asymptomatic volunteers revealed a statistically significant predominance of all variants of lumbar vertebral asymmetries at all lower lumbar levels. Based on the results of clinical and radiological studies, a consistent concept of the pathogenesis of motor stereotype disorders in patients with lumbar osteochondrosis has been developed. Correction of the imbalance of the muscles of the lumbar-pelvic region and thighs was chosen. The results of the developed program of physical rehabilitation (combination of extracorporeal shock wave therapy with the program of relaxing exercises and coordination exercises) of patients with lumbar osteochondrosis with myotonic reactions and violation of motor stereotype demonstrated its effectiveness, which was manifested by a significant decrease the intensity of pain, levels of disabling and kinesiophobia, a significant increase in the mobility of the spine and its lumbar region, as well as the amplitude of flexion in the hip joints; introduced – in the practical work of health care institutions; branch – medicine.