The dissertation is written in the State Educational Institution of the high Professional education “Russian State High Educational University of the Federal Agency of Health Protection and Medical University of Social Development”.

Supervisor of Studies Professor G.Ye.Ivanova, Doctor of Medicine.

Official opponents: Professor M.B.Tsikunov, Doctor of Medicine, Professor A.N.Ivanokov, Doctor of Medicine.

The leading institution: Moscow Academy of Medicine named after I.P.Sechenov.

Defending the thesis will take place on Oct. 30th 2006 at 2.00 pm at the meeting of the Dissertation Council
Address: 1, Octrovityaninov St., Moscow 117997 Russia.

The dissertation is available at the library of RSMU. Address: 1, Ostrovityaninov St., Moscow 117997, Russia.

Scientific Secretary G.Ye.Ivanova, Doctor of Medical Science.

One of the most actual problems in clinical medicine is the problem of painful (algesic) syndrome. Backache, according to WHO experts, in the end of XX century got the character of non-infectious epidemy since about 80% of people suffer it (mostly people of able-bodied age). The results of investigations show that the expenses on diagnostic, treatment and the compensation for encapacity for work and disability increased in the USA from 4.6 billion dollars in 1997 to 11.4 billion dollars in 1994. In Great Britain in 1992 90 million working days were lost. 75% of patients were people aged 30-59 (maximum ability for work (128). According to WHO in 2000 the figures were 25-28 billion dollars for the USA and 6 milliard pounds for Great Britain. It shows the constant raising of prices for the cure of such patients (11). The most often are cases of Lumbadynia (to 70%) and Lumbar Ischialgia because of the peculiarities of the functional anatomy of lumbar region. There are very many such kind of patients, especially in outpatient departments. In such situation a lot of problems have not been solved yet: unity of diagnostic algorithm for the definition of the disorder of functions in lumbar region of the spinal column during the painful syndrome; tardiness of the beginning of treatment, insufficient effect of therapy. All this leads to chronic forms of the disease, to the development of constant disorders followed by the disability for professional work, for the progress of psycho-emotional disorders. Everything cited above shows the importance of the problems.

The purpose of research is to raise the effectiveness of methods of Exercise Therapy for the rehabilitation of motional functions for patients with Lumbodynia during acute periods of the disease.

1. to study on the base of somatometric and somatoscopic research the peculiarities of regional postural imbalance and changes of dynamic stereotype of the patients with Lymbodynia in the acute period.
2. to study the peculiarities of biologic activities of the patients’ muscles in the Lumbar region in the acute period of the disease using the data of electromyography.
3. to work out the methods of Exercise Therapy in the complex of rehabilitating measures for the patients in the acute period of the disease.
4. to study the effects of the given complex of physical exercises for the rehabilitation of motion functions of the patients with Lumbodynia.

1. The given physical exercises directed to the complex treatment of lumbodynia are used to rehabilitate the regular tone, power and bioelectrical activity of the lumbar region not only in the stare of rest but during active and passive movements.
2. The method of physical exercises directed to stretching that envisages gradual transition from passive static stretching (therapeutic stretching) to passive-active stretching, ballistic stretching, active stretching with someone’s help and active stretching is the effective means of reducing pain syndrome, improving clinical state, co-ordinated rehabilitation of static and dynamic functions of the lumbar region, improving the quality of the life of patients with lumbodynia in the complex of rehabilitating actions which include dry skeletal extension, manipulations on Vertebro-motional segments, classical massage, physiotherapy and medicament therapy.

It is for the first time that the rehabilitating complex is based on detailed learning of postural, dynamic and bioelectric functions of muscles of the lumbar region. For the first time the modern data about biomechanics and neurophysiology of changes in muscles that take place in the result of stretching have become the base for the method of therapeutic exercises based on consecutive use of different types of stretching of muscles.

The influence of physical exercises on the state of lumbar region muscles was estimated; it became clear that the new method is more effective than power exercises. For the first time it is found that the complex of therapeutic exercises which include passive static stretching (therapeutic stretching), passive-active stretching, ballistic stretching, active stretching with someone’s help and active stretching helps the differentiational increase of muscle power in the lumbar region with the changed function against the background of the normalization of the muscular tonus and bioelectrical activity. This, in its turn, promotes balances static and dynamic changes of the lumbar region. Our research shows (for the first time) the power exercises don’t produce considerable changes on the muscular tonus of the lumbar region, that’s why the initial disbalance is remained.

The results of the research allowed to raise the effectiveness of physical exercises of the complex rehabilitating course for the patients with lumbodynia. We have worked out the method of the use of physical exercises in the complex rehabilitating treatment which includes dry skeletal extension, manipulations on Vertebral Motion Segments classical massage, physiotheraphy and medicament therapy.

We have found out the indications for and contraindication to the use of exercises on stretching.

The possible fields of the use are medicine (exercise therapy, sports medicine, neurology, orthopedics, traumatology), social rehabilitation (rehabilitating centres for invalids from traumas).

The results of the work are inculcated in the Polyclinic Department №55 (neurology) (Moscow), in the Clinic of Manual Therapy (Sochi), in the Town (municipal) Hospital №1 (Sochi), in the work of the department of rehabilitation, sports medicine and physical culture of Russian State Medical University of Federal Agency on Health Care and Social Development.

The thesis is written in accordance with the scientific research of Russian State University. The main points of the thesis are discussed at the scientific conference of the departments of Rehabilitation, Sports Medicine, Physical Culture with the course of physiotherapy, Therapy Exercises, Sports Medicine of the Institute of the Advanced Training of Doctors of the Russian Medical University; the Neurology Department and the course of Neurology and Traditional Medicine Advanced Training Course of Russian State Medical University. Two articles in Central editions were published on the materials of the thesis.

The Thesis consists of the Introduction, Review of Literature, 3 Chapters of the author’s own research, the Conclusion, Practical Recommendations and the List of the used Literature which includes 207 original sources (79 are foreign ones). The volume of the Thesis is 129 pages, it’s illustrated with 14 diagrams and 26 tables.

The Main Substance of the Work. The Ways and Methods of Research, Characteristics of the Examined Patients.

The work is based on the dynamic observation on 115 patients – 41 women (35.7 per cent) and 74 men (64.3 per cent) at the age of 25-67 who had the course of treatment in the day hospital of the clinic of manual therapy in Sochi, Russia. They all suffered pain in the lumbar region. The criteria of the research were the pain syndrome and the limitations of movements in the loin connected with the changes of the position of the body or physical tension, the absence of morning constraint, confirmed by roentgenograms and the results of degenerative and dystrophic processes in the lumbar region on the spinal column computer tomography; the absence of the centers of evident bone destruction, the absence of temperature rise during attacks of pain, the absence of the changes of the blood formula typical for inflammation (ESR, leukocytosis), the absence of rheumatism, the absence of the high range of alkaline phosphatase in blood the absence of psoriasiform changes, the absence of aggregation, the absence sacroileitis. The lingering of the diseases varied from 1 to 30 years.

Two patients (0.56%) suffered Lumbodynia for the first time in their life. In 64.6% the lingering of the disease was up to 10 years. As there were a lot of combinations of unloaded muscles, it was quite difficult to define some mioadoptive syndromes (V.P.Vesselovsky, 1991(88)). Still, on the base of the analysis of clinical presentations we could classify the following reflex syndromes: muscle tone syndrome 80.8% (93 patients), neurodystrophic syndrome 15.7%, neurovascular 3.5%.

The peculiarities of clinical courses were characterized with the quantities of attacks and combination with pathology of other organs and systems. Patients who suffered Lumbodynia for the first time in their lives or had rare attacks (1 per year) – 16.5%; those who suffered two attacks per year – 40.8%; more than two attacks per year – 34%; more than 6 attacks per year – 8.7%.

Acute attacks of the disease were caused by different things: cold, physical tension, weight lifting, awkward movement, trauma, inconvenient footwear. In many cases the acute attack was provoked by stress. Some other causes were provoked by catarrhal and virus diseases. As associated diseases Billiary dyskinesia (24.3%), cholelithic disease (35.6%), gall-stones (4.3%), colitis (31.3%), adnexitis (5.2%).

Patients complained of pain in the region of loin that irradiated along the outer surface of the leg up to the big toe and on the inner surface of the belly, to the groin, along the inner surface of the thing up to the knee. While studying pain syndrome grade we got the following data: according to the visual-analogue scale the intensity of the pain syndrome was characterized as moderate (4-7 marks); according to the Pain index (Mc Gill) patients characterized the pain syndrome mostly as darting, sharp, disturbing, excruciating, tiring pain; the change of the quality of life of patients in connection with the pain syndrome was 63.37% (according to the date of chronic Disability Index after Vaddel.

When patients were examined in the position “on the belly” we found out scoliotic changes in the lumbar region (8 patients in the basic group and 3 patients in the control group). In the position “on the back” some patients couldn’t completely straighten their legs, because of the pain syndrome (55 patients (76.3%) in the basic group and 32 patients (74.4%) in the control group). We found out asymmetry of the height of shoulders and slight rotation of the chin mostly to the right (27 patients (37.5%)) in the basic group and 16 patients (33.2%) in the control group. When the patients were in the position “sitting with one’s back to the doctor” we found out asymmetry of the height of shoulders at the beginning of the research (47 patients (65.3%) in the basic group and 28 (65.1%) in the control group). When there was asymmetry of the height of shoulders, we saw the relief of muscles of the lumbar regions that was the indirect sign of the increased muscular tone. While sitting on the chair patients were in hyperextensional pose and presses against the back of the chair (79.2%). When patients were examined for the first time standing we found out asymmetry of the lumbar region in the frontal plane (38 patients (52.8%) in the basic group and 22 (51.2%) in the control group). We found out scoliotic abnormality of bearing in the thoracal and lumbar regions of the spinal column with on-sided (18 patients – 15.6%) 11 and 4 patients accordingly) curvature of spine. The change of the motional stereotype of walking included slowing down the tempo, diminishing the length of the step, diminishing the mobility of the pelvis to make the position for unloading and limitation of the mobility of the lumbar region, inclination forward and to the side (mostly to the right), fixing with the hand the place of pain localization while walking. During palpation muscles in the state of rest patients felt local pain (54.5 patients) in the kind of compact painful bands of tissue and places of local muscle induration, especially in extensor muscles. As the muscles of the lumbar region are considerably large the changes of the muscular tone were irregular. What concerns extensor muscles of the back the main changes were on the level of the upper lumbar vertebral and lessened in the direction of pelvis. In the abdominal external oblique muscle the main changes were fixed in the right part of hypogastrium and lessened in the direction of ribs. In the straight abdominal muscle the most dense parts were in the left upper third. These changes were especially aright in the position of standing. Besides, the change of the tone of the erector muscle of spine coordinates with the increase of the tone of the … muscle on the opposite side. Which coordinates with the data of the other authors.

According to MMT most of the patients had increased muscular tone during passive movements (0.3-2.5 marks), especially in the extensor muscle of the back. And the muscular tone on the back surface of the lumbar region is increased mostly on the left, while on the frontal surface it is increased mostly on the right that is, perhaps a variant of compensatory changes.

When we tested the joints of the lumbar region with the help of passive test movements we found out the limitation of lateral inclinations to the right because of the pain paravertebrally in the region of spinal joints on the level L3-L5. Active muscle testing showed that contracting function of the muscles lessened when the tone was increased. It means that the muscles are in the state of long static tension, which is connected with keeping body balance when the centre of the mass is displaced. It leads to the further changing of the motional stereotype with the lessening of the active movements volume from 20% to 62%.

During the neurological examination 72 patients had bad mood, nervousness, irritation. The examination of the functions of cerebrospinal nerves showed that 57 patients had the slight reduction of sensitivity and tingling on the outer surface of the hip, the frontal-outer surface of the leg to the toes, mostly on the left: 49 patients – along the frontal-inner surface of the thigh to the popliteal space; 43 patients – on the inner surface of the thigh; 54 patients had stupor. 82 patients had painfulness of paravertebral points; 13 patients – of spinal processes and interspinal ligaments. 6 patients had considerable painfulness during the palpation of the lower parts of belly; 4 patients – during the epigastral parts of belly. During the deeper palpation 62 patients had considerable painfulness along the ridge of the iliac bone and on the sacral; 18 patients – in the region of symphysis pubis. 8 patients had considerable constant red dermographism on the frontal – lateral wall of the belly, 6 patients had white dermographism. 85 patients had Lasegne’s sign when they raised their legs to 30 (28 patients – on the right, 34 – on the left, 23 – on both sides). Changed and pathological reflexes were not found. 4 patients had the changes of the skin colour of the legs: paleness, cyanosis, slight edema. During the examination on stability in Romberg position we watched non-systemic reeling (П=48); digitonasal sign showed no deviations; heel-knee test was limited (74% of patients) because of pain.

All the patients expressed the high level of anxiety, psychological disintegration, that is too high control over their emotions with the overestimation of the situation.

Electromyography in the state of “rest” showed electrical activity of muscles with the amplitude 6.4 Mkw-9.4 MKw. In the condition of arbitrary muscular contractions 54% of patients showed mostly 1-Иа type EMG. The research of the character of the changes of maximal amplitude M-answer it ht state of rest and during fulfilling of maximal isometric tension before and after the treatment gave the data about the asymmetry of EA of the patients both in the state of rest (especially abdominal external oblique muscle) and maximal tension. Some patient had small increase of EA of the muscles in the state of rest and the decrease of EA spasmic muscles in comparison with normal state during the active tension. The given data are coordinated with the results that were given before (83) for the patients with Lumbodynia.

During radiographic examination the sings of osteochondrosis of different stages were discovered in all the cases. The analysis of spondylograms according to G.S.Yumashev and M.Ye.Furman (1973) showed that each patient had static disorders and local symptoms in different combinations: flattering lumbar lordosis 91 (79.1%); scoliosis 15 (13.0%); increase of lumbar lordosis 15 (13%); instability of moving segment 41 (35.7%); decrease of the disc height 91 (79.1%); Schmorl’s nodule 3 (2.5%); sclerosis of closing plates 86 (74.8%); uncovertebral arthrosis 45 (39.13%). Degenerative process mostly caught 2-3 segments.

The changes founded during the examinations of the patients, some peculiarities of structure and functioning of their spinal columns and the data given during the examinations (stretching and contraction) let us work out the methods of physical rehabilitation of patients with pain syndrome of reflex nature in the lumbar region (Lumbodynia), learn its effectiveness and recommend it to the use in medical practice.

The method of physical rehabilitation for the patients with Lumbodynia is the staged, individual and adequate planned system of treating measures which include the complex of physical exercises based on the staged use of different types of stretching, that give the constant and gradual increase of joints moving range during the definite period of time (Aten. Knight, 1978; Corbin, Noble, 1980) (2) with the definite intensity.

The main principles of the therapeutic exercises method were the following:1) thorough diagnostics of the starting stereotype of movement in the lumbar part of the spinal column; 2) the rehabilitation of the regular tone, power and flexibility of muscular and connective tissue of the region (separate muscles, fascia, joint and ligament capsules) which form pathological stereotypes of the pose and movements; 3) rehabilitating of the regular coordination of the muscles which form the static and dynamic stereotype of the region.

The differential approach to the prescription of the therapeutic exercises was used: we took into consideration the configuration of the lumbar region of the spinal column, the state of the muscular and connective tissue of the right and left sides of the body, belly and back. We used symmetrical exercises at the final stage, after levelling the tone and power of pair muscles for saving the symmetry of the static stereotype and maintaining the balance of muscular tone in the dynamic stereotype.

The peculiarity of this complex is the use of stretching of muscles, fascia, joint capsules and ligaments as the stage of rehabilitation of normal active contractive ability of muscles. The program of stretching envisages the staged transition from passive (therapeutic) stretching to passive-active stretching, active stretching with someone’s help and active stretching.

The task of the first stage is removing pain and approaching mechanic balance (the balance of the length, tone and flexibility of the muscles) in the lumbar part for the reducing muscle resistance. The task for the increase of the power of the oganist was made after the rehabilitation of muscle flexibility in its physiological limits. The program of stretching was mostly directed to the lengthening of muscles and fascia because over stretching of joint and ligament capsules can lead to joint destabilization and increasing the possibility of hypermobility and traumas. The consecutive use of the passive, passive-active and active (with help) stretching helped strengthening weak muscles – antagonists. The obligatory condition of fulfilling the complex of stretching exercises on the first stage was preliminary, warming of the body with dry heat.

The task of the second stage was approaching of the functional balance of the tissues in the lumbar region (rehabilitation of static and dynamic stereotypes) and rehabilitation of muscle power; in this case the exercises on active and active-passive stretching were done in the first part of the studies (warming-up). In the main part of the study there is training load on the muscle for increasing its strength (ballistic stretching, active stretching with help and active stretching). All the active and passive exercises were done during exhalation.

For more effectiveness of stretching exercises we used the following methods: repeated shortenings, rhythmical initiating, slow reversing-keeping, stabilization, contracting – weakening, reversing-keeping-weakening, slow reversing-keeping-weakening, reversing agonists.

All the patients had careful preliminary examination; we determined their muscle and fascia groups and their static and dynamic stereotype disorders. According to the examination we worded out individual complexes of physical exercises for different stages. The therapeutic exercises were the base of physical rehabilitation. The whole course included 13-17 procedures.

As we wanted to study the effectiveness of the complex of physical rehabilitation of patients with Lumbodynia and to value its contribution into the general therapeutic effect of the treatment we divided all the patients (according to the methods of rehabilitating treatment) into 2 groups: basic (72 patients) and control (43 patients). All the patients were of similar age and sex. Their clinical symptoms, the duration of the diseases, ethiolohy were similar and could be compared.

The complex program in the basic group included medical therapy, manual therapy with the use of soft manipulations techniques and dry skeletal extension with small weighs, classical massage and physiotherapy; it also included the use of staged physical exercises on stretching (according to special method) to correct the static and dynamic stereotype. In the control group we used not only medicinal therapy, manual therapy and dry extension but physical exercised directed on the development of power, muscle hypertrophy to correct static and dynamic stereotype. The rehabilitation procedures in both groups were made together with the identical base medicinal therapy and physiotherapy.

The program of the research was determined by the tasks and included preliminary complex examination, study the effectiveness of certain procedures of the rehabilitating complex; control of the patients’ state; the stare of the muscle and fascia jacket before and after each procedure according to the method; the final complex examination.

The analysis of the effectiveness of separate procedures of the rehabilitating complex included the control of Ps, blood pressure, manual muscle testing (MMT), angle and linear measuring, EMG (electromyogram).

Control of the patients’ general state and hemodynamic before and after each procedure wad made by means of registrating blood pressure and pulse.

After the treatment 12 patients (16.6%) suffered pain. In the control group 10 patients suffered pain syndrome (23%). After the treatment the intensity of pain syndrome decreased to the level of mild pain (1-3 points), mostly in the basic group.

At the end of the treatment more patients had mild pain than moderate pain. According to McGill index at the end of the treatment the feeling of discomfort and weight was 1.75 less in the basic group than in the control group. Besides, patients of the control group had aching and worrying pain. The patients’ activity (according to the Chronic Disability Index (Vaddel) was higher in the basic group (11.25%) than in the control group (18.5%).

In the basic group (in comparison with the control group (we saw the better dynamics of changing the bearing in the position of lying on the belly, on the back, sitting with the back to the doctor, standing, walking. After the treating course the muscle tone in the state of rest was better leveled and reduced (After Zhuleyev N.M., 1992). Muscle testing shows that in the basic group the muscle tone of stage 1 (reduced tone) decreased from 25.8% to 17.4%; stage 2 (normal tone) – increased from 38.7% to 81.8%; stage 3 (increased tone) – decreased from 35.3% to 0.8%. In the control group after the course the indexes of muscle tone of stage 1 (reduced tone) decreased from 25.8% to 15.4%; stage 2 (normal tone) – increased from 38.7% to 79.8%; stage 3 (increased tone) – decreased from 35.3% to 4.5%.

According to the data of manual testing after the treatment we had the decrease and levelling of the tone, the increase and balanced leveling of the muscle power. The decrease of the tone is expressed 2.08 times more in comparison with the control group; change of the power didn’t differ that showed the better positive dynamics of the muscle tone not only in the state of rest but during the muscle activity.

The volume of active movements increased in both groups, but by the end of the treatment the reliable differences of the volume can be determined only by the test “fingers-floor” and Shober test which shows, perhaps, the absence of the influence of the program directed to the increase of the muscle power on the flexibility of the ligaments and muscle fascia of the loin; it does not change the limitation of the movements to the end of the course.

The neurological examination at the end of the complex treatment showed the following: 12 patients had bad mood; there were no displays of nervousness and irritation. The examination of the functions of cerebrospinal nerves no disorders of sensitivity were discovered. We didn’t discover any painfulness of paravertebral points, spinal processes and interspinal ligaments. During the deeper palpation 2 patients of the basic group and 10 patients of the control group had had considerable painfulness along the ridge of the iliac bone, 3 patients of the control group – in the region of symphysis pubis. All the patients of the basic group had moderate unstable red dermographism on the frontal wall of the belly at the end of the course. 2 patients of the control group had considerable constant red dermographism on the frontal-lateral wall of the belly, 1 patient had white dermographism. No patients of the basic group had symptoms of tension at the end of the course; 3 patients in the control group had Lasegue’s sigh. No changes of the skin color were discovered in both groups. During the coordinating tests Romberg position and digitonasal sign were fulfilled satisfactorily. 3 patients of the control group had some difficulties during the fulfillment of the heel-knee test.

Psychological test after the treatment showed the decrease of emotional stress (tension in both groups of the examined patients that was determined by the decrease of the level of reactive anxiety. The correlation of the personal and reactive anxiety after the course became more balanced.

After the course the asymmetry of EA in muscles of the patients in the basic group became levelled (both in the state of rest and under load). In the state of rest the background EA decreased, under load it became considerably more.

In the control group after the course of physical rehabilitation directed to the development of the muscle power increase of the absolute meanings of EA in the state of rest was less, but in didn’t have any considerable differences from the one in the basic group. The increase of the asymmetry of EA of the muscles of right and left sides in the state of rest after the course must be taken into consideration.

During the isometric contraction in the control group EA of the muscles is less displayed after the course but this tendency in not quite reliable. The asymmetry of EA of the muscles during isometric contraction didn’t practically change by the end of the course.

At the end of the course according to the results of the radiographic examination the number of discovered local symptoms practically didn’t change which perhaps can be connected with the short course of treatment. The number of patients with the decrease of the disk height didn’t lessen much. The number of patients with flattening of lumbar lordosis and instability of motional segment considerably decreased. In the control group the number of the patient with flattening of lumbar lordosis is less decreased in comparison with the initial data. The number of patient with the instability of motional segment decreased quite reasonably but was less discovered than in the basic group. The changes discovered during radiographic examination were considered as preconditions for the rehabilitation of joint congruity in the vertebromotional segments which was the precondition of the rehabilitation of the stability of the static stereotype of the lumbar region.

According to the plan of our research we studied the effectiveness of each procedure of the rehabilitating complex and the effectiveness of the complex.

In both groups the reaction of the patients for the dry skeletal extension was the same. In an hour after the procedure of dry skeletal extension we watched statistically doubtful increase of the volume of the test movements. The manipulation of the vertebromotional segment caused short-term decrease of the contracting ability of the lumbar region muscles. Rotations, bendings and extensions increased but these changes were not constant and didn’t influence much on change of the static stereotype single procedure of classic massage the passive tone of the massaged muscles reduced but not for a long time – for 15-20 min. As a result of a single procedure of therapeutic exercises patients had the improvement of the mobility in the lumbar region which lead to the increase of the volume of the test movements. But all these changes became considerable only after 4-5 procedures. After the first procedure we watched the considerable reduce of pain both in the state of rest and in motion; local painfulness reduced, too. We discovered the reduce of painfulness in the points of fastening muscles to the iliac crest and symphysic pubis, spinous processes of vertebra, the decrease of passive (after Жулеев Н.М.) and active (after Ашфорт) tone of the discovered muscles, differential increase of their power. It was discovered that the more the tone of the muscle decreases, the more its power increases.

In the control group the volume of the fulfilled exercises at the first procedures was limited by the considerable pain in the muscles, especially, in the lumbar quadrate muscle and in the region of vertebral bodies (L3-L4). The absence of the changes of the active tone and the symmetrical increase of the muscle power, perhaps, didn’t help to the correction of the static stereotype. The volume of the movements after the first procedure and during 7 days after it didn’t considerably change.

The course of the rehabilitating complex was done till the complete disappearance of pain. If the acute pain syndrome was reduced fast the results of rehabilitating procedures was better and the dynamic was better too. The reduction of the acute pain took place after 2-3 visits of patients. In the control group the reduction of pain was displayed after 4-5 visits.

The best result was when the duration of the illness was not long (1-3 years). The best therapeutic effect was received when the pain syndrome was limited by 2-3 vertebra motional segments. Patients with neuroostreofibrosis had the longest treatment course (17.1±1.3 procedures) while patients with muscle tone reactions had 14.7±2.1 and with neurovascular reactions had 15.5±1.6 procedures.

The given results show the advantage of these medical exercises over the ones directed to the development of the lumbar region muscles’ power. They are a part of the complex directed to the rehabilitation of motional function of the patient with the pain syndrome of the reflex ethiology in the lumbar part of spinal column for the formation of the adequite static and dynamic stereotypes.

Thus, the results of the complex treatment course showed that the duration of the pain syndrome reduction defined the duration of the rehabilitating course for the patients with this pathology; the best therapeutic effect was for those patients whose pathological process touched 2-3 vertebramotional segments. The change of the character of the pain syndrome, bearing, the volume of active and passive movements, power, tone and electrical activity of the lumbar region muscles, clinical stage and the data of instrumental and test research tell about the advantage of the physical exercises of stretching in the complex of therapeutic measures for the reduction of pain syndrome and stabilization of the achieved state.

The data of the research the power, tone and electrical activities of the muscles during the process of physical rehabilitation show that the influence of the exercises of stretching on the tone of the muscles was considerable. It leads to the differential reduce of the muscle tone (which was increased before), the increase of muscle power that courses the rehabilitation of the balance and coordination of the muscles in all flats of the movements. The use of the exercises directed to the development of the muscle power and body jacket in the complex treatment of the pain syndrome of the region of loin reduces the therapeutic effect.

Thus, the method of physical rehabilitation in the complex treatment of Lumbodynia which was worked out in our clinic is the effective method for the treatment of this pathology.

1. Patients with Lumbodynia have the increase of the tone in the state of rest and during fulfilling passive movements though they have the limitation of the fulfilling active movements; they have the increase of bioelectrical activity in the state of rest and the decrease of bioelectrical activity in the time of the maximal efforts of the spastic muscles. The most displayed asymmetry of the bioelectrical activity of the muscles of the right and left sides of patients body is in the abdominal external oblique muscle both in the state of rest and during the maximal isometric tension.
2. Slow passive stretching at the beginning of physical rehabilitation during the muscle rehabilitating that enlarges the extensibility of the parallel flexible component and serial flexible component in the symmetric muscles not more than 1.5 initial length of the muscle gives the reduction of the muscle tone, provides with relaxation, reduces pain, balances the morphological parameters of the muscle (the length) before the next contraction.
3. The given method of physical exercises on stretching in the complex treatment of Lumbodynia helps to rehabilitate the normal tone of the muscles of the loin region not only in the state of rest but during the motions on the background of the increase of the muscle power. The method of the physical exercises directed to the increase of the muscle power in the loin region doesn’t influence the changing of the tone of spastic muscles in the Lumbar region.
4. The method of physical exercises directed to the stretching which means the staged transition from passive static stretching (therapeutic stretching) to passive-active stretching, ballistic stretching, active stretching with help and active stretching proper helps to increase the muscle power on the quantity than can be considerable compared with the increase of the muscle power during doing the exercises directed to the increase of the power by fulfilling isotonic and isometric work.
5. Our method of physical rehabilitation of the patients with Lumbodynia based on the staged use of different types of stretching is the effective means of the reduction of pain syndrome, improvement of clinical state, coordinated rehabilitation of static and dynamic functions of the lumbar region, improvement of the quality of patients’ lives. The best effect of this method of physical rehabilitation is displayed when the duration of the discase is not more than 3 years and with the pain syndrome limited by 2-3 vertebramotional segments.

1. The main principles of the method of therapeutic exercises are:

- careful diagnostics of the initial stereotype of movement in the lumbar region of the spinal column on the base of the research of the tone, power and volume of active and passive movements of muscles of this region;
- the rehabilitation of the normal tone, power and flexibility of muscular and connecting tissue of the region (separate muscles, fascia) which form pathological stereotype of the pose and movement by using staged stretching;
- the rehabilitation of the normal muscle coordination that forms the static and dynamic stereotype of the region.
2. The method of stretching includes the successive staged transition from passive static stretching (therapeutic stretching) to passive-active stretching, ballistic stretching, active stretching with the help and active stretching proper.
3. The task of the increase of the agonist’s power is raised and solved only after the rehabilitation of the muscle flexibility in its physiological limits.
4. The obligatory condition of the fulfilling the complex of stretching exercises is the preliminary heating of the body.

1. Колягин Ю.И. (Kolyagin Yu.I.), Поляев Б.А. (Polyayev B.A.), Ерин В.Н. (Erin V.N.), Илюгина Л.Б. (Ilyugina L.B.) To the problem of the complex rehabilitation of the patients with Lumbodynia //Journal of the Russian Association of Sports Medicine and Patients and Disabled People Rehabilitation. –M., №1(18), 2006.-pp.17-23.
2. Кудрявцев М.А. (Kudryavtsev M.A.), Колягин Ю.И. (Kolyagin Yu.I.), Илюгина Л.Б. (Ilyugina L.B.) Therapeutic exercises for the Treatment of Backache of the Lumbar Region of the Spinal Column// Russian Association on Sports Medicine, Patients and Disabled People. M. №20(19), 2006, pp.26-27.