methods, which include
kurvimetricheskie, uglometricheskie, miotonometricheskie, tenzoalgimetricheskie,
as applying only to clinical technique significantly narrows the possibilities
physician in terms of the diversity of diagnostic symptom of the disease .
Moreover, the integral exponent of functional disorders of the locomotor system
reflects the severity of the disease and can be used as a criterion for evaluating the effectiveness of treatment
[4, 16, 19, 36, 50, 53].
Manual'noye testing allows us to establish the nature, severity and localization
pathobiomechanical changes in the locomotor apparatus and
identify pathologically intense or relaxed muscles, as any
biomechanical disorders leads to changes in the static component
motor stereotype , along with that determined by active and latent trigger points
. And the vertebral column with manual examination
biokinematicheskaya regarded as a single chain, with an estimate of the degree of restriction
movements and their pain in three mutually perpendicular planes -
sagittal, frontal and horizontal as well as assessment of bilateral symmetry
stasctures . Very important to evaluate the relative position of the head
about the spine and pelvis relative to the spine. Taz is
key area in the musculoskeletal system and has a number of biomechanical
features. Paired nameless bones, which consist of three fused bones:
ilium, pubis and ischium, and azygos - sacasm, formed between a
following joints: sacroiliac, lumbosacral,
sacro-coccyx, lonnoe symphysis (pubis) and the hip joint.
Ligamentous apparatus of the pelvis before sacro-sacrotuberal, sacro-spinalis,
sacro-iliac, sacro-lumbar and inguinal ligament. Complexity
stascture of the pelvis and a variety of complex and combined motions carried
between the joints, contributes to a number of dysfunctions, the most significant of which
- lonnaya, sacral and nameless dysfunction. Identified
pathobiomechanical violations then purposefully specified in
palpation, the study of active and passive movements, isometric muscle tension
, testing, relaxed and shortened muscles, joint research
games [2, 3, 9, 22, 38, 41, 51].
important role in the differential diagnosis dorsalgia play
radiological tests, with the help of which you are installing
pathomorphological substrate is carried out differential diagnosis between
and other degenerative diseases of the spine, defined anomalies and
individual characteristics of bones and joints [14, 47, 52].
To refine these biomechanical disorders of spine as stability
vertebral-motor segment, the displacement of the vertebrae relative to each other,
state of the ligaments, is used in functional spondilography
extreme positions of flexion and traction [11, 14, 23].
also in the diagnosis of compression syndrome complicated by osteoarthritis
used contrasting methods of X-ray - myelography, epidurography,
discography [18, 25, 39, 45].
to a sufficiently informative methods for diagnosis of back pain include
computed tomography. Computed tomography allows to obtain reliable data on
severity and nature of the spine, the condition of the spinal
brain and surrounding stasctures in tumors, trauma, judge the severity
protassion and prolapse discs, their location and orientation, the state of
ligamentous system and the musculoskeletal system may also be able to accurately measure the diameter of the spinal canal
. In connection with the use of computer-tomography-
study was made possible tomoreadequately plan treatment policy,
establish the indications for conservative and surgical treatment, conduct
dynamic control over the degree of pathological changes and evaluate
effectiveness of therapy [1, 12, 33, 35, 40].
in recent years in medicine is increasingly composed principally new
diagnostic methods, which include, in particular, magnetic resonance imaging
. This method allows the study to enhance the contrast
image, which is very important for a clear differentiation of soft tissue
formations. Advantages of magnetic resonance tomografiches-one method
lie in the fact that it avoids radiation exposure and the introduction of
contrast agents, allows to reveal spinal stenosis, sequesters
changes in a yellow binder, in the intervertebral joints and discs , spinal cord,
soft tissues and bones of the extremities. The most reliable diagnostic signs
detected in the combined use of magnetic resonance imaging,
be able to better visualize soft tissue formation, and computer-
tomography, in whichmoreclearly different bone stasctures [13, 29, 34,
46 , 57, 59].
The diagnosis dorsalgia hold a special place sonographic method
study. The most commonly used sonography in the diagnosis of anomalies and
destasctive changes of vertebrae, changes in the nucleus pulposus, fibrous ring of intervertebral discs
, determining the status of radicular sleeves, revealing
spinal canal stenosis and disc protassion determination [22, 24 , 26,
30, 31, 42, 58].
Criteria for assessment of degenerative changes of intervertebral discs were developed
LG Plekhanov et al. (1992). The authors identify four types of stasctural changes
intervertebral disc:
1 type - characterized by moderate stasctural changes in the intervertebral discs
(heterogeneity, echogenicity and hyperechoic foci in the nucleus pulposus
, seal internal contour of the fibrous ring).
type 2 - Stasctural changes in the disc, characteristic of type 1 in combination with
displacement of the nucleus pulposus, thinning, or aspture of the fibrous razvolokneniem
ring-side bias .
3 type - stasctural changes in the disc, characteristic of type 2, in conjunction with
disc herniation which resulted in a contraction and (or) asymmetric deformation
spinal canal.
4 Type - pronounced stasctural changes drive (a sharp increase in echogenicity
until opaque, a large number of hyperechoic foci, reduction
disk thickness).
also very promising is the use of sonography in determining
malnutrition, atrophy and fibrosis of muscles, which is important when
diagnosis of myofascial pain syndrome [17, 49, 55].
Given that the vascular component plays an important role in the pathogenesis and clinical manifestations
back pain, a very important method for studying the regional hemodynamics
is rheographic research method, which
gives indirect information about the magnitude of blood flow, as well as the relative
blood flow velocity, the state of the arterial inflow and venous outflow, while
use of functional tests on the reactivity and elasticity of the vascular wall
. Moreover, in addition to qualitative characteristics, it is possible and quantitative
assessment study. This method has been applied in the study
paraartikulyarnyh zones, as well as during reolyumbografii and
reokaudospondilografii. Rheoencephalography allows to assess the state
cerebral vascular pools, conduct of level diagnosis of cervical
spondylogenic process, and using such functional tests, as
tilt and rotate the head, vibratory stimulation of the point of the vertebral artery and
neyroosteofibroza zones can be judge the presence of vertebrobasilar insufficiency
[4, 6, 15, 21, 56].
EEG study in dorsalgia can identify
disorganized a-rhythm, increasing the number of fast waves at distsirkulyatsii
in the vertebrobasilar basin recorded the phenomenon of desynchronization, diffuse
changes in brain bioelectrical activity. As a consequence of chronic pain syndrome
may fix the changes, indicating the activating
influence of reticular formation on cortical brain bioelectrical activity
[4, 5, 8, 27].
To identify pathological changes in the back and limbs as
method can be used remote infrared thermography in virtue of its
safety, ease of implementation, as well as the ability to assess the effectiveness of
treatment. This method allows to determine the pathological changes
joints, blood vessels, peripheral nerves and to evaluate vertebral breaches
[20, 28, 37, 43, 44, 48, 61].
main method of characterizing the functional state
segmental-peripheral neuromotor apparatus is
Electroneuromyography. Decisive role in the topical diagnosis of lesions and axonal
compression-neural syndromes plays stimulus
Electroneuromyography allowing qualitatively assess the rate of
on motor and sensory fibers of peripheral nerves. More informative and precise for clinical
electroneuromiography considered a local diversion
biopotential of muscle with concentric needle electrodes.
advantage of this technique is the possibility of qualitative and quantitative assessment of local
dystrophic changes in muscle, the main parameters of single motor units
deeply located muscles, as the bioelectric activity of superficial muscles
does not reflect the full picture
morphofunctional changes neuromotor apparatus [7, 9, 10, 28, 32, 60].
Thus, when examining patients dorsalgia be considered
severity of the stasctural and functional changes in the locomotor system,
allows for differential diagnosis and to define adequate treatment tactics
.
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article was published in the journal Manual Therapy "¹ 3, 2001
